Address by Dr Tedros Adhanom Ghebreyesus, WHO Director-General at the 67th session of the WHO Regional Committee for Europe

12 September 2017, Budapest, Hungary

Thank you, Madam Chair.

Your Excellency Alexis Tsipras, Prime Minister of Greece, Excellencies, honourable ministers, Dr Zsuzsanna Jakab, Regional Director, colleagues, ladies and gentlemen,

I would like to welcome His Excellency Prime Minister Tsipras and share my experience with him. A few months ago I met him and would like to share two takeaway messages from that meeting. Firstly, I’d like to say how impressed I was by Greece’s commitment to universal health coverage and, secondly, Greece’s generosity in the way it has been managing its migrants. I was really inspired by that, to see how leadership can make a difference, even in times of difficulty.

I am very proud to stand before you as Director-General for the first time. It was an immense honour for me to serve my country as health minister and foreign minister. But the opportunity to serve the people of the world – including the people of the European region – is an even greater privilege.

However, I am acutely aware that with great privilege comes great responsibility. We are here because our mission is the health of all people, everywhere, and the European region is home to 900 million people. Every one of them has the right to health.

This region is immensely diverse, from Scandinavia to Central Asia; from the Arctic to the Mediterranean; from the Atlantic to the North Pacific.

Just as there is a great diversity of people, cultures and landscapes, so there is a great diversity in the people of this region, and its health systems.

There is much to be proud of. Hundreds of millions of people in Europe enjoy all the benefits of universal health coverage: world-class health services that in many places are provided free at the point of delivery.

As a result, the European region has some of the longest life expectancies in the world.

But at the same time, your region has the world’s highest rates of smoking and alcohol use. You face a high burden of non-communicable diseases, including cardiovascular disease, cancer, diabetes, and mental illness.

These diseases cut people down in the prime of life, in their most productive years.

And you know only too well that as populations get older, the number of people needing long-term care – and the cost of providing that care – will only increase.

No country, however wealthy, can simply sit back and wait for those people to turn up in its hospitals. The cheapest and most effective interventions are those that promote health and prevent disease, from tobacco taxation, to better food labelling, and even measures as simple as speed bumps.

But some of the reasons people get sick and die are out of their control, including the health effects of changes to the climate and the environment in which they live. For that reason, we must not see our work in silos, where health policy is formed in isolation. Instead, we must work collaboratively with colleagues in energy, transport and urban planning to ensure we build a future that adapts to and mitigates the health effects of the climate and environment.

Your discussions this week on environment and health in the context of the SDGs are therefore very important, and very timely. It is my hope they will result in meaningful improvements to the health of the region. That is why we’re here.

But to achieve that, we also need meaningful change at WHO. Some of this change has already begun; some is yet to come. Let me describe how I view our work during the coming weeks and months.

In times of transition it’s vitally important that we continue our important ongoing work; we have to keep the ship afloat. Every day, WHO staff around the world are working hard to improve health at the country level in thousands of ways, small and large. This must continue.

But I have also heard from you that there is a set of urgent priorities on which we can and must act immediately. So far, I have launched several “fast track initiatives” such as:

• boosting our effectiveness in emergencies;
• enhancing our governance by examining the work of the Executive Board and the Assembly to make it more efficient and strategic;
• making WHO an even better place to work;
• strengthening WHO’s communications to mobilise political support for our global health agenda;
• rethinking resource mobilisation with a shift in the way we mobilise resources;
• pursuing greater value for money in the use of our resources;
• and establishing a special initiative for climate change and health in small-island nations; and
• planning for the polio transition, among others.

These are the immediate priorities. But we have also begun to prepare for the larger, transformative changes we need to make WHO an organization better able to meet future health challenges.

We started by listening. I initiated an “Ideas for Change” programme within WHO to stimulate fresh thinking and innovative ideas at all levels of the organization. We have harvested hundreds of great suggestions that we are now organizing into a strategic plan.

In that regard, we have started work on shaping our next General Programme of Work, which will guide the strategy of WHO between 2019 and 2023.

This concept note was first discussed at the AFRO regional committee meeting in Zimbabwe, and then at the SEARO committee meeting in the Maldives last week. I have been very encouraged by the feedback that we received. Health ministers were deeply engaged.

The most consistent feedback was to elaborate on how countries can progress toward universal health coverage by developing stronger and more resilient health systems, a robust health workforce including community health workers, and adequate domestic health financing.

Yesterday you also had the opportunity to hear about the draft concept note on the General Programme of Work, and I thank you for your feedback. Ultimately, this is your WHO, and its priorities are determined by you, the Member States.

Let me take a few moments to remind you of the priorities we are proposing.

Our starting point is the Sustainable Development Goals. The SDGs are the framework for everything we do. They are the priorities that you, the Member States, have agreed on, and must therefore be our priorities. There are many synergies between the SDGs and Health 2020, the European health policy framework, especially in terms of their shared emphasis on equity.

The SDGs feature one goal devoted explicitly to health, but health either contributes to, or benefits from, almost all the other goals. And some of the biggest health gains will come from improvements outside the health sector. It is therefore essential that WHO engages with partners in all relevant sectors to drive progress; the social political and economic determinants cannot be addressed unless all sectors are mobilised.

Within the context of the SDGs, the concept note for the General Programme of Work proposes the following mission for WHO: to keep the world safe, improve health and serve the vulnerable. Let me repeat that: keep the world safe, improve health and serve the vulnerable. Clarity of the mission is always important. This is how I see the mission of WHO. To achieve that mission, we propose five strategic priorities.

First, the world expects WHO to be able to prevent, detect and respond to epidemics and other health emergencies.

This must include the urgent priority of fighting the spread of antimicrobial resistance. This is especially relevant here in the European region. Out of every 400 deaths in this region, 25 are from a resistant bacterial strain. This is not a theoretical threat; it is a real and present danger. If we do not treat it as the pressing global health emergency that it is, we will be left defenceless against some of the most common infections.

There is perhaps no better illustration of the need for action across sectors than antimicrobial resistance. This is not a problem that those of us in the health sector can solve on our own; we must work in partnership with colleagues in the food and agriculture industry if we are to have any hope of success.

I’m encouraged that countries in this region, including the UK, the Netherlands and Denmark, are taking the lead in the fight against antimicrobial resistance. Thank you for your leadership.

The second priority is linked closely to the first: to provide health services in emergencies and help to rebuild health systems in fragile, conflict and vulnerable states. And this is exactly what WHO is doing through its office in Gaziantep, Turkey, where we are providing essential health services to northern Syria. In the coming days we will send the first shipment of dedicated kits to treat non-communicable diseases such as cardiovascular disease, diabetes and asthma into Syria through our Gaziantep office.

The third priority is helping countries strengthen health systems to progress towards universal health coverage. If you don’t already know that universal health coverage is my top priority for WHO, you do now. Health is not a luxury for those who can afford it. It is a human right, and a political choice that I urge countries to make.

The road to universal health coverage is investing in health systems, which are the glue that binds together all the priorities in the General Programme of Work (our strategic plan). Crucially, this includes access to essential medicines, which is a major driver of out-of-pocket health spending, and a health workforce that has the right numbers and the right skills to meet modern health needs. These are both items on your agenda this week.

In order to measure progress towards universal health coverage, we need to know where we are. That’s why by the end of this year, we will publish our first universal health coverage monitoring report, with data on how countries are performing on the three dimensions of health systems: service delivery, financial protection and equity.

We will also be documenting best practices, and working with countries to implement evidence-based solutions.

The fourth priority is to drive progress towards the specific SDG health targets. I have already spoken about the SDGs as the frame within which we see all our work, but we also carry the responsibility of providing the practical tools and technical know-how to help countries advance towards the specific health targets.

We will focus our attention on four areas: improving the health of women, children and adolescents; ending the epidemics of HIV, tuberculosis, malaria and hepatitis; preventing premature deaths from noncommunicable diseases, including mental health; and protecting against the health impacts of climate change and environmental problems.

Finally, we provide the world’s governance platform for health. This is one of WHO’s key comparative advantages; only WHO has the authority and credibility to convene the numerous players in global health and to build consensus towards achieving shared goals. WHO can and must therefore play a vital role in orchestrating the increasingly complex global health architecture.

Now, we all know that strategies sometimes just sit on the shelf. So the draft concept note pays attention not only to what WHO will do but how we will do it (and of course why we should do it, the most important question.) It lists several big shifts I would like to highlight.

1. We will focus on outcomes and impact.
2. We will set priorities.
3. We will become more operational, especially in fragile, vulnerable and conflict areas.
4. We will put countries at the centre of WHO’s work, and
5. We will provide political leadership by advocating for health on the global stage. WHO will be more political in addition to its technical competencies.

WHO should not be shy about engaging with world leaders. Our cause is too important; the stakes are too high. Meaningful change happens when political leaders are engaged. WHO must therefore not be afraid to go beyond the technical to the political in pursuit of its mission.

Everywhere I go, I am heartened by the enthusiasm I see for health at the highest political level. I also see huge enthusiasm for WHO and the work that you all do. I know from my own experience that political will is the key ingredient for change. It is not the only ingredient, but without it, change is much harder to achieve. For a paradigm shift, we need political intervention.

My friends, and His Excellency Prime Minister, we are here because we care about the health of the world’s people. They must be foremost in all our minds this week, and weeks, and months later, and should be our daily thinking.

The challenges we face are great. So must be our ambitions.

Thank you so much. Köszönöm.

And I would like to thank once again His Excellency Prime Minister. This is the kind of political engagement that we welcome and need, and is an example of leadership. I thank you once again and look forward to working with all of you.