Address by Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia at Opening Session of the 14th World Congress on Public Health, Kolkata, India
11 February 2015
Dr Mengistu Asnake, President of the World Federation of Public Health Association,
Dr James Chauvin, the Immediate Past President of WFPHA,
Ladies and Gentlemen,
Let me add my welcome to this important event. The Regional Office of the World Health Organization is proud to be a co-sponsor of the 14th World Congress on Public Health.
I would like to start by congratulating the organizers - the World Federation of Public Health Associations and the Indian Public Health Association. You have put together a remarkable and wide-ranging programme, attracting delegations from across the world, and you have brought together an impressive line up of eminent speakers.
Kolkata was an inspired choice for the venue of this meeting. Public Health is, indeed, coming home.
This city has a long and proud history of achievements in public health. The Calcutta School of Tropical Medicine, for example, celebrated its centenary two years ago this month.
I have no doubt that the eminent scientists who worked there - Leonard Rogers (its founder), Lt-Col Knowles, Ronald Ross, Upendra Nath Brahmachari, Ram Nath Chopra, JB Chatterjee and many others - whose efforts brought the School of Tropical Medicine to prominence in the early part of the last Century - would have approved of the theme of this conference. They knew, all too well, about the link between healthy people and healthy environments from their groundbreaking work on malaria, leishmaniasis and kala-azar.
While it is important that we acknowledge the past, it is our job as public health professionals to look to the future. Healthy People - Health Environments is our theme this week. So when we talk about a healthy environment in 2015, what exactly do we mean? What are we actually talking about? The thematic sessions at this meeting give a good sense as to the answer.
Our horizons must be broader. No longer can we afford to focus only on the immediate environmental causes of ill-health - clean water, sanitation, clean air, safe food and shelter - vital though they remain.
Public health, if it is to be an effective force, must look beyond the immediate determinants of disease. We have to look at the social, economic and political determinants of ill health. Not just the causes, but the causes of the causes.
I would like to spend a few moments on some of the key pillars in the agenda for public health. These will form the basis of our work in the South East Asia Region, where one-quarter of the world’s population bears a disproportionate share of the global burden of disease. But they are equally relevant elsewhere.
The starting point is to recognize that health is an outcome of political choices, both within and between countries. The biggest problems we face - from the health impact of climate change to the management of severe outbreaks like Ebola - are not amenable to technical solutions alone. They require action across sectors, across governments, across societies, across countries and regions. National sovereignty is a vital concern, but to tackle the really wicked problems, requires that it be balanced by greater solidarity. We are all in this together.
Public health in the 21st Century requires a 21st Century approach.
Let’s start with health systems.
We can no longer afford to see health systems in terms of one health problem, or one population group at a time. Even with polio, finishing the job requires an environment that allows access, ensures security and sustains political support. It not just a technical issue.
More broadly, Universal Health Coverage is gaining traction globally. UHC promotes equity and is a key weapon in the fight against poverty. It is the means by which the health sector can make real inroads on all the continuing challenges of communicable and non-communicable diseases, as well as child, newborn and maternal health. But UHC has to be more than a public health mantra. It requires a political environment, which supports access and financial protection for all, not just those in employment, not just those who have the right citizenship papers. Universality doesn’t just happen. As we have seen in some of the wealthiest countries, universal access will be a hard-fought political issue. We have to be prepared to make the case. We know our populations are ageing.
More children survive childhood, and adults - everywhere - are living longer. This change has enormous potential benefits to society, but it requires that the policy environment keep pace with demographic change. In some richer countries for example, life expectancy has increased in recent decades by 9 years. Retirement age in those countries, by contrast, has increased by less than 6 months. More important, while we know that longevity will continue to increase, there is little or no evidence to suggest that the extra years are spent in good health. Quite the opposite in fact. Health systems can help keep older people active. This is great, but little is gained if healthier older people still live in an environment which is unsafe, difficult to navigate, and in which they are cut off from the financial and social support they need.
NCDs approach like a juggernaut, threatening communities, health systems and economies if we do not act now.
One example from this country: over 60 million Indians are diabetic and this number will cross 100 million by 2030. Estimates of future economic loss in India due to NCDs and mental health run into trillions of dollars. We cannot hope to outrun NCDs without an environment that requires and stimulates action in the many sectors that impact on health: finance, trade, agriculture and education. Partnership across all sectors of society - public and private - is not an add-on in this fight. It is an absolute necessity.
Equitable access to safe, effective and affordable medicines, vaccines and diagnostic is a key pillar of our agenda.
You do not need me to remind you of the challenges of working in this highly political environment, in which the interests of many powerful stakeholders conflict. But even as we struggle to increase access to existing medicines, and to promote the development of new tools relevant to the needs of the poor, we face the equally urgent problem of preserving what we have got.
Antimicrobial resistance if not checked and soon, can return us to an era where we will be stripped of tools that today we take for granted. We have to create an environment that brings together fundamental research, better information for the public and politicians, and action at the interface between health and agriculture.
Outbreaks and disasters, man-made and natural, something to which this Region is so prone, can destroy what we have worked so hard to build.
We must not just expect the unexpected, we must have what it takes to do something about it, and fast. The outbreak of Ebola is not just a wake-up call, it is a dramatic call to arms. We have to have a health security system, globally and in each country, that works. We need clear lines of command; we need funds and people that can be mobilized at short notice; we have to have people that are trained for the job; and we need International Health Regulations with teeth. Yes, this has implications for national sovereignty, but if we cannot find the political will to support solidarity in these circumstances, then we leave our populations exposed to the next surprise that the microbial world will throw at us. This, in my view, is unacceptable.
Ladies and gentlemen,
Expectations for better health are rising. Health has to be seen as a right for all, not a privilege for the few. Health equity must be a cornerstone of our policy environment: not tomorrow, but today.
This year will see decisions about the global goals that will shape our work for some years to come. This is a vital opportunity to influence the policy environment in which we work. The SDGs, if they are to fulfill the aspiration that was articulated in Rio, need to make links - between people and the planet, between people and the resources they consume, between sectors, and between nations. Health is - genuinely - a precondition, outcome and indicator of sustainable development. It is important not to lose this vital insight in the fight to recognize each and every individual priority.
This Congress brings together in Kolkata some of the best minds in public health from around the world. As a community we can be a voice for change. Public Health can make a difference. Let me end by assuring you of my support, and the support of WHO in this critical endeavour.