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AFRO-NETS> Bruntland speech from Winterthur Health Forum

  • Subject: AFRO-NETS> Bruntland speech from Winterthur Health Forum
  • From: Tim France <tfran@hdnet.org>
  • Date: Tue, 10 Oct 2000 10:08:19 -0400 (EDT)

Bruntland speech from Winterthur Health Forum

Dear all,

Here is another of the speeches made at the Massive Effort Forum last
week in Winterthur, Switzerland. In it, Dr. Bruntland (DG of WHO) ex-
plains a little more about how she understands the popular movement
that is needed in order to 'keep up the pressure on decision makers'
and one based on 'plurality and new ideas'.

I took part in the forum, and left sensing a change of attitude among
some of the international organisations, and genuine potential to
achieve many shared aims through a popular movement. Of course the
crucial catalyst is how such an idea is received.

Will AFRO-Netters give some initial responses to the speech below or
the one from Jeffrey Sachs circulated yesterday?

Tim France


Dr. Gro Harlem Brundtland Director-General World Health Organization
Winterthur, 3 October 2000

Massive Effort Advocacy Meeting

Councillor Dreifuss, President Fuhrer, Mayor Haas, Dr Frei, Col-
leagues and friends,

I am very pleased to see you all here tonight. I would like to thank
the City of Winterthur and its co-sponsors for the warm hospitality
and commitment you have shown by hosting this forum. I also thank the
Canton of Zurich for hosting us all in this evening's dinner.

The coming few days will be interesting, I am sure. Hard work, too.
But in a beautiful city and excellent venue. Unfortunately, I am not
going to be able to join you in your work throughout this week. I
would therefore like to use this opportunity to share with you some
of my ideas about what we are trying to do and what our challenges
are - for this week and beyond.

Poverty is the underlying obstacle to human well-being. Despite the
unprecedented prosperity and quality of life enjoyed in large parts
of the world, 1.2 billion people survive on less than one dollar a
day and another 1.3 billion scrape out a living on less than two dol-
lars a day.

The difficult question has always been: how do we reduce poverty on a
large scale? People are poor not only because their income is low,
but because they do not have access to basic services, such as health
and education, which would have increased their freedom. Poverty de-
prives people of the opportunity to live a real life.

For poor people, becoming ill frequently means becoming poorer - both
directly, because you have to spend a part of your small income to
pay for treatment and medicines, and indirectly, because your choices
become so limited.

A rickshaw driver in Khulna, Bangladesh may well know that he lives
in a place where the risk of tuberculosis is high. But his poverty
deprives him of the choice to live somewhere else. When he gets in-
fected, he cannot compete so well for work. His income goes down.
This sends the family into a spiral of debt and increasing poverty.
His children - particularly the girls - may be kept from school. The
family may have to cut out fish from their meals most days. Their
malnutrition increases vulnerability, risk of illness - and death.

Being too poor to go to an ordinary bank, the family has to borrow
from loan sharks who charge crippling interest, in order to pay for
medicines. With such costs, our rickshaw driver understandably
chooses to cut the treatment as soon as he feels better. It is likely
that the infection will return, the next time maybe resistant to the
normal drugs used for treatment. The health of others, who live
nearby, is in real danger.

During the early 1990s, the world began to accept that there is a
complex, but close-knit relationship between health and poverty. Be-
ing poor is bad for your health. But being ill also reduces your
chances of getting out of poverty.

There is new data about the extent to which ill-health is impacting
on the economy of some communities and nations, particularly in Af-
rica. We now know that a few diseases, such as malaria, HIV/AIDS, tu-
berculosis, the traditional childhood killers and reproductive health
conditions, are directly biting into the economic growth of poor

Analysis of data from thirty-one African countries during the period
1980 to 1995 showed that the annual loss of economic growth due to
malaria has been as high as 1.3% per year. If this loss had been com-
pounded for that 15 year period, GNP would have decreased by nearly

When HIV prevalence reaches 8% in the population - as is the case in
at least 21 African countries - per capita growth is reduced by 0.4
percentage points each year. Given that annual per capita growth in
Africa for the past three years has averaged 1.2%, this is a signifi-
cant reduction.

There is an increasing recognition of the sheer difficulty faced by
developing nations as they seek to counter these health threats. It
is becoming clear that health systems which spend less than $60 or so
per capita are not able to even deliver a reasonable minimum of ser-
vices, even through extensive internal reform. It doesn't matter how
good the structure is - as long as you can't afford to pay your doc-
tors and nurses proper salaries and fill the shelves with essential
medicines and vaccines, a health system will not be performing at a
reasonable level.

It should not be like this. A number of health interventions can dra-
matically reduce mortality from the main killers. Supervised medica-
tion regimes for TB; nets impregnated with insecticide against mos-
quitoes, and wide distribution of malaria treatment among children
and pregnant women; prevention programmes for HIV/AIDS - or access to
care programmes that can substantially slow the mortality among those
living with HIV. There are many more interventions, proven to be ef-
fective on a local or national level.

Quite simply, if we can take these interventions to scale - and by
that I mean to a global scale - we have in our hands a concrete, re-
sult-oriented, and measurable way of starting to reduce poverty.

This is what we have given the working title: "The Massive Effort".

The Massive Effort, therefore, is a process to scale up actions, to
achieve widespread outcomes, a road to follow, a framework for think-
ing and a set of values.

At this stage, a lot of the work lies ahead of us. We do not have all
the answers. But several things are clear:

We are not thinking of replacing or substituting existing health or
poverty reduction initiatives. We want to use good work, already un-
derway, scaled up and bringing tangible benefits. National authori-
ties of developing countries will be stewards of this effort. They
have called for it and we in the international community are respond-
ing. We must strengthen health systems. We must also go beyond the
traditional health sector - working with people in their homes, their
work places, their schools, their community halls and their places of
worship. We will need better mechanisms to channel and disburse more
funds in ways that bring clear benefits to poor people. We must
stimulate development of new drugs and vaccines that can replace
those that are threatened by increasing resistance. And break new
ground - such as malaria and HIV/AIDS vaccines. We must also work to
reduce the prices of those medicines we need so they can become
available to all those who need them. Finally - and crucially - in
order to succeed, substantial new resources are needed. Current esti-
mates suggest that an additional $1 billion dollars annually will be
required to combat malaria effectively. The situation with TB is
similar. Another billion dollars annually spent on drugs - linked to
work on health systems - could result in a 50% drop in mortality over
the next five years. With HIV/AIDS, we need even more. Sums in the
order of $2.5 billion dollars annually are needed for prevention
alone. Add the cost of care, and the figures rise dramatically.

In July, the G8 leaders committed themselves to support significant
improvements in health outcomes among poor communities. As Councillor
Dreifuss has told us, they committed to targets set by international
fora for reducing the toll from HIV, from malaria, and from TB by

The European Commission has shown a strengthened push to fight
HIV/AIDS, malaria and tuberculosis. It has adopted a policy framework
to increase access for poor people to essential health goods and ser-
vices; works to reduce prices of vital medicines and commodities; and
aims to create incentives for strategic research to develop new and
more cost effective products for prevention, diagnosis and treatment.

This is a long-term affair. We are talking about the need for sus-
tained, additional financing for 10- 15 years.

In order to maintain this political commitment, we need to catalyse a
popular movement:

We need a movement that can keep up the pressure on decision makers.
We need a movement that stimulates people in all countries to find
their own best ways of carrying forward the Massive Effort. We need a
movement that is inclusive, pluralistic and positive, but at the same
time doesn't lose its focus and its determination. It must be a move-
ment that is based on a shared and strong set of values. It must be a
movement that is oriented towards action - with measurable, clear
goals and outcomes. And it must be a movement that celebrates plural-
ity and new ideas.

This leads us to Winterthur. You are invited here this week to become
seeds of something new and ambitious. We invite you to immerse your-
self in the ideas and the values of the massive effort and make them
your own. Above all, we are asking you to contribute your knowledge
and experience to build an effective, popular, global movement for
the beginning of the 21st century.

This is not a forum for finding solutions to medical, developmental
and financial challenges facing the massive effort, although many of
you have the expertise to provide valuable input also in these mat-

Instead, we will focus on the task of building a global movement. How
do we build popular support? How do we engage the media? How do we
create ownership of this movement - among mothers and fathers from
Afghanistan to Zambia as well as among voters from America to Swit-

We are not expecting finished products by the end of this week. But
we do hope we have taken the process significantly forward.

Colleagues and Friends

You come from 70 countries and represent a wide variety of back-
grounds, professions and political convictions.

When people with vastly different backgrounds come together with a
shared purpose, new energy can be released and expertise used in in-
novative ways.

We hope that we can all build on our shared basic values - and work
towards a common goal. In short - we are asking for a Massive Effort.

Thank you.

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