Grundsatzrede Dr. Tedros Adhanom Ghebreyesus, Generaldirektor, WHO

17 September 2018, Rome, Italy

Dr Armando Bartolazzi, chair of the session,

Dr Zsuzsanna Jakab, WHO Regional Director for Europe,

Excellencies, heads of delegation, honourable delegates, colleagues and friends,

As I said this morning, it’s a great honour to be here in the Eternal City, Rome.

You have a busy week ahead of you, I know, with several important matters to discuss and resolutions to pass.
There are many encouraging signs of progress in this region in relation to each of the “triple billion” targets.

As I said this morning, Europe has some of the world’s most advanced health systems, the highest rates of service coverage, and the lowest rates of catastrophic spending.

In many ways, many European countries are a model of health equality for the rest of the world.

And yet we know there is a lot of inequality in Europe between east and west, between north and south, between rich and poor, between citizens and migrants, as we discussed during lunch.

The most established health systems face challenges of financial sustainability.

Although Europeans enjoy the world’s lowest rates of catastrophic health spending, even in Europe there are people who experience financial hardship because of out-of-pocket health spending.

That means more people in this region are being forced to make difficult choices between health and other basic needs.

Tomorrow my colleagues from the Regional Office will be presenting new evidence about financial protection in Europe.

You are aware of these issues. And you are working to address them.

The meeting in Tallinn in June emphasised that inclusion, investment and innovation are the essential building blocks of the health systems of the future.

And the meeting in Sitges in April this year brought an important focus to building health systems to address the burden of noncommunicable diseases.

The resolution before you this week is a powerful statement that universal health coverage is a journey, not a destination.

No country and no region can ever afford to rest. There are always new challenges to overcome. There are always gaps in service coverage to fill. There are always people being left behind.

The resolution calls on you to design health systems that are uniquely tailored to the challenges you face;

It calls on you to emphasise equity, with a special focus on the poorest and most vulnerable;

It calls on you to increase your investments in health, and to seek efficiency gains to ensure you get the most health for the money;

It calls on you to keep a close eye on out-of-pocket spending, especially for medicines;

It calls on you to prioritize primary health care, with a focus on health promotion and disease prevention;

It calls on you to invest in health workers;

And it calls on you to invest in research and innovation so that your health systems keep pace with shifting needs and expectations, and are based on the best evidence.

I echo each of these calls.

As I said in the morning, Europe inspired me to believe in universal health coverage. You’re really doing well, but there are these issues you need to address as well.

Investing in health is not only the right thing to do, it’s the smart thing to do. It’s an investment not just in healthier populations, but in more prosperous and stable societies. It’s an investment in the future – but it’s also an investment in the now, in the present.

Next month we will gather again in Astana to celebrate the 40th anniversary of the Alma-Ata Declaration. I thank my sister Zsuzsanna and my brother Dr Birtanov, the health minister of Kazakhstan, for their leadership in bringing this important event to fruition.

But we are not simply looking back on the past 40 years; we’re looking forward. We’re looking forward to societies and governments that prioritize, promote, and protect people's health;

To people and communities empowered and engaged in determining their own health;

To sustainable health care that is available, accessible and affordable for everyone, everywhere;

And to quality health care that serves people with compassion, respect, and dignity.

This is what primary health care means. This is what health for all looks like.

I’m pleased to see that alongside the resolution on universal health coverage, you are also considering a resolution on public health for sustainable development.

This is very encouraging.

It recognizes that to build the healthier, more prosperous societies we all want, health systems cannot simply treat the sick. That is like fighting a fire with a garden hose.

We must protect the healthy, by addressing the root causes of ill-health: the social, economic, commercial and environmental factors that are the reasons people end up in our hospitals.

We must make it easier for people to choose the healthy option.

Encouragingly, the European region is on track to meet the SDG target for a one-third reduction in premature mortality from noncommunicable diseases by 2030.

But there is much work to do. Data published just this week by the International Agency for Research on Cancer shows that Europe is home to 23% of the world’s cancer cases and 20% of cancer deaths, even though it accounts for just 9% of the world’s population.

Although lung cancer is falling among men, it’s rising among women, particularly in northern and western Europe.

But in other areas, Europe is leading the way. There are many lessons in this region from which the rest of the world can learn.

Just this year, Ireland and the United Kingdom introduced taxes on sugar-sweetened drinks, and Norway increased its levy.

Many of your countries are also leaders on plain packaging and tobacco taxation.

But although tobacco taxation is higher in this region than many others, there has been little progress in recent years. Less than half of your countries tax tobacco at the recommended level. This is an easy win, both for reducing tobacco use, and for generating revenues for your health systems.

Alcohol consumption is higher in Europe than anywhere else in the world. But it is encouraging to see many of your countries taking measures to reduce harmful alcohol use – through taxation, labelling, marketing regulations and more. Keep going.

Indoor air pollution is not the problem in Europe that it is in Asia, and yet more than half a million people die prematurely every year because of outdoor air pollution.

These are just some of the successes you have had, and the challenges you are facing. I know there are many more.
Addressing these and other risks pays huge dividends. It keeps people out of hospitals and in their communities, working, learning, innovating and contributing to society.

Many of the risks I have described affect men. Which is why the strategy on the health and well-being of men is so important. It provides a much-needed complement to the strategy on women’s health adopted two years ago.

Men have unique health needs that require a unique health response.

Men can also suffer from health inequities and discrimination based on their age, race, class, ethnicity, sexual orientation and gender identity, among others.

The strategy and its five priority areas cover a wide range of actions that all countries can take to address those needs.

It includes health policies that address key risks for men’s health including alcohol, tobacco, road injuries and mental health;

Addressing gender norms that contribute to health risks for men and women;

Engaging men in preventing violence;

Addressing men’s unmet needs for sexual and reproductive health;

Empowering men to play their part in promoting and protecting the health of women;

And engaging men as users of health services in designing systems that are uniquely adapted to their needs.

All of the measures you are considering this week require investments. Nothing comes for free. But it’s critical that countries see them as investments, and not costs.

They’re investments in a healthier Europe. They’re investments in a fairer Europe. And they’re investments in a safer Europe.

You will get tired of hearing me say that health systems and health security are two sides of the same coin. But I will keep saying it because it is a fundamental truth.

I will keep saying it until vulnerable people are no longer left exposed to outbreaks by the weakness of their health systems.

The two most recent Ebola outbreaks in the Democratic Republic of the Congo show that we have come a long way.

The changes we have made to make our emergency operations more agile and responsive are working.

Together with our partners, we’re saving lives.

But we can always do more. Last week we held the first meeting of the Global Preparedness Monitoring Board in Geneva.

This is a new mechanism put together by WHO and the World Bank to monitor the world’s readiness for outbreaks and other health emergencies.
Its job is to identify gaps in the world’s defences, and to keep all of us accountable for filling those gaps.

We are only as strong as the weakest link. The world is as vulnerable as its most fragile health system. We’re still vulnerable

Europe may not face regular Ebola outbreaks, but you do face other weaknesses that pose major threats to the region’s people.

Declining vaccination rates are allowing measles to make a comeback in Europe. The region is on track for the most measles cases in a decade.
You must address this outbreak with the same urgency as you would any other. Its effect is the same – lives lost to a preventable disease.
Vaccines are the cornerstone of health and well-being.

I urge you this week to commit to fully implementing the European Vaccine Action Plan.

Colleagues, ladies and gentlemen,

In the coming weeks and months, you will be hearing more about how WHO is transforming to put countries at the centre of everything we do.
But the clearest example is our Programme Budget for 2020 and 2021.

The budget has been developed based on country priorities. Its focus is on strengthening the capacity of our country offices to deliver impact.
As you will hear, we are proposing an almost 30% increase in technical capacity for country offices, while the headquarters budget will stay flat.
This is what it means to put countries first. This is part of our commitment to leaving no one behind.

The good news is that the 2018-19 budget is already more than 90% financed. We’re grateful to all Member States for this vote of confidence. Thank you so much.

I also want to emphasise that WHO’s transformation is linked closely with the wider UN reforms.

Both the GPW and the new UN Resident Coordinator system will take effect as of the 1st of January next year.

This is a great opportunity for us to become more effective – to deliver as one.

We must all break out of our silos and work together with colleagues from across government and across the UN family.

That is exactly what the Sustainable Development Goals demand of us. One UN family, whole-of-government, focused on achieving the SDGs that we committed to implement in 2015.

In closing, I leave you with three challenges:

First, I urge you to rise to the challenge you are setting yourselves on universal health coverage. Take ownership for ensuring that the people of this region are set free from catastrophic health spending. Celebrate your successes, learn from your mistakes, and share those lessons with the region and the world. Europe is the home of universal health coverage. It should continue to lead from the front.

Second, I urge you to work with your colleagues across government to promote and protect health, as well as treating disease. The causes of ill-health are complex and dynamic – so must be our response. Create cleaner environments, build safer roads, and do not be afraid to stand up against powerful industries that profit from harming health.

Third, I urge you to fight declining vaccination rates head-on. Do not allow this problem to become worse than it already is. Lives are at stake.

Children are dying. I recognize that this is a complex problem. I recognize that there is no silver bullet. But if you can’t address these issues, who can? You are the people who have been charged with protecting the health of your people. You have resources at your disposal and science on your side.

Thank you to all of you for your commitment and dedication.

Thank you for everything you do every day to promote health, keep the world safe, and serve the vulnerable.

Thank you so much, and see you in Astana!

Vielen dank. Merci beaucoup. Spasiba. Grazie mille !