Mr Chairman, Excellencies, honourable ministers, distinguished delegates, Dr Singh, colleagues in the UN family, ladies and gentlemen, I thank the government of Sri Lanka for hosting the Sixty-ninth session of the Regional Committee for South-East Asia.
During this first session held under the 2030 Agenda for Sustainable Development, I am especially pleased to speak to you in a country that provides universal health coverage to its citizens, and has health outcomes comparable to those seen in countries with several times its wealth.
As your Regional Director has noted, the health situation in South-East Asia is undergoing a profound transition. Well-known drivers of ill health, including poverty and poor living conditions, persist, especially in the region’s predominantly rural populations.
At the same time, growing economic prosperity and the reach of global trends are introducing new threats, including noncommunicable diseases, which are equally important drivers of ill health, especially in cities. Economic benefits do not always offset detrimental effects on health.
The technical document that best expresses the extreme health challenges facing the region is the one on the double burden of malnutrition. The region’s nutrition landscape is characterized by persistent undernutrition existing side-by-side with growing rates of obesity and overweight. This landscape of extremes can be seen in individual countries, communities, and even families.
The consequences of malnutrition are severe. Undernutrition contributes to about 45% of preventable childhood deaths in South-East Asia, while overnutrition drives high rates of diet-related NCDs. Region wide, more than one fifth of adults are now overweight.
Wasting, stunting, and micronutrient deficiencies are long-standing problems. Most of your established nutrition strategies and interventions, such as highly successful salt iodization, are designed to address these older problems.
Undernutrition continues to be driven by predominant dietary patterns that are plant based, often inadequate in energy, protein, and micronutrients, and lacking in diversity.
At the other extreme is the rise of obesogenic environments shaped by an international food system that relies on the industrialized production of meat, the appeal of cheap, convenient, and tasty highly processed foods, and the aggressive marketing of these products, especially to children.
These are energy-dense but nutrient-poor foods, which helps explain why micronutrient deficiencies are found in both under-nourished and over-nourished populations in this region.
As elsewhere in the world, health in South-East Asia is being shaped by the same powerful forces: demographic ageing, rapid unplanned urbanization, and the globalized marketing of unhealthy products.
Under the pressure of these forces, NCDs have overtaken infectious diseases as the leading killers. These diseases now account for an estimated 8.5 million deaths in the region each year.
In this case, economic growth and modernization, long associated with better health outcomes, are actually creating the conditions that allow heart disease, stroke, diabetes, tobacco-related cancers, and diet-related cancers to flourish.
Addressing the rise of these complex and costly diseases requires a major shift in the mind-set of public health. That is: a move from curative care to prevention, from a focus on individual diseases to comprehensive people-centred care, and from a strictly biomedical model of health to one that embraces the social and life sciences.
It also requires greater financing and appropriately trained staff to cope with the ever-increasing costs of providing care for people living longer, sicker lives. As the root causes of these diseases lie outside the health sector, it requires a broad multisectoral approach led and coordinated at the highest level of government.
Above all, as so clearly stated in the document for the ministerial roundtable on NCDs, addressing these diseases depends on resilient health systems, based on primary health care and aiming for universal coverage.
The 2030 Agenda for Sustainable Development provides the impetus, the platform, and the ethical imperative to pursue all these transformational changes.
Ladies and gentlemen,
I am impressed to see how quickly this region has adapted its strategies to embrace the new agenda for sustainable development.
I sometimes see articles arguing that health has been short-changed in the SDG agenda, given less prominence than it deserves.
After all, three of the eight Millennium Development Goals were directly focused on health and two others, on nutrition and water supply and sanitation, addressed major determinants of health.
In the new agenda, health is only one in a crowd of 17 goals. As some have argued, such small space undermines the significance of health as an issue that matters profoundly to every person on this planet.
I disagree. What the SDGs do especially well is to recognize that health challenges can no longer be addressed by the health sector acting alone. Reducing the rise of antimicrobial resistance requires policy support from agriculture. Abundant evidence shows that educated mothers have the healthiest families. Access to modern energy fuels economies, but it also reduces millions of deaths from chronic lung disease associated with indoor air pollution.
In my view, health occupies pride of place in the agenda for several reasons. First, health is an end-point that reflects the success of multiple other goals. Because the social, economic, and environmental determinants of health are so broad, progress in improving health is a reliable indicator of progress in implementing the overall agenda.
In the final analysis, the ultimate objective of all development activities, whether aimed at improving food and water supplies or making cities safe, is to sustain human lives in good health.
Second, all health targets can be reliably measured using sophisticated scientific methods. Disease burdens and their causes can be measured, the impact of specific interventions can be assessed, and changes over time can be tracked. This precision contributes greatly to transparency and accountability.
Finally, the inclusion of a target for reaching universal health coverage, including financial risk protection, gives health the power to build fair, stable, and cohesive societies while also furthering the overarching objective of poverty reduction.
The UHC target provides the platform for moving towards all other health targets through the delivery of integrated, people-centred services that span the life course, bring prevention to the fore, and protect against financial hardship.
UHC is the ultimate expression of fairness. It is one of the most powerful social equalizers among all policy options.
Nobel laureate Amartya Sen has described UHC as "an affordable dream". I agree. UHC is affordable if properly managed. As a way of organizing health services, it promotes a comprehensive and coherent approach to health which moves away from a focus on individual diseases and all the fragmentation and duplication that brings.
UHC opens numerous opportunities to reduce waste and inefficiency. For example, studies show considerable savings when supply chains established to deliver drugs for HIV are used to deliver multiple other medical products.
Earlier this year, WHO verified that Thailand has interrupted mother-to-child transmission of both HIV and syphilis. Central to this success story was the integration of maternal and child health services with services for sexual and reproductive health and HIV.
Efforts to reach the ambitious goal of ending tuberculosis in this region will benefit from comprehensive services that address risk factors like diabetes, poor nutrition, silicosis, and tobacco and alcohol use. Moreover, reducing user fees encourages more people to seek care early, when the chances of cure are best and the costs are lowest.
UHC is a direction on the route to better health, not a destination. Any country, at any income level, that really wants to can move towards universal coverage.
As your Regional Director notes in her annual report, no country is starting from zero, especially given the region’s long commitment to the principles and approaches of primary health care.
Ladies and gentlemen,
As this is the last time I will address this committee, I want to commend the region on its achievements, which I have watched with pride.
Progress in reducing child mortality and curbing the epidemics of HIV and TB has been remarkable.
The last case of polio in India was in January 2011. The region proudly maintains its polio-free status. This is an inspiration for the entire world. India has also eliminated yaws. The region is steadily ridding itself of lymphatic filariasis and visceral leishmaniasis.
In an amazing feat, the prevalence of schistosomiasis has been pushed down to just two small districts in Indonesia.
You have challenges, of course. The region is disaster-prone, which amplifies the havoc wreaked by climate change. Government expenditures on health are too low, and the proportion of spending from out-of-pocket payments is too high.
Weaknesses in public health services send too many people to private clinics and hospitals, where neither quality nor prices are regulated and waiting times can be extremely long. The health workforce is concentrated in cities, leaving the region’s vast rural population with limited access to care. These problems must also be addressed.
But you are moving in the right direction and are well on your way. As stated in the RD’s annual report, "The future is bright".
Thank you.