Health Promotion International, Vol. 16, No. 1, 95-98,
March 2001
© Oxford University Press 2001
MEXICO |
Statement by Dr Gro Harlem Brundtland, Director General WHO, to the Fifth Global Conference on Health Promotion, Mexico City, 5 June 2000
World Health Organization, CH-1211, Geneva 27, Switzerland
Address for correspondence: Dr Gro Harlem Brundtland, Director General, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
Your Excellency, President Ernesto Zedillo, Secretary of Health, José Antonio González Fernández, Dr Alleyne, Distinguished participants, colleagues, members of the press,
Last Wednesday, I was at a mass meeting in Bangkok. Standing on a platform I looked out over a sea of blue caps and white T-shirts. Wave upon wave of slogans against tobacco. Ten thousand health volunteers from villages all over Thailand had marched or bicycled to the city to mark the World No Tobacco Day. Health was being promoted on a giant scale. From local level to regional, from regional level to national, people were mobilized.
The speeches, though, weren't just about telling people not to smoke. They were not about local, or even national issues. They were about levels of taxation, about world-wide bans on advertising and the Framework Convention on Tobacco Control. These global responses support a growing national movement in Thailand: a movement against a public health disaster now killing someone in our world every 8 seconds.
What happened that Wednesday morning brought out the essence of health promotion. Promoting health is about enabling people to keep their minds and bodies in optimal condition for as long as possible. That means that people know how to keep healthy. It means that they live under conditions where healthy lifestyles are feasible. It means that they have the power to make healthy choices. Yes, health promotion is about making decisions—within the household, within society and within the nation state. It's about making decisions within international institutions, whether they are concerned with development, trade, health or finance.
So much has happened since the last global Conference on Health Promotion in Jakarta in 1997. The landscape for international health is changing in fundamental ways. More and more people understand the benefits of good health. We know what needs to be done in our lives and in our environments. We now understand the links between health, politics and the economy more clearly than ever before. For those of us meeting here in Mexico City, dedicated to promoting health, this really is a powerful moment.
It is a powerful moment because we know how to benefit from the increasing inter-dependence in our world. Yes, globalization frightens some people and causes uncertainty to many more. But it also presents us all with genuine opportunities. New opportunities for global solidarity continue to emerge. There is great convergence of values, of ideas and of action.
At the same time the search for equity and justice in health now involves more people in effective local-level action than ever before, reflecting our cultural and linguistic diversity.
Bringing the two trends together, we recognize the power of linking global values with local action. This is our responsibility as workers for health, as health promoters. No group is better placed to ensure that greater economic integration brings benefits to those who need them the most. Through encouraging global solidarity while nurturing diversity, we help to shape events in line with the values of equity and fairness.
Now to a second reason why this is a powerful moment. Health is very big news—everywhere. It involves more and more people. Health is no longer a concern only of health professionals. A much wider constituency is engaged.
Let us reflect on what is happening.
- Both national and international health issues are prominent on the agenda when Heads of State, including the G8 leaders, debate the major political issues of our time. Just last week, global health featured prominently within the discussions at the US European summit.
- A month ago, Africa's Heads of State assessed the economic impact of malaria for their continent and their peoples. They took responsibility for a continent-wide effort to help people to halve the impact of malaria on their lives. They undertook to promote a series of proven interventions, making them available to people in their homes, when they need them.
- More and more governments see good health as a critical element of human security. In some nations this combination of human development and national security has become the basis of foreign policy. It is therefore no surprise that a health issue—HIV/AIDS in Africa—has been taken up by the Security Council of the United Nations.
- The mobilization of resources to improve national efforts for promoting health is on the agendas of finance ministers as they discuss debt relief with the World Bank and International Monetary fund.
- Sustained improvement in International Health is a key theme in the Millennium Report by the United Nations Secretary-General.
Health has now moved to the heart of domestic and international development agendas. Good health is increasingly recognized as a prerequisite if communities are to be enabled to fight against poverty.
How can those of us who promote health take advantage of this powerful moment? We have an unparalleled opportunity to make a real difference. Our mission is clear. We must empower people to make healthy choices for themselves and their families.
When the World Health Organization (WHO) set out to improve health 50 years ago, there were hopes that antibiotics, vaccines and biomedical technology would provide the tools to achieve health for all. However, decades of health development have clearly shown that technologies are not enough to guarantee peoples' health. A range of civil, cultural, economic, political and social conditions have to be addressed as well.
Many of the major determinants of better health lie outside the health system. Such determinants include knowledge made available to people, clean environments, access to basic services, fair societies, fulfilled human rights, good government, enabling of people to make decisions relevant to their lives and to act on them.
Let us agree on the key points. For people to have the power to be healthy, they first need knowledge: accurate, reliable knowledge about how to achieve good health and about the risks to health that they face in their daily lives. They need knowledge that helps them to make the best choices and to implement them. They need to know how she or he can achieve good health: how the family can stay healthy. As we see from the recent trends of reduction in heart diseases and cancers in several industrialized countries, up-to-date, applicable knowledge is a prerequisite for better health.
Knowledge is necessary, but it is not sufficient alone. For people to have the power to be healthy, they must be in a position to choose better health. This means making the right choices and putting them into practice. If people are not able to do so, the new knowledge leads to frustration. That is why health promotion has focused extensively on the issues of healthy cities, healthy schools, healthy workplaces and healthy homes—environments within which people can choose to be healthy and implement their choices in their daily lives. A good example is this city, which has made great strides to improve its environment over the past decade.
Yet, the combination of knowledge and a healthy environment may not be enough. Many people will still not feel that the power to be healthy is in their hands. The third element is their being empowered to make the healthy choices for themselves—and stick to them. This means local, national and even international policies that give them the freedom to do what they want, and need, to do.
- Promoting sexual health, among teenagers, often requires those responsible for local or national government to adopt policies that fly in the face of deeply held beliefs.
- Enabling people at risk to protect themselves and their families from the risks of malaria may call for liberalized access to mosquito nets, insecticides with which to coat them, and treatment for those affected by malaria.
- Empowering young people to avoid tobacco use involves global action to limit the tobacco industry's attempts to lure children and youth into smoking: knowledge and encouragement are, on their own, insufficient to protect those under 20 from nicotine addiction.
Promoting health means transcending the narrow slot traditionally labelled ‘health promotion’. That is why, when I am asked who is in charge of health promotion at WHO, I answer "I am". All departmental staff, be they in Geneva, the regional or the country offices, have explicit health promotion responsibilities.
Promoting health means reducing risks to health and modifying behaviour that affects it. Our contribution is clear. We help to provide knowledge about determinants of health, and ensure that it is made widely available. We help to build consensus around ways in which this knowledge can be put into practice—in different settings, among different communities. We encourage public policies that help people themselves to take the action necessary to put this knowledge into practice.
We recognize that this work poses important challenges.
- How do we balance the role of governments in pursuing healthy public policies while, at the same time, enabling individuals to choose what they want to do for themselves as long as it does not harm others?
- How can we be sure that the complex debates about interactions between different risks to people's health are comprehensible to the majority who lack specialized knowledge, wherever they live, whatever their circumstances?
- How can we help health systems evolve into organizations that work on behalf of all people, reflecting the complex interplay of risks to people's health, and offering advice to individuals, to communities and to local authorities that promote health-seeking and care-seeking behaviour?
- Which mechanisms are appropriate and effective to take forward transnational interventions against global health threats, such as tobacco?
- What approaches can we use to promote access to public goods such as essential drugs when people are unable to access them because of systematic market failures?
- How do we ensure that minimum environmental, labour and health standards are followed in a world where investors move assets in a matter of months and capital in a matter of seconds to ensure maximum short-time gains?
You will be discussing such questions over the coming days. The Member States and Secretariat of the WHO have a key role to play in helping to find answers.
WHO's overall strategy helps to set priorities. It lays out four strategic directions: reducing excess mortality and disability, reducing risks to human health, developing health systems that equitably improve health outcomes, and putting health at the centre of economic and development policy. All these four directions have elements of health promotion. Each involves us in disseminating knowledge, establishing consensus about how the knowledge can be implemented, and encouraging healthy public policies that encourage people to implement the knowledge for themselves.
In serving as the international technical agency for health, WHO has several core functions through which the directions are pursued. WHO will set standards and bring forward the evidence. Take the issue of food safety. Our core function is to act as an independent provider of knowledge and evidence. Yet, providing knowledge is not enough. Evidence must translate into action. We must speak out about the information we possess. Broaden the constituency of organizations that have the power to act. Build coalitions of different partners, both nationally and internationally. Working with others will translate ideas and commitments into better and more effective health systems.
Then we must help policy makers, regulatory authorities and trade bodies make the best decisions possible. The tougher the issue for society, the greater the need for WHO to help decision-makers reach informed judgements.
We in WHO have learnt that programmes and policies are most likely to be sustained and successful if the people they are meant to serve are engaged in their design and implementation. Initiatives that rely on one sector alone are less likely to be effective than multi-sectoral efforts. Local initiatives are more likely to be effective when supported through global efforts. The issue of tobacco illustrates this. The current annual toll of 4 million tobacco deaths world-wide will rise to 10 million by 2030. Seventy percent of the increase will damage developing countries. The WHO Framework Convention on Tobacco Control will become one of the most powerful tools to promote health. Full negotiation on this item will begin in October, and already we see emerging unprecedented global support for strong action. Adoption of the Convention, and its implementation, will be a crucial move by nations of the world to adopt healthy public policies.
Mr President,
Promoting health is a noble pursuit, but is it a goal in itself? Many of you say yes, and I share that view. But I would like us to widen our ambitions. Health is important not only for how it lengthens life and improves its quality—it is also an important contributor to economic and social development.
Poverty perpetuates ill health.
In all our efforts we have to give special attention to the challenge of reducing poverty. The Nobel economics prize laureate Amartya Sen defines poverty as ‘deprivation of capability’. He argues that people are poor not only because their income is low, but because they do not have access to basic services, such as health and education, which would have increased their freedom. Poverty, he says, seriously deprives people of a number of choices they must have available in order to live a satisfying life.
But improvements in health reduce poverty and enable growth.
As in Europe at the end of the 19th and beginning of the 20th century, we have seen that developing countries that invest relatively more, and well, on health are likely to achieve higher economic growth. In East Asia, for example, life expectancy increased by more than 18 years in the two decades that preceded the most dramatic economic take-off in history. A recent analysis for the Asian Development Bank concluded that fully a third of the phenomenal Asian economic growth between 1965 and 1997 resulted from investment in people's health.
There is solid evidence to prove that investing wisely in health will help the world take a giant leap out of poverty. We can drastically reduce the global burden of disease. If we manage, hundreds of millions of people will be better able to fulfil their potential, enjoy their legitimate human rights and be driving forces in development. People would benefit. The economy would benefit. The environment would benefit.
Our task is no less than this. It is a difficult one. But, at this powerful moment, here in Mexico, we can commit ourselves to its achievement.
Thank you.
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