Mr Chairman, Excellencies, honourable ministers, distinguished delegates, colleagues and friends in the UN system, Dr Shin, ladies and gentlemen,
This is the last regional committee that I will address during my tenure as Director-General. I am pleased to do so in what I have always considered my home region. Like most people, I have a special fondness in my heart for places where I feel at home.
The Western Pacific is one of the most diverse regions in terms of culture, socioeconomic development, climate, geography, and population size, from very large countries to small island nations. The region includes some of the world’s least developed countries, but also some of its richest.
Health threats are equally diverse. Around 86 million people still lack access to improved drinking-water sources. The number of chronically undernourished children decreased from nearly 55 million in 1990 to 8 million in 2014. But the region now has 6.2 million children who are obese or overweight.
Of the ten fattest countries in the world, eight are Pacific island nations. Lifestyle-related noncommunicable diseases are alarmingly prevalent throughout the region.
At the same time, your countries are concerned about dengue, malaria, the neglected tropical diseases, and emerging diseases, like chikungunya and, most recently, Zika.
What holds this diverse region together is the exceptionally strong spirit of solidarity and the need for a collective response to threats, whether these are widely shared or found mainly in poor and marginalized populations.
It is this sense of collective responsibility and the sharing of experiences that helps explain why the poorer countries in the region are such big over-achievers.
Good progress in health is readily apparent in the ambitious strategies and action plans being considered by this committee. I commend ministers of health for their leadership and commitment to the well-being and health of their people. I also commend Dr Shin for leading his team in providing strong policy and technical support to the countries and territories in the region.
Ladies and gentlemen,
The region is often described as the world capital of dengue. Your countries continue to be battered by epidemic cycles associated with rapid economic growth, unplanned urbanization, the mass movement of people and goods, and possibly also climate change.
In recent years, the incidence of dengue has increased dramatically, though mortality has gone down, thanks to improved case management.
Your action plan for dengue prevention and control proposes an important shift away from a focus on attempting to contain outbreaks, to an approach that aims to reduce the impact of dengue on communities. All countries can learn from Malaysia’s national environmental cleanliness campaign, which engages communities to remove mosquito breeding sites.
The elimination of malaria is a realistic goal for several countries. Between the year 2000 and 2015, malaria deaths decreased by an impressive 87%. Top priority now goes to the interruption of transmission in areas of the Greater Mekong Subregion where artemisinin resistance has emerged and evolved into multidrug resistance.
You have rightly recognized this alarming development as a threat not just to the region but to every country where malaria remains a threat. I thank you for acting on your responsibility to the global health community.
The latest Asia Pacific strategy for emerging diseases and health emergencies is a model for a step-by-step staged approach for building core capacities to implement the International Health Regulations. It could serve as a handbook for any country seeking to improve its IHR compliance.
Of the region’s 27 countries, 20 have achieved core capacity requirements to detect, assess, notify, and report infectious disease events, and to respond to public health risks and emergencies. This is a remarkable achievement.
The strategy, with its focus on eight functional areas needed for emergency preparedness, is embedded in the health system, not something tacked on. You have established good mechanisms for command and control, using event management systems and emergency operations centres.
A large number of public health laboratories have the capacity to identify exotic pathogens and perform antimicrobial susceptibility testing. The region is a hotspot for emerging diseases, but you are prepared and keep getting better and better.
Zika cases in the region are on the rise, and ASEAN health leaders have expressed their concern. Unfortunately, scientists do not yet have answers to many critical questions.
Is the virus, known since 1947, now endemic in at least some of your countries? If so, why are the first true outbreaks involving local transmission being detected only now? Is this because the virus had to move into densely populated urban areas, like Singapore, to become highly visible?
Except for pregnant women, this is usually a mild disease, and 80% of those infected shown no symptoms at all. Why did the first signal that the virus is present in some of your countries come from travellers whose Zika infection was confirmed once they got home? Are they sentinels?
Is this weak surveillance, an indication of population-wide immunity, or proof that the virus has somehow acquired greater epidemic potential?
I wish we knew. You are rightly increasing surveillance for the congenital Zika syndrome, including microcephaly, which will need to continue as current pregnancies in infected women come to term.
But we do know two things. First, no currently available approach to mosquito control is fool proof. You know that from decades of efforts to contain dengue. Second, this region has the scientific talent and research capacity to get some answers soon. All the world will be waiting as you investigate an evolving disease that continues to deliver so many surprises.
Ladies and gentlemen,
Your regional framework for action on health and the environment is wide-ranging and hard-hitting. The region is especially vulnerable to the health consequences of environmental degradation arising from a damaged planet.
The list is long. More frequent and intense extreme weather events that cause floods, droughts, diminished harvests, and massive population displacement. Rising sea levels that threaten the viability of small island nations and areas.
The nearly year-round haze from the deliberate burning of forests to clear land for crop production. The dirty air that more than 80% of people in cities are regularly forced to breathe.
For a very long time, health was barely mentioned in debates about climate change and its consequences. But as your framework for action so clearly shows, health has some of the most compelling evidence-based arguments for interpreting climate change as a potential catastrophe.
Simply stated, the earth is losing its capacity to sustain human life in good health.
The challenge, of course, is to convince officials in energy, agriculture, transport, housing, and urban design to pay attention to the health consequences of their policies that affect the environment.
To meet this challenge, the framework presents a menu of practical options set out according to four patterns of institutional arrangements that bring health and environmental issues together. We hear many calls for multisectoral action. Less often do we see these calls so firmly anchored in practical arrangements already operational in your countries.
The region enters the era of sustainable development with an exceptionally refined and comprehensive action agenda. It calls for nothing less than a transformational change in the thinking of public health, the way it organizes service delivery, and the way it interacts with other sectors.
Health must move from a narrow biomedical model of disease to a mindset that embraces a holistic, integrated, people-centred approach. Again, institutional arrangements that can nurture multisectoral collaboration are a concrete way forward.
As you rightly recognize, finding an entry point to leverage health arguments is especially difficult in some sectors. The health sector does not always have an influential voice in setting social and economic priorities despite the fact that health spending often represents upwards of 10% of a country’s GDP.
All too often, short-term commercial and economic interests trump longer-term health objectives. But you have much to build on.
The region has a long history of addressing the social determinants of health and an excellent track record. Examples include tobacco control in Australia, China, and the Philippines, healthy diet campaigns in Pacific island countries, and the healthy cities and healthy islands initiatives.
China’s leadership in training public health officials in global health diplomacy also deserves special mention. In the SDG era, health diplomacy is gaining prominence in South-South, North-South, and trainagular multisectoral collabration.
Your guide for school principals, titled “Be smart, drink water”, is part of a wider campaign to remove sugar-sweetened beverages from school vending machines and shops in the vicinity of schools.
Your sugars checklist, with practical tips for interpreting food labels, empowers consumers and makes another contribution to healthy lifestyle choices.
I have no doubt that such campaigns provoke a heavy pushback from industry. As industry will argue, tooth decay and childhood obesity are the result of bad parenting, not marketing practices. Or another favourite: the WHO sugar recommendations are based on flawed science.
Hold your ground. The fact that tiny Uruguay, with its population of just 3.5 million people, legally defeated the world’s largest tobacco company in July is a tremendous victory. Health can indeed trump the interests of powerful economic operators.
Ladies and gentlemen,
As I conclude these last formal words to my home region, let me congratulate Cambodia, Cook Islands, Niue, and Vanuatu for their remarkable health achievement.
Earlier this year, WHO validated that these four countries have eliminated lymphatic filariasis as a public health problem. This achievement is the culmination of more than a decade of accelerated efforts by governments, development partners, and donors, supported by WHO.
Lymphatic filariasis is an ancient, disfiguring, and debilitating disease that causes untold misery, sapping productivity and leaving people trapped in poverty. Imagine being able to assure populations that a disease like this one has been vanquished.
I thank this region for leading the world in the battle against lymphatic filariasis, and many other threats to health, both new and old.
Thank you.