Discours du Dr Margaret Chan Director-General OMS (version anglaise)

Opening remarks at the Global Ministerial
Forum on Research for Health
Bamako, Mali, 17 November 2008

Your Excellency, the President of Mali, honourable ministers, colleagues and partners in health development, ladies and gentlemen,

First and foremost, let me thank the government of Mali for hosting this global ministerial forum. In the coming days, you will be building on the momentum for health research launched at previous events, in Bangkok and Mexico City, and giving this momentum new direction.

Let me acknowledge, too, the tremendous amount of work undertaken to prepare for this forum, including work done in five regional meetings.

The Bamako Call to Action is an eagerly awaited outcome of this meeting. I find it most appropriate that this Call to Action gives particular attention to the pressing health needs in Africa, and the capacity of research to address these needs.

I also find it appropriate that this high-level forum, aimed at strengthening research for health, development, and equity, is held in Mali. This country has more than its fair share of pressing health needs, many of which are linked to poverty, and reinforce poverty.

But Mali has an asset. This, Mr President, is a government policy that makes equitable access to health care a national ambition, supported by a strong grassroots demand for quality care, close to homes. In my view, the decision, made in the 1990s, to revitalize primary health care put this country’s quest for equitable health care on the right track.

This year’s World Health Report, on primary health care, sets out evidence that supports an especially relevant conclusion: meeting the public’s rising expectations for health is a marker of good government and a solid route to stability and prosperity.

The World Health Report singles out Mali’s progress towards universal health coverage as an example of what can be achieved when policy engages community participation, especially of women, and uses health as an entry-point for wider community development.

Above all, health policy in this country has been strongly guided, and constantly fine-tuned, by evidence generated during numerous internal and external evaluations, pilot studies, and research projects.

This is what we need for health development and equity – everywhere.

Ladies and gentlemen,

Let me go straight to the point.  We need health research, and the right kind of research, now more than ever before.

We are in the midst of the most ambitious effort in history to alleviate poverty, spread the benefits of modern society, and reduce the great gaps in health outcomes.

We also face a fuel crisis, a food crisis, a severe global financial crisis, and a climate that has already begun to change in ominous ways. All of these crises have global causes and global consequences that affect health in profound, and profoundly unfair, ways.

We have been in this situation before. The oil crisis, global recession, and debt crisis that followed the Declaration of Alma-Ata thirty years ago led to structural adjustment programmes that shifted budgets away from the social sectors, including health. Health care in large parts of Africa, Asia, and Latin America has still not recovered from the consequences of these mistakes.

I am firmly convinced that the health sector has a better chance of weathering the crises we face today. The health sector is not like that famous raft on an open sea, tossed around by forces of winds and waves beyond our control.

Research gives us the dynamic power to overcome these forces. We have the scientific method on our side. And we have developed some convincing evidence and arguments as a result. But as I stated, we need more of the right kind of research, and now more than ever.

Ladies and gentlemen,

Since the start of this century, WHO and its member states have benefitted from the reports of three high-level commissions.

In 2001, the Commission on Macroeconomics and Health recast the economic significance of health development. Health is not merely a drain on economic resources. It is a producer of economic gains. With this report, the long hard climb to make health an international priority reached a peak.

In 2006, the Commission on Public Health, Innovation and Intellectual Property Rights recast the responsibilities of the health sector. Health has a responsibility to tackle issues, including those driven by commercial interests and market forces, that affect access to essential medicines and influence the products of R&D.

In matters of health, equitable access to care really is a matter of life or death. When equity is at stake, the health sector must take on a proactive role, even if this means stepping into territories outside the usual domain of public health.

In August of this year, the Commission on Social Determinants of Health recast the engagement of the health sector. The striking gaps in health outcomes are its main concern, and greater equity is the objective. 

As the report argues, factors residing in the social environment – like poverty, poor housing, lack of jobs and educational opportunities – are the true root causes of ill health.

The report challenges governments to make equitable health outcomes an explicit policy objective in all government policies. Political decisions ultimately determine how economies are managed, how societies are structured, and whether vulnerable and deprived groups receive social protection.

Gaps in health outcomes are not matters of fate. They are markers of policy failure.

Ladies and gentlemen,

In the short span of seven years, evidence has been used to recast the economic significance, responsibilities, and engagement of the health sector in significant ways.

Of the three commissions, the one on social determinants of health provides the greatest challenge to health policy and systems research. Arguably, it also promises the greatest rewards.

The challenge is enormous: to persuade political leaders to include health in the policies of all government ministries and departments. This is the best route to equity, and the best chance to prevent the causes of ill health at their source.

But let us be frank. In most countries, an appeal to health equity will not be sufficient to gain high-level political commitment. It will not be enough to persuade other sectors to take health impacts into account in all policies. We must have evidence, and we need the right kind of evidence.

This is not easy, but it can be done. Let me give two examples.

This year, the World Health Assembly adopted a resolution on public health, innovation and intellectual property. The resolution, which is linked to the 2006 Commission, demonstrates that international agreements that affect the global trading system can indeed be shaped in ways that favour health.

The WHO Framework Convention on Tobacco Control provides a second example. That story began, of course, with overwhelming scientific and medical evidence about the harm caused by tobacco use.

But even that overwhelming evidence was not sufficient to persuade high-level political action. Evidence from multiple other sectors was needed to convince ministers of finance, commerce, trade, and agriculture, to convince business interests ranging from restaurants and bars to airlines.

Implementation of the Convention also goes well beyond the domain of the health sector. Measures such as tax increases, bans on advertising and smoking in public places, warnings on packages, and limits on sales require support from a host of ministries, backed by legislation and enforcement.

Ladies and gentlemen,

We have many urgent reasons for taking the health research agenda forward with great haste.

We need to see health included in all policies, and we need research to make the case. We need research to guide health system reforms, as we have seen here in Mali. We need operational research to help give existing interventions a greater impact. 

Above all, we need research to persuade the world that investments in health must continue as one of the surest – and best proven – routes to a stable and prosperous global society.

This is the challenging, but vastly rewarding task before you.  I wish you a most productive meeting.

Thank you.