MAKING HEADWAY
WHO director general outlines progress in public health, but says more needs to be done
GENEVA
With increasing investments in health systems, the world is making significant progress in many areas of public health, particularly in the battle against communicable diseases. Addressing the recent annual meeting of the WHO's executive board on an optimistic tone, Dr. Margaret Chan, WHO director general of the World Health Organization, highlighted three trends that gave her personal encouragement.
First, she cited the increasing willingness of development partners, United Nations agencies, and funding facilities to invest in health systems, calling this a "striking and welcome change from the past."
Second, she applauded the acceptance of climate change as a reality by world leaders. "Up to now, the polar bear has been the poster child for climate change. We must use every scientifically sound and politically correct mechanism in the book to convince leaders that humanity really is the most important species endangered by climate change," Chan told the board members.
"According to the latest projections, released in November, Africa will be severely affected by as early as 2020. This is just a dozen years away. Our sector has good evidence about what droughts, floods, storms, heat waves, air pollution, malnutrition, displaced populations, and water-borne and vector-borne diseases mean for health," Chan said. Climate change and health will be the focus for World Health Day celebration on April 7.
Her third reason for encouragement was the revival of interest in primary health care. "I believe we will not be able to reach the health-related Millennium Development Goals unless we return to the values, principles, and approaches of primary health care. I believe we must reach these goals, as the ability of countries to adapt to climate change will depend on the state of population health and the systems in place to protect it." Primary health care will be addressed in this year's World Health Report.
She highlighted two ways in which public health can "improve the world in permanent ways"-the eradication of polio and of Guinea-worm disease. "Both initiatives have pushed previously widespread diseases into just a few small corners of the world. Indeed, we have these diseases cornered in a final standoff. We must finish the job."
For the high-mortality diseases, she noted some good news, but said it had to be qualified. For HIV/AIDS for example, the estimates published in late 2007 indicate that global HIV incidence peaked in the late 1990s and that the number of people dying of AIDS-related illnesses declined over the past two years.
"This is encouraging news. But we are still a long way from the goal of universal access. The yearly number of new infections outpaces our ability to expand access to treatment. We are not doing enough to prevent mother-to-child transmission. Some governments are still closing their eyes to infections in high-risk groups."
Chan reported that the global annual incidence of tuberculosis has stabilized in some parts of the world and may even be declining. "Tuberculosis-control efforts are paying off," she said, but she drew attention to the worldwide emergence of extensively drug-resistant TB as an especially alarming trend.
In recent years malaria has risen to unprecedented heights in the political and public profile. "The best reason for optimism comes from the results we are seeing in some African countries, particularly following better coverage with bednets and use of the newer strategy for home-based management."
Chan confirmed that considerable progress has also been made in combating neglected tropical diseases, which especially affect the "bottom billion"-the world's poorest people. "Last year China and Egypt announced the elimination of lymphatic filariasis, a disease that currently disables some 40 million people. Other countries are on the verge of similar achievements. These are victories, not just for health, but also in our struggle to free people to live productive lives."
Chan addressed a potentially huge gain for children around the world; the global immunization strategy developed jointly by the WHO and the United Nations Children's Fund in collaboration with many member states and immunization partners. The WHO is reporting a massive reduction in deaths from measles, particularly in Africa, and in increased coverage of routine immunization. "Progress in 2006 was record-breaking. I believe it is useful to look at what lies behind this achievement and what it promises for the future."
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