World Health Organization (WHO) · Governing Bodies documents

Fifty-fifth World Health Assembly, Geneva, 13-18 May 2002: verbatim records of plenary meetings and list of participants = Cinquante-cinquième Assemblée mondiale de la Santé, Genève, 13-18 mai 2002 : comptes rendus in extenso des séances plénières et liste des participants

December 31, 2002 World Health Organization

The full text is hosted by the publishing organisation. lawenc.com indexes the metadata and links to the official source.

Full text

WHASS/2002/REC/2

WORLD HEALTH ORGANIZA TION ORGANISATION MONDIALE DE LA SANTÉ

FIFTY-FIFTH WORLD HEALTH ASSEMBL Y GENEVA, 13-18 MAY 2002

VERBATIM RECORDS OF PLENARY MEETINGS AND LIST OF PARTICIPANTS

CINQUANTE-CINQUIEME , ASSEMBLEE MONDIALE , DELA SANTE GENÈVE, 13-18 MAI 2002

COMPTES RENDUS IN EXTENSO DES SÉANCES PLÉNIÈRES ET LISTE DES PARTICIPANTS GENEY A GENÈVE 2003

WHA5 5/2002/REC/2

WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ

FIFTY-FIFTH WORLD HEALTH ASSEMBLY GENEVA, 13-18 MAY 2002

VERBATIM RECORDS OF PLENARY MEETINGS AND LIST OF PARTICIPANTS

CINQUANTE-CINQUIÈME ASSEMBLÉE MONDIALE , DELA SANTE GENÈVE, 13-18 MAI 2002

COMPTES RENDUS IN EXTENSO DES SÉANCES PLÉNIÈRES ET LISTE DES PARTICIPANTS GENEY A GENÈVE 2003

PREFACE The Fifty-fifth World Health Assembly was held at the Palais des Nations, Geneva, from 13 to 18 May 2002, in accordance with the decision of the Executive Board at its 108th session. Its proceedings are issued in three volumes, containing, in addition to other relevant material: Resolutions, decisions and annexes- document WHASS/2002/REC/1 Verbatim records ofplenary meetings, list of participants- document WHASS/2002/REC/2 Summary records of committees and ministerial round tables, reports of committees - document WHASS/2002/REC/3 For a list of abbreviations used in these volumes, the officers of the Health Assembly and membership of its committees, the agenda and the list of documents for the session, see preliminary pages of document WHASS/2002/REC/1. In these verbatim records, speeches delivered in Arabie, Chinese, English, French, Russian or Spanish are reproduced in the language used by the speaker; speeches delivered in other languages are given in the English or French interpretation. The texts include corrections received up to 30 August 2002, the eut-off date announced in the provisional version, and are thus regarded as final.

AVANT-PROPOS La Cinquante-Cinquième Assemblée mondiale de la Santé s'est tenue au Palais des Nations à Genève du 13 au 18 mai 2002, conformément à la décision adoptée par le Conseil exécutif à sa cent huitième session. Ses actes paraissent dans trois volumes contenant notamment : les résolutions et décisions et les annexes qui s'y rapportent- document WHASS/2002/REC/1, les comptes rendus in extenso des séances plénières et la liste des participants - document WHASS/2002/REC/2, les procès-verbaux des commissions et des tables rondes ministérielles et les rapports des commissions- document WHASS/2002/REC/3. On trouvera dans les pages préliminaires du document WHASS/2002/REC/1 une liste des abréviations employées dans la documentation de l'OMS, l'ordre du jour et la liste des documents de la session ainsi que la présidence et le secrétariat de l'Assemblée de la Santé et la composition de ses commissions. Les présents comptes rendus in extenso reproduisent dans la langue utilisée par l'orateur les discours prononcés en anglais, arabe, chinois, espagnol, français ou russe, et dans leur interprétation anglaise ou française les discours prononcés dans d'autres langues. Ces comptes rendus comprennent les rectifications reçues jusqu'au 30 août 2002, date limite annoncée dans leur version provisoire, et sont donc considérés comme finals.

- Ill -

llPE~HCJIOBHE

TI.siTb,ll,eCHT n.siTaJI ceccHH BceMHpHoH accaM6J1eH 3,ll,pasooxpaHeHH.ll npoxo)J,HJ1a BO ,l];soprw HaQHH B )l{eHeBe c 13 no 18 Ma.si 2002 r. B cooTBeTCTBHH c peweHHeM HcnoJ1HHTeJ1bHOro KOMHTeTa, npHH.siThiM Ha ero CTo BOChMOH ceccHH. MaTepHMhi ceccHH ny6J1HKYIOTC.ll B Tpex ToMax, B KOTOpbiX, llOMHMO ,ll,pyrHX )J,OKyMeHTOB, CO,ll,ep)l<aTC.ll: Pe30J1IOQHH, peweHH.si H npHllO)I<eHH.ll - )J,OKyMein WHA55/2002/REC/l CTeHorpaqmqecKHH oTqeT o nJleHapHbiX 3ace)J,aHHHX H cnHCOK yqacTHHKOB - ,ll,OKyMeHT WHA55/2002/REC/2 TipOTOKOJlbl 3aCe)J,aHHH H 3aCe)J,aHHH Kpymoro CTOJ1a )J,Jl.ll MHHHCTPOB, ,ll,OKJ1a)J,hl KOMHTeTOB )J,OKyMeHT WHA55/2002/REC/3 CnHcoK coKpa~eHHH, HCllOJ1h3yeMhiX B 3THX H3,ll,aHH.siX, H nepeqeHh )J,OJl)I(HOCTHhiX J1HQ AccaM6J1eH 3,ll,paBooxpaHeHH.si, TaK :>Ke KaK H qJleHCKHH cocTaB KoMHTeTOB, noBeCTKa )J,H.ll H cnHCOK ,ll,OKyMeHTOB ,ll,Jl.ll ,ll,aHHOH ceccHH, npHBO,ll,.siTC.si B Haqane ,ll,OKyMeHTa WHA55/2002/REC/l. B CTeHorpaMMax 3aCe)J,aHHH BbiCTYllJleHH.ll Ha aHfJlHHCKOM, apa6CKOM, HCllaHCKOM, KHTaHCKOM, pyCCKOM H <lJpaHQY3CKOM .ll3biKax npHBO)J,.liTC.ll B üpHrHHaJle; BbiCTYllJleHH.ll Ha ,ll,pyrHX .li3LIKaX )J,aHbl B nepeBO,ll,e Ha aHmHHCKHH HJ1H <tJpaHey3CKHH .si3hiKH. YKa3aHHhie TeKCThi BKJ1IOqaJOT HcnpaBJleHH.si, noJlyqeHHhie CeKpempHaTOM )J,O 30 aBrycTa 2002 r., KaK o TOM 6bmO o6b.siBJ1eHo B npe,ll,BapHTeJlhHhiX npOTOKOJlaX, H llOTOMY HaCTO.si~a.si pe,ll,aKQH.ll cqHTaeTC.ll OKOHqaTeJlbHOH.

INTRODUCCION La 55• Asamblea Mundial de la Salud se celebro en el Palais des Nations, Ginebra, del 13 al 18 de mayo de 2002, de acuerdo con la decision adoptada por el Consejo Ejecutivo en su 1os• reunion. Sus debates se publican en tres volumenes que contienen, entre otras cosas, el material siguiente: Resoluciones y decisiones, y anexos: documenta WHA55/2002/REC/l Actas taquigraficas de WHA55/2002/REC/2 las seswnes plenarias y lista de participantes: documento

Actas resumidas de las comisiones y de las mesas redondas ministeriales e informes de las comisiones: documento WHA55/2002/REC/3. En las paginas preliminares del documenta WHA55/2002/REC/l figuran una lista de las siglas empleadas en estos volumenes, la composicion de la Mesa de la Asamblea y de sus comisiones, el orden del dia, y la lista de documentas de la reunion. En las presentes actas taquigraficas los discursos pronunciados en arabe, chino, espafiol, francés, inglés o ruso se reproducen en el idioma utilizado por el orador. De los pronunciados en otros idiomas se reproduce la interpretacion al francés o al inglés. Las actas contienen las correcciones recibidas hasta el 30 de agosto de 2002, fecha limite anunciada en la version provisional, y por consiguiente se consideran definitivas. -IV-

~l 'r' ü..o ôjlill -} ~ r-<>YI ~ ~ 0 _,.-=..!1:_, ~WI ~1 ~1 ~ ~1 ~ L-Aiy.::.L- y!ü:l.J ,~WI ~ ~WI ~.J.Jj _;""~JI ~1 O.J.J w \.4]=. -'.,. •• .,. ~Lr. 1 .Jlfi '" :~ Lr. ,A.LJI d~ t..Sft~l ji_,..JI ~ ~} 'JJ~'jy ,~ d~ ~

fr • •'l'jo or_~ ~_,11) y .,;----JI ~_ji.!..JI Wt!.J ~I.J ~1..?.-'JI d.J.Ji.JI.J ul)_;ll ''/~

';~_,11

- L.:) j_,ll

ô..>----:!~1 ~1 _,JI .J 0~1

..>---:!.Jt:i:j.J ô~ _,JI .rf~

~b..JI

j'l' •• 'l'joor_~~

.fl:i%tJtAf~ 9! ~--

o J\Ji~i5l..~l}t;t,

.li+ Jï.Jittl:Jf<E.!t;k~-T 2002 .if-s JJ

I38~Is8~8~~Eoot•ft. ~~~~~~~ili~. ~~~**#~*· $~•

'êLM: /}ti)(_, /}t}t{Ptsft1~ - X1~ WHA55/2002/REC/l ±#.~i5l..Ji!:f~Jjt,&.!§~A9!.t ~- )(1~ WHA55/2002/REC/2

~~ 9! ~{tl~*~lm;(~i)(_~~~Jjt,&~~ 9! ~:J!i%

)(1~ WHA55/2002/REC/3

~~~~m~~~~~,~!t*~~tff!.&~~~ff!~~m~,~~.&~~x~~

. ~.

~)(1~ WHA55/2002/REC/1 j\:ifigf.

M~~)(, ~)(,~)(,*)(,•x•w~~x~~~Ji!:f~JJt.m~~A~m~

~ èflJ~; Jt~~ ~ ~~ ~

m~x•*xifx flJ~. -v-

~J!k:.~JJtJU1UV3 ~

J 2oo2 .if-s JJ 3o

8 1;1_ ]tr t&Jtl ~~JE.

~~ 11âï at x*~

w:r~J ~ J.tJ: 8 m,

w~ 1fJ ~ t:J§- ~x*·

CONTENTS

Page Preface .. . ... .. . .. . .. .. . . .. .. . .. .. . .. .. .. .. .. . ... .. .. .... . ... .. .. .. .. .. . .. . ... .. .. . .. .. .. .. ... .. ... .. . .. ... . ... .. .. . ... .. .. .. .. ... .. .. ... ... .. ... .. . nt

VERBATIM RECORDS OF PLENARY MEETINGS First plenary meeting 1. 2. Opening of the Assembly .................................................................................................... .. Address by the representative of the Secretary-General of the United Nations .................. .. Address by the representative of the Conseil d'Etat of the Republic and Canton of Geneva .................................................................................................................................. . Address by the President of the Fifty-fourth World Health Assembly ................................ .. Appointment of the Committee on Credentials .................................................................... . Election of the Committee on Nominations ........................................................................ .. First report of the Committee on Nominations .................................................................... .. Second report of the Committee on Nominations ................................................................ .

1 2

3. 4. 5. 6. 7. 8.

4 5 7 8 8 9

Second plenary meeting 1. 2. 3. 4. 5. 6. Presidential address .. .. .. .. .. .. .. .. .. ... .. .. ... .... . .. . .. .. .. ... . .. .. .. . .. .. ... .. .. ... .. .. ... .. .. ... .. .. ... .. .. .. .. .. .. ... .. ... .. . Adoption of the agenda and allocation of items to the main committees .................. ............ Announcements .. .. .. .. .. .. .. .. . .. ... .. ... .. .. .. ... . .. .. . .. .. .. .. .. .. .. . .. .. .. .. ... .. .. .. .. ... .. .. ... .. ... .. .. .. .. .. .. .. ... .. .. .. .. . Reports of the Executive Board on its 108th and 109th sessions.......................................... Address by the Director-General........................................................................................... Invited speaker....................................................................................................................... 12 16 22 24 25 31

Third plenary meeting 1. 2. Address by the Director-General ( continued).............. .......................................................... Centenary ofthe Pan American Health Organization ........................................................... 36 61

Fourth plenary meeting 1. First report of the Committee on Credentials ...................................................................... .. Address by the Director-General (continued) ...................................................................... ..

64 64

Fifth plenary meeting

1. 2.

Invited speaker....................................................................................................................... Address by the Director-General (continued)........................................................................

108 112

Sixth plenary meeting Address by the Director-General ( continued)........................................................................ -vii119

Page Seventh plenary meeting Awards.................................................................................................................................. Presentation of the Ihsan Dogramaci Family Health Foundation Prize .. .. .. .. .. ............ Presentation of the Sasakawa Health Prize. ....... .. .. ......... ....... .. ..... .. ... ........ ........ .. .. ..... Presentation of the United Arab Emirates Health Foundation Prize .......................... 151 151 153 156

Eighth plenary meeting 1. 2. 3. 4. 5. Second report of the Committee on Credentials ................................................................... Announcement ...... .. .. ...... ........... ....... .. ............ ... .. ... .. ... .... .... ....... ..... ....... .. ... .. .... ..... ....... .... ... Executive Board: election..................................................................................................... F irst report of Committee B ....... .................................................................. .. ....................... Second report of Committee B ... ................. .. ..................... .. .......... ................ ....... .... ......... .. 160 160 161 161 162

Ninth plenary meeting 1. 2. Reports of the main committees ... .. ...... ....... .. ............................................................. .. .... .. .. Selection of the country or region in which the Fifty-sixth World Health Assembly will be held................................................................................................................................... 163 166

Tenth plenary meeting Closure of the session, ............................................ ............................................... ................ 167

MEMBERSHIP OF THE HEALTH ASSEMBL Y List of delegates and other participants........................................................................................... Representatives of the Executive Board.......................................................................................... 171 246

Indexes (names ofspeakers; countries and organizations).............................................................

247

- Vlll -

TABLE DES MATIERES Pages Avant-propos.................................................................................................................................... iii

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES Première séance plénière 1. Ouverture de l'Assemblée .................................................................................................... . Allocution du représentant du Secrétaire général de l'Organisation des Nations Unies ...... . Allocution du représentant du Conseil d'Etat de la République et Canton de Genève ........ . Allocution du Président de la Cinquante-Quatrième Assemblée mondiale de la Santé ....... . Constitution de la Commission de Vérification des Pouvoirs ............................................. .. Election de la Commission des Désignations ....................................................................... . Premier rapport de la Commission des Désignations ........................................................... . Deuxième rapport de la Commission des Désignations ....................................................... .

2. 3. 4. 5. 6. 7.

4 5 7 8 8 9

Deuxième séance plénière 1. 2. Discours du Président de l'Assemblée .................................................................................. . Adoption de l'ordre du jour et répartition des points entre les commissions principales ..... . Communications ................................................................................................................... . Rapports du Conseil exécutif sur ses cent huitième et cent neuvième sessions ................... . Allocution du Directeur général ........................................................................................... . Intervenant invité .................................................................................................................. . 12 16

3. 4. 5. 6.

22 24 25 31

Troisième séance plénière 1. 2.

Allocution du Directeur général (suite) ................................................................................ . Centenaire de l'Organisation panaméricaine de la Santé .................................................... ..

36 61

Quatrième séance plénière 1. 2. Premier rapport de la Commission de Vérification des Pouvoirs ......................................... . Allocution du Directeur général (suite) ................................................................................ .

64 64

Cinquième séance plénière 1. 2. Intervenant invité................................................................................................................... Allocution du Directeur général (suite)................................................................................. 108 112

Sixième séance plénière Allocution du Directeur général (suite) ...... .............. ............ ............ .. ...... ............................. - lX-

119

Pages Septième séance plénière Distinctions ......................................... ....... ........................ ................................................... Remise du Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille.......... Remise du Prix Sasakawa pour la Santé..................................................................... Remise du Prix de la Fondation des Emirats arabes unis pour la Santé..................... Huitième séance plénière 1. 2. 3. 4. 5. Deuxième rapport de la Commission de Vérification des Pouvoirs .. ..... ............ ..... ......... .. .. Communication..................................................................................................................... Conseil exécutif: élection..................................................................................................... Premier rapport de la Commission B.................................................................................... Deuxième rapport de la Commission B................................................................................ 160 160 161 161 162 151 151 153 156

Neuvième séance plénière 1. 2.

Rapports des commissions principales ........... ... ............................. ..... .. ............... ....... .. ....... Choix du pays ou de la Région où se tiendra la Cinquante-Sixième Assemblée mondiale de la Santé..................................................................................................................................

163 166

Dixième séance plénière Clôture de la session ... .. .. ...... .. ........ ................ .. ....... .. .. .... .... .. .. ... ... ..... .... ... ........... .... ... ......... 167

COMPOSITION DE L'ASSEMBLEE DE LA SANTE Liste des délégués et autres participants......................................................................................... Représentants du Conseil exécutif.................................................................................................. Index (noms des orateurs; pays et organisations)..........................................................................

171 246 247

-x-

A55NR/1 page 1

VERBATIM RECORDS OF PLENARY MEETINGS COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES

FIRST PLENARY MEETING Monday, 13 May 2002, at 10:00 President: Dr HONG Sun Huot (Cambodia) later: Dr J.F. LOPEZ BELTRÂN (El Salvador)

PREMIERE SEANCE PLENIERE Lundi 13 mai 2002, 10 heures Président: Dr HONG Sun Huot (Cambodge) puis: Dr J.F. LOPEZ BELTRÂN (El Salvador)

OPENING OF THE ASSEMBLY OUVERTURE DE L'ASSEMBLEE

Le PRESIDENT : La séance est ouverte. Distingués délégués, Mesdames et Messieurs, nous voilà réunis pour la Cinquante-Cinquième Assemblée mondiale de la Santé. En ma qualité de Président de la CinquanteQuatrième Assemblée mondiale de la Santé, j'ai le privilège et le plaisir de vous souhaiter la bienvenue. J'espère que nos travaux au cours de cette session de 2002 seront aussi fructueux que ceux des années précédentes et je suis particulièrement confiant dans les progrès qui seront réalisés grâce à nos débats. Je déclare donc ouverte la Cinquante-Cinquième Assemblée mondiale de la Santé. J'ai maintenant le plaisir, au nom de l'Assemblée et de l'Organisation mondiale de la Santé, de souhaiter la bienvenue aux personnalités suivantes: M. Serguei Ordzhonikidze, Directeur général de l'Office des Nations Unies à Genève, M. Pierre-François Unger, Conseiller d'Etat, Chef du Département de l'Action sociale et de la Santé de la République et Canton de Genève, et les représentants officiels de la République, du Canton, de la Ville et de l'Université de Genève, et des organismes et fonds du système des Nations Unies. Je salue aussi les représentants du Conseil exécutif.

ASSNR/1 page 2

ADDRESS BY THE REPRESENTATIVE OF THE SECRETARY-GENERAL OF THE UNITED NATIONS ALLOCUTION DU REPRESENTANT DU SECRETAIRE GENERAL DE L'ORGANISATION DES NATIONS UNIES

Le PRESIDENT : M. Ordzhonikidze, représentant le Secrétaire général de l'Organisation des Nations Unies, prononcera maintenant une allocution. Mr ORDZHONIKIDZE (Under-Secretary-General of the United Nations, Director-General of the United Nations Office at Geneva, representing the Secretary-General of the United Nations): Thank you, Mr President. Mr President, Madam Director-General, excellencies, ladies and gentlemen, it is a pleasure to welcome you ali to the Palais des Nations on behalf of the United Nations. lt is an honour to address this distinguished Assembly of the World Health Organization. 1 am privileged to con vey to you the good wishes of the Secretary-General, Mr Kofi Annan, for success in your deliberations at this the Fifty-fifth World Health Assembly. At national levet, priorities and principles in the health care sector reflect dominant concerns and trends. Likewise, at global levet, the international public health debate mirrors the international community's current challenges and preoccupations. Health is not an isolated, self-contained issue. It is directly Iinked to economie and social issues and is part of a political context. Collaboration between the World Health- Organization and its fellow members of the United Nations family is therefore key to the effectiveness and wide reach of the Organization's policies and programmes. In an increasingly complex world, where people are connected over long distances, problems cannot be easily and neatly grouped. They are inter-Iinked and must be addressed accordingly. WHO, therefore, is working with the rest of the United Nations system to maximize efficiency and impact. It seems almost commonplace to mention, but it cannot be stressed enough: poor health and poverty are inextricably linked. Disease not only compounds poverty; in many cases it is caused by poverty through malnutrition, insufficient access to safe drinking water and insanitary dwellings. Improved health for the more than 1.2 billion people who live on Jess than a dollar a day is essential for achieving sustainable and equitable development. Improvement in the health of the poor is an end in itself and a means of attaining substantial poverty reduction. The combating of disease and improving health conditions in the developing countries, therefore, rightly features prominently among the United Nations Millennium Development Goals. The 2002 report of the WHO Commission on Macroeconomies and Health marks a significant step forward in the recognition of the linkages between health, poverty reduction and long-term economie development. The conclusions are unequivocal and concise: ill-health causes economie tosses and stunts growth. The Commission's Chairman, Professor Jeffrey Sachs, emphasizes that health may be the single most important factor retarding development in Africa. The report's sound analysis and clear recommendations form an important foundation for scaling up efforts at national, regional and international levet. Only by attacking disease and poverty in tandem through focused, concerted action can the negative link between the two be broken. lmproved health care requires not only a considerable increase in national and international funding, but also changed mechanisms of donor financing. The current momentum of high-level political engagement and the consensus that "business as usual" will not suffi ce has provided impetus for the creation of new global partnerships to address the shortage of resources. The World Health Organization and fellow members of the United Nations family have been active in cultivating well-targeted, result-oriented public-private alliances. The establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria represents an important innovation. The Fund's recent announcement of the award of US$ 378 million is an encouraging sign that the Fund is fulfilling its purpose of raising much-needed extra capital. It represents a determined effort to mobilize and tap ali forces, including business interests, in the fight against these diseases.

A55NR!l page 3 Children take centre stage in the year 2002. The newly-concluded United Nations General Assembly special session on children enabled us to reaffirm our commitment to the most vulnerable members of the human family. Emergencies, poverty and violence often affect children disproportionately. Sadly, this is ali the more true with respect to disease. The majority of malaria victims are children under five. lt is estimated that malaria kills a child every 40 seconds. According to the World Health Organization and UNAIDS, more than 4 million children under 15 have been infected with HIV since the epidemie began. Another 13 million have lost their mother or both parents to the disease. Equally important, but often Jess commonly acknowledged, children are widely exposed to risk from malnutrition. Directly or indirectly, malnutrition has been responsible for 60% of deaths annually among children under five. WHO's new global strategy for infant and young child feeding is, therefore, a vital contribution towards realizing the Millennium Development Goal of reducing the mortality rate among children under five by two thirds. 1 am pleased to note that the new strategy is the result of a comprehensive and science-based consultative process, involving 100 Member States, United Nations partners and members of civil society. This inclusive process and the strategy's integrated approach will help towards its wide adoption and implementation. At the other end of the spectrum, health concems of our elderly citizens also need to be heeded. The United Nations projects that by 2050 one in every five persons will be over 60. This dramatically changes the demographie composition of the world's population and has significant economie and social implications, which also have an impact on health priorities. The recently concluded United Nations World Summit on Ageing paid particular attention to the importance of maintaining health and quality of life as individuals age. 1 am pleased to recognize that the World Health Organization has presented detailed proposais on how to design health ageing policies. In ali the areas that 1 have touched upon, access is the key word: access to care, access to treatment, access to clean water, access to food, access to information about best practices, and access to funds. It is a poignant fact that many people continue to suffer from, and succumb to, diseases that can be effectively controlled and treated because they do not have access to or cannot afford adequate treatment. While the potential for disease control has never been greater, inequity in the provision of health care is growing at an alarming speed. lt is, therefore, encouraging that the past year has seen much progress in the recognition of the need for equal access to medicines. In particular, the consensus at the Fourth World Trade Organization Ministerial Conference in Doha in November 2001 that trade agreements should be implemented in a manner to promote access to medicines for ali is noteworthy and most welcome. We need to build on this understanding of the importance of access on an equitable basis to reverse the trend of a growing health gap between developed and developing countries. It is the necessary basis for an even stronger alliance between public and private sectors in the battle against disease. The agenda before this Assembly is heavy and detailed. lt reflects both continuing and emerging challenges. The inclusion of mental health, which for too long has been considered a poor relation in international public health, is an important acknowledgement of the growing suffering and costs in this area. There are, however, also positive aspects to mention. Member States now need to consider the end game of the fight against poliomyelitis. Moreover, the world has experienced dramatic improvements in terms of longevity. But, of course, large differences in mortality levels persist between countries. As pointed out by the World Health Organization, genetic research can potentially lead to major medical advances against the great ki liers: tuberculosis, malaria and HIV1AIDS. Wh ether in research or at the operational levet, it is crucial that les sons of past sucees ses are integrated into new strategies for disease eradication both at the levels of prevention and cure. This Assembly offers an important occasion to ensure this. Let me conclude by wishing you ali once again much success during this Fifty-fifth World Health Assembly. Thank you. Le PRESIDENT : Monsieur Ordzhonikidze, je vous remercie pour votre remarquable allocution.

ASS/VR/1 page 4

ADDRESS BY THE REPRESENTATIVE OF THE CONSEIL D'ETAT OF THE REPUBLIC AND CANTON OF GENEYA ALLOCUTION DU REPRESENTANT DU CONSEIL D'ETAT DE LA REPUBLIQUE ET CANTON DE GENEVE

Le PRESIDENT: Je donne maintenant la parole à M. Pierre-François Unger, Conseiller d'Etat, Département de l'Action sociale et de la Santé de la République et Canton de Genève. M. UNGER (représentant du Conseil d'Etat de la République et Canton de Genève): Monsieur le Président, Madame le Directeur général, Excellences, Mesdames et Messieurs les Ministres, Ambassadeurs et délégués, Mesdames et Messieurs, à l'occasion de la CinquanteCinquième Assemblée mondiale de la Santé, j'ai le plaisir de vous souhaiter, au nom des autorités fédérales, des autorités cantonales et des autorités de la Ville de Genève, la bienvenue à Genève et en Suisse. Les risques majeurs pour la santé qui font l'objet du Rapport sur la santé dans le monde, 2002 sont largement connus : la malnutrition, le tabagisme, les principales maladies infectieuses que sont le paludisme, la tuberculose et le VIHJSIDA. Les pays en développement paient ici un tribut tout simplement intolérable. Les atteintes à la santé mentale, qui ont fait l'objet du Rapport sur la santé dans le monde, 2001, constituent aussi une priorité mondiale. Leur charge de morbidité s'alourdira encore dans tous les pays, dans les années à venir. Enfin, deux autres grands problèmes de santé au niveau mondial sont les pathologies maternelles et infantiles, qui continuent à toucher de plein fouet les pays en développement, et, comme le Directeur général nous l'a dit, le vieillissement rapide de la population mondiale. Celui-ci, mis en lumière par le récent Sommet de Madrid, doit également orienter les politiques de santé vers la prévention précoce des maladies non transmissibles chroniques. Si, dans ce dernier domaine, des mesures sérieuses ne sont pas prises, la charge qui pèsera sur le système de soins sera écrasante à l'avenir. Or ces mesures de promotion de la santé sont connues: elles permettent de vieillir en bonne santé et de sauvegarder, pour les personnes âgées, une place dans la société par le maintien des liens sociaux. Nous devons être attentifs au fait que les pays en développement doivent simultanément faire face aux maladies non transmissibles et transmissibles. Le rapport émanant de l'ONUSIDA, de l'UNICEF et de l'OMS a établi un bilan, en particulier dans ces pays. Il permet d'espérer que le paludisme, la tuberculose et le VIH/SIDA feront très prochainement l'objet de stratégies de prévention et de thérapeutiques efficaces. Il en va de la réalité des objectifs de développement consistant, d'ici à 2015, à réduire simultanément la pauvreté et la mortalité infantile et maternelle. Il en va également de la solidarité internationale face aux plus démunis. Tous les problèmes évoqués à ce stade sont largement décrits. Ils sont probablement maîtrisables. Ils doivent faire l'objet de données quantitatives fiables et d'évaluations des politiques publiques. Leurs causes et leurs facteurs de risque sont identifiés, leurs impacts sanitaires, sociaux et sur le développement également. Les actions à mener relèvent de manière privilégiée de volontés politiques et d'investissements monétaires et peuvent répondre à des critères bien établis d'analyse coût/efficacité. Mais, à côté de cela, il apparaît de nouveaux problèmes qui nous confrontent à des crises nouvelles, celles de notre savoir scientifique, celles de notre capacité de maîtrise des avancées technologiques, celles de la perception anthropologique du risque dans les sociétés modernes. Ainsi, nous nous réjouissons de la décision de l'OMS de conduire une étude sur les champs électromagnétiques. La téléphonie mobile fait l'objet d'une réelle préoccupation tant de la population que des politiques, relayée au niveau de toutes leurs instances. L'établissement de données probantes est fondamental. L'expérience gouvernementale des préoccupations du public démontre que la résistance aux innovations est tout autant de l'orJre du savoir que de celui de l'émotion. La participation active des citoyens aux connaissances technologiques devient une réelle exigence. Les crises, qu'elles soient liées à l'encéphalopathie spongiforme bovine et à sa transmission à l'être humain, ou aux organismes

A55NR/1 page 5

génétiquement modifiés, démontrent qu'aujourd'hui un autre rapport doit être construit entre la science, la politique et la population. Celle-ci, en accord avec l'idée de résilience ou de responsabilisation, veut être informée, mais veut également être partie prenante aux décisions. Dans le domaine de la bioéthique, des concertations ont lieu pour apprécier autant les risques liés aux manipulations du vivant que le respect de la dignité humaine. En effet, la recherche génomique avance à grands pas, comme en témoigne le tout récent rapport de l'OMS Genomics and world health. Là encore, la question est clairement posée d'étendre la réflexion éthique au-delà des cercles classiques des experts choisis par les instances officielles ou autodésignés. Enfin, nos gouvernements doivent s'interroger sur l'impact que toute politique publique, qu'elle soit à l'intérieur ou à l'extérieur du domaine sanitaire, a sur la santé. Le principe de précaution est largement évoqué depuis quelques années. Il est apparu dans la grande presse et dans le domaine public autour des crises alimentaires. S'il doit être un instrument de gouvernement dans les politiques sanitaires, il ne saurait en revanche se confondre avec les principes et avec les actions de prévention. Il s'impose par contre lorsque les risques sont mal connus et lourds d'incertitudes. Ce principe exige des recherches afin d'établir les faits et donc ne saurait, contrairement à ce qui est dit parfois, être opposable à la démarche scientifique. En conclusion - et les travaux de cette Assemblée de la Santé le montreront clairement -, les défis que doit relever l'OMS en ce début de xxr siècle restent nombreux, en particulier dans les pays en développement où il faut absolument diminuer la morbidité infantile et maternelle. Mais d'autres enjeux touchent aussi la totalité des Etats : on citera notamment l'éradication de la pauvreté et des grandes épidémies, telles que le SIDA. De nouveaux problèmes surgissent qui sont liés aux nouvelles possibilités de manipulation génétique ; ils posent d'importantes questions éthiques à l'ensemble de l'humanité. Je suis certain que vous allez affronter tous ces problèmes et que vous allez contribuer, chacun à votre manière, à rapprocher un peu plus l'OMS du grand idéal qui a été fixé à sa naissance, celui d'amener tous les peuples au niveau de santé le plus élevé possible. Enfin- et il n'est pas inutile de le rappeler en ces temps particulièrement difficiles -, la lutte pour la santé et la lutte pour la paix doivent aller de pair: c'est bien pour cela que la présence de l'OMS à Genève est indispensable, Genève, cette capitale des activités humanitaires et, nous l'espérons, carrefour de la paix ! Le PRESIDENT : Je vous remercie, Monsieur le Conseiller d'Etat.

ADDRESS BY THE PRESIDENT OF THE FIFTY-FOURTH WORLD HEALTH ASSEMBLY ALLOCUTION DU PRESIDENT DE LA CINQUANTE-QUATRIEME ASSEMBLEE MONDIALE DE LA SANTE

Le PRESIDENT : Excellences, Mesdames et Messieurs les Ministres, Mesdames et Messieurs les délégués, Madame le Directeur général, Mesdames et Messieurs, j'ai le grand plaisir et le privilège de m'adresser à la Cinquante-Cinquième Assemblée mondiale de la Santé. En ma qualité de Président de la Cinquante-Quatrième Assemblée mondiale de la Santé, je tiens à vous exprimer à tous ma profonde reconnaissance pour votre dévouement à la cause de la santé de tous les peuples du monde. Examinons d'abord les résultats obtenus dans le domaine de la santé depuis un an. L'action que nous n'avons cessé de mener contre les maladies transmissibles s'est soldée par de nombreux succès. La lutte contre la poliomyélite nous a rapprochés plus que jamais du but de l'éradication, et nous pouvons nous féliciter des importantes percées faites contre la tuberculose, le paludisme et le VIH/SIDA.

A55NR/1 page 6

La détermination de la communauté mondiale à faire reculer ces maladies est illustrée par la création, depuis notre dernière session, du Fonds mondial de lutte contre le SIDA, la tuberculose et le paludisme. Un bref laps de temps a suffi pour trouver des fonds et élaborer des propositions. Le monde n'a encore jamais vu une mobilisation aussi massive face aux maladies transmissibles. Mais cette action s'assortit d'énormes responsabilités. Ceux qui fournissent les fonds, de même que ceux qui en bénéficient, doivent veiller à ce qu'ils constituent véritablement un financement supplémentaire et aient un impact. Nous devons veiller à ce que le Fonds et les autres initiatives similaires apportent un complément au développement sanitaire durable, sans le fausser. Nous devons rester vigilants et surveiller les effets négatifs de toute injection de fonds précipitée ou trop étroitement focalisée et nous tenir prêts, en cas de besoin, à prendre des mesures correctives. Au cours de l'année écoulée, l'influence de la pauvreté, du sous-développement et des inégalités sur l'instabilité régionale et mondiale a retenu notre attention. Les inégalités aux plans de la santé et des soins de santé jouent là un rôle très important. Elles peuvent, toutefois, résulter de l'instabilité et du sous-développement. Les événements du 11 septembre 2001 ont entravé notre action destinée à protéger et améliorer la santé des peuples du monde. Je ne pense pas seulement aux civils innocents qui ont tragiquement perdu la vie lors de ces attaques armées et du fait de leurs retombées. Les effets de l'insécurité et de l'instabilité se font également sentir dans les pertes économiques que subissent les pays directement affectés et dont les progrès sur la voie du développement sont sérieusement menacés. Les pays en proie à une guerre ne sont pas les seuls à être victimes de ces effets. La santé peut être menacée même dans les pays où l'insécurité n'est pas un problème, parce que les besoins liés à leur développement sanitaire ne retiennent plus l'attention du monde et ne permettent plus de mobiliser des ressources. La guerre contre le terrorisme, qui absorbe elle aussi une part des ressources, s'est ajoutée à la liste des priorités de la communauté internationale. Une réallocation des ressources mondiales pourrait accroître involontairement les inégalités au plan de la santé. L'Organisation mondiale de la Santé et notre Assemblée de la Santé mènent déjà l'action de sensibilisation aux inégalités dans le domaine de la santé qui entravent le développement. La détermination à combattre ces inégalités paraît sincère. Les stratégies destinées à réduire la pauvreté qu'adoptent de nombreux pays, associées aux objectifs de développement du Millénaire des Nations Unies, visent à réduire la pauvreté au moyen d'actions concrètes. Les objectifs 4, 5 et 6 de développement du Millénaire concernent directement la santé, les autres, indirectement. La Conférence internationale sur le financement du développement, qui s'est tenue en mars à Monterrey (Mexique), a appelé l'attention sur la nécessité d'une action concertée urgente pour libérer les pays les moins avancés de leur pauvreté. Le Sommet mondial sur le développement durable, qui aura lieu en septembre à Johannesburg (Afrique du Sud), sensibilisera l'opinion. Les événements de l'année dernière font ressortir clairement l'interaction qui existe entre la paix, le développement et la santé. Faute de l'un de ces éléments, les autres sont menacés. Ce qui revient à dire: pas de paix, pas de développement, pas de santé. C'est pourquoi je saisis cette occasion pour lancer un appel à ceux qui décident de l'utilisation des ressources pour la santé au niveau mondial. L'action humanitaire n'existe pas seulement pendant et après les crises. Nous faisons tous de l'humanitaire. Que notre but soit d'éliminer la maladie ou de réformer le système de santé, nous cherchons à améliorer la vie des populations en améliorant leur santé. Je demande qu'une aide humanitaire soit accordée à tous ceux qui en ont besoin, et pas seulement à ceux dont les besoins font brièvement la une des médias et frappent l'imagination des pays industrialisés. La menace d'une guerre biologique, récemment illustrée par la libération intentionnelle de spores du charbon, a souligné le besoin d'une coopération mondiale contre les maladies transmissibles et l'importance du rôle de l'OMS, des lignes directrices et des instruments qu'elle met au point et actualise depuis de nombreuses années. En combattant ensemble ces nouvelles menaces, nous ne devons pas perdre de vue les problèmes anciens, très répandus, qui sont responsables de la plupart des décès et des souffrances dans le monde, comme les maladies de 1'enfance jointes aux effets de la malnutrition. Trop nombreux sont les pays où la mortalité infantile est demeurée inchangée ou s'est même aggravée. La Consultation mondiale sur la santé et le développement des enfants et des adolescents, qui a eu lieu en mars à Stockholm, et la session extraordinaire de l'Assemblée générale des Nations Unies consacrée aux

ASSNR/1 page 7 enfants, qui s'est tenue la semaine dernière, nous ont rappelé à tous qu'il est important d'accorder une attention accrue à la santé des enfants et des jeunes. Et il doit en être de même de la santé des femmes. Les niveaux élevés de mortalité maternelle constituent un témoignage accablant de notre échec à assurer sérieusement une maternité sans risque. Grâce en partie aux travaux de ces dernières Assemblées de la Santé, les maladies non transmissibles ont gagné en notoriété. Les pays sont de plus en plus nombreux à reconnaître qu'elles font peser sur eux un énorme fardeau, qui ne cesse de s'accroître. C'est ainsi que, dans le domaine de la santé mentale, du fait notamment de l'attention accordée ces dernières années par l'OMS à cette question, on a observé une importante prise de conscience et une évolution sensible des mesures adoptées. L'immense travail accompli par l'organe intergouvernemental de négociation de la convention-cadre pour la lutte antitabac a témoigné de la solide détermination de la communauté internationale à faire face à l'énorme charge de morbidité due au tabac. Ce problème se pose avec une acuité particulière dans les pays d'Asie, où des techniques de marketing très insistantes ont cours et où les cigarettes sont bon marché. Le tabagisme n'est pas le seul aspect du mode de vie qui affecte la santé des personnes qui l'ont choisi. Au mois de mars, cette année, j'ai eu le privilège de participer à une réunion des ministres de la santé de l'Association des Nations de l'Asie du Sud-Est. La déclaration de principe publiée à l'issue de la réunion s'énonce comme suit: «Les pays de l' ANASE continueront à éduquer leurs citoyens et à leur donner les moyens qui leur permettront d'adopter un mode de vie sain et de créer un environnement propice où ils pourront choisir un mode de vie sain dont les différents aspects seront accessibles, abordables financièrement et durables. ». Il est essentiel d'oeuvrer dans ce sens, non seulement en Asie du Sud-Est mais aussi dans le monde entier, pour protéger la santé de nos populations et la pérennité de nos services de santé. L'exemple des pays de l'ANASE pourrait, je pense, inspirer les autres régions du monde. En conclusion, Mesdames et Messieurs les délégués, je voudrais dire toute ma reconnaissance, en tant que Ministre de la Santé, pour le travail en faveur de la santé accompli cette année par les responsables de la santé dans le monde. Le slogan « la santé pour tous » nous est très familier. Source d'inspiration pour nous tous, il oriente notre action depuis de nombreuses années. Les pays du monde entier reconnaissent de plus en plus que la santé est la clef du développement. Cependant, nous avons aussi observé les effets de la guerre et de l'insécurité sur les efforts que nous déployons pour améliorer la santé. Sans la paix et le développement, la noble perspective de la santé pour tous est réduite à néant. Elle pourra se concrétiser si nous unissons nos efforts pour la santé, la paix et le développement. Je souhaite que cet idéal influence et imprègne les travaux de cette Cinquante-Cinquième Assemblée mondiale de la Santé. Je vous remercie de votre attention. Le PRESIDENT : Je prierai nos distingués invités de bien vouloir rester assis pendant que l'Assemblée examine les deux premiers points inscrits à son ordre du jour provisoire, ce qui ne devrait pas prendre très longtemps.

APPOINTMENT OF THE COMMITTEE ON CREDENTIALS CONSTITUTION DE LA COMMISSION DE VERIFICATION DES POUVOIRS

Le PRESIDENT : Nous commençons par la constitution de la Commission de Vérification des Pouvoirs. L'Assemblée de la Santé doit constituer une Commission de Vérification des Pouvoirs aux termes de l'article 23 de son Règlement intérieur. Conformément à cet article, je soumets à votre approbation la

A55/VR/1 page 8 liste suivante de 12 Etats Membres : Chypre, Ethiopie, Fidji, Guinée équatoriale, Islande, Panama, Pologne, Qatar, Thaïlande, Togo, Turquie et Uruguay. Y a-t-il des objections ? Si tel n'est pas le cas, je déclare constituée par 1'Assemblée la Commission de Vérification des Pouvoirs telle qu'elle a été proposée. Sous réserve de la décision du Bureau, la Commission tiendra sa première séance le mardi 14 mai à 14h30.

ELECTION OF THE COMMITTEE ON NOMINATIONS ELECTION DE LA COMMISSION DES DESIGNATIONS

Le PRESIDENT : Nous allons maintenant passer à l'élection de la Commission des Désignations. Cette question relève de l'article 24 du Règlement intérieur de l'Assemblée. Conformément à cet article, il a été établi une liste de 24 Etats Membres et du Président, qui est membre d'office, que je soumets à 1'examen de l'Assemblée. Je précise que, pour l'établissement de cette liste, on a appliqué la répartition régionale suivante : Afrique, 6 Membres ; Amériques, 5 ; Asie du Sud-Est, 2 ; Europe, 6 ; Méditerranée orientale, 3 ; et Pacifique occidental, 2. Je propose donc les Etats Membres suivants : Angola, Canada, Chili, Chine, Equateur, Fédération de Russie, France, Grèce, Guatemala, Indonésie, Iran (République islamique d'), Jamaïque, Koweït, Liban, Malawi, Maldives, Mauritanie, Ouzbékistan, République centrafricaine, Royaume-Uni de Grande-Bretagne et d'Irlande du Nord, Samoa, Seychelles, Slovaquie et Zimbabwe, et le Dr Hong Sun Huot, Cambodge (Président de la Cinquante-Quatrième Assemblée mondiale de la Santé, membre de droit). Y a-t-il des observations? En l'absence d'observations, je déclare élue la Commission des Désignations. Comme vous le savez, l'article 25 du Règlement intérieur, qui définit le mandat de cette Commission, dispose en outre que « les propositions de la Commission des Désignations sont immédiatement communiquées à l'Assemblée de la Santé ». Je suspends maintenant la séance pour que la Commission des Désignations puisse se réunir dans la salle VII. Dès que la Commission des Désignations aura terminé ses délibérations, la séance plénière reprendra ses travaux, probablement dans une demi-heure environ. Avant de suspendre la séance, je tiens à remercier nos distingués invités de nous avoir honorés de leur présence et je prierai tous les délégués de ne pas s'éloigner pendant que la Commission des Désignations se réunit, de sorte que nous puissions nous réunir à nouveau rapidement à la fin de ses travaux.

The meeting was suspended at 10:55 and resumed at 11:35. La séance est suspendue à 10h55 et reprend à 11h35.

FIRST REPORT OF THE COMMITTEE ON NOMINATIONS 1 PREMIER RAPPORT DE LA COMMISSION DES DESIGNATIONS 1

Le PRESIDENT: Nous allons maintenant examiner le premier rapport de la Commission des Désignations. Je vais donner lecture du rapport, qui sera disponible sous la forme d'un document dans les six langues officielles cet après-midi.

1 1

See report of committees in document WHASS/2002/REC/3. Voir les rapports des commissions dans le document WHASS/2002/REC/3.

ASSNR/1 page 9

La Commission des Désignations, composée de délégués des Etats Membres suivants : Angola, Canada, Chili, Chine, Equateur, Fédération de Russie, France, Grèce, Guatemala, Indonésie, Iran (République islamique d'), Jamaïque, Koweït, Liban, Malawi, Maldives, Mauritanie, Ouzbékistan, République centrafricaine, Royaume-Uni de Grande-Bretagne et d'Irlande du Nord, Samoa, Seychelles, Slovaquie, Zimbabwe, et du Dr Hong Sun Huot, moi-même, pour le Cambodge, s'est réunie le 13 mai 2002. Conformément aux dispositions de l'article 25 du Règlement intérieur de l'Assemblée de la Santé et à la pratique de rotation régionale suivie de longue date par l'Assemblée de la Santé à cet égard, la Commission a décidé de proposer à l'Assemblée de la Santé la désignation du Dr L6pez Beltnin (El Salvador) pour le poste de président de la Cinquante-Cinquième Assemblée mondiale de la Santé. Y a-t-il des observations ?

Election of the President Election du Président de l'Assemblée Le PRESIDENT : En l'absence d'observations, et comme il semble qu'il n'y ait pas d'autres propositions, je propose, conformément à l'article 80 du Règlement intérieur, que l'Assemblée approuve la désignation soumise par la Commission et élise son Président par acclamation. (App/ause/Applaudissements)

Le Dr L6pez Beltran (El Salvador) est donc élu Président de la Cinquante-Cinquième Assemblée mondiale de la Santé et je l'invite à prendre place à la tribune.

Dr Lopez Beltnin (El Salvador) took the presidential chair. Le Dr Lopez Beltran (El Salvador) prend place au fauteuil présidentiel. El PRESIDENTE: Excelencias, honorables ministres, embajadores, delegados, sefiora Directora General, quisiera expresar las gracias a esta augusta Asamblea por la confianza que ha depositado en mi al elegirme presidente de la 553 Asamblea Mundial de la Salud. Deseo expresar mi agradecimiento al Doctor Hong Sun Huot, mi predecesor, por su contribuci6n a la ultima Asamblea Mundial de la Salud. Mas tarde pronunciaré el discurso habituai y al memento proseguiremos nuestro trabajo.

SECOND REPORT OF THE COMMITTEE ON NOMINATIONS1 DEUXIEME RAPPORT DE LA COMMISSION DES DESIGNATIONS1

El PRESIDENTE: A continuaci6n invito a la Asamblea a que examine el segundo informe de la Comisi6n de Candidaturas. Daré lectura del informe, que se pondra a disposici6n de ustedes por la tarde. En su primera sesi6n, celebrada el 13 de mayo de 2002, la Comisi6n de Candidaturas, de conformidad con lo dispuesto en el articule 25 del Reglamento Interior de la Asamblea, acord6 proponer a ésta las candidaturas siguientes: 1 1

See reports of committees in document WHASS/2002/REC/3. Voir les rapports des commissions dans le document WHASS/2002/REC/3.

A55/VR/1 page 10

Vicepresidentes de la Asamblea: Sra. J. Phumaphi (Botswana), Profesor V. F. Moskalenko (Ucrania), Sr. S. S. Bhandari (Nepal), Sr. B. R. Mooa (Kiribati), Dr. A. J. M. Suleiman (Oman). Comision A: Presidente- Dr. J. Kiely (lrlanda). Comision B: Presidente- Profesora A. M. Coll Seck (Senegal). Para los puestos de la Mesa de la Asamblea, cuya provision ha de hacerse por eleccion en virtud de Jo dispuesto en el articula 31 del Reglamento Interior de la Asamblea, la Comision acordo proponer las candidaturas de los delegados de los 17 paises siguientes: Barbados, China, Côte d'Ivoire, Cuba, Emiratos Arabes Unidos, Espafia, Estados Unidos de América, Federacion de Rusia, Francia, Japon, Marruecos, México, Reino Unido de Gran Bretafia e Irlanda del Norte, Republica Popular Democratica de Corea, Rwanda, Santo Tomé y Principe y Sierra Leona. Election of the five Vice-Presidents Election des cinq vice-présidents de l'Assemblée El PRESIDENTE: Invito a la Asamblea a que decida, en el orden oportuno, acerca de Jas candidaturas propuestas. Comenzaremos por la eleccion de los cinco Vicepresidentes de la Asamblea. Se han propuesto los nombres siguientes: La Sra. Phumaphi, el Profesor Moskalenko, el Sr. Bhandari, el Sr. Mooa y el Dr. Suleiman. z,Hay alguna observacion? Como no hay ninguna observacion, propongo que la Asamblea declare a los cinco Vicepresidentes electos por aclamacion. (Applause/Applaudissements)

A continuacion, determinaré el orden en el cual los Vicepresidentes seran llamados a ocupar la presidencia en nombre del Presidente, cuando éste no pueda hacerlo. Los nombres de los cinco Vicepresidentes estan escritos en sendas hojas de papel, que voy a extraer al. azar. Los Vicepresidentes ocuparan la presidencia en el orden siguiente: Sr. Mooa (Kiribati), Sra. Phumaphi (Botswana), Profesor Moskalenko (Ucrania), Sr. Bhandari (Nepal), Dr. Suleiman (Oman). Election of the Chairmen of the main committees Election des présidents des commissions principales El PRESIDENTE: Procederemos ahora a la eleccion del Presidente de la Comision A. Se propane al Dr. Kiely (lrlanda). z,Hay alguna observacion? No habiendo ninguna observacion, invito a la Asamblea a que declare al Dr. Kiely (lrlanda) Presidente de la Comision A elegido por aclamacion. (Applause/Applaudissements)

Tenemos ahora que elegir al Presidente de la Comision B. Se propane a la Profesora A. M. Coll Seck (Senegal). z,Hay alguna observacion? Como no hay ninguna objecion, invito a la Asamblea a que declare Presidenta de la Comision B a la Profesora A. M. Coll Seck (Senegal). (Applause/Applaudissements)

Establishment of the General Committee Constitution du Bureau de l'Assemblée

A55NR/1 page 11 Ahora examinaremos el establecimiento de la Mesa de la Asamblea. De conformidad con el articulo 3 1 del Reglamento Interior, la Comision de Candidaturas ha propuesto los nombres de 17 paises cuyos delegados, junto con los titulares de los cargos que acaban de ser elegidos, constituinin la Mesa de la Asamblea. Estas propuestas posibilitan una distribucion geognifica equitativa de la Mesa de la Asamblea. Los paises propuestos son: Barbados, China, Côte d'Ivoire, Cuba, Emiratos Arabes Unidos, Espafia, Estados Unidos de América, Federacion de Rusia, Francia, Japon, Marruecos, México, Reino Unido de Gran Bretafia e Irlanda del Norte, Republica Popular Democnitica de Corea, Rwanda, Santo Tomé y Principe y Sierra Leona. z,Hay alguna observacion? Veo que no hay ninguna; por consiguiente, quedan elegidos. Los miembros de la Mesa de la Asamblea son el Presidente y los Vicepresidentes de la Asamblea, los Presidentes de las comisiones principales y los delegados de los 17 paises que se acaban de elegir. Antes de levantar esta sesion plenaria quisiera anunciar que, inmediatamente después de la misma, frente a la Puerta 16 se tomara una fotografia de grupo de todos los Ministros de Salud y los jefes de delegacion de los Estados Miembros. Después de ello, los miembros de la Mesa de la Asamblea deben dirigirse a la Sala VII, donde la Mesa celebrara su primera sesion, aproximadamente a las 12.10 horas. En el salon de delegados proximo a la Sala VII se serviran bocadillos a los participantes en la Mesa de la Asamblea cuando se levante su sesion. La proxima sesion plenaria se celebrara en esta misma sala esta tarde a las 14.30 horas. Se levanta la sesion.

The meeting rose at 11:55. La séance est levée à 11h55.

ASSNR/2 page 12

SECOND PLENARY MEETING Monday, 13 May 2002, at 14:30 President: Dr J.F. LOPEZ BELTRAN (El Salvador)

DEUXIEME SEANCE PLENIERE Lundi 13 mai 2002, 14h30 Président: Dr J.F. LOPEZ BELTRAN (El Salvador)

PRESIDENTIAL ADDRESS DISCOURS DU PRESIDENT DE L'ASSEMBLEE

El PRESIDENTE: Distinguidos Ministros de Salud, delegados, sefiora Directora General: Es un honor para mi pais y para la Region de las Américas haber sido elegido Presidente de la Asamblea Mundial de la Salud. Quiero darles a todos una calida bienvenida a Ginebra, y desearles éxito en las discusiones importantes que marcanin esta Asamblea. Es un orgullo persona!, ademas de una maravillosa coincidencia, que este afio le corresponda a la Region de las Américas ocupar una posicion tan prestigiosa. El afio 2002 marca un hito muy importante para la Region, ya que estamos celebrando el centenario de nuestra Organizacion Panamericana de la Salud, que ha venido liderando la busqueda de una mejor salud para nuestros pueblos desde 1902. Sefioras y sefiores: Hemos entrado en un siglo nuevo y en un milenio nuevo, en el cual la situacion de la salud ha mejorado para muchos. Pero millones de seres humanos, especialmente los mas pobres, todavia tienen poco o ningun acceso a los servicios de salud, lo cual es inaceptable. Cada uno de ustedes conoce la realidad de sus paises, pero cuando nos juntamos, ya sea en Washington, en Brazzaville, en Copenhague, en Nueva Delhi, en Manila o en El Cairo para nuestras reuniones regionales, o aca en Ginebra para nuestra reunion mundial, podemos ver la perspectiva mas amplia. Y tenemos que decirlo francamente: esta perspectiva es triste. Quiero iniciar estas palabras mencionando los grandes desafios que por afios hemos venido enfrentando, no siempre con el éxito que hubiéramos querido. El articulo 25 de la Declaracion Universal de Derechos Humanos establece una voluntad que esta lejos de ser realidad para millones de seres humanos. El derecho a la salud. Muchos paises han incorporado en su Constitucion la salud como un derecho humano y sefialan las consiguientes responsabilidades que ello implica. Sin embargo, este compromiso explicito aun no alcanza su realizacion practica en amplias zonas de nuestro planeta, donde aun el ejercicio del derecho a la salud se ve dificultado por diversos factores de orden financiero, cultural, geografico, de género, étnico y religioso, entre otros, configurandose asi, una «geografia de la exclusiôn» de la protecciôn social en salud, a la que no hemos podido, o querido, poner fin.

ASSNR/2 page 13 De hecho, tratar de remediar esta situacion, que no ha tendido a disminuir sino a mantenerse o, en algunos casos, a aumentar, ha sido uno de los objetivos declarados de muchas conferencias y de muchas de las agendas de cambio que se han ido introduciendo en los sistemas de salud. Estos cambios declaran como sus propositos mejorar el desempefio de los sistemas y servicios de salud en los ambitos de la equidad, la efectividad y la calidad, la eficiencia, la sostenibilidad y la participacion social. La diversidad de nuestras realidades y la insuficiencia de la informacion dificultan la adecuada evaluacion de las diferentes experiencias de cambio que la mayoria de los paises vienen impulsando. Sin perjuicio de esto ultimo, y por razones diferentes -en unos por el envejecimiento de sus poblaciones y por la emergencia de nuevos desafios epidemiologicos, en otros por presiones financieras, en otros por la insatisfaccion de sus ciudadanos, en otros simplemente por razones de supervivencia- en todos los paises buscamos mejorar las condiciones de salud de nuestros pueblos, introduciendo reformas estructurales en los sistemas de salud. La salud es un bien social y los sistemas de salud desarrollan funciones publicas cuyo objetivo es social. En muchas paises, la realidad se ha caracterizado por politicas publicas insuficientes, fuertes inequidades en la cobertura y en la calidad de los servicios. Paises del mismo nive! de gasto en salud obtienen distintos resultados, probablemente debido a politicas intersectoriales integradas y mas costo-efectivas, tales como educacion y saneamiento basico. En muchas paises, ademas de la pobreza y de la marginacion en que viven parte importante de sus habitantes, es probable que sus sistemas de salud aun no hayan alcanzado toda su capacidad potencial de contribucion, al estar mal estructurados, mal gestionados, organizados ineficientemente o financiados en forma inadecuada. El logro de mejoras en los niveles de salud promedio de las personas debe ser uno de nuestros principales objetivos, especialmente en aquellos lugares del planeta con condiciones sanitarias que hace decenas de afios otros ya han superado. Pero éste no debe ser el unico objetivo. También la equidad en el logro de esas mejoras y la capacidad de respuesta que el sistema tenga no tan solo a las necesidades percibidas de salud de las poblaciones, sino también a variadas aspiraciones que el ciudadano tiene en el ambito del respeto a su dignidad, autonomia y derechos. La salud y el desarrollo humano. Sabemos que los sistemas y acciones de salud representan una importante actividad de las economias, tanto por la importancia relativa del gasto sectorial con relacion al producto nacional de los paises, como por la cantidad de personas que trabajan en los servicios de atencion y por el aporte que el sector hace a la competitividad de las economias. La salud, al ser un bien de caracter social, de be ser vista como una inversion, primero en justicia y luego en desarrollo humano. La salud y la educacion aportan fuertemente a la calidad del capital humano y son factores clave en el desarrollo sustentable de las sociedades. Esto es especialmente importante para que el crecimiento vaya aparejado de una necesaria proteccion social, y para que dicho crecimiento sea equitativo, fomente las condiciones de vida mas justas y promueva la paz social. En enero de este afio la Dra. Brundtland, Directora General de la OMS, afirmo que, en el futuro, multiplicar los esfuerzos y las inversiones en salud en los paises en desarrollo seria uno de los principales objetivos de las actividades de la OMS. Dijo que para el afio 2015 se precisaran 66 000 millones de dolares, de los cuales mas de la mitad debera proceder de la asistencia intemacional para el desarrollo. Las cifras se hasan en el informe de la Comision sobre Macroeconomia y Salud, en el que se insta a aumentar las inversiones en salud en los paises mas pobres. Permitanme recordar hoy estas cifras y solicitar a los Miembros de la Asamblea el respaldo a este objetivo fundamental de la Organizacion Mundial de la Salud. En esta busqueda de globalizacion solidaria encontramos importantes iniciativas que deseo relevar. Las Naciones Unidas y su Secretario General, el Sr. Kofi Annan, han aplicado en el ultimo afio estos principios de manera muy evidente, creando el Fondo Mundial de Lucha contra el SIDA, la Tuberculosis y el Paludismo. Por otra parte, la OMS y su Directora General también han buscado nuevas formas de responder a los desafios sanitarios del presente. La Comision sobre Macroeconomia y Salud ha reunido a sectores y a profesionales de ambitos diversos, que dificilmente se habrian encontrado sin esta convocatoria de la Dra. Brundtland. Durante la Asamblea tendremos la oportunidad de conocer y analizar en detalle la propuesta. Sin embargo, creo que ya es de valor la reflexion y el analisis efectuado, asi como el reconocimiento

ASSNR/2 page 14

de las capacidades disponibles en los cinco continentes. Esperamos que estas y otras iniciativas en marcha cumplan con las expectativas y confianza que los paises hemos colocado en elias. Salud, Estado y ciudadanos. Invertir mas en salud es una responsabilidad ineludible de los paises. También Jo es el hacerlo adecuadamente y contemplando los cambios a que hoy asistimos en muchos paises en lo que respecta al roi que el Estado y los ciudadanos juegan en los sistemas sanitarios. Estos roles hoy son materia de debate, ya que las personas estan dejando de ser objetos pasivos de politicas sociales de corte patemalista y exigen tomar parte en las decisiones nacionales que afectan a sus perspectivas de vivir mas y mejor. Asi como las personas tienen derecho a no ser reducidas al roi de meros consumidores, los ciudadanos son también corresponsables de su salud como sujetos protagonistas de la generaci6n de condiciones que determinan la salud. Esto exige un adecuado equilibrio y armonia entre autonomia, libertad y bien comun, y entre la acci6n y participaci6n del Estado, las personas y la sociedad civil organizada en el quehacer de los sistemas de salud. Equilibrios aun no bien logrados en muchos paises del mundo. Desarrollo de los sistemas de salud. Enfrentamos hoy la necesidad de efectuar cambios que hagan a los sistemas mas eficaces en funci6n de los costos, mas equitativos y mas accesibles. Todos estos cambios deben estar orientados desde las prioridades sanitarias, 16gicamente en el contexto de los recursos disponibles, pero sin subordinaciones de Jo sanitario a Jo financiero, a los requerimientos politicos de corto plazo, o a otros intereses ajenos al interés de las necesidades de las personas. Los cambios en salud obligan también a mejorar las competencias de los gobiemos para desarrollar, desde una perspectiva de descentralizaci6n territorial y funcional, su capacidad de rectoria y regulaci6n de los sistemas de atenci6n, integrando cooperativamente a todos los actores tras objetivos sanitarios de caracter publico. Las dificultades que enfrentan los gobiemos a la hora de implementar los cambios ponen a prueba su capacidad de generar amplios consensos sociales en tomo a la salud; la voluntad politica de priorizar la salud en las agendas de gobiemo; y por sobre todo la perseverancia de los lideres sanitarios. Considerando el importante gasto que los paises hacen en sus sistemas de salud, la complejidad de sus estructuras y lo ambicioso de sus fines, estimamos relevante que la OMS promueva la evaluaci6n de sus resultados. Hago votos por que las metodologias que utilicemos para desarrollar estas complejas evaluaciones sean cada vez mas precisas y consensuadas, con el fin de que sus resultados sean reconocidos por todos. Apreciamos los esfuerzos desarrollados por la OMS y la OPS en este sentido, y esperamos que los mismos sean cada vez mas complementarios. No solo sera importante continuar evaluando. A la luz de dichos resultados, tendremos que fortalecer politicas y estrategias globales, que nos permitan cooperar, intercambiar experiencias y apoyamos mutuamente, tras los objetivos de intervenciones sanitarias mas eficaces, protecci6n financiera equitativa, organizaciones sanitarias mas eficientes y mayor calidad. Lograr mayor impacto con los recursos de que se dispone, sobre todo cuando son escasos, es un imperativo ético, porque en grandes extensiones del planeta miles de millones de seres humanos viven en condiciones de extrema marginaci6n, muriendo de causas que todos sabemos pueden evitarse. La responsabilidad de disefiar politicas publicas, con la consiguiente definici6n de objetivos y prioridades, incumbe a los gobiemos, asi como implementar instrumentas efectivos de regulaci6n de la prestaci6n de servicios, especialmente en el ambito de la calidad. En el cumplimiento de dichas funciones centrales, los gobiemos no pueden obviar, para el 6ptimo funcionamiento del sistema de salud, la definici6n de politicas en los ambitos de la formaci6n y desarrollo del recurso humano, la inversion, la introducci6n de tecnologia costo-efectiva y del estimulo a aquella investigaci6n cientifica que resulta esencial para la toma de decisiones en materia de prioridades de salud. La tarea de armonizar las estructuras, los recursos disponibles, los incentivos organizativos, con los objetivos globales de las politicas publicas, es parte de las funciones clave de los gobiemos en rectoria y regulaci6n y no es algo que pueda dejarse al solo arbitrio de los proveedores de servicios. La debilidad de los gobiemos de muchos paises, especialmente de aquellos con mayores necesidades en salud, es en gran medida responsable de la segmentaci6n y fragmentaci6n de nuestros sistemas de salud, en los que diversos actores estatales y privados no comparten reglas del juego comunes y tienen serias dificultades para colaborar entre si, todo esto en detrimento de la eficacia y calidad de la atenci6n.

A55NRI2 page 15

Sefiores Ministros y delegados: Conformamos la Asamblea Mundial de la Salud, autoridad sanitaria respetada en todo el mundo. Nunca seran suficientes nuestros esfuerzos en responder a tantos que sufren a causa de dafios que podriamos haber evitado. Tendremos que extremar nuestro empefio en idear politicas que los ayuden, que corrijan los problemas a nuestro alcance, siempre valorando la diversidad y la riqueza de las diferentes culturas, con una vision amplia del futuro, asi como de los problemas que enfrentamos. Las condiciones ambientales, asociadas tanto a la pobreza extrema como a un desarrollo tecnologico y economico no respetuoso del medio ambiente; problemas antiguos como la tuberculosis, el paludismo y el dengue, o recientes como el VIH/SIDA; los desafios derivados del avance cientifico y tecnologico, el desarrollo de la genética, de la bioética, y tantos ternas relevantes que ocupan nuestra atencion, deben ser abordados con el (mico objetivo de responder a las necesidades de la persona humana, especialmente de aquellas que sufren marginacion y pobreza. La solidaridad de los pueblos debe expresarse en acciones globales y en capacidad para disefiar y administrar bienes publicos planetarios tales como la informacion y la investigacion. También debe expresarse a través de acciones concretas, como, por ejemplo, la lucha permanente de todas las regiones para interrumpir la transmision del virus del sarampion, problema de salud publica que estamos a punto de derrotar en Latinoamérica. En esta busqueda de globalizar respuestas solidarias efectivas, quizas uno de los factores mas importantes sea el de fortalecer elliderazgo del sector salud en el mundo. La salud no solo es importante, también nos une a todos, a través de la implementacion de politicas publicas que involucren fuertemente a la ciudadania. Estas politicas pueden constituirse también en instrumentas para promover la paz, el enriquecimiento del tejido social y el fortalecimiento de formas democraticas y participativas de convivencia social. La experiencia de Centroamérica en el desarrollo de la iniciativa «Salud, un puente para la paz» debe ser reconocida como un paso importante en esta direccion. La salud y la paz tienen una importancia fundamental en nuestros dias, lo que cobra mayor relevancia tras los sucesos del 11 de septiembre. Muchos pensabamos que tras el fin de la guerra fria podriamos dedicar menos dinero para las armas de la muerte y mas para dar pan, educacion y medicinas. El terrorismo es un flagelo que debe preocupamos a todos. Tenemos que alzar la voz pidiendo respeto a las misiones médicas en zonas de conflicto, y también tenemos que ayudamos unos a otros, para responder adecuadamente ante amenazas biologicas y quimicas, para asi cumplir con nuestro deber de dar tranquilidad y confianza a nuestros pueblos. Algun dia, en el discurso de algun Presidente de esta Asamblea se mencionara a la desnutricion, la malaria, la mortalidad materna, la falta de acceso a los servicios, como cosas del pasado. Ese dia desafortunadamente aun esta lejos. Esa brecha entre la realidad y nuestros anhelos, debe ser la tension que nos anime a extremar nuestros esfuerzos en hacer realidad el derecho a la salud para todos los habitantes en cada rincon de nuestra Tierra. Sefiores Ministros, esta Asamblea Mundial de la Salud es la gran esperanza de cada persona enferma. En cada uno de nuestros paises, algunos saben lo que es la OMS, otros no, pero casi todos saben lo que es estar enfermo. Demasiados saben lo que es no poder ir al doctor porque no tienen dinero, o tener que esperar boras y boras en un puesto de salud y recibir atencion de mala calidad. Aunque lo sepan o no, dependen de nuestras acciones y nuestros esfuerzos para que logren alcanzar un acceso equitativo a la salud. No los dejemos atras. En esta reunion y en todas nuestras acciones, personales u oficiales, pensaremos en las caras humanas que estan detras de cada una de esas cifras y tasas de incidencia que manejamos. No nos olvidemos de esas caras. Muchas gracias, y que Dios nos bendiga a todos.

A55NR/2 page 16 2. ADOPTION OF THE AGENDA AND ALLOCATION OF ITEMS TO THE MAIN COMMITTEES ADOPTION DE L'ORDRE DU JOUR ET REPARTITION DES POINTS ENTRE LES COMMISSIONS PRINCIPALES

El PRESIDENTE: El primer punto que examinaremos esta tarde es el 1.4 «Adopcian del orden del dia y distribucian de su contenido entre las comisiones principales», que ha sido examinado hoy por la Mesa de la Asamblea en su primera sesian. La Mesa de la Asamblea examina el orden del dia provisional de la 55 3 Asamblea Mundial de la Salud (documenta A55/1), preparado por el Consejo Ejecutivo y enviado a todos los Estados Miembros. Antes de pasar a las propuestas sobre la introduccian de un punto suplementario del orden del dia, quisiera ocuparme del orden del dia provisional que figura en el documenta A55/l. La Mesa de la Asamblea recomenda que se suprimieran los siguientes puntos del orden del dia, porque no hay nada que examinar al respecto: punto 5 «Admisian de nuevos Miembros y Miembros Asociados [si hubiere lugar]»; punto 15.5 «Contribuciones de nuevos Miembros y Miembros Asociados [si hubiere lugar]»; punto 15.7 «Modificaciones del Reglamento Financiero [si hubiere lugar]». l,Estâ la Asamblea de acuerdo con esta recomendacian? No habiendo objeciones, asi queda decidido. La Mesa de la Asamblea ha propuesto que el titulo del punto 13.15 del orden del dia provisional, «Uso deliberado de agentes biolagicos y quimicos para causar dafio,» se cambie por el siguiente: «Liberacian natural y accidentai de agentes biolagicos, quimicos o radionucleares que afectan a la salud, o uso deliberado de éstos para causar dafio». l,Desea la Asamblea aceptar esta modificacian del titulo del punto 13.15 del orden del dia provisional? Puesto que no hay ninguna objeci6n, asi queda decidido. Inclusion of supplementary items on the provisional agenda Inscription de points supplémentaires à l'ordre du jour provisoire

La Mesa de la Asamblea también examina la incorporacian de un punto suplementario del orden del dia, habida cuenta de las propuestas recibidas por la Directora General. Se ha propuesto introducir el siguiente punto suplementario del orden del dia: «lnvitacian a Taiwan a que participe en la Asamblea Mundial de la Salud en calidad de observador». La Mesa adopta la misma posician que en Asambleas anteriores en las que se habia presentado esa propuesta y recomenda que no se incorporara este punto en el orden del dia. Cuando se examina esa propuesta en Asambleas anteriores, hicieron uso de la palabra dos oradores favorables a la incorporacian de dicho punto del orden del dia y dos oradores contrarias a la misma. Para facilitar nuestro trabajo, quisiera proponer que adoptemos la misma prâctica, por lo que daré la palabra a Malawi. Mr MW A WA (Malawi): Thank you Mr President, Madam Director-General, distinguished delegates. We would like to support the bid of the Republic of China (Taiwan) for observer status. Taiwan, with its population of 23 million people, has its own public health insurance system, network of health treatment, reporting and research facilities, and an active pharmaceutical industry. We cali upon the international community therefore tolet Taiwan put its resources to work to enhance global health. We believe that inviting Taiwan as a health entity to participate in the World Health Assembly as an observer is a pragmatic, interim solution and the continued exclusion of 23 million people cannot improve the health of its people. This Organization is the only global forum that coordinates the activities of ali

ASSNR/2 page 17

responsible health authorities to ensure that ail peoples around the world realize their inalienable human right to the highest attainable standard of health. As a function of an interim health Organization, WHO must facilitate ali effective health entities to benefit from and contribute to the Organization and it must not exclude any segment of the world's people. With this in mind, Members of this Organization should consider the matter at hand from a broader perspective that will provide positive, realistic solutions to global health issues. My delegation believes, therefore, that the participation of Taiwan as a health entity in the World Health Assembly constitutes a constructive force to the better functioning of this Organization, which is a global forum dedicated to the noblest humanitarian purpose of promoting the health of ail peoples across the world. Globalization erodes sovereignty; it is especially true in health, so we feel that it is simply to demonstrate that WHO is willing to show its care for the well-being of 23 million people that it will inelude Taiwan in its quest for global progress. Dr MODESTE-CURWEN (Grenada): Thank you Madam Director-General, Mr President, distinguished delegates, please allow me to speak briefly on the issue ofthe request for the Republic of China (Taiwan) to be included as observer in WHO. This request does not seek to interfere with the one China issue. We recognize that this is not the business of this honourable forum. However, we be lieve that participation in WHO is a matter of fundamental human rights, rather than a question of politics or sovereignty. It is a universal truth that health has no boundaries and that humanitarianism heeds no such limitations. The inclusion of 23 million people in the Republic of China (Taiwan) in the international health body conforms to the spirit and principles upheld by the constitution of WHO. The World Health Assembly has, in the past, granted observer status to non-sovereign state entities and there are several examples of this in this Assembly. My country proposes that the Republic of China (Taiwan) be granted observer status to the World Health Assembly as a health entity. As a matter of fact, similar formulas have been used for membership of the Republic of China (Taiwan) in the World Trade Organization as a separate customs territory, in the Asia-Pacific Economie Cooperation as an economy and in the Commission established in accordance with the Convention on the Conservation and Management ofHighly Migratory Fish Stocks in the Western and Central Pacifie Ocean, as a fishing entity. My delegation believes that granting observer status to the Republic of China (Taiwan) is a rational means of permitting the island to be included in the global health system. With the absence of the Republic of China (Taiwan) from WHO for three decades, health officiais and medical professionals have been unable to participate in any WHO-sponsored forums or workshops dealing with the latest advances in diagnosing, monitoring, and control of diseases. The health authorities of the Republic of China (Taiwan) have also been denied the opportunity to establish contact and coordinate with WHO and its experts even in emergencies involving the containment and cure of existing diseases or newly emerging infectious diseases. Colleagues, we speak of "Health For Ali", but we exclude with impunity 23 million people. Nevertheless, the Republic of China (Taiwan) has made great strides in achieving good health for its 23 million citizens over the past few decades. Apart from its successful experiences in the eradication of many infectious diseases, such as malaria, poliomyelitis, smallpox, and plague, the Republic of China (Taiwan) has been engaged in various activities in the fields of foreign medical assistance and humanitarian relief, thus saving thousands of lives. Much of this aid has been provided at the most difficult of times and circumstances, making the efforts even more laudable. 1 therefore strongly urge you, colleague Members, to take a more positive and broader perspective on this issue. 1 thank you.

A55NR/2 page 18

Mr ZHANG Wenkang(China):

*)C.Ll ( .p 00 ):

WW~--~~~~~--~~.~~~*·-~T.*~*~-~~~-~~~ ~I1f:1f~.

~rl~~~~~L~*~L. Y~OO*~~-~~~~~~~. --~f~20~

~7o~~~-EM~1~~k~*·~·· -~-*-~Af*~M~~·~~~~ ~~-. *R~~~*~~I.~.~~~~~~k~~~·-~~--~+*L~~~ ~~M~L. X~~1~~~-~-~~-~*~S~~~~-.~~~~1.~~~ ~

WHO ~ ~ $-. .P 00 1-t* ffi Jf Jlt;t\t ;7JÇ i~H~.

~lit. ft~*~.POO~M~~~~~~-L~~*~~: Y~OO*~~~~~~. ~~L~m~~-~~M00~~~~-±~-.~#~*~1«-~00~-»~~*· ~. *~1-~00*~~~~L~*~~*#~~. ~~~MOO~~~~~M.

••oo*~~~-±~-.R~**~~~«-~oo~•»m~~~~~oo*#J ~~*·~-~~L~*-+.POO. ~~~.POO~--~. ~~~-~.POOA~~~~ ~~*oo~~~oo.~oo~~loo.m~L.~OO~~~~±~A.~g#$~~~~. ~J~ "~+.P

~-·~· ~~~-~~~~.POOA~~~-~. ~~ft#~M#OO·~~~~·~*

~1-~00*~~~~-±~-~~1~·~•-+*·*~A~~-~~~400~L

00"

"- .P -~", 0

fit~

.P OO~M~A~•tftJLOOiJE-~~~~'~;t~,

~~ ~il~71~!1~J&~

JI;:Jijj-~jn, WHO~-~OO~M~~_z-, ~*~;fxOO*;t~~~iJP. i-5ZAo~~L~*~ WHA25.1 %~1-JZPA~~-iA: .P$A~#~OOïE5<.M~1~;t\t~

**2758 %~ .P 00~

~00~~~L~M~•m*•~oo~~.p~~-~*~*· ~~~~.POO~-+~.

*&**ti-~iJP~~L~*~· *M~~OO*·~~~~~-±~--~·~*M~~~~~*~~OO*;t~~~ ~oo~m~.~*~-~~~~--~~-~oo~Moo.•s•~•~oo~•~•*~ ~1-JZ. 1t:~~~L~tR~~~0.

00,

Ji!U~Jiff*~±~E-~

WHO tR~?t,&~~L~*~

~~~-YtOO*~~~~~~~~L~*~~-. ~~L~~m~«-~00~-»~ ~~L~M~~~-·~· -~~ft~~#~~?W#R~~: ~!

~~~~~-~~-~. ~~*~,&~*~~~~1-+m~"L~~~,~-~ ~- il~i)t~~LJJt~*$Y~~. -i4*~!fr~ili$Y~~- *-,~,~aA~~.

WHo

~~;fX_OO*~iJP~li*~OO;f!LttJ, ~~1ti. "~~" jfi~~;fJLttJ. WHOjfi~JUt~&* "L

ASSNR/2 page 19

.r:r-~". ~~,

1.~#." ~~~. WHO iii- 50 ~if.~~J&!f-tJ1J,l?f;:tl:l~it1t~ ".=P..:i~#.". i)ié 1, ~>f ~ ~ ~!Hiii .&.~Hl~~ JfJ 1t ~~;X_ ".P $ ~ 00", "~ ~" ~ ".=P.. 1. ~#.", 1-t!!.1fJ ~ !§ ~x;ff-1'-, ~ttl~!l~it~~#fA~-é--OO~OO~~f!l.fJUlt7.1-~!f00, 1jjùJ! "001'-l:ff!l", "-

~itf1ij:7t1~*~*-1~1-t~oo1·t*~*u*~~h 1.

~~ *ffiiJ<.;Jti)i~~p{t-: "~~~~JJI1 WHO, 2300 7J~~À~1t-~xÀitl~, 'AA~1f1tJ*'~ o %x7t:Œ ~~f~~o" ~P.«~-:1!~, x1r:ri:3:.tx.OO*-~~~, 1~1 !K7}]1J~:JJP1

J~~t~

"A.A.f.;ff{tJ*" ~P%, ~Jîf'!,tJta}J!§*~g_ WHO f!l.~7i.&_;Jtt},t;t~~9! !t~o §'~ * ffiiiJt: "~il~ ~JJilÀ WHO, lit.Jt~ WHO)§-,

;f~~~~

u~~~oo~.=P..&•~~~Mo"~P.«~-~*·*~~V!oooo~~ff~•~· ~.&.~ *f~{f~~-f*., x!l;JJ;f~ WH01f~-~~%!Atl.:tJ3PJ~JJI1À WHO,~~~. WHO${.~ Jt~{E~ WHO Jo 1-t!!.1i'J:1ii)i: "~~~,tf'!,t~~JJPÀ WTO, litm~~~JJPÀ WHO." ~ft~ OO{E WHO :Ji1tJi)f1.~ "WTO ~~"o 1.ê.k WHO ~ft WTO, WHO Jt~t-f!l{-J'l;f}L~, X~~$ 3:.{X.00*-~:hl1, WTO ~~-tl-*~it)f] -f~t-OO&Jt{-J'l;f}L~.

~~*ffii&;Jt~~~~~~~~~{i:~~~o7.1-~l:f00 . • ~§'-~±~-Jt~~

~. ;fk·~~~~~À~~~~-~~-*~ff~.

-, WTO ~WHO Jt·f!~~~ ~OO~f!l.f~o WHO Jt~t-00{-J'l;f}L~, ffiJ WTO ~ Jt~t-oo*m~oo~~~. oo~~~~~~-~~~~0

.=., WHO ~ WTO :ri:f!I.~~~7J if~~ Jt-;ffPJ lt•f!. WHO 5Z ~~ !i13:.{X.00 *-fR~, ffiJ WTO ~~9!!Jt3:.{X.00*-&~, :!iPJ~-§M.~!k*{JLIK. {Eit-.~J:, WTO 1&-§tli WHO :ri: ~~~t-OOf!l.~;ff;ftl*-~~~ o .=_, §' ~ lJ}, "lf 00 ~ ~~" ~ }(JJPÀ WTO ft~ lf 00 lf ~~}ff ~ t ~ o lf 00 ~}ff Jt -îlp ~ ~JJilÀ

WTO, k1t:xt*fJt·rtJJt1f ill ~*f'*~*lF. ~/f}J!lA

~:#-~ ;t'*;f~1fJ:ri: ~ ~ fal)Jl!J:~

Y~1r*~~~) ~~;t-'**~~~~~1f*~~~o

WTO ~~~~1-t!!.~MJ'~f!J~~f!l.~lk.OO~~~~ ( ~P WHO~ WHA) PT g~ 1;}j ~i ~ ~ ~ o WTO • ~ ( 1it 12 ~ ) Jt -ît. ~!k * {JL il~~ ~ 9! , §' ~ft ~ " ~ j~ ~lb -~!k*;ft!K" ~~)( (%'j{t- "o/00~~~") JJPÀ WTOo ffiJWHOf!l.~5t~Jt, x;f;r3:.{X. OO#;f~~~~~~~9J., -1--00*-~-*~~PJ~~~$~9!, Jîf'!.t, ~~~~·J: ~ VJ;.ï {If ·rt ))(, o ii~)};: i)i a}j , ~ ~ i(.;ff ~;ft lJ}, 1:f:~ 3f3 ~, 1:f:~ ~ )( ~ JJI1 WHO ~ 15 ~, ~ IZ!L i(_;f;r~;ft~*~~;X_~}J!l~~_]_1_*~0

1it-,

*~~~' 1#1~4i_;K.jt:It:, ~~~9='00~1'-~1?}-{.f:, 5f:±~~7J\.~ WHO~

_]_ &1t .~. ~ ~ ~~ oo 1± .=P.. &~

*rtr *

1~ ~ JJ.t#, ~ 1E ± ~~ gt_* ± ~1/ïE ff

m 19! ~1t .~,.

A55NR/2 page 20

•=·*~A~~t~A~~~·-A~~-nA~-#.e~~OOA.**~~ ~g~•~.ft~•*~*~~~oo~*m~•**~••~•n~~~rM.~ffi~ ~~~t~~a•oo**•· ~*~~--~~-~~~~~~-~~••· -~.~~ft§·~~~. ~OO*M~-•ft«-~*00~~~~~~~--~00 ~ft~fi~~-~~~~~~~-~~•w~m~.•+A*-~*&*t~~~~m -~00~~~"~~~~~~~~§·~~~~.*~*~~~- ~~.~~00~

•.

~~. -~~-*~· ~~~~*t~A~-*~~~M··~~-M~*·

~ft, ~ ii.~~~~· j}-~ ~* -f /F tE~ {ltj~ ~il· JE i5Z ~ ~ 1~J5Z. ~.ffiW, "i' ~ ll:_ -f!f ~", "0-:it ~ft A~~·", Jf-f~ -Jti)Z, ft~~~**

flft 1fJ

jU A*

-~~ili~-~~-. ~~~ffift~~~~*~~M*~-#.

.1-IÇ*ffJ

Mr ASLAM (Pakistan): Thank you, Mr President. The question of representatiQn of China at the World Health Organization was settled in 1972 where the World Health Assembly decided to recognize representatives of the Government of the Republic of China as the only legitimate representatives of the Republic of China (Taiwan) to the World Health Organization. This decision was in conformity with United Nations General Assembly resolution 2758 which considered restoration of the lawful rights of China as essential both for the protection of the Charter and for the cause of the United Nations. Respect for States' sovereignty and territorial integrity is a fundamental principle of the United Nations Charter. Taiwan is an inalienable part of China and the Govemment of China is sole representative. The proposai of sorne delegations to suggest that a province of one of its Member States can become an observer to the World Health Assembly is an assault on the territorial integrity in China. It is also a grave interference in its internai affairs. If accepted, this would set a dangerous precedent whereby Members of WHO would be faced with situations where integral parts of their territory would seek membership or observership at WHO. It also distances WHO from its mandate as a health organization. The proposai of sorne delegations for inclusion of items relating to the status of the Republic of China (Taiwan) as an observer in the World Health Assembly bas no legal basis. International law, the United Nations Charter, the WHO Constitution and ali relevant resolutions and decisions of the United Nations General Assembly and the World Health Assembly provide the framework in which these proposais need to be considered. This framework establishes without any shadow of doubt that there are no grounds on the basis of which the Republic of China (Taiwan) can enter WHO whether as a Member or as an Associate Member or as an observer. The authors of the

ASSNR/2 page 21 proposai under consideration are aware that there is no legal basis for its consideration. They also know that there is no consensus on this issue. Their insistence on bringing this issue, year after year, before the World Health Assembly notwithstanding its doomed outcome, is a clear manifestation of the political designs. lt is obviously a political ploy of a handful of delegations to call into question the one China policy of the United Nations. The real objective of the efforts of these delegations is to initiate a process that leads to the cession of Taiwan from China. These delegations had made a similar abortive effort at the 109th session of the Executive Board that failed dismally wh en the Board refused to consider their proposai. We therefore do not understand why they have raised this issue again in the World Health Assembly. We should not be deceived by the high moral ground claimed by the delegations sponsoring this proposai. Evidently, their objective is not the health needs of the people of the Republic of China (Taiwan). The Govemment of China has on severa) occasions displayed its commitment to the promotion of the Republic of China (Taiwan). The recommendations made by the General Committee are sound and based on legal grounds as weil as precedent. lt shows that there is very little support for the inclusion of such an item on the agenda of the Fifty-fifth World Health Assembly. We endorse the recommendation of the General Committee and agree that the proposai for inclusion of this additional agenda item should be rejected. 1 thank you, Mr President. El PRESIDENTE: Hemos escuchado cuatro intervenciones sobre este tema. i,Puedo entender que la Asamblea esta de acuerdo con la recomendaci6n de la Mesa de no incorporar este punto suplementario del orden del dia? No habiendo objeciones, se aprueba la recomendaci6n. (,Puedo entender que la Asamblea acuerda adoptar el orden del dia provisional en su forma enmendada, suprimiendo los tres puntos conforme a lo decidido al comienzo de nuestra sesi6n de esta tarde? Asi queda decidido. Mafiana por la mafiana se distribuira el documento A55/l Rev.l con las modificaciones que acabamos de introducir. Allocation of items to the main committees Répartition des points de l'ordre du jour entre les commissions principales El orden del dia provisional de la Asamblea fue preparado por el Consejo Ejecutivo de manera que propusiera una distribuci6n de puntos entre las Comisiones A y B de conformidad con los respectivos mandatos de las comisiones principales. La Mesa de la Asamblea ha recomendado que los puntos del orden del dia del Pleno, en su forma enmendada, que todavia no se hayan asignado se debatan en sesi6n plenaria. Con respecto al punto Il del orden del dia provisional, «Mesas redondas», la Mesa de la Asamblea ha formulado las siguientes propuestas que reflejan los criterios seguidos en afios anteriores: En la mafiana del martes se celebraran cuatro mesas redondas simultaneas sobre riesgos para la salud. Cada una de estas mesas redondas se considerara como una comisi6n de composici6n limitada. Estara integrada exclusivamente por los ministros de salud, o los jefes de delegaci6n designados para representar a los ministros en esta Asamblea, que se hayan inscrito en la Secretaria. La lista de participantes en cada una de las mesas redondas se publicara en el Diario. Repito que solamente esos participantes se consideraran miembros de cada una de las mesas redondas. Todas las demas delegaciones y los observadores ante la Asamblea de la Salud, incluidos los miembros de la delegaci6n del Ministro de Salud o del jefe de delegaci6n que participa en la mesa redonda, asistiran como observadores. En consecuencia, para posibilitar un debate pleno entre todos los participantes, el uso de la palabra estara limitado a éstos, es decir a los Ministros de Salud o a las personas designadas para representarlos que sean miembros de la mesa redonda.

A55NR/2 page 22 Como la finalidad de las mesas redondas es permitir que todos se beneficien de un intercambio de puntos de vista entre los participantes, y no necesariamente llegar a un acuerdo en cada caso, las mesas redondas no tendran el mandato de adoptar resoluciones, sino solo de presentar al Pleno un resumen de los debates. La mesa ha propuesto a los siguientes Ministros de Salud, presentes en esta Asamblea, como Presidentes cada uno de ellos de una de las cuatro mesas redondas: Dr. Manuel Dayrit (Filipinas), Sr. Thami El Khiyari (Marruecos), Dr. Julio Frenk (México) y Dr. C. P. Thakur (lndia). La Mesa también acordo que uno de los Presidentes presente al Pleno un informe oral resumido de los debates habidos entre los participantes. Se entiende que, mas adelante en el transcurso de las deliberaciones, quizas se haga necesario transferir algunos puntos de una comision principal a otra, segun el volumen de trabajo de cada una. (,Esta la Asamblea de acuerdo con estas propuestas? No habiendo objeciones, asi queda decidido.

ANNOUNCEMENTS COMMUNICATIONS

El PRESIDENTE: A continuacion deseo hacer un anuncio importante sobre la eleccion anual de Miembros facultados para designar una persona que forme parte del Consejo Ejecutivo. El articulo 101 del Reglamento Interior, en su forma enmendada por resolucion WHA50.18, dice Jo siguiente: «Al comienzo de cada reunion ordinaria de la Asamblea de la Salud, el Presidente invitara a los Miembros a comunicar a la Mesa de la Asamblea cuantas propuestas deseen presentar sobre la eleccion anual de los Miembros facultados para designar una persona que forme parte del Consejo. Esas propuestas deberan hallarse en poder del Presidente de la Mesa en el plazo maximo de veinticuatro horas a contar desde que el Presidente, en aplicacion del presente articulo, haya formulado la invitacion.» Por consiguiente, invito a los delegados deseosos de formular propuestas relativas a dicha eleccion a que las presenten al Asistente de la Secretaria de la Asamblea, a mas tardar el martes 14 de mayo a las 16.00 horas, para posibilitar que la Mesa se reuna con objeto de formular a la Asamblea recomendaciones sobre estas elecciones. El programa de trabajo para mafiana, martes 14 de mayo, sera el siguiente: A las 09.30 horas de la mafiana se reuniran las mesas redondas a fin de intercambiar puntos de vista sobre el tema «Riesgos para la salud». En la tercera sesion plenaria, que se celebrara a las 14.30 horas, se procedera al debate general del punto 3, mientras que la Comision A y la Comision de Credenciales celebraran cada una su primera reunion. La Mesa acordo que a las 17.00 horas se examine en sesion plenaria el punto 8 del orden del dia, Centenario de la Organizacion Panamericana de la Salud. El miércoles 15 de mayo, el Pleno se reunira a las 09.00 horas para examinar el informe de la Comision de Credenciales, seguido del debate general del punto 3. Simultaneamente, la Comision A celebrara su segunda sesion. Por la tarde, el Pleno se reunira a las 14.30 horas; pasara al punto 4 y escuchara la alocucion del orador invitado, Profesor Jeffrey Sachs, Director del Centro para el Desarrollo Internacional de la Universidad de Harvard, Presidente de la Comision sobre Macroeconomia y Salud, y nombrado recientemente Asesor Especial del Secretario General de las Naciones Unidas en Jo concerniente a los Objetivos de Desarrollo del Milenio. Con respecto a la organizacion de los trabajos para el resto del miércoles por la tarde, la Mesa adopto dos decisiones: Como expliqué a la Mesa, muchas delegaciones desearian adelantar el debate del punto 18 del orden del dia, «Situacion sanitaria de la poblacion arabe en los territorios arabes ocupados, incluida Palestina, y asistencia prestada». También se desea que ese punto se examine tempranamente a fin de

ASSNR/2 page 23

asegurar que estén presentes los miembros apropiados de las delegaciones. Aunque normalmente son las propias comisiones las encargadas de determinar el orden conforme al cual examinan los distintos puntos, el comienzo de las actividades de la Comision B esta previsto para la tarde del miércoles, lo que significa que esta cuestion relativa al calendario se abordarfa en principio cuando los debates de la presente Asamblea estén relativamente avanzados. Por consiguiente, la Mesa de la Asamblea decidio sugerir al Pleno - como organo decisorio supremo de la Asamblea - que resuelva que la Comision B, como primer tema después de haber elegido a los miembros de su Mesa el miércoles por la tarde, examine el punto 18 del orden del dia, «Situacion sanitaria de la poblacion arabe en los territorios arabes ocupados, incluida Palestina, y asistencia prestada». A este respecta expliqué a la Mesa de la Asamblea que se preferirfa que ni la Comision A ni el Pleno tuvieran que reunirse coincidiendo con las deliberaciones que sobre el punto 18 habra en la Comision B, para que todas las delegaciones puedan seguir los debates. La Mesa de la Asamblea esta facultada para resolver este tipo de problemas horarios. En consecuencia, a fin de acelerar los trabajos de la Asamblea y previendo una posible decision del Pleno como la que acabo de seiialar respecta del orden de los trabajos de la Comision B, la Mesa decidio que el miércoles por la tarde, apenas acaben las intervenciones sobre el punto 3, se levante la sesion de la Comision A. La Comision B iniciara entonces sustrabajos. Eso ocurrira previsiblemente en torno a las 16.00-16.30 boras, y se habran tomado las disposiciones necesarias para poder proseguir las deliberaciones incluso después de la hora habituai de clausura de la sesion, si fuera necesario. La Mesa se reunira el miércoles a ultima hora de la tarde, segun lo previsto, o mas tarde, por la noche, si la Comision B tuviese que prolongar los debates. El jueves volveriamos a atenernos a lo indicado en el calendario diario preliminar y ambas Comisiones proseguirian el examen de sus respectivos ordenes del dia. Después de haber escuchado las decisiones de la Mesa de la Asamblea sobre las modificaciones del calendario diario preliminar, ~desea el Pleno decidir que la Comision B, inmediatamente después de la eleccion de sus miembros el miércoles por la tarde, examine el punto 18 del orden del dia, «Situacion sanitaria de la poblacion arabe en los territorios arabes ocupados, incluida Palestina»? Como no hay observaciones, asi queda decidido. Volviendo a las sesiones plenarias, para facilitar la organizacion de los trabajos de la semana, deseo proponer un procedimiento consistente en que, como en ocasiones anteriores, se siga estrictamente el orden de la lista de oradores para el debate general del punto 3 del orden del dia y que los nuevos inscritos intervengan ateniéndose al orden en que se inscribieron. Las inscripciones se deben entregar a la oficina del Asistente del Secretario de la Asamblea o, durante la sesion plenaria, al funcionario responsable de la lista de oradores que se balla en la tribuna. Propongo que la lista de oradores se cierre maiiana martes a las 12.00 boras. Esta maiiana propuse una lista de paises como participantes en la Comision de Credenciales. En clicha lista figuraba Polonia, pero este pais ha indicado antes que no estaria en condiciones de participar en los trab~os de esta Comision. Solicito que la Asamblea me autorice a suprimir aPolonia de la lista de miembros e introducir a Estonia, que también es Miembro de la Region de Europa. Muchas gracias. Asi queda establecido. Deseo recordar a los pocos delegados que aun no hayan presentado sus credenciales oficiales que las entreguen a la secretaria de la Comision de Credenciales, en la oficina A.667 de este edificio, a mas tardar maiiana a las 11.00 boras.

A55NR/2 page 24 4. REPORTS OF THE EXECUTIVE BOARD ON ITS 108TH AND 109TH SESSIONS RAPPORTS DU CONSEIL EXECUTIF SUR SES CENT HUITIEME ET CENT NEUVIEME SESSIONS

El PRESIDENTE: Pasaremos ahora al punto 2, «Informes del Consejo Ejecutivo sobre sus 1osa y 109a reuniones». Antes de dar la palabra al representante del Consejo Ejecutivo, quisiera explicar brevemente la funci6n de los representantes del Consejo Ejecutivo ante la Asamblea de la Salud y la del Consejo mismo, para evitar que algunos delegados abriguen dudas a este respecto. El Consejo Ejecutivo desempefia una funci6n importante en las actividades de la Asamblea de la Salud. De conformidad con la Constituci6n de la OMS, el Consejo debe dar efecto a las decisiones y a la politica de la Asamblea de la Salud, actuar como 6rgano ejecutivo de la Asamblea de la Salud y asesorar a ésta en los asuntos que ella le encomiende. El Consejo también presentani propuestas por iniciativa propia. Por consiguiente, el Consejo designa cuatro miembros para que lo representen en la Asamblea Mundial de la Salud. La funci6n de los representantes del Consejo Ejecutivo consiste en transmitir a la Asamblea de la Salud en. nombre del Consejo las principales cuestiones planteadas durante sus deliberaciones, asi como el tenor de las deliberaciones del Consejo durante su examen de las cuestiones que es necesario sefialar a la atenci6n de la Asamblea de la Salud, y explicar las razones y el caracter de toda recomendaci6n sometida por el Consejo Ejecutivo al examen de la Asamblea. Durante las deliberaciones de la Asamblea de la Salud sobre esas cuestiones, los representantes del Consejo Ejecutivo deben responder a cualquier cuesti6n suscitada toda vez que consideren necesario aclarar la posici6n adoptada por el Consejo. Las declaraciones de los representantes del Consejo Ejecutivo que hablan como miembros del Consejo designados para presentar la posici6n de éste se deben distinguir, pues, de las declaraciones de los delegados que expresan las posiciones de sus respectivos gobiemos. Ahora me complace dar la palabra a la representante del Consejo Ejecutivo, Sra. Myriam Abel, Presidenta del Consejo. Mrs ABEL (Vanuatu) (Chairman ofthe Executive Board): Mr President, Madam Director-General, honourable delegates, your excellencies, ladies and gentlemen, firstly, I would like to congratulate you, Mr President and your Vice-Presidents on your election and, on behalf of the Executive Board, extend to y ou our full support and wish you weiL For me, this year, as Chairman of the Executive Board, has been a challenging, but very rewarding experience, as the Organization addresses sorne of the critical issues facing ali of us working in health. I would like to highlight sorne of those issues and how the Board has dealt with them. A written report has been submitted to you in document A55/2, and three of my colleagues and I will be with you during the week and will be happy to answer questions and expand on the Executive Board's work or the Board's deliberations. The 108th session of the Board he1d in May last year dealt with a short agenda but included the very important items of food safety and the revision of the model list of essential drugs. lt also began discussions on two of the major themes of its work at the l 09th session in January this year, namely review of methods of work of the Executive Board, and intensizying work on the health conditions associated with poverty. Members of the Board met informally late in 2001 at a retreat in Florence, ltaly. The purpose of the meeting was to share ideas and experience on sorne of the issues on the agenda of the January session. lt afforded members an opportunity for free interchanges of views amongst each other and with the Director-General, the Regional Directors and senior staff. The 109th session of the Board met from 14 to 21 January and addressed a very full agenda, including a large number of technical issues. Many of the se items are on the agenda ofthe Health Assembly, and my colleagues and I will have the opportunity to briefyou in more detail on each ofthese items in the Committees. I would like to highlight a few of them. The January session of the Executive Board and the current World Health Assembly were convened in the context of a very different global environment from two years ago, particularly from a

A55NR/2 page 25

health perspective. Increasingly, health has become a major part of the global development, financing and, of course, the political agenda. In January, the Director-General drew the Executive Board's attention to the report of the Commission on Macroeconomies and Health. The World Health Assembly will discuss how the report can be used to increase and focus resource allocation on health. The same period also saw the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Executive Board discussed the health implications of the Millennium Declaration and raised the issue of global conferences being held this year. The first four items scheduled for consideration by Committee A carry implications for how we, WHO, carry forward sorne of these issues. Another change has been the increasing emphasis on preparedness for dealing with outbreaks of disease resulting from natural and, unfortunately, man-made causes. The Executive Board also addressed a number of management issues, which have been forwarded to the Assembly, and the issue of its own methods of work. The addressing of the latter issue included the establishment of the Ad hoc open-ended intergovemmental working group to review the working methods of the Executive Board. This working group held its third meeting last Friday under the chairmanship of Professor Zeltner of Switzerland. 1 will report to the World Health Assembly in more detail on the meeting when the issue is discussed later this week. The group has begun to clarify the direction of its work and sorne very interesting options have been raised. The Executive Board reappointed Dr Hussain Gezairy as Regional Director for the Eastern Mediterranean Region for a further term, from October this year. We congratulate him and wish him weil. This year also we celebrate the centenary of the foundation of the Pan American Health Organization and we congratulate the Organization and wish it good health for the next 100 years. Severa} of my predecessors in recent years have remarked how the work of WHO was facing a situation in an era of great change. 1 agree with them, and from my own experience, it is clear that if anything the change is happening even faster. Our challenge is how we, both the Executive Board and the World Health Assembly, work together to guide this Organization. We have a lot of work to do and we have an enormous responsibility. Mr President, 1 wish you every success. 1 am confident you will rise to the challenge. Madam Director-General, your excellencies, 1 thank you for your attention. El PRESIDENTE: Muchas gracias, sefiora Abel, por su excelente informe. Deseo aprovechar esta oportunidad para encomiar la labor del Consejo Ejecutivo, y en particular para expresar nuestro profundo agradecimiento a los miembros salientes que han contribuido muy activamente a las actividades del Consejo.

ADDRESS BY THE DIRECTOR-GENERAL ALLOCUTION DU DIRECTEUR GENERAL

El PRESIDENTE: A continuaci6n daré la palabra a la Dra. Gro Harlem Brundtland, Directora General. Doctora Brundtland, tiene usted la palabra. The DIRECTOR-GENERAL: Mr President, ministers, distinguished delegates, ladies and gentlemen, for years we have ali been striving to get health in its proper place. Ali of us in this hall know that health for ali is vital for human security. Now, advocacy for health has moved beyond circles of health professionals. Prime ministers and presidents, rock singers and sports' stars, business leaders, share our position. Put simply- unless people are healthy, we will not see economie growth; we will not see stability; we will not see human dignity, or fulfilment ofhuman rights; we will not be at peace. 1 do not mean that health is everything. But most of the world's leaders now recognize that good health is essential for the

A55NR/2 page 26 secure future of our planet. They have agreed on a set of development goals for the millennium. Many of these goals are concemed with health. The Commission on Macroeconomies and Health has presented them with a road map for how these health goals can be achieved. At the International Conference on Financing for Development, held in Monterrey, Mexico in March 2002, severa! of them agreed to scale up their investments in achieving the Miilennium Development Goals. A growing portion of such investment is being earrnarked for health. This increased emphasis is much needed and most welcome. And we should not be too modest. We have ali been instrumental in making this happen. The dreams that inspire us at the World Health Assembly, our cails for action and our carefuliy crafted resolutions- ail of this has a broader meaning. We have triggered a change. Now we are taking it forward. A hearty welcome to you ali. I would like to speciaily greet the Minister of Health of Afghanistan, Dr Sediq, who is with us here today. That our coileague is a woman is ali the more welcome and itself an encouraging sign that Afghanistan is on its way to recovery. Colieagues, in a world where we tend to focus on shocking inequities and crises, let us not forget what has been achieved in the last few years. We are weil down the road to poliomyelitis eradication with a dramatic reduction in the number of cases detected over the last year; we have agreed targets- and clear strategies - for confronting AlOS, tuberculosis and malaria; we are seeing a real increase in available resources through a new global fund to fight these conditions; millions more children are being vaccinated against common childhood illnesses, and immunization coverage is increasing; mental illness is now being addressed as a major cause of suffering and disability; nations are united in initiatives to control tobacco marketing and reduce its use, the forthcoming soccer world eup is smoke free, many countries have banned cigarette advertising, and many more have increased tobacco taxes; and ali over the world, these results are being achieved by under-funded health systems, often through joint efforts by the public sector and civil society. I salute the thousands of dedicated health workers who have made these achievements possible. Ail of you here today have built on these achievements and worked hard to make health a real development issue. Your work enables me and my WHO colleagues to speak out - confidently- and cail for greater investments. 1 thank you. Now is the time to chart the way ahead for the next few years. As 1 reflect on the increased public interest in health, three big challenges stand out. First: we need to speak out about the threats of ill-health in different societies and the potential for tackling them. Systematic work on risks to health is vital: it will be the focus of our discussions at this Assembly. Second: we need to invest in better health systems everywhere - bringing benefits to those who need them, responding to needs and expectations, and fairly financed. And, third: we must sustain the momentum in the fight against diseases of poverty, empowering affected communities - and countries - to take action for health equity. We cannot speak out about risks to health unless we know clearly what they are. The world health report 2002 on risks to health, to be published in October, will be a wake-up cail to the global community. It represents an intensive effort by WHO- one of the largest projects it has ever undertaken. lt tries to quantify sorne of the most important risks to health, and to assess the costeffectiveness of measures to reduce them. The ultimate goal is to help govemments of ail countries lower these risks, and rai se the healthy !ife expectancy of the ir populations. The picture that is taking shape from the research on the report gives an intriguing - and alarrning - insight into current causes of disease and death and the factors underlying them. lt shows how human behaviour is changing around the world, and the impact of these changes on people's health. At one end of the risk factor scale lies poverty, undemutrition, unsafe sex, unsafe water, poor sanitation and hygiene, iron deficiency and indoor smoke from sol id fuels. These are among the 10 leading causes of disease. Ail are much more commonly found in the very poorest countries and communities. At the other end of the scale we see unhealthy consumption. High blood pressure and high blood cholesterol, strongly linked to cardiovascular and cerebrovascular diseases, are also closely related to excessive consumption offatty, sugary and salty foods. They become even more dangerous when combined with the deadly forces of tobacco and excessive alcohol consumption. Obesity, as a result of unhealthy consumption, is itself a serions health ris k. Ali of these factors - blood pressure, cholesterol, tobacco, alcohol and obesity, and the diseases linked to them are weil known to wealthy societies. They dominate in ali middle- and upper-income countries. The real drama is that they are becoming more prevalent in developing communities, where they create a double burden on top of the infections

ASSNR/2 page 27

diseases that always have afflicted poorer countries. The world is living dangerously: either because it has little choice, or because it is making wrong choices. Let me put it another way. Six billion people co-existing on our fragile planet. On the one side are the millions who are dangerously short of the food, water and security they need to live. On the other side are the millions who suffer because they use too much. Ali of them face high risks of ill-health. Unhealthy choices are not the exclusive preserve of industrialized nations. They have consequences for global security and individual destiny everywhere. We ali need to confront them. In order to improve world health, we ali have to tune up our policies for managing risks of ill-health. Countries need to be able to adapt these policies to their needs. We know that risks like unsafe sex and tobacco consumption will increase global deaths substantially in the next few decades. They will continue to do so until they are brought under better control. lndividual behaviour is frequently governed by the circumstances in which people live and work. It influences their level of exposure to individual risk factors. We have effective means to reduce these risks. The critical question is: How do we implement these measures on a wide scale and ensure better health outcomes? We must never forget what lies behind the figures and statistics. Every day, every hour and every minute, a fellow human being is suffering, and approaching an early death. Families are coming to terms with tragedy. We have to respond in ways that reflect the realities of people's lives. This calls for concerted and evidence-based action. WHO's mandate is to get the evidence right and to see to it that the world uses this evidence to become a healthier place. Our first priority must be the children and the young. They are particularly vulnerable to physical and emotional risks. Two-thirds of ali diseases in later !ife can, in fact, be traced back to behaviour patterns established during the teenage years or to exposures to health-threatening environments in childhood. 1 learned about ways to turn evidence into action when working as an environment minister and then Prime Minister 15 years ago. The evidence must be clearly presented in ways that make sense to policy-makers. Our Commission on Environment and Development did this, spelling out the risks to our environment, and the consequences of neglecting them. Then we had to make sure that they themselves communicated the evidence and acted on it. That called for severa! years of consensus building- by the leaders themselves. That is what happened at the Rio summit in 1992. Now over the last few weeks 1 have reviewed the evidence on risks to health caused by indoor smoke pollution, environmental tobacco smoke, lead in gasoline, and unclean water. Ali these hazards endanger the health of children. The world hea/th report will show us the human cost. Millions are disabled, and hundreds ofthousands die needlessly. We can prevent ali these deaths. 1 have seen how ministers of health and environment want to tackle the risks, save lives and promote child development. So, when 1 attend the World Summit for Sustainable Development in Johannesburg in August, 1 shall launch a new initiative to promote healthy environments for children. lt will bring a range of national and international actors together, and provide back-up for evidence-based action at the community leve!. 1 shall also reinvigorate WHO's work on diet, food safety and human nutritionlinking basic research with efforts to tackle specifie nutrient deficiencies in populations and the promotion of good health through optimal diets- particularly in countries undergoing rapid nutritional transition. We have come a long way in developing new guidelines for healthy eating. When these are complete 1 shall invite the key players in the food industry to work with WHO in addressing the rising incidence of obesity, diabetes and vascular diseases in developing countries. We also have an immediate, safe and reliable remedy for sorne of the major health risks linked to unhealthy consumption. lt is free. It works for rich and poor, for men and women, for young and old. It is physical activity. At least 30 minutes each day. This is why 1 chose "Move for Health" as the theme for this year's World Health Day. 1 spent it in Brazil, witnessing an impressive mass movement for "movement". lt is an example many co untries can learn from. The gains, in terms of the number of chronic diseases prevented, will be huge. We know that most people will choose to adopt healthier behaviours - especially when they receive accurate information from authorities they trust, and when they are supported through sensible laws, good health promotion programmes and vigorous public debate. We have seen in the global movement for tobacco control that transparency and disclosure are the keys to success. Promoting trustworthiness is the key. This requires long-term vision and step-bystep action, over the years. Sorne countries - such as Brazil, South Africa and Thailand - can proudly point to reductions in tobacco consumption. WHO has been intimately involved in the tobacco-free movement. We have created the environment within which governments are negotiating a framework

ASS/VR/2 page 28 convention for tobacco control. We are committed to seeing the process through. Success will bring benefits to millions of people: they will be healthier and they will live longer. We have seen many countries strengthen their national tobacco control policies, but many are still not doing enough. I urge ail Member States to redouble their efforts before our deadline of a completed convention at the Health Assembly next year. For the sake of future generations we cannot afford complacency. On alcohol, we are much further behind. New data to be released in The world health report show that the burden of alcohol on mortality and morbidity has significantly increased since last reported in 1990. Alcohol, like tobacco and other risk factors, is widely marketed - particularly to young people. This does undermine health. Tum on the television, open a newspaper or magazine, visit a store or market. In just about any country you will see that children and youth are the targets of the new technologies of persuasion. Getting loyalty to brand names is the key to influencing consumer be havi our- from the time children start to walk. Children currently influence 45% of household purchases in the United States of America and 65% in urban China. Brand name promotions - whether for tobacco, alcohol or fast foods- are designed to take advantage of people's subconscious. They use messages which influence behaviour through their emotional appeal. These marketing approaches matter for public health. They influence our own- and in particular our children's- patterns of behaviour. Given that they are designed to succeed, they have serious consequences for those at whom they are targeted. We need to work on healthy messages that promote healthy lifestyles and healthy products. There is certainly a need for guidance: in sorne cases, like tobacco advertising and alcohol advertising aimed at the young, what we need, frankly, is control. WHO will play its part. We provide an umbrella of authoritative positions under which many others can act for health. This includes speaking out against tobacco use and confronting ail forms of discrimination linked to mental disorders, leprosy or other stigmatizing conditions. lt means calling for policies to improve access to essential health care for ail; urging pharmaceutical companies to reform their pricing structures and to invest more in drugs to treat AIDS, malaria and other infectious diseases; urging a fair and innovative use of new knowledge in the field of genomics so that developing countries benefit on an equal footing with industrialized countries. That is why our own advocacy must always be rooted in our evidence base; in our bank of scientific knowledge. In the past, few paid attention to our work to develop recommendations. Now advocates for health - whether outside or within govemment - see their importance. There is widespread interest in our recent recommendations for the treatment of people affected by AIDS in resource-poor settings. This has been reported as a breakthrough in the effort to reach the six million people who need it. The need for good evidence is reflected in the continuous vigilance that must protect the quality of the food people eat, permit the early detection of infectious diseases and help the world detect and respond to dangerous pathogens, particularly those resistant to modem medicines. The evidence should also be used to make healthy food the choice that is easy and attractive. Collecting and presenting such evidence are core tasks for WHO. We will expand this work. Now let me tum to the challenges of health systems. I know from my own experience as a politician that if we do not have the ability to measure how systems perform, we cannot implement policies properly, and meet the requirements expected of us. Without the data we cannot adjust the systems and improve results. Establishing systematic methods for assessing health systems' performance has been one of my key concems over the past four years. The work was pioneered in 2000 and has now been subject to rigorous review. 1 salute the staff who are working on this within WHO, and the thousands of people within countries who are putting together the evidence base for it to be revised and taken forward. Demands on health systems are ever increasing. Care for acute conditions, such as malaria and injuries, as weil as for pregnant women, delivering and caring for newborns, is essential. Much more attention is also being paid to accessible care for longer-term conditions: tuberculosis treatment, care for people with HIV, therapy for those with noncommunicable illnesses, including mental illness, epilepsy, cardiovascular disease, cancer and disabilities. Wherever I go I see the difficulties being faced. Resources for health are always scarce. Dedicated health workers are achieving miracles, frequently with minimal pay. Often they succeed by going outside the traditional structures, through joint efforts with nongovemmental organizations and private entities. But health ministers are always subject to criticism. That is why 1 want us to provide them with better methods for examining health system coverage and quality, based on the new world health survey. Health systems need to make the best use of available funds. So 1 have established a new initiative to

ASSNR/2 page 29

provide guidance on health care financing in different settings. Health systems also need people with expertise. 1 have also established an initiative to improve human resources in national health systems. This has many facets: one is the damage to the health systems which serve poor communities by the relentless recruitment of skilled nurses and other health personnel to places where the pay is better. The initiative will also examine options for developing stewardship and technical skills within the health professions. When we speak of a health system, we imply a functioning organization overseen by a competent health ministry. Countries in crises usually have health systems too, but often they have broken down. People caught up in conflicts and crises need humanitarian help, but they also need the basic infrastructure of !ife - essential water supplies, sanitation, health care, food and persona! security. Women, children and men suffer terribly as a result oftheir being caught up in other people's conflicts. It is cruel and unjust when they are deliberately targeted, when they are deprived of what is essential for their survival. Intentional attacks against innocent civilians as they go about their daily lives can never be justified, no matter what the political or military context. I condemn such attacks, wherever they occur. Imagine the anxiety of a mother as she searches for loved ones in the ruins of what used to be her village; imagine a father's anxiety as he puts his child on the school bus and wonders whether he will ever see her again. Within any conflict, there are fundamental elements of a people's existence, including the ability to maintain its health, that must be respected. The respect for the neutrality of health staff needs to be upheld by ali sides at ali times. I want to stress clearly, to ali: restrictions should never be imposed on the movements of medical staff, patients, medicines, ambulances and other goods; military operations should never target the infrastructure necessary for water and electricity supplies, or waste disposai. The current crisis in the Palestinian territories shows us the impact of what happens if the health system - and the rest of the infrastructure needed for li fe breaks down as a result of conflict. The Assembly will be debating this and will be anxious to know our analysis of the health situation. WHO has managed to get sorne medical supplies into the Palestinian territories, and we are currently working to get more across from Jordan where it is now pre-positioned. But that is not enough. The health system in the territories must start functioning again, as soon as possible. Let me add the voice of public health in support of ali who are urging ali parties in the current conflict to move towards peace and away from confrontation. Israel and the Palestinian territories are now zones where people suffer mental and physical ill-health as a result of military conflict. The spiral of violence must be turned. During the coming years WHO will give added emphasis to taking exceptional action for health in emergency and crisis situations, throughout the world. We will assemble information on health situations and responses, work in synergy with ali concerned partners, and jo in them in improving access to essential health commodities, equipment and personnel. At ali times we will help coordinate an effective response by ali involved. This, Madam Minister, is the rote we seek to perform in Afghanistan. In this hall in 1998 I said that only a broad alliance can manage the critical task of bringing the 1.2 billion people who live on Jess than a dollar a day out of poverty. I said WHO must be the health component of that alliance- impatient and ready to fight for the health needs of poor people. We should lead when required, and seek to make a difference. Now, four years later, I feel WHO has fully taken on that rote. We are a growing force in the global effort to improve people's lives. We are reaching towards the millions who have been excluded from this century's and the last's health revolution. We have helped to focus international attention on what this really involves- in terms of political commitments and new resources. WHO set up the Commission on Macroeconomies and Health to get world class practitioners and scholars to analyse the degree to which people's ill-health impacts on human and economie development. Professor Sachs, the Commission's Chair, will be with us this week. Their analyses have aroused rouch interest and debate among people who- until nowhave not been focused on international health. Now they want action to reduce this drain on world development. The position we are in today is approaching what we envisaged when we first spoke of the need for a "massive effort", three years ago. We have seen considerable movement: summits setting goals for AIDS action, to Roll Back Malaria, to Stop Tuberculosis, to improve children's health; partnerships to tackle AIDS, malaria and tuberculosis, improve access to medicines, tackle epilepsy and unsafe motherhood; also to vaccinate children, develop new medicines, prevent chronic diseases, reduce malnutrition, tackle influenza and eliminate leprosy and filariasis. There are new

ASSNR/2 page 30

funding mechanisms, such as the Vaccine Fund, the Tuberculosis Fund, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. We have introduced an integral approach towards reducing the suffering from HIV/AIDS, malaria and tuberculosis through programmes that combine prevention, diagnostics, treatment and care. We are better able, now, to fight for more resources to tackle these devastating conditions. We have moved a long way towards making essential medicines accessible to a much larger number than we could have envisaged even only three years ago. But it is not enough. We need continued reduction in priees of medicines and other commodities, and expansion of quality services to the millions in need. We must scale up our efforts even if the struggle seems beset with political and institutional minefields. The Global Alliance for Vaccines and Immunization (GAVI) is a great innovation. lt has shown what can be done. In severa) countries, vaccine coverage figures have already started to rise - by as muchas 8% in sorne cases. 1 salute the people who work tirelessly to make children's immunization a reality, whether they maintain the cold chain, keep vaccine-carrying vehicles running, encourage children to come for their jabs, mobilize financial resources, keep partnerships going, or handle the paperwork that enables the money to move. If ali the 74 countries that have engaged with GAVI meet the targets they have set (and 1 believe many of them will) they will have saved two million lives annually. Communities, governments, activists, donors and private entities ali share the credit because every !ife saved is a real victory, a triumph for us ali. But we must press on. We must further increase the funding for tackling the illnesses of poverty. The "absorption capacity" of countries far outstïips donor capacity. We must increase the number of people who can access treatments, like antiretroviral drugs, at the same time as we scale up prevention programmes. This means rolling out diagnostics and treatment schemes in a way that broadens access while being equitable, fair and realistic. We must improve our ability to measure the impact of interventions on poor people's health. We need to know how we are progressing towards our goals. We must know what is working and fine tune our programmes. We must also do ali we can to increase access to essential medicines and health technologies. Participants in last year's WTO meeting in Doha supported the differentiai pricing of essential medicines, and encouraged flexible interpretation of the Agreement on Trade-Related Aspects oflntellectual Property Rights with a view to enhancing access to essential medicines. Further work will be undertaken this year: 1 know that severa! ministers of health have asked for WHO to help in this process. New funds, antiretroviral care, measuring impact and better access to essential medicines are ali challenges for Member States and for WHO. So we will improve our capacity to work with countries, to help them interface both with the new funds and with other global initiatives. We will strengthen our backing for the Roll Back Malaria, Stop Tuberculosis and AIDS partnerships, particularly within countries. We will support national and global initiatives to improve maternai and child health, and reduce the impact of mental illness, injury, sleeping sickness and other health conditions on poor societies. At ali times we will pay attention to the ways in which people's gender influence their health. Gender concerns must be infused in ali of our efforts. In a world filled with complex health problems, WHO cannot solve them alone. Governments cannot solve them alone. Nongovernmental organizations, the private sector and foundations cannot solve them alone. Only through new and innovative partnerships can we make a difference. And the evidence shows we are. Whether we like it or not, we are dependent on the partners, the resources and the energy necessary for at !east a 30-fold scale-up in effort- to bridge the gap and achieve health for ali. That is what we are talking about. lt is because we are reaching out, as 1 said when 1 started in 1998 - that we are ali succeeding, on so many fronts. We will continue to reach out, for one reason only. We will continue to engage more partners, build stronger movements and move beyond the health sector, for one reason only. Why? To pursue health for ali, achieving real impacts among the world's poorest people. 1 should add that in every joint venture we seek to define what each partner can bring to the relationship. We identifY its importance where potential conflicts of interest may limit certain types of interaction. We aim to play to each others' comparative advantages. Ali of this has required WHO to strengthen its work on ensuring transparency in the affiliations of ali special interests, on ethics and on our internai oversight mechanisms. What matters most, though, is the extent to which the people of the world achieve better health, and especially those in poor nations. For WHO a crucial question is always "How can we best help the achievement of sustained and equitable health gains in countries?". We must subject everything we do to the "women, men and country" test. Will it

A55NR/2 page 31 make a difference? How much? What else could achieve a better result? That means being selfcritical. Taking account of the enormous demands on national institutions and capacities, the constraints they face- notably limited human and financial resources. There is strong support for scaling up WHO's focus on countries- from inside and outside WHO. Through the country focus initiative we are intensifYing action white doing our best to ensure the development of capacities within countries as weil as within WHO country teams. lt has been a long 12 months sin ce we last met in this hall. Over the course of these 12 months, the context for our work has changed. As world leaders have struggled to chart a course towards a more stable, secure and peaceful world, they have agreed on the importance of reducing poverty, suffering and inequity. They see, now, how instability and inequity in one place, or affecting one community, threatens the whole world. They see how global action against health risks in one country can help protect ali people in ali countries; and that efforts to tackle stigma and deniai have to work at home at the same time as they are promoted abroad. We have far togo to respond to these imperatives. The health-for-all concept, the Millennium Development Goals, Health Assembly resolutions, our corporate strategy and now the report of the Commission on Macroeconomies and Health, the Monterrey Consensus, the outcome of the Second World Assembly on Ageing held in Madrid in April and the declarations of the United Nations General Assembly special sessions on children and on AIDS are there to guide us. These road maps remind us that we are fighting against poverty and inequity, that the world's goals are ambitious, and that ali of us committed to change must work together. Nothing can be sustained unless the people of poor nations want it, and their leaders act on this desire when they make decisions about how resources are to be used. In Johannesburg, this coming August, I hope to see different national leaders working with civil society in concerted efforts to invest in people for their sustained development. This is the only viable route to the long-term future of our planet. lt means continuing with our massive effort to fight the health conditions which most affect poor people, with ever stronger alliances and partnerships, and a relentless focus on longterm results. We have a full agenda ahead of us. Forging real change is never easy. Y ou have to confront established ways of thinking and working. But if you are convinced, as I am, that the change is essential for our shared purpose, then there is no opportunity to yield to short-term pressures because this would be the more comfortable way togo. I have never seen real change happen easily. Never in history was equity achieved without a battle. We must continue to build the momentum to fight the diseases ofpoverty. We must build new alliances and new initiatives to address the risks to health that threaten the essential requirements for a healthy life. Thank you. El PRESIDENTE: Muchas gracias, doctora Brundtland, por sus elocuentes palabras. El texto de la alocuci6n de la Directora General se distribuira en esta misma sala esta tarde.

INVITED SPEAKER INTERVENANT INVITÉ

El PRESIDENTE: Es un gran honor para mi dar la bienvenida en nombre de esta Asamblea a la Sra. Carol Bellamy, Directora Ejecutiva del UNICEF. Sefiora, tiene usted la palabra. Ms BELLAMY (Executive Director, United Nations Children's Fund): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, on behalf of the United Nations Children's Fund (UNICEF), 1 am delighted to have this opportunity to

A55NR/2 page 32 address the World Health Assembly and I send warm thanks to my friend and colleague, your excellency Director-General, and to you, the members of the Assembly for your invitation. Three nights ago, in the presence of an unprecedented number of child delegates and nongovemmental organizations, the General Assembly's special session on children strongly reaffirmed the 1990 commitments to children and put forward a 21 st century agenda that calls for major improvements in child survival, health, education and protection by the year 2015. The agenda, part of the outcome document entitled "A world fit for children", includes a series of objectives, sorne reflecting the unfinished agenda of the World Summit for Children, others the longer term goals endorsed at the United Nations Millennium Summit and other major summits and conferences. Ali of us have reason to be enormously proud and pleased by what was accomplished last week when national leaders declared their intention to change the world for and with children. The question now is whether the solemn promises of the special session can be translated into strategies and subsequent investments in children and how ali of us concemed with child health issues - ministers of health, multilateral agencies like WHO and UNICEF, nongovemmental organizations, how ali of us can work together to make lasting improvements in the health status of children and women. Take for example the yearly deaths of sorne 11 million under-five children, a figure that represents a reduction of only 14% over the last decade with virtually no progress in sub-Saharan Africa. But there is one effective way to meet the challenge of 11 million yearly deaths, and indeed ali the health challenges set forth in "A world fit for children", and that is to reach every child and every adolescent with basic, highly cast-effective interventions. This approach is a practical expression of UNICEF's view that the survival, growth and development of children are universal development imperatives and integral to human development and integral as weil to human progress. But what is to be done wh en there are so many needs and never enough resources? In times of scarcity, investment choices must be made to maximize retums and the evidence is clear that investing in the health of children and adolescents yields particularly high retums. Looking beyond the health and nutrition, or education sectors is crucial as weil. Many of you today who are here are ministers of health, but perhaps what is needed in a govemment is a minister of linkages. For example, basic nutrition, appropriate infant feeding that encompasses breast feeding and complementary feeding, micronutrient delivery by supplementation and fortification and sufficient calories and quality, quantity for growth and development is ali too often forgotten. Y et, it is essential for improving health and achieving overall development imperatives. Health bas also been identified as an important element in sustainable development. That is why we are hopeful that children's health will be prominent in the outcome document being drafted for the World Summit on Sustainable Development, to be held in Johannesburg in August and I congratulate the Director-General for ber initiative. There needs to be more reference to children and women in this document, certainly more then there was in Monterrey. Expanding coverage to reach every child benefits not only individuals but it benefits their communities. Expanded coverage of health and nutrition interventions means more children are ready and able to leam in school. Empowering young people to avoid substance abuse and HIV1AlOS infection deepens the pool of talent available to societies as healthy adolescents can then build their own human capital and assume productive roles in their families and in their communities. What then is needed to reach every child and every adolescent? Given the gaps in coverage of even the basic interventions, business as usual simply is not enough. Our analysis of the situation of children and adolescents begins with the family. In addition to providing the primary developmental space for children and adolescents, the home is also where 80% of child deaths occur. Services that are focused in facilities and institutions will never really address this reality. We at UNICEF welcome additional resources for health, resources that must flow to interventions that work in imprm;ing health outcomes. However, it is critical that their disbursement fosters accountability. Recipient govemments that shift domestic resources from health to other activities as official development assistance flows for health increases are playing a variation on a sad tune. Second, decentralization has profoundly altered the delivery of health services and the role of ministries of health in that delivery. Increasingly, rare is the country where there is a vertical public system in which ali services are planned, managed and delivered by government. There are no countries where such a structure can hope to reach every child. Government has untapped power to increase the quality of services, but it must go the extra mile to exercise that power properly. Reducing

ASSNR/2 page 33 under-five mortality rates means moving from being ministers ofhealth services to ministers for health outcomes. In sporting two hats, you as health ministers must not only meet the political challenges of allocating resources and managing human resources, but also bring private providers into functional relationships with those in need. Be assured that we at UNICEF will work with you to ensure that increasing numbers of children and adolescents benefit from effective health services that can be delivered to where they live. Let me now tum for just a moment to the new agenda for children that came out of last week's United Nations General Assembly special session on children. Under the heading "Promoting healthy lives", the new agenda's health and survival priorities include: reductions of at least one-third in infant and under-five mortality in this decade, which is on the way to two-thirds reduction by the year 2015, the millennium development goal; improvements in access to safe water and adequate sanitation. Both these objectives build on the unfinished business from the World Summit for Children in 1990. Let me mention two others: promotion of early childhood development programmes, including health and nutrition, and development and implementation of national health programmes to safeguard adolescence. These are the global priorities. For the period 2002-2005, UNICEF will focus on five overarching priorities in no particular order of importance; they are ali equally important. First, early childhood development with a focus on health and nutrition. Second, immunization plus for ali children, recognizing the important role of immunization, but seeing immunization as a door-opener for many other kinds of interventions, everything from vitamin A distribution to perhaps delivery of impregnated bed nets. Third, quality, basic education with a particular emphasis on making sure that ali girls as weil as boys get an education. Of the 120 million children around the world of primary school age still not in school, 60% are girls. Fourth, that ali children are protected against abuse, violence and exploitation, and five, combating the pandemie of HIV1AIDS. This should foster the best start in life for ali children and afford ali adolescents the opportunity to enjoy the fullness of life. Sectoral health activity as you can hear, is vital to ali ofthese, but most important, ali ofUNICEF's priorities can contribute to improved health for children and adolescents. Our emphasis on reaching every child and adolescent highlights the confluence between our efforts on health and our commitment to the rights of children and adolescents. Health is not only a right of ali children and adolescents under the Convention on the Rights of the Child, but it is an essential prerequisite to realizing the rights that we ali share as humans. What then is the role of ministers of health in building a world fit for children? Over the last 10 years, many of the countries facing the highest burden of illness and deaths among children and adolescents, have also undergone extensive health sector reform. 1 must say and 1 think we ali agree, with mixed results. Many health sector reforms may have made health services more efficient, but ali too often have stopped at the health centre door. As we at UNICEF look ahead to the next decade, we see an opportunity to focus our energies on strengthening health systems to focus on bringing services to people rather than people to services. Imagine health sector reform that delivered family-friendly services, where the onus was on the service delivery to reach every child and adolescent. A second key aspect of expanding coverage concems commodities essential to health. Medicines are but one example. Too often, after walking for severa) hours to the clinic, care givers leave empty handed. Despite the care givers correctly assessing that the child was sick and needed treatment and travelling to the appropriate facility, the medicine needed to treat the sick child is often out of stock or locked up, the person in charge of the key having gone home. 1 challenge you to consider how to make those essential commodities more available to households. Are we ready to empower families with a survival pack of essential medicines as a step to prevent sorne of the eight out of 10 child deaths occurring at home? But services and commodities al one are not enough, knowledge is also crucial. Here, two examples come to mind. First, integrated management of childhood illnesses includes both knowledge for upgrading health care workers but also community action to increase the knowledge of families to care for their children when sick, to ensure proper nutrition and to create an environment in which the child can grow and develop. Second, UNICEF and multiple partners, including certainly first and foremost WHO, have been collaborating on the booklet known as Facts for Life for al most two decades. Facts for Life - and 1 hope y ou ali have the new version, the new highly improved version - presents and provides information that is vitally imperative, vitally

ASSNR/2 page 34

important to child health and development and puts it into the hands of families and communities, the hands that will be the first to respond to illness and will build the environment in which the child blossoms or withers developmentally. When one looks at successful efforts of going to scale on any health intervention, the knowledge and the commodities needed to improve health are accompanied by communication for behavioural change and communication for social mobilization. In short, support for strategies that emerge from communities about how to use a health commodity, or how to change a care practice, coup led with the creation of an environment that enables - even expects- that such change should occur. So if I, a lowly lawyer, might borrow a medical metaphor, we have the diagnosis, but what are we going to do to change the prognosis? Business as usual means at least 11 million child deaths a year, so I feel that we ail agree that business as usual just is not an option. Re garding how you, as ministers, structure your work, I can only urge you as I urge us at UNICEF, to focus on results, results that matter for children, results that matter for adolescents, results that matter for families, results that mean fewer deaths, Jess illness and reduced disability. Distinguished delegates, you and your govemments represent the final common pathway through which our advocacy, resources and programmes translate into improved health for your citizens. A vital role in which we stand shoulder to shoulder with you to move past business as usual. A major priority is reducing under-five mortality, reducing maternai mortality and reversing the HIV/AIDS pandemie. How do we reach these goals? We are ready to help you make a start in partnership with such agencies. Let me go a step further, we have ali heard of the need for focus, for accountability, for stewardship of scarce resources. The goals in a world fit for children mark out a clear destination. In health, we are certainly ready to commit ourselves to a simple but effective strategy, working with ministers of health and other partners to reach every child with immunization, with oral rehydration for diarrhoea, with antibiotics for pneumonia, with improved nutrition, including micronutrient supplements and to impart the knowledge required for families, communities and health services to use them effectively. In sorne of the most resource-constrained environments, particularly in sub-Saharan Africa, the stakes are even higher, and so the list is slightly longer including insecticide-treated bednets, antimalarial drugs and nevirapine to prevent mother-to-child transmission ofHIV/AIDS; for adolescents, information, skills and services to enable them not only to reduce their AIDS infection but to grow into capable adults and th us a strong foundation for the next risk of HIV1 generation and the global future; and finally, a concerted effort to deliver effective antenatal care to every pregnant woman, to promote proper nutrition to women of child-bearing age, to ensure skilled attendance at delivery and care of the newbom. Ali these interventions require collaboration between health systems and other sectors or actors in society. Ministers of health outcomes are desperately needed to move ahead and produce results, results that matter for children and adolescents and results increasingly demanded by those who fund multilateral organizations and official development assistance, and indeed by that person down the hall - your own minister of finance. Sorne see this emphasis on results as undesirable interference with the process of development, but I propose to you that results matter, not simply because the donors want them, but because you, through your govemments, and UNICEF, through its role in the multilateral system, are ali committed to results. UNICEF looks forward to working with ali ofyou. Thank you very much. El PRESIDENTE: Muchas gracias, sefiora Bellamy, por su alentadora e inspiradora presentaci6n. En nombre de la Asamblea, deseo expresarle nuestro calido agradecimiento por habemos honrado con su presencia. El texto de la alocuci6n de la Sra. Bellamy se distribuini mafiana por la mafiana. Antes de levantar la sesi6n deseo recordarles que las mesas redondas sobre «Riesgos para la salud» se celebrarân mafiana, martes 14 de mayo, a las 09.30 horas, en las salas VII, XII, XVII y XVIII. A las 13.00 horas, en la sala XVI se celebrarâ una sesi6n de informaci6n técnica sobre «Uso deliberado de agentes biol6gicos y quimicos para causar dafios». Por la tarde, a las 14.30 horas, celebraremos nuestra tercera sesi6n plenaria y comenzaremos con el debate del punto 3 del orden del dia; mientras, se celebrarâ la primera sesi6n de la Comisi6n de Credenciales simultâneamente con la

ASSNR/2 page 35

primera sesi6n de la Comisi6n A. A las 17.00 horas, en sesi6n plenaria, examinaremos el punto 8 del orden del dia, «Centenario de la Organizaci6n Panamericana de la Salud». Se levanta la sesi6n.

The meeting rose at 17:15. La séance est levée à 17h15.

ASSNR/3 page 36

THIRD PLENARY MEETING Tuesday, 14 May 2002, at 14:30 President: Mr B.R. MOOA (Kiribati) later: Dr J.F. LOPEZ BELTRÂN (El Salvador)

TROISIEME SEANCE PLENIERE Mardi 14 mai 2002, 14h30 Président: M. B.R. MOOA (Kiribati) puis: Dr J.F. LOPEZ BELTRÂN (El Salvador)

ADDRESS BY THE DIRECTOR-GENERAL (continued) ALLOCUTION DU DIRECTEUR GENERAL (suite)

The PRESIDENT: The Assembly is called to order. Before we start the review of item 3, I would cali delegates' attention to the Executive Board recommendation that statements should give special attention to the theme of risks to health. Delegates wishing to report on salient aspects of the ir health activities could make such report in writing for inclusion in the record, as provided in resolution WHA20.2. I would like to draw your attention also to resolution WHA50.18, recommending that delegates should limit their statements to five minutes. The list of speakers is published in the Journal. Delegates will speak from the rostrum. In order to save time, whenever one delegate is invited to come to the rostrum to make a statement, the next delegate on the list of speakers will also be called to the rostrum, where he or she will sit until the time to speak has come. In order to remind speakers of the desirability of keeping their address to not more than five minutes, a system of lighting has been installed; the green light will change to amber on the fourth minute and finally to red on the fifth minute. Should a delegate wish to submit - in order to save time - a prepared statement for inclusion in extenso in the verbatim records which is permissible to do under agenda item 3 only, or whenever a written text exists of a speech which a delegate intends to deliver, copies should be handed to the officer responsible for the list of speakers in order to facilitate the interpretation and transcription of the proceedings. This procedure would also apply to those delegates who have to leave Geneva and are not able to deliver their speech under this agenda item before they leave; they can ask for their text to be published in the records of the Assembly. The debate on item 3 is now open. The first two speakers on the list are Mexico and Mongolia; may I invite them to come to the rostrum. The delegate of Mexico has the floor.

ASSNR/3 page 37 El Dr. FRENK (México): En nombre de mi pais y del mio propio, agradezco al Presidente y a los Vicepresidentes de la 55 Asamblea Mundial de la Salud y a la Dra. Gro Harlem Brundtland, Directora General de la Organizacion Mundial de la Salud, la oportunidad de compartir con ustedes algunas retlexiones. Vivimos tiempos inéditos. La conciencia sobre la necesidad urgente de mejorar la salud en el mundo es hoy un elemento central del consenso entre las naciones. La nueva agenda para el desarrollo reconoce que la salud es un fin en si mismo, pero también un instrumenta para mejorar el aprendizaje escolar, incrementar la productividad laboral, fortalecer el crecimiento economico, combatir la pobreza, asegurar la proteccion de los derechos humanos y garantizar la seguridad global. Bajo el liderazgo de la Dra. Gro Harlem Brundtland, la Organizacion Mundial de la Salud ha jugado un papel renovador e innovador para colocar a la salud en el centro de la agenda del desarrollo. El proceso para poner al dia la vision, los objetivos y las estrategias sobre el desarrollo global arranco con la Cumbre del Milenio a la que la Organizacion de las Naciones Unidas convoco en septiembre del afio 2000. Ahi quedo subrayada la importancia vital de la salud. Esta vision se consolido en el periodo extraordinario de sesiones de la Asamblea General de las Naciones Unidas dedicada al VIH/SIDA, cele brada en junio de 2001. Ésta fue la primera vez en la historia que un periodo de sesiones de la Asamblea General se dedico a un tema de salud, lo que retleja la creciente conciencia del estrecho vinculo que existe entre la salud, el desarrollo economico y la seguridad global. La salud volvio a ocupar un lugar prominente en la reunion ministerial de la Organizacion Mundial del Comercio que se celebro en Doba. Esta reunion dio origen a una declaracion, suscrita por el Gobiemo de México, que busca conciliar la proteccion de los legitimas derechos de propiedad intelectual y los estimulos a la innovacion, con el imperativo ético y politico de garantizar el acceso de todos, incluyendo los mas pobres, a los medicamentos y otras tecnologias capaces de salvar vidas. Fue asi como llegamos a la exitosa Conferencia de las Naciones Unidas sobre la Financiacion del Desarrollo, celebrada en Monterrey, México, en marzo de 2002, con la asistencia de casi 60 jefes de Estado y de gobiemo. Una vez que los paises se habian comprometido a las metas del milenio para el desarrollo, era crucial analizar los mecanismos para financiar su logro. Nuevamente la salud ocupo un lugar central en los debates. En muchos casos, las soluciones a los mas graves problemas de salud publica ya existen, pero se carece del financiamiento para que todos se beneficien de elias. En otros casos, se requiere de la accion colectiva intemacional para investigar y desarrollar nuevas soluciones que constituyan bienes publicos globales. El consenso de Monterrey fue claro: movilizar los recursos necesarios para reducir las muertes prematuras y la discapacidad representa no solo un imperativo ético, sino también una de las inversiones mas redituables. Después de Monterrey, la siguiente oportunidad para avanzar en la agenda global del desarrollo sucedio hace apenas un os dias en Nu eva York, durante el periodo extraordinario de sesiones de la Asamblea General de las Naciones Unidas sobre la infancia. El proceso de construccion de un futuro mejor para la humanidad habra de continuar en la Cumbre Mundial sobre el Desarrollo Sostenible, que se celebrara en Johannesburgo el proximo mes de septiembre. Al otorgarle un lugar tan destacado, la nueva agenda intemacional reconoce a la salud no solo como un objetivo, sino también como un medio para el desarrollo. Éste es precisamente el mensaje central del Informe de la Comision sobre Macroeconomia y Salud, cuya pertinencia e impacto nos hablan del liderazgo de la Dra. Gro Harlem Brundtland. La Comision ha reunido evidencias sobre el papel crucial de la salud en el combate a la pobreza y en el crecimiento economico. En México, el gobiemo del Presidente Vicente Fox asi Jo ha entendido. Por ello, atendiendo a una de las recomendaciones del Informe, recientemente bernos formado la Comision Nacional de Macroeconomia y Salud, que nos permitira avanzar en el disefio de respuestas eficaces a los tres grandes retos de nuestro sistema de salud: equidad, calidad y proteccion financiera. La cooperacion internacional en materia de salud esta Hamada a ser crecientemente un ambito concreto donde las aspiraciones por un desarrollo incluyente, justo y sustentable puedan materializarse. Pero hay también un aspecto mas profundo: en nuestro turbulento mundo, donde abundan las excusas para subrayar las diferencias entre naciones, etnias o religiones, la salud 3

ASSNR/3 page 38

permanece como uno de los pocos valores realmente universales. La salud representa un punto de encuentro donde el interés propio de cada pais coïncide con el interés comun de todas las naciones. Por ello, desde esta importante tribuna hago un llamado a redoblar nuestros esfuerzos por invertir en salud y colocar al desarrollo humano en el centro de la agenda global. Muchas gracias. Professor NYMADA WA (Mongolia): Honourable President, honourable Director-General, distinguished delegates, ladies and gentlemen, 1 would like to offer my congratulations to the President on his election and wish him every success during his esteemed duty as President of this Health Assembly. 1 am confident that un der his able leadership the Assembly will reach the conclusions needed for the next step of tackling world health issues. On behalf of the people and Government of Mongolia, 1 also wish to extend my congratulations to the Director-General for the comprehensive report on the work of the World Health Organization during 2001 with highlights of actions taken to tackle major health problems and to implement the Millennium Development Goals. Our united goal is to prevent and protect humankind from devastating ill-health problems in an era of globalization, with increasing interdependencies between countries. Mongolia is having sorne real successes in reaching and maintaining this goal, yet we must do more. Since last year's Health Assembly, the Government of Mongolia has been active in locally fostering the recommendations of the Assembly. As a result, 1 am pleased to inform you that three major policy documents have been developed and adopted in Mongolia, a national public health policy, a national mental health programme, and a national programme on food security, safety and nutrition. The Government has started actions to implement these programmes by establishing a committee at the Prime Minister's Office level to coordinate ali public health programmes. This committee will function with its full terms of reference from 2003. Since the 1990s, poverty has increased to now include up to one-third of the total population of Mongolia. The co-dependency and mutually supporting relationship between poverty and tuberculosis is clearly visible in Mongolia. Notified tuberculosis cases have increased over the past five years reaching a level of 142 per 100 000 population in 2001. Study results conducted among acute tuberculosis patients between 1996-2000 found that 53% were unemployed, 74% spent less than 20 cents on food per day and 87% were malnourished. Tuberculosis cases among inmates of the detention institutions in Mongolia are 26 times higher than the average rate for the general population. The Government is responding to the situation. A national programme to reduce tuberculosis was initiated in 1994. Since then the cure rate for infectious tuberculosis patients has climbed to reach 85% from around 30% for the general population and has almost doubled for the prison population. The Government of Mon go lia is now aiming to reduce the incidence of and mortality from tuberculosis by half by 20 l 0, using successful directly observed treatment, short course (DOTS), early detection strategies, and the integration of tuberculosis treatment into primary health care settings. Taking this opportunity, 1 would like to express my sincere thanks to the Global Fund to Fight AIDS, Tuberculosis and Malaria for its support of the Government's goal and targets to stop tuberculosis in Mongolia. The United Nations Millennium Development Goals incorporate health goals to reduce maternai and infant mortality, decrease communicable diseases and improve essential drug supply. Although Mongolia still has a high maternai mortality of 161 per 10.0 000 live births, it is down from a recent historical high of 244 in 1993. We still have much more to do, as 9% of ali births are to adolescent mothers, 40% of ali pregnant mothers are anaemic, 33% are chronically ill and 26% of ali maternai deaths are due to a complicated pregnancy with chronic illness. The Government has revised a national programme on reproductive health and a strategy to reduce maternai mortality between 2000 and 2004. Acute respiratory infections and diarrhoeal disease are leading causes of morbidity and mortality among children under five. These two pathologies still remain responsible for two-thirds of child deaths and more than 60 per cent of morbidity. A national acute respiratory infections/control of diarrhoeal diseases programme was established in 1991. As a result of this programme and a more recently introduced integrated management of childhood illnesses strategy, the infant and under-five

ASSNR/3 page 39

mortality rates have decreased to 30.2 and 40.8 from 70 and 95 per 1000 live births respectively in 1991. The number of deaths due to acute respiratory infections is now a quarter of those experienced by Mongolia in 1991. Deaths due to diarrhoeal diseases are now one third ofthose in 1991. We will continue our efforts. Mongolia is working with noticeable success to reduce vaccine preventable communicable diseases and the Mongolian people are proud to be among the countries of the Western Pacifie Region declared free from poliomyelitis in 2000. However, during the last five years various infectious diseases, including measles, have been increasing, despite good vaccination coverage. A detailed study of a measles outbreak in 2000-2002 in Mongolia among adolescents and young adults has revealed that the one-dose measles vaccination experience between 1975 and 1995 has left a gap in immunity against measles virus. To make essential drugs available to the population on a continuous basis is a major duty of the Government of Mongolia. Past and recent systematic and chronic shortages of essential drugs in rural areas alerted the Government to the action that needed to be taken. Based on recommendations by WHO, the Government recently approved a state policy on essential drugs and revised the fourth national essential drug list in 2001. A new tendering process for the pure hase of drugs was introduced to assure the maximum quality supply for the available funds. We will continue to improve our purchasing and distribution efforts along with extra efforts to ensure that essential drugs are appropriately used. Despite the economie hardship affecting the population of Mongolia and the resulting low Government revenue, our Parliament has approved amendments to various health legislation including the Health Insurance Law, Drug Law and the Public Health Law. This new favourable legislative framework will facilitate the achievement of our health goals for Mongolia. In July of this year we are preparing to celebrate the 40th Anniversary of Mongolia's membership in the World Health Organization. The people and Government of Mongolia see this event as a significant occasion for the nation, taking into consideration WHO's invaluable contributions in supporting national efforts for the health and well-being of the people of Mongolia. On this occasion, 1 would like to convey the sincere gratitude of the people and Government of Mongolia to WHO for its tremendous efforts and successful work in Mongolia. Thank you very much for your attention. Dr TAG-EL-DIN (Egypt):

A55NR/3 page 40

ASSNR/3 page 41

Mr THOMPSON (United States of America): Mr President, Madam Director-General, and distinguished delegates, l am very honoured to represent the United States of America at this Assembly and to reaffirm, on behalf of President George W. Bush, my country's strong commitment to the World Health Organization. The ties we create at the World Health Assembly bind countries together- common bonds that safeguard public health, prevent and combat disease, improve the health and well-being of ali people and promote peace. Such ties mean even more to us today, as we join together to fight the evils of terrorism. The recent terrorist attacks on the United States have confirmed that the intentional release of smallpox is not a remote possibility. Twenty years ago, this global community, under the leadership of WHO, worked hard to eradicate this deadly, insidious disease. But today, we agree with the recommendations that further research is needed on the virus in arder to develop new drugs, vaccines and diagnostic tools. The United States stands ready to provide assistance to other countries to help them deal with any outbreak of smallpox, wh ether resulting from a natural re-emergence of the disease or from its intentional use as a bioweapon. While this assistance could include vaccines and other needed medical supplies, the world cannat depend solely on the United States of America for the global supply of vaccine. We will work bilaterally and through WHO to help other nations and regional groups develop the ability to produce international stockpiles of smallpox vaccine. We continue to explore ways to use our resources and our expertise to improve the lives of ali citizens. The Global Fund to Fight AlOS, Tuberculosis and Malaria, the Global Alliance for Vaccines and Immunization, and last week's United Nations special session on children ali exemplifY our collective efforts to find new ways to work together as partners. Yet we continue to face seriaus public health challenges. Ours, delegates, is a daunting task, energized by an awareness of our shared humanity. Ali nations have a stake as partners in this common battle. And please have no doubt that President Bush and 1 are absolutely committed to working with you as, together, we wage war against the historie enemies of humankind- disease, epidemie and illness. We must work creatively to find sustainable solutions through strong international and public/private partnerships. One such partnership we are undertaking in my own country involves improving preventive health care. lt is time, ladies and gentlemen, to change the funding priorities in our health care system to invest in prevention earlier in life, allowing people to lead healthier lives which will, of course, free up resources to meet other health needs. And we are working with public and private partners to communicate to the American people the importance of disease prevention. We are encouraging moderate but consistent exercise, wiser choice of foods and no smoking as key ways to improve the quality of life and longevity no matter what country you live in. Just a few days ago, 1 was joined at my department by sorne leading athletes to talk about the importance of staying in shape. Just 30 minutes of walking a day, five days a week, can significantly improve your health. Showcasing sorne sports heroes sends a strong message to young people that exercise is so very important. And 1 have had news conferences with the victims of diabetes and other ailments to underscore the need for better dietary and lifestyle choices. As 1 have launched our preventive health campaign, 1 have come to the conclusion that for prevention campaigns to work, we must promote individual decision-making and ownership of healthy choices. In the same way, over the past year, 1 have been gratified as many ofyou have reached out to me in friendship to help me better understand the concerns important to you and to ail of us. Getting to know a number ofyou personally, my colleagues, and gaining an understanding ofyour work and the challenges you face, has reinforced my commitment to working with you to find shared solutions. Permit me to mention a few ways in which the Bush administration is working to do just that. Recognizing the link between economie development assistance and sound policies in development countries, the President has initiated a new millennium challenge account to help developing nations improve their economies and strengthen good governance. A key component of the initial pledge of US$ 5 billion over the next three years is to provide investments for the health and the education of the people of developing countries, including healthcare and immunizations. In addition, the United States has pledged US$ 500 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria. These funds will support a range of health programmes, prevent mother-to-child transmission of HIV, and provide care to infected individuals and the ir families in many of the most affected nations. They will

ASSNR/3 page 42

also help build the needed capacity at the local and national levels to implement prevention, counselling and treatment services. I led a White House mission to Africa last month to visit with ministers ofhealth and community-based providers of care to explore strategies to combat HIV/AIDS, tuberculosis and malaria. We discussed ways to work together better to prevent one of my passions, mother-to-child transmission, address the growing numbers of AIDS orphans, and expand programmes and services to support those most at risk. 1 recently joined the Caribbean island nations to sign a Pan-Caribbean partnership agreement to bolster our collaboration on the prevention and the treatment of HIV and AIDS. Our Global AIDS Programme in the Caribbean provides experts within the countries affected in order to improve care and treatment and, yes, build capacity to address the global pandemie. 1 would also like to recognize the 1OOth anniversary of the Pan American Health Organization. Ali our neighbours in the Region of the Americas and people around the world appreciate the Pan American Health Organization and its continuing work to help us establish our health priorities. Let me also thank Sir George Allyene for his leadership of PAHO, which has produced a higher quality of !ife for millions. But we will not forget the many other critical public health needs. Through the agencies in my Department that are leading the world in their fields, the Centers for Disease Control and Prevention, the National Institutes of Health and the Food and Drug Administration, ali in the Department of Health and Human Services, we will continue to foc us on the full range of public health issues from cancer research to prenatal care that affect our citizens as weil as men, women and children throughout the world. I compliment everyone here at WHO on their hard work and their leadership. This has been a banner year for the Organization. 1 thank the Director-General for her vision for the future. She has placed health squarely in the global policy dialogue in a way that few could have foreseen just a few years ago. I look forward to working with her and with my colleagues and delegates at this Assembly to achieve those goals that you have set for us. The United States is absolutely committed to remaining active in the many spheres of international health whose implications for current and future demands affect everyone in sorne way. We are, ladies and gentlemen, your partners. Our resources, our expertise and our knowledge must be drawn together in a co mm on purpose if we are to better achieve our ongoing goal of a healthier world for ali. Thank you so very much. Dr Lopez Beltran (El Salvador), President, resumed the presidential chair. Le Dr Lopez Beltran (El Salvador), Président de l'Assemblée, reprend la présidence.

Professor SHEVCHENKO (Russian Federation): I1po4J. IllEBqEHKO (PoccwifcKa51 <l>e.D,epaQH51): YsmKaeMhlll r-H Ilpe.D,Ce.D,aTeJib, ysmKaeMa51 r-)l<a reHepaJibHblll .D,HpeKTOp, .D,aMbl H rocno.D,a. l103BOJ1bTe OT HMeHH PoccHÜCKOll .D,eJieraQHH no6Jiaro.D,apHTb reHepaJibHOro .D,HpeKTopa 3a npe.D,CTaBJieHHblll )J,OKJia.D,. Mbi penmTeJihHO no.D,.D,ep:tKHBaeM ycHJIH51 e.D,HHOÜ B03 no pa3BHTHIO mo6aJihHOÜ CTpaTerHH .D,OKa3aTeJihHOll npo4JHJiaKTHKH H nporpaMM yKpenJieHH51 3.D,Op0Bb51 HaCeJieHH51 TIJiaHeTbl. ll6o :no Hama 06llla51 H OCHOBHa51 MHCCH51 nepe.D, BCeM qeJioseqeCTBOM! B peaJIH3aQHH 3Toif noJIHTHKH nepsocTeneHHoe 3HaqeHwe HMeiOT .D,Ba acneKTa. Ilepsoe. ,ZJ,o611ThC51 6aJiaHca Me:tK.D.Y npo4JwJiaKTHKoif B KJ111HI1qecKoif Me.D,HQHHe H ycHJI1151MH no yKpenJieHHIO 3.D,OpOBh51 Ha nonyJI51QHOHHOM, KOMMYHaJihHOM yposHe. BTopoe. HaJia.D,HTh 34J4JeKTHBHOe Me:tKceKTOpaJibHOe COTPY.D.HHqecTBO .D,J151 scecTopoHHero perneHH51 npo6JieM npo4J11JiaKTI1KI1. Pa3yMeeTC51, npw coxpaHeHHH JIH.D.HPYIOIIIeif poJII1 e.D,I1HOÜ B03 Ha mo6aJihHOM H perwoHaJihHOM ypOBH51X H aKTHBHOM HCTIOJ1b30BaHHH ee lliHpOKHX 3KCnepTHbiX B03MO:tKHOCTeif. ,lJ,JI51 scex Hac CTaJio y:tKe oqesH.D,HhiM, qTo 3.D,pasooxpaHeHI1e - 3TO cwcTeMa :tKH3Heo6ecneqeHI151 qeJIOBeKa, qTo OT ero npaBHJlbHOrO 4JyHKQHOHHpOBaHH51 3aBI1CI1T 6JiaronoJiyqwe Ka)K)J,Oll CTpaHbl 11, B KOHeqHOM cqeTe, 6e30TiaCHOCTb 11 CaMO Cyll!eCTBOBaHHe qeJIOBeYeCTBa. Cero.D,H51 3.D,oposbe y:tKe CTaJIO BmKHeifrnHM 4JaKTopoM ycToifql1soro coQHaJihHoro pa3BHTH51. 3.D,Op0Bbe .D,OJI:tKHO npHo6peCTH HpaBCTBeHHYIO QeHHOCTb H Mepy KaqeCTBa BeKTOpa rocy.D,apCTBeHHOll TIOJIHTHKH.

ASSNR/3 page 43 Hawa o6ma51 3a.uaqa - sceMH .uocrynHhiMH cpe.D,CTBaMH <!JopMHposaTh HLJ.eaJI 3LJ.OpOBh51 B ero no.UJIHHHOM co.uep)t<aHHH KaK BIDKHelîwelî cocTaBJI51IOlll,eH Ka'leCTBa :>KH3HH H o6mecTBeHHoro npeCTH:>Ka Ha~HH, C03)l.aBaTh ycJIOBH51 .D,JIH pa3BHTH51 TeXHOJIOfHH KYJihTypbl 3LJ.Op0Bb51 H 3LJ.OpOBOfO o6pa3a :IKH3HH. I1pH 3TOM JIH'lHOe yqaCTHe rpa:>K.D,aH - 3TO CaMa51 He06XO)l.HMa51 npeLJ.llOCbiJIKa ycneWHOH pa3pa60TKH H peaJIH3a~HH CTpaTefHH, OCHOBaHHOH Ha npHOpHTeTe npo<lJHJiaKTHKH 3a6oJieBaHHH H yKpenJieHHH 3LJ.OpOBbH. ÜTBeTCTBeHHOCTb Ka:>K.[l,OfO 'lJieHa 06lll,CCTBa 3a CBOe 3LJ.Op0Bhe H 3LJ.Op0Bbe CBOHX )l.eTeH )l.OJI:>KHa 6biTb OCHOBaHa Ha npH3HaHHH BbiCWeH ~eHHOCTH caMooxpaHHTeJibHoro nose.ueHH51 u 3LJ.Oposoro o6pa1a :>KH3HH. Ho 'lT06hi .uoHeCTH 3TO noHHMaHue .uo 06lll,eCTBa, Tpe6yJOTC51 HaWH HeycTaHHbie YCHJIHH. 3TO HCKJIIO'lHTeJibHO BIDKHO, H60 OT csoespeMeHHoro u npaBHJihHOro peweHHH 3TOH CTPaTeruqecKOH npo6JieMhi 3aBHCHT 6y.uymHH yposeHb <!Ju3H'lecKoro H HpaBCTBeHHoro 3.UOpOBhH HaceJieHHH scelî Hawelî nJiaHeThi! Mhl C'lHTaeM ~eJiecoo6pa3HhiM peKoMeH.uosaTh OpraHH3a~uu aKTHBH3HposaTb pa3pa6oTKY nporpaMM .D,HafHOCTHKH <!JaKTOpOB pHCKa H )l.0Ka3aTeJibHOH npo<!JuJiaKTHKH Ha Ha~HOHaJihHOM ypoBHe H HX llOCJie.UyiOlll,ee BHe.upeHHe. I1o HaWeMY y6e)K.[l,eHHIO, MeTO.D,OJIOrH'leCKOH OCHOBOH TaKOH pa60Tbl npH3BaHa CTaTh HHH~HHpoBaHHa51 reHepaJibHbiM .uupeKTOpOM" aKTHBHO pa3BHBaeMaH EsponeHCKHM 610po Hawelî OpraHH3a~HH IlporpaMMa 6uoMe.UH~HHCKOH 3THKH B 3.UpasooxpaHeHHH. KoHe'lHaH ~eJib 3THX yCHJIHH - <!JopMyJIHpOBaHHe ~eJIOCTHOH H Hay'IHO o60CHOBaHHOH CTpaTerHH npo<lJHJiaKTHKH 3a6oJieBaHHH H yKpenJieHHH 3LJ.OpOBbH HaCeJieHHH nJiaHeTbl. IJpo~eCCbl rJI06aJIH3a~HH 3KOHOMHKH, TOprOBJIH, HH<lJOpMa~HH OKa3biBaiOT Ka:>K.[l,O)l.HeBHOe H cylll,eCTBeHHOe BJIHHHHe Ha )l.eTepMHHaHTbl 3LJ.OpOBhH H <!JaKTOpbl pHCKa - o6pa3 :IKH3HH, CO~HaJihHYIO H <lJH3H'leCKYIO OKpy:>KaJOmYIO cpe.uy. Cero.UHH HHKaKue rocy.uapcTBeHHhie rpaHH~hi He 3alll,Hlll,aJOT OT 3nu.ueMHH KypeHH51, HapKoMaHHH, He3.uoposoro nuTaHHH. Bee 3TO 3acTaBJIHeT Hamy e.uuey10 B03 H scex Hac COBMeCTHO HCKaTb peweHHH npo6JieM npo<lJHJiaKTHKH, .D,yMaTb H .D,eHCTBOBaTh rJI06aJihHO H C006lll,a. 06 3TOM B CBOeH MHCCHH Mbl 06513aHbl llOMHHTb BCer.D,a. 11 no3BOJihTe eme o.uHo 3aMe'laHue, ysiDKaeMhiH r-H Ilpe.uce.uaTeJib! Mbi noJIO:IKHTeJibHO o~eHusaeM .ueHTeJihHOCTh B03 u ycHJIHH CeKpeTapuaTa, HanpasJieHHhie Ha yKpenJieHue npecTH:>Ka u JIH.UHPYIOmYIO poJih OpraHma~uu B perneHHH mo6aJibHhiX npo6JieM npo<!JuJiaKTHKH 3a6oJieBaHHH H yKpenJieHHH 3.UOpOBhH HaceJieHHH Harnelî nJiaHeTbi. XoTeJI 6hi no.uqepKHYTh masHoe - 3TO cnoco6HoCTh OpraHH3a~uu H3MeHHThCH B MeHHIOlll,eMC51 MHpe. 51 y6e:~K.D,eH, 'ITO BCe 3TH H3MeHeHHH He HBJIHIOTCH CaMO~eJihfO - pe<!JopMaMH pa.D,H pe<!JopM, a yqHTbiBaJOT MHeHHe WHpOKOH 06lll,eCTBeHHOCTH H rocy.uapCTB-qJieHOB. 5I xoqy ucKpeHHe H c rop.uocTbJO H 6oJihiiiHM y.uosJieTsopeHHeM omacHTh peweHue He.UaBHO nporne.urnelî KoJIJieruu MHHHCTepcTBa 3.UpaBooxpaHeHHH PoccHHCKOH <l>e.uepa~uu npu no.u.uep:>KKe JIH.UepaMH 3.D,paBooxpaHeHHH CTPaH Co.upy:>KeCTBa He3aBHCHMhiX rocy.uapcTB: "3a Bhi.D,aJOlll,HHCH BKJia)l. B yKpenJieHHe 3LJ.OpOBbH qeJIOBeqecTBa, pa3BHTHe ryMaHHCTHqeCKHX OCHOB Me)l.H~HHCKOH npo<!JeccHH, no.u.uep:>KKY poccHHCKoro 3.D,paBooxpaHeHHH " Me.UH~HHCKOH HayKH "3oJIOTM Me.UaJih PoccHHCKOH <l>e.uepa~"" 3a 3acJiyru nepe.u oTeqecTBeHHhiM 3.D,paBooxpaHeHHeM" npHcBaHBaeTCH .u-py rPY XAPJIEM EPYH,ll;TJIAH,[(, reHepaJibHOMY LJ.HpeKTOPY BceMHpHOH opraHH3a~HH 3.UpaBooxpaHeHHH". IJ03BOJihTe MHe BbinOJIHHTb 3'fY noqeTeyJO MHCCHIO H BpyqHTb Harpa.uy HaiiieMy .UOCTonoqTeHHOMY reHepaJibHOMY LJ.HpeKTopy B03 .u-py rpy XapJieM EpyHLJ.TJiaH)l.. Mr KONDO (Japan): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, on behalf of the Govemment of Japan, I would like to express our gratitude for the opportunity to present our position and ideas conceming the issues related to the present Health Assembly. Since her inauguration, the Director-General has brought about a wide range of changes to WHO and we highly commend the positive changes. In particular, we appreciate WHO's contribution to the establishment of the Global Fund to Fight AlOS, Tuberculosis and Malaria and the completion of the report of the Commission on Macroeconomies and Health. The report clearly revealed that improved health is the basis for economie development. We also appreciate WHO's proactive guidance in health policy formulation. In order for health policies to get support from general citizens and policymakers, it is critically important to formulate them on the basis of an objective and

A55NR/3 page 44 quantitative assessment of the causes of diseases and injuries. We expect WHO to move further in this direction. 1 agree, as the report of the Commission on Macroeconomies and Health clearly pointed out, that investment in health is beneficiai to the whole of society. lt is our responsibility to continue our efforts to gain the support of citizens for such an investment. However, we have to face up to the reality that our resources for health are Iimited. Many countries, including our own, are suffering from economie recession. The Government of Japan is seriously tackling ali aspects of structural reform. We ask WHO not only to cali for an investment in health, but also to show that it is making efforts to reform its own Organization. We can never forget the horrible tragedy that happened on September Il last year. Since then, we believe that everybody is seeking to find out how they can contribute to ensuring that such a tragedy will never happen again. The most important contribution that we, the international health community, can offer is to continue our efforts to improve the health of the world in solidarity. The establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, achieved the progressive goal of formulating a public-private partnership, and we consistently supported that effort. During the present Health Assembly, we must show the world that the Member States of WHO can unite together to make concerted efforts in many health aspects, including against bioterrorism. Japan, along with other Member States, is determined to support such efforts, and believes that it is our noble mission to actively participate in them. Thank you very much. M. OLANGUENA A WONO (Cameroun) : Monsieur le Président de la Cinquante-Cinquième Assemblée mondiale de la Santé, Madame le Directeur général, distingués délégués, Mesdames, Messieurs, c'est avec un réel plaisir que je prends la parole devant notre auguste Assemblée pour partager avec vous ces quelques réflexions sur les risques pour la santé et vous faire part de la vision du Cameroun sur la promotion de la santé. Vous me permettrez tout d'abord de féliciter le Président de la Cinquante-Cinquième Assemblée mondiale de la Santé et son bureau pour leur brillante élection. Monsieur le Président, soyez assuré du total soutien de la délégation du Cameroun pour l'accomplissement de votre délicate mission. A vous, Madame le Directeur général de l'OMS, je me dois de présenter les vives félicitations de S. E. Paul Biya, Président de la République du Cameroun, chef de l'Etat, et de son Gouvernement pour l'énorme travail que vous avez accompli depuis votre élection à la tête de notre Organisation. Les différents problèmes qu'aborde votre excellent rapport 2001 et les stratégies proposées témoignent du suivi constant et compétent de la situation de la santé dans le monde par l'OMS. Honorables délégués, comme nous l'avons fait ce matin lors des tables rondes ministérielles, nous aurons à débattre en profondeur, dans le cadre des travaux en commission, de grands problèmes de santé dans le monde, notamment comment s'attaquer aux causes de la mauvaise santé au sein des populations pauvres, comment déceler et évaluer les risques pour la santé et aider les sociétés à prendre des mesures pour les réduire, comment améliorer la performance des systèmes de santé, et, enfin, comment encourager l'adoption de politiques nationales destinées à promouvoir la santé. En réalité, les défis auxquels nous devons faire face en matière de santé sont nombreux et complexes, en particulier dans les pays en développement où les systèmes de santé ont besoin d'être renforcés et remis en état pour mieux lutter contre la maladie et contribuer à la réduction de la pauvreté et au bien-être des populations. Mesdames et Messieurs, le monde a fait un pas historique en reconnaissant que l'investissement dans la santé est un facteur déterminant pour la correction de la pauvreté et pour le développement. Le Cameroun soutient pleinement cette vision, qui sous-tend la réforme du secteur de la santé prescrite par le Président de la République et adoptée par consensus en octobre 2001 à travers une stratégie sectorielle 2001-2010 actuellement mise en oeuvre par le Gouvernement. Comme vous le savez, la plupart de nos pays connaissent depuis quelques années une période de transition épidémiologique, avec un tableau de morbi-mortalité où prédominent les maladies infectieuses et parasitaires, la grave crise du VIH/SIDA, la réémergence de maladies jusque-là considérées comme maîtrisées, par exemple le paludisme et la trypanosomiase humaine africaine, l'apparition de nouvelles pathologies telles que les affections cardia-vasculaires, le diabète et d'autres liées à la consommation de drogues et à la dégradation de l'environnement. L'exacte identification des

ASSNR/3 page 45 facteurs de risque, leur analyse et leur gestion pour en réduire l'impact nécessitent des approches novatrices de promotion de la santé. Au-delà des approches bien connues de définition des programmes, d'organisation, de renforcement des capacités et de mobilisation des ressources, ce qui est vraiment essentiel et nouveau, c'est la mobilisation de l'engagement individuel et collectif autour des grands problèmes de santé publique, c'est aussi l'engagement pour obtenir des résultats tangibles et mesurables en termes de progrès réels. Il s'agit donc de gérer les risques de manière pragmatique et opérationnelle sur la base des principes de responsabilité et de participation en mobilisant les individus, les communautés, les entreprises, les fondations, les confessions religieuses, les médias, les organisations non gouvernementales et les associations sur les risques pour la santé. Dans cette perspective, la promotion de la santé cesse d'être l'affaire de l'Etat ou du seul ministère de la santé; elle devient l'affaire de tous. Dans mon pays, le Président de la République et son Gouvernement attachent une importance toute spéciale à cette approche ; c'est pourquoi la décentralisation et la multisectorialité de la lutte contre le VIHISIDA sont plus que jamais opérationnelles grâce à la signature de contrats d'objectifs avec les entreprises, les confessions religieuses et la société civile engagée. Ces contrats sont largement financés sur les ressources publiques et amènent ainsi le service public de la santé au coeur de la sphère privée. Les autorités camerounaises sont convaincues de l'efficacité de cette approche, qu'elles entendent développer pour optimiser les politiques et la performance du système de santé. Pareillement, elles sont déterminées à privilégier les approches régionales et sous-régionales dans la gestion en commun des problèmes de santé compte tenu de la mobilité des populations; c'est le cas en matière de surveillance des maladies à potentiel épidémique, de lutte contre le VIHISIDA chez les populations migrantes et riveraines des pays du bassin du lac Tchad, de lutte contre la trypanosomiase humaine africaine en Afrique centrale, d'éradication du ver de Guinée et d'organisation de journées nationales de vaccination synchronisées. Cette approche de gestion des risques nécessite une mobilisation et un appui conséquent de la communauté internationale en termes d'expertise technique et de ressources financières, sans oublier l'indispensable remise à niveau de nos systèmes de santé. C'est le lieu de remercier l'OMS pour les actions qu'elle mène déjà dans ce sens et d'encourager Mme le Directeur général à renforcer les interventions de l'Organisation pour nous appuyer davantage et relever les défis qui nous interpellent tous. Le Cameroun, dans le cadre de sa politique de justice sociale, considère la pauvreté comme le premier facteur de risque pour la santé. C'est pourquoi la stratégie nationale de lutte contre la pauvreté met un accent prioritaire sur les mesures pertinentes visant à améliorer l'état de santé des populations. A cet effet, la volonté politique est d'autant plus claire qu'elle s'affirme chaque jour, y compris en matière d'allocation prioritaire de ressources résultant de l'allègement de la dette des pays pauvres très endettés. (L'orateur poursuit en anglais.) (The speaker continued in English.) In conclusion, considering the numerous health risks that we have to deal with, 1 would like to mention that in addition to the standard vision, Cameroon has opted to lay emphasis on the innovative approach of getting everyone at the leve! of the community, the civil society, the media and the private sector involved and really empowered in contributing in a tangible manner to health promotion. In this way, health issues will cease to be considered as the sole responsibility of the state or of health professionals, and become everybody's business. Working through such a large partnership, prevention becomes for us the key. 1 thank you very much for your kind attention.

ASSNR/3 page 46

Ms MCLELLAN (Canada): Mr President, Madam Director-General, distinguished delegates, thank you for the opportunity to address the Health Assembly and to offer the Government of Canada's views on sorne key international health issues. Globally, we have made substantial progress in many regions of the world in the last decade. These advances cannot, however, mask the tragedy of AIDS in Africa, the Caribbean and beyond and health inequalities in many countries. As Canada's Minister of Health, 1 would like to commend the Director-General for her vision, creativity in resource mobilization, and steadfast leadership in pursuit of key WHO reforms and initiatives that already have done so much to begin to meet the se challenges. Canada will remain an active supporter of WHO under her leadership. We also commend Professor Sachs and his fellow commissioners for their extensive work on the Commission on Macroeconomies and Health. Canada agrees that new international partnerships called for in the report would do more than simply improve the health of people around the world, although that would be benefit enough. The report strengthens the evidence that improved health across a population contributes to the achievement of broader social and economie goals. Canada's Prime Minister, the Right Honourable Jean Chrétien, recognizes this important link. During his recent visit to Africa, he stated the importance of ensuring that the benefits of globalization are truly global. As host of the G8 Summit next month in Alberta, the Prime Minister has stated that Canada will mobilize energies to help realize this goal, particularly in Africa. Last year in Genoa, G8 leaders asked Canada to lead the development of a concrete Africa action plan for adoption at this year's Summit in Kananaskis, Canada. This plan should help strengthen the vision put forward by African leaders in the New Partnership for African Development, or NEPAD. This also supports the Millennium Development Goals and Declaration. The Government of Canada has already committed US$ 500 million to a special fund for Africa, and has increased its development assistance for basic needs in Africa, including health and education. Canada and other like-minded countries have been working together to improve health security amongst our countries and globally. We have endorsed the WHO resolution on the Global public health response to the deliberate use of biological and chemical agents, and radio-nuclear attacks to cause harm. Canada strongly encourages members to support this resolution as part of enhancing the global community's collective preparedness and response to such incidents. Let me now refer to Canada's views on priorities for the work of WHO. First, risks to health. The costs to society and to individuals of physical inactivity, and unhealthy eating and smoking to society and individuals are a major problem in many societies including Canada. Diabetes and heart disease are only two of the manifestations of these failures. We know that these conditions often exist in poverty. Canada encourages and supports the work of WHO in this area. Disease surveillance remains a key concern and one which has been heightened by the global health security issue. The strengthening of WHO's standard setting and scientific work remains of paramount interest to Canada, and I would be remiss if I did not signal our firm commitment to a strong framework convention on tobacco control. WHO is also to be commended for its initiatives to better control, tuberculosis, malaria and HIV/AIDS. We urge more intensive work on maternai and child health, including the right of men and women to have access to family planning. International cooperation through WHO is producing results of value to people around the world, results that Canada is proud to support. Thank you. El PRESIDENTE: Muchas gracias a la representante del Canada. Tiene la palabra el delegado de Espafia, que hablara en representacion de la Union Europea. La Sra. VILLALOBOS TALERO (Espafia): Sefior Presidente, Directora General, miembros de la Asamblea, buenas tardes. Tanto la Organizacion Mundial de la Salud como la Union Europea comparten objetivos y esfuerzos de Jucha contra la pobreza y ambas estan comprometidas en crear un entorno propicio al desarrollo humano. La Union Europea esta totalmente comprometida con los objetivos establecidos en la Declaracion del

ASSNR/3 page 47

Milenio de las Naciones Unidas. Nos gustaria subrayar el importante papel de la OMS para alcanzar estos objetivos (incluyendo los referidos a mortalidad materna e infantil, salud reproductiva, VIH/SIDA, malaria y tuberculosis). Quisiera recordar las recientes palabras escuchadas en Barcelona al Primer Ministro de Mozambique, Dr. Pascoal Mocumbi, en un acto organizado por la UE para presentar el Programa Europeo sobre ensayos clinicos para potenciar la investigacion de las enfermedades relacionadas con la pobreza: «A mayor pobreza, peor salud, a peor salud, mas pobreza». La Union Europea agradece a la OMS el Informe de la Comision sobre Macroeconomia y Salud de diciembre de 2001. La Union Europea ha asumido este tema en una reciente Comunicacion sobre salud y reduccion de la pobreza en paises en desarrollo, y se ha comprometido a incrementar la ayuda oficial al desarrollo y apoyar el desarrollo social en los pafses menos avanzados, con especial énfasis en mejorar los resultados en salud y educacion. El SIDA, conjuntamente con la malaria y la tuberculosis, es el paradigma de la relacion entre pobreza y salud: 40 millones de personas viven con SIDA en el afio 2001, produciéndose 16 000 nuevas infecciones diarias. La esperanza de vida de algunos pafses del Africa subsahariana disminuye a los niveles de los afios cincuenta. El numero de huérfanos que el SIDA produce exige un esfuerzo urgente comparable al que se realiza en una crisis de ayuda economica. Otras regiones presentan también un crecimiento del SIDA exponencial. Desde los esfuerzos que la Organizacion Mundial de la Salud y el Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA), consecuentes con la Declaracion del Milenio sobre la erradicacion de la pobreza y el objetivo de que, para el afio 2015, se baya conseguido detener y reducir su propagacion, se plantea la necesidad de cooperacion de los paises ricos con los pobres para cooperar y poder responder globalmente a este problema. La Union Europea apoya a la OMS en estos esfuerzos. El periodo extraordinario de sesiones de la Asamblea General de las Naciones Unidas sobre el VIH/SIDA supuso la constatacion de un compromiso mutuo, tanto de los paises desarrollados como de los pafses en vias de desarrollo. La Comision y los Estados miembros de la Union Europea estan hacienda frente a este compromiso para optimizar al impacta de las intervenciones, servicios y bienes existentes para combatir las principales enfermedades transmisibles que afectan a los sectores mas pobres de la poblacion, mejorando el acceso a los f<irmacos esenciales, aumentando la investigacion y desarrollando tratamientos innovadores. Permitame, sefior Presidente, algunos ejemplos: • A nivel colectivo, la Comision adopto en septiembre de 2000 un programa de accwn acelerada contra el VIH/SIDA, la malaria y la tuberculosis en el contexto de la reduccion de la pobreza. En el Fondo Mundial de Lucha contra el SIDA, la Tuberculosis y el Paludismo, la casi totalidad de los paises de la Union Europea han comprometido una importante suma de recursos y participan activamente en la Junta de dicho fondo, iniciando ya la financiacion de proyectos en todo el mundo. • Hay que resaltar la participacion activa de las representaciones de las delegaciones de la Union Europea en las cumbres internacionales de comercio, como la de Doha, en la busqueda de soluciones de consenso para clarificar la relacion entre los Aspectas de los Derechos de Propiedad Intelectual relacionados con el Comercio (ADPIC) y las politicas de salud publica para promover el acceso de los ciudadanos de paises en desarrollo a medicamentos esenciales para el tratamiento del SIDA y las infecciones oportunistas, la tuberculosis y el paludismo. • Existen también numerosas iniciativas nacionales de los Estados miembros de la Union Europea en esta area, por ejemplo, Espafia, junto con otros Estados miembros, acaba de formalizar el acuerdo de compromiso para la Red de Solidaridad Terapéutica Hospitalaria contra el SIDA como una medida que pretende facilitar el cuidado integral de pacientes que son atendidos en paises en vias de desarrollo. Sefior Presidente, como reza el lema de la XIV Conferencia Internacional sobre el SIDA, que tendra lugar el proxima mes de julio en Barcelona: «Tenemos el conocimiento y el compromiso. No debemos, ni para el SIDA ni para la Jucha contra la enfermedad, demorar la accion».

ASSNR/3 page 48

El aumento de la esperanza de vida en muchas regiones del mundo es uno de los principales logros de la humanidad. La transformacion demognifica supone un reto para nuestras sociedades para promover mayores oportunidades, en particular para las personas mayores, de darse cuenta de su potencial para participar completamente en todos los aspectos de la vida. No obstante, somos conscientes de que un desarrollo equilibrado y sostenible, condicion indispensable de toda sociedad que aspira a vivir en paz y en libertad, necesita adaptar sus estructuras a las nuevas necesidades. En este contexto, los problemas de salud de las personas mayores ya estan demandando los cambios en los sistemas sanitarios que perrnitan responder a una demanda que merece todos nuestros esfuerzos. La reunion del Consejo Europeo celebrada en Barcelona el pasado mes de marzo ha supuesto, en este sentido, un progreso en la definicion de estrategias y en la toma de decisiones. El Consejo Europeo en Barcelona solicito a la Comision Europea y al Consejo que investigaran en detalle el acceso, calidad y sostenibilidad financiera en relacion a la salud y la atencion a los ancianos antes de la primavera de 2003. La salud y la atencion a las personas mayores tendran un pape! importante en el campo de la politica socioeconomica en el proximo futuro. El Reino de Espafia, a través de su actual presidencia Europea, desea pasar del viejo paradigma de aumentar la esperanza de vida a un nuevo paradigma donde lo mas importante sea dar esperanza a los que llegan a la vejez. A través del lema que hemos acufiado: VIDA CON ESPERANZA, confiamos en que los servicios sanitarios sean capaces de asumir los retos del siglo XXI, manifestando la creencia que tanto la OMS como la Union Europea pueden suscribir este nuevo reto. Desde la resolucion adoptada por la Asamblea Mundial de la Salud (WHA28.72) en 1975, en la que se instaba a los Estados Miembros a promover la creacion de servicios nacionales de transfusion basados en las donaciones de sangre voluntaria y no remunerada, y a promulgar una adecuada legislacion que regulase el- funcionamiento de los servicios de transfusion, asi como a tomar otras medidas destinadas a proteger y promocionar la salud de los donantes y receptores de sangre y productos sanguineos, han sido numerosas las iniciativas y programas dirigidos a conseguir tales objetivos. Sefior Presidente, compartimos la preocupacion de la OMS en lo concemiente a la seguridad de la sangre y a la prioridad que ha otorgado al establecimiento de sistemas que garanticen un abastecimiento de sangre y productos sanguineos adecuado y seguro para toda la poblacion mundial. La Union Europea se une alllamamiento realizado por la OMS en este campo. En esta linea la Union esta actualmente discutiendo la propuesta de una Directiva por la que se establecen las norrnas de calidad y seguridad de la sangre humana y sus componentes. Con respecto a la sangre o los componentes sanguineos, como material de partida para la manufactura de productos medicinales, la Directiva 200 1183/EC se refiere a las medidas a tomar por los Estados miembros para prevenir la transmisi6n de enferrnedades infecciosas, comprendiendo la aplicaci6n de las monografias de la Farmacopea Europea y las recomendaciones del Consejo de Europa y la OMS en particular en lo referente a la seleccion y comprobacion de los donantes de sangre y plasma. Ademas, los Estados Mieinbros deberian tomar medidas para promover la autosuficiencia a nive! comunitario en sangre humana y componentes sanguineos y estimular la donacion voluntaria y no remunerada. Desde la gestacion del concepto de medicamentos esenciales en la década de los setenta, éste se ha convertido en la piedra angular en el disefio y puesta en marcha de politicas farrnacéuticas en numerosos paises con el fin ultimo de hacer accesibles los medicamentos a toda la poblacion. A pesar de los buenos resultados obtenidos en el establecimiento de politicas farrnacéuticas nacionales ligadas a la politica sanitaria, todavia un tercio de la poblacion mundial, alrededor de 2000 millones de personas, sigue careciendo de acceso regular a medicamentos basicos. Por otro lado, como consecuencia de la globalizacion de la economia, se plantean muchos interrogantes sobre las posibles implicaciones que ésta podria tener en el acceso a los medicamentos. La Union Europea esta de acuerdo con la OMS en que existen cuatro elementos para mejorar el acceso a los medicamentos: financiacion sostenible, disponibilidad, seleccion y uso racional y reforzamiento de los sistemas de salud. La Union Europea y sus Estados miembros estan comprometidos en politicas y medidas en todas estas areas.

ASSNR/3 page 49

Creemos que la OMS debe jugar un pape! importante asesorando a los Estados Miembros que Jo demanden sobre las posibles opciones que los nuevos acuerdos comerciales ofrecen para la defensa de la salud publica, como se establece en la Declaraci6n de Doha. Se consideran de gran interés los contactos emprendidos por la OMS con los organismos intemacionales encargados de la regulaci6n del comercio intemacional, de modo que puedan incorporar elementos de sensibilidad sanitaria en el terreno de las negociaciones comerciales. La Union Europea valora de forma positiva los esfuerzos realizados por la OMS en la promoci6n de sistemas de precios diferenciados con arreglo a los niveles de renta de la poblaci6n, estrategia que ha sido tenida en cuenta por la Union Europea a la hora de disefiar un plan de Jucha contra las principales enfermedades transmisibles en los paises emergentes - VIHISIDA, paludismo y tuberculosis - que introduce propuestas en este sentido y coïncide en sus areas de actuaci6n con las sefialadas por la OMS en sucesivos informes. Asimismo, se valora muy positivamente el trabajo de la OMS en materia de ayuda en emergencias en cuanto a proporcionar ayuda humanitaria util, destacando sus publicaciones sobre directrices sobre donaciones de medicamentos y el nuevo botiquin de urgencia. Creemos, asimismo, que la OMS puede realizar una importante contribuci6n para prevenir desastres futuros causados por el uso deliberado de agentes biol6gicos y quimicos para causar dafio, y solicitamos a las delegaciones que apoyen la resoluci6n propuesta en este tema. Sefior Presidente, quisiera aprovechar esta intervenci6n para recordar las conclusiones del Seminario Ministerial realizado en febrero de este afio en Malaga sobre el uso terapéutico de tejidos y células de origen humano en el marco de la Union Europea. Partimos de la base del articulo 152 del Tratado de Amsterdam que presenta como uno de los objetivos de las politicas y acciones de salud de la Union Europea la adopci6n de las medidas que permitan restablecer altos niveles de calidad y seguridad de 6rganos y sustancias de origen humano, logrando la adecuada protecci6n tanto a los receptores como a los donantes y, por otro lado, conseguir unos estandares de calidad y seguridad de los tejidos y células extraidas e implantadas. Coincidiendo con la presidencia portuguesa de la Union Europea, sus miembros por unanimidad decidieron elaborar una directiva europea sobre el uso de tejidos humanos, siendo impulsado definitivamente este proyecto por la presidencia espafiola en la actualidad. Expertos de la Union Europea reunidos en Malaga consideran que se ha hecho un gran esfuerzo de preparaci6n por parte de la Comisi6n delegada para tratar los contenidos de la Directiva. Invitamos a la OMS a compartir las medidas cualitativas y de seguridad que en nuestra futura Directiva se van a explicitar. Sobre la calidad, equidad y otros aspectos pertinentes de los sistemas de salud, la OMS adopta una resoluci6n EB 107 .R8 referida a la evaluaci6n del desempefio de estos sistemas en diferentes contextos. La Union Europea asume esta resoluci6n en todo su espectro, participando plenamente en cuantas actividades sirvan para llegar a conclusiones y a planes de evaluaci6n. Desde la presidencia espafiola, entendemos que es un tema fundamental y tenemos un interés especial en trabajar y apoyar las actividades de la OMS en la evaluaci6n de los sistemas de salud, identificando sus calidades y su adaptaci6n a las necesidades de los ciudadanos a los que van dirigidos. Quisiera destacar, en el caso de Espafia -y aqui hablo como ministra de mi pais, y no como representante de la Union Europea- la experiencia que poseemos en procesos de descentralizaci6n de la gestion sanitaria, puesto que, a finales de 2001, hem os culminado nuestro propio proceso descentralizador. Espafia esta dispuesta a compartir esta experiencia y a trabajar conjuntamente con la OMS en su difusi6n. Respecto al tabaco, quisiera, sefior Presidente, referirme a la participaci6n de la Union Europea en la negociaci6n del Convenio Marco de la OMS para el Control del Tabaco. Este Convenio tiene, en nuestra opinion, gran importancia dadas las reconocidas consecuencias negativas que el consumo de tabaco tiene para la salud de las poblaciones. Las medidas previstas en el Convenio cuentan con el apoyo de la Union Europea y su participaci6n activa en los trabajos que se desarrollan, en la creencia de que las acciones que se pretenden llevar a cabo supondran una contribuci6n decisiva en la Jucha contra las enfermedades que

ASSNR/3 page 50

provoca el tabaquismo y que suponen, como es bien sabido, la muerte de muchos miles de personas anualmente en Europa y el resto del mundo. Sepa, sefior Presidente, que la Unifion Europea hace ya tiempo que tomo medidas sobre los ingredientes que contiene el tabaco, y sobre la reduccion de los contenidos de alquitnin, nicotina y monoxido de carbono, aplicables a los 15 Estados miembros. Ademas, recientemente la Union Europea ha adoptado una disposicion por la que se reclama a los fabricantes de tabaco la lista de todos los ingredientes utilizados en la fabricacion de sus productos y prevé elaborar una lista comun de esos ingredientes. Respecto a la salud mental, Espafia quisiera destacar el esfuerzo realizado por la anterior presidencia helga en el campo de la salud mental. La Union Europea apoya la resolucion sobre el impacto de la salud mental en el desarrollo social, economico y cultural. Tras el Informe sobre la salud en el munda 2001, dedicado a la salud mental, creemos que la OMS debe considerar los trabajos y recomendaciones realizadas. Instamos desde la Union Europea a poner en marcha politicas y programas explicitos, continuando con la recogida de informacion que permita analizar la efectividad de los mismos. La falta de salud mental con salud fisica es enfermedad, y creemos que es un claro objetivo de la OMS hacerle frente. En esta Jucha, sefior Presidente, cuenten con todo el apoyo de la Union Europea. Por ultimo, la Union Europea agradece los esfuerzos intemos de reforma realizados por la OMS. Estas reformas reforzaran la capacidad de la OMS para responder de manera mas efectiva a las necesidades de los Estados Miembros y mejoraran el sistema de contratacion de persona!, reduciendo notablemente el numero de los denominados «COntratos largo pJazO-COrtO plazo». Y no quisiera finalizar mi intervencion sin decir que la presidencia de la Union Europea ve con satisfaccion la estrecha colaboracion que se ha desarrollado entre la OMS y la Comision Europea tras el intercambio de cartas que tuvo lugar en diciembre de 2000. Muchas gracias. Mr DAYARA TNE (Sri Lanka): Mr President, Madam Director-General, distinguished delegates, first of ail, on behalf of my country, it is my pleasure to congratulate the President on being given the honour of chairing this Assembly. 1 also wish to congratulate the six Vice-Presidents and the other office bearers. Next, 1 must thank the Director-General of WHO for her unstinted support for my country and for the South-East Asia Region. Your leadership and strong advocacy, Madam, have succeeded in placing health at the centre-stage of development, and in shaping the goals and the future directions for the health of the world. We appreciate your commitment and dedication to seeing a tobacco-free world, to eliminating the gross disparities in health between and within countries, and to minimizing the scourges of HIV1AlOS, tuberculosis and malaria. Sri Lanka is fortunate to have made significant achievements in health over the past few decades, because of a number of social sector policies that successive govemments have followed. According to the estimates of WHO, this has enabled the citizens of my country to enjoy one of the highest levels ofhealth in South-East Asia. Sri Lanka's past successes were built on the foundation of primary health care with a strong public health base, rather than concentrating merely on curative and tertiary care. This resulted in steady, incrementai gains in health, rather than on radical sector-wide reforms, which may have brought rapid, but yet uncertain, results. However, now we visualize a situation where the socioeconomic changes of recent years, in the overall context of globalization, may tend to exaggerate the health gaps between the poor, in rural areas, and the rich, who mainly reside in urban areas. We in Sri Lanka have seen a reduction, sorne even say dramatic reduction, in mortality, especially among infants and children. But, recently we have become increasingly concemed that our population seems unable to enjoy healthy years throughout their !ife span. While our indices of survival are creditable, our quality-of-life indicators do not seem to keep pace with them; in fact we are concemed that sorne of these may even be deteriorating. To meet many of these prob\ems the Govemment of Sri Lanka has developed a poverty reduction strategy which clearly identifies the role of each sector, and within this, the health sector figures prominently. The newly elected Govemment

ASSNR/3 page 51

of Sri Lanka has already taken concrete steps to implement the key recommendations of this strate gyespecially those relating to intersectoral action, health promotion and village-leve! empowerment for public health action. We are promoting non-political community-level health development teams, under a "health awakening" movement. We have an intersectoral mechanism at the highest leve!: the National Health Council, which is chaired by the Prime Minister to address health issues, particularly stressing the relationship between health and economie development. In this regard we appreciate the work of WHO's Commission on Macroeconomies and Health and we intend to set up a national commission on similar lines to increase investment in health. My country has been facing other serious constraints on health development. Twenty years of internai armed conflict has exposed our people to many physical and mental health risks and problems, the untimely and unnecessary deaths of many civilians and the internai and external displacement of about a million people. Moreover, externat migration, mostly of women, for employment abroad has added major burdens to families. These social problems have exposed our people to malnutrition, infectious diseases, and other stress-related illnesses. I am particularly concerned about the effects on the large number of children who have been exposed to wartime experiences, which will surely adversely affect their growth and development. Now there is a distinct prospect for a permanent peace in my country. We are heartened by the overwhelming show of support and solidarity expressed by the international community for this initiative. We appeal for your fullest cooperation in the coming years to consolidate this peace. In this regard, we would like WHO to lead the health sector and mobilize international support for our work. We were pleased to leam of the recent decisions made by the Global Fund for AIDS, Tuberculosis and Malaria. Countries such as mine may not suffer from the same disease burdens as sorne other countries, but we have ali of the risk factors for the rapid spread of these communicable diseases. We need to take pre-emptive action and we need the Global Fund to help us to protect ourselves and to mi ti gate potential disasters. Ali of us reacted with horror to the tragedy of September 11 last year, and grieved for the many victims. lt will forever remain in our minds. This event also demonstrated our interdependence and the need for mutual cooperation. lt also made us mindful of the 8000 people who died of AIDS, the 5000 who died of tuberculosis, on that day alone, and the six million children who will die of respiratory illness and diarrhoea during this year. Therefore, our deep concern at the events of last year must also reinforce our response to these health crises faced by the poor and disadvantaged around the world. In ali of this work, we need WHO to lead the way. We need you to find the knowledge and technology and cost-effective measures to meet the health challenges that we face. We need WHO to continue to galvanize the global community to mobilize the resources that will be needed to continue this work. Dr Brundtland, in ali of this challenging work, we will solidly stand by you. We urge you to continue to provide us with the inspiration, the vision, and the strength for our collective effort to improve the lives of our people. Thank you. Ms KING (New Zealand): Kira tata and many Pacifie greetings to you ali. Participants at this forum have been identifying the risks to health both in their countries and globally. This morning we had an excellent round-table discussion. I thank the Director-General for putting this issue on the Health Assembly agenda. As I said this morning, the biggest risk for New Zealand is noncommunicable diseases. lt is our greatest threat. A significant risk in addressing this threat is the lack of access many people on low incomes with high health needs have to primary health care services in their communities. Such access is crucial if we are going to be able to improve the health status of our people. This reality was identified in a report issued last month by The European Observatory on Health Care Systems. The report examined New Zealand's experiences over the past 10 years alongside European countries. The period in question was a time when our country experimented with a market approach to health. We know from research in New Zealand that the cost of primary health care is a major barrier to access. We also know services must be provided in a way that is appropriate and relevant to people in their individual communities. This means that we have to be innovative in the ways that we provide services to meet particular needs. As a new Govemment, the first thing we did in New Zealand to

A55NR/3 page 52 tackle the Jack of access was to develop a broadly accepted primary health care strategy, written with considerable input from local communities and health professionals working in primary health care. lt is a strategy that focuses on better health for a population and works to reduce health inequalities between different groups. Our second task was to convince doctors and other health professionals such as nurses, nutritionists, mental health workers, to think of primary health care in different terms. The third objective was to build the new structures to deliver services- primary health organizations- and to encourage ali those health professionals to work together within those structures in teams. The fourth challenge was to provide funding to implement the strategy and to begin to address the cost of access in particular. Our aim is to provide affordable primary health care over time to ali New Zealanders regardless of income. But our first priority is to address the need of people on low incomes who make high demands on the health system. As 1 see it, it is absolutely essential to break down the cost barriers to accessing health services. In New Zealand, user charges have become an increasingly powerful disincentive to accessing primary health care. That is no surprise. In the past 20 years the contribution from private insurance and payments by individuals towards their health care has almost doubled as governments have reduced their contribution to primary health care costs. The latest New Zealand health survey points to the number of adults who thought they needed to see a doctor in the previous year, but have not been able to do so. lt showed that for Maori and Pacifie people the figure was close to 20%. Of those, almost 75% of Pacifie people and half of Maori gave cost as the main reason. When you eliminate or minimize user charges, people start using services again. For example, since the introduction of affordable visits to the doctor for children under the age of six years, the numbers of prescriptions for that age group have increased, indicating greater doctor use. At the same time, the number of young children admitted to hospital with acute respiratory illnesses has gone down. In this next year, costs will be reduced for at !east 300 000 New Zealanders as another step towards a better system. As weil as reducing costs of access to services, it is also essential to be innovative in delivering services in appropriate and effective ways to meet the particular needs of individuals and their communities. One such model occurring in New Zealand has been the development of mobile health services taking services to parts of the country that are difficult to reach or into urban areas with high health needs - dental, medical, nursing services, health promotion, screening and immunization programmes to name but a few. lt is essential to do this to eradicate sorne of our more striking disparities in health. These disparities affect people living in rural New Zealand, and they affect those living in poor socioeconomic circumstances, and they affect Maori and Pacifie people in particular. For example, at least twice as many Maori children are hospitalized or die from asthma as other children and the indigenous Maori people have one of the highest death rates from diabetes in the world. Improving access to health care in these sorts of innovative ways is crucial to making a real difference to the health of our people. One consequence of not doing so is the number of avoidable hospital admissions with ali the social and fiscal costs that that entails. We need to change the pattern of hospital admissions. lt is estimated that up to a third of hospital admissions for people und er the age of 75 years are avoidable, and that two-thirds of th ose admissions could be avoided with earlier access to effective primary health care. That is a goal certainly worth striving for, but it also illustrates that we have a long way to go to minimize the risk to sorne groups in our society. With the rapid growth of noncommunicable diseases caused by tobacco consumption, obesity, Jack of exercise, alcohol, environment issues, etc., it means that we must take a strong prevention approach now, and access to primary health care that is affordable is a major key. The value of international meetings like this is that they provide us with an opportunity for sharing ideas that can work. None of us wants to re-invent the wheel, we can learn from each other, and coming to a forum like this makes it Jess likely that we will have to do so. Thank you for the opportunity to share a brief snapshot of sorne of our risks and sorne of our solutions. Kira tata. El PRESIDENTE: Doy las gracias a la delegada de Nueva Zelandia y tiene la palabra el delegado de la Arabia Saudita, representando a Bahrein, los Emiratos Arabes Unidos, Kuwait, Oman y Qatar.

A55/VRJ3

page 53 Dr SHOBOKSHI (Saudi Arabia):

:(~..ly..JI ~yJI ~1) ~ ~1 ~ <Y. ~t.....l .J~I .)tw,~l

,~)1 ~)1 ..&\ ~ ô..lL.JI ,ô..lt...__..JIJ .)L-.JI y~l '~J.ll.JI ûl~ ,~WI ô~l ,~)1

Jt-

Jla.... .

:û............ll ~yJI ~~ JJ.l..-.lüJklll ~ JJ..ll'"""4 ~1 ~î ,J ~111\ 0-o ~~ '.J~I ~yJI ~ S1ool\J 'Û-..:!_,sl\ :ÜJ..lJ ,_;Y :ÜJ..lJ ,0W:. ~J 4LJ:!~I 4Sl-J 'Ô~~ ~yJI û\)o.A'j\ ,~WI ~~ ~<•l:.:üw ·t.-:.11 '-' ~~j ()C~ · ')1 c.r-,~.~~ U•• ~<1 ... _-:ll.J -;.1< :_t.-: ·- ~ -- .11 , . o1\ ~\.j) 1.-.r"t-"' ~_,..-.

.~WI ~1 tAY! ~_,t ~1 ~1 ~ t.t.~~....:=:.lJ 0l;Jll ~L....j.JJ ,~)1 yi~ ô..li....JI ~l L.S y..;--c.ÎJ ~WI ..lly ~tJI ..!.:l.JJ..l.) <.j\i•;;l\ uJ;...JI i"t.J ~WI ô~l _;:fo. o~Î üÎ J ~J )~ ~Î L.S ,LlfJ_;F..~I üfJ.JJ..lll.) uJ;...JI 4-:11 ~1 ~1 û\).JÏliJ û'iJb.Jllh.4:i) 0C ~ . L..j,l\1--~1 . .J.h...,_-: -1\ , .. •.1 ~~~ :u:J.\1 \ ,i 1- ~~ ~ '• '\ 1.) ...! .oi.:l.)J..l <.,? . .J t.j .lJiül\ ..L .Il (.)A ~ • <.,? ~ '-'..)""" ~ • • • .) ...r c.s~ ~ .l.......F ~ ~ .Jfo..lll .)tw,~l ~.&.fo. y •• ' _;:foÎ- ~ ~ ~4.)4 .lie. <.j.).\1 ~}iiJ

"·~ ~~J ~ \.jj.,lb t.\4 0C 1..;:- (.5y..Î û\_,1... ~ ô..l....l ~~~~~ 1~ <.j.)lj.;JI Jlj)l 1 -~L.....Ju\ .ll.ou W\11\ .!:-:_-: ~.11 ~ ~~ u ·l.llJ.l 11 ~ :l~~--:11 ,~~ ~l .:11 o1\ ~ · ~·l J '-t-' • • • i" ~ ~...,? ~ • .)A . ~~ ~ c.r. , ~...)'"' .~)~1 ~1 1-4J.)J~I ôl~l 0fil.l YJj..lll·-~ ~ ~IJ J.olS 0.,;! .JJ~J '<.j_,l....ll l..j .,).;li 0Jklll ~ tlb:i....l ..lil ,~WI ô~l ,)'- ,ô..lbl\J Jt-.11 y~Î ,~)1 1 \('":": ~lAc.Î · L \..o.o "'..i\..li\Î -::.::_-:.1 ~U-.1\ ~~ ~~ ' \ ~\.:.. ~ ~ .~ ·Î. · ,i ~ ~ ~~J ~·- ~J ~u u...r~.J.Y.C-

Jla....

~1..;: ';cï;;J ~J ~ ~~....:=:.~1 -t~J..l ~111\ ..lc.t..... ..lilJ ·~' J-..11 û'it.;..... ~.) c~ ._'l.. , ~1 _t:.~ll ~1......~1 Wl n ('": 1 <.r . .J ~j L.S .WWI ~1 ~ d·~ lb\ . .J ~1 J~ , r- . , . u~ , ~Y .J • <.r • ~L.....!JI 4 Jb•::JIJ ~IJ ô)..l'jl ûy~ ~tij.J'JIJ ,~~~ ~1 I.A..l).JA ~ 4.l...:ai_,...J ,~\ _;:iL.WI ~\.:.. ~J..l~IL>-o 4-J~\.:hl ~t,J ~~~~ ô..l_,::JIJ ~~0~1 ~t- ~J ,û~4 .~~~ ~1~1 ~\_;: ~ 0-o ~1 ûlAjh....JIJ d~IJ ~1......';11 1 • -~ -;Il ~.lJiüll ~ .• ·.-:11 ûlbWI J d .) ·W'iw · Î i"LWI 11\ <.,? . .J c.r -~ . 'i J ~ i"_JAJ ~...,? , , J --~J-"' J ~1 ,, . • . ~Î , u ( o'i? ali :u...- ~ ~~~ W"'.Jl.:JI I.A.J~4 ~WI ~~ ~ ~ .)J 4-Jb.)AJ ô~l ~~~ û~ly..::JI 0-- ~ iZ.~ lAJ ,û\~J ûi~Î 0-o ô_;F..~\ ~]il.) r.lWI (.5_;c.llA ~..;:! ·JJ..lll Lcjc.jJ ..l)~l.) uaii 0-o ~~y lAJ ,~~J ~ û)fi 0-o ~k.; lAJ ,~U::JIJ ~yJI tljLJIJ tly..::JI ûbl...... 0-o ..l)_,.JI Jij .Jk..!. ô~\ ~~\ ûa.i.J .üS. ~.) .k.....J ·t.j..lt..-:i!l ..ll..SJ ~ 't~IJ ,~~~ :~1 ~L....i'jl ~l..lè.Î u-11 4.&..;-ll ~_; ~~~ ~J '0lAYIJ ~~ yb.J u-11 û.....l..-l.fJJ '.J._,.b:ill.) ~1 <Z-"1..;:.11 'û~t! ·'.'· .,.·JIJ ,~\J ,~~IJ ,4,1~\J ,Jr.JIJ ,.fo.l\J .~1 .) ~1 ûiY:.:,.JI ll.t . .J ·~1 ûw..ll.....::.:lil ~ ~· · • . ) . 1 1 ~WI ô .. -.11 ·Lu . .J ..l a .l:.~ ~ ..lilJ .;: , <.r , . .J:..r- ~ t.j ~ u ,. <.,? .)J lA, ....,~ , .ô~l JJ..l!IJ ~1 J~l ~ô ~1 ~ ô.JJ~ .)1 ~ <.j.)l\J rWI 11\ 0-o 0l 0-- Y • •' ,~L_,l\.} ~4 (.}'=lW\ _;:fil~ lA .)1 J~l 11\.) ~t 0i ..lJtJ 0-o Ï.i. y..ï.) y.lb ~ 4)'n;j)\ ~.JI....J\ _;:F ~~y~\ 0C ~\.:JI ~IJ ~1~\J ôt!~l û'ib ~~..»~1 J_p::JI y..ï ô..l:ll_jj..JI ûl.\~'il 0tJ .~WI ~~~ ~'-:-JC 0-o Ï. f ï J ôt!~l û';/6. ~ ~..l:j ll.o ~ <.j.).\1 .)A~\ .JÀJ . y. y. rk J~ û'i.lot.....ll o1t. Uc.\....4i .)c. ..lc.L....:i Ù_J-W~ .;.4~\J . ..l~l 11\ ~ ~.lâ.'ill- ~WI ûi.......JWI ~J ,~\~1 ~IJ ô~l .l:sWt ~-k.;->"" û'iL..::.. 0-- ô..l:ll]l-JI .li~~~.}~ ~1 o..l:l..l.:;JI ûy..l.::o.::JI .J~'il.) i:..G 0i ~ ~ ,~, .)~..l:lliJ ,û\.)~1 Û..ll_,:.. 11\.} ~ ,ltJS~.J ~_,..._Il ô~l ûi~J '<.S.fi.ll tsJ_,bll L..- ,O,J..lly 41.....- 0~ t. ~J~-~t..-....~1 ..l..lc. ~.ill~~ j..l:l'il ~4JJ ,~, û'i~'iiJ .<li~ ôyUI ~\....JI d).)ll ~ ~b.\1 o..lk1 ~

~L.:l.i ~J ~ ~ JJ..lll ~ (.)4~ c.r"L....Î ylb ~1 ~h:.)l Ô..l_?. ~ 0Î ~'iJ 4 r·,u ~~ ~1..lt ~ ~~~ ~~ ûtA~'iiJ .J~,,~.} ~~ ..l.Jt-?o r~'il 0-o ..l:l~

A55NR/3 page 54

L< • ~1 J.J _;iJÂJ ~1 j~)'l _, jt....:lc'JI ~1.:-_, ~ I}JI ùl y!..}4 0~ ~WI r. .J:!.l.JI ~i c;.lll .Jla..:JIJ 1

~1 ~ 0JLwl4 ~~ ~y.\1 ~ ~ ~ J_,i ~ .,. •• ' l"k ÜA J:.) ~ ~ .ill_, ,.!,.\ L-1 u ~ _-: .. 11 ~ ,, oll ·-<1 ..)""'"~ .11. ul ys:.'JI J jt....:lc'JI .)Al '-r '...! ~ ~ .b....~ _-: .1, ~..r.•.1 -r:-. .l!'JI ~ . 1

../""

-~1 0J~I ~ J_,~ ~_,.ill r.j~l

JU:ic'JI_, ~~ ~ ~_,_;i.JI .JL..-:JI _,

JL-c.4 ~~

i~ 0:!Y:.,:. _p-i ~ ~~ ~yJI ·~~.)YI

:_,._,~YI~~ ~

.JA4 ~ ~~ ~ .fi~l LJ ~~ 'J ~ c.J'I.Jw

j~l ()A ~)4 .;_,.JI jil_, dyi~~~ï ..~JI 0:J_,AJ_, ~.l.JI tl.h\1_, ub)'l ûl)o:~-..a

~~ JJill _, ~~~ _, .)c. ~ <J.bWI o~

oi..-.\ ~Ll.J ~_, ~ <.) Y?-)_, ..b~)'l_, ~ ~ ~ ~1_, ~~ <-Î:!Y u'LJ.:)' 4.3_,~1 ~_,j}l ~I.JYI ~ y~l <JS.....U~I JlpY4 ~WI t_y-;.s_,..JI rfo.JC ~ ~1 ()A~~ ~1 ~i.....\ 0 ts__... 0--J:- ~~ ).bYI o~ ~.Jj ~ ~.J~ ~ l..l1J! -~y~ ,~1 ~y.\1

. .llw:LII 1~ ~ r..Jji.....:JI ()AYI ~ ùl)_)_, ~_,j}l ~y!.ll ~~ ~ Jj1.11 ~I.JYI

"'4\,j\.S.>u ~\ ~.JJ ~ ~1_, ,~w....a1··~ ~_pi Mr LEE (Republic ofKorea): Mr President, on behalf of the delegation of the Republic of Korea, frrstly let me congratulate the President on his election. Most Member States gathered here today believe that they are experiencing unique risks to health because of the different environments and socioeconomic conditions of each Member nation. However, most of those risks are similar to those other countries may have gone through in the past or are still going through right now. Member States that have overcome health problems · such as communicable diseases and malnutrition are channelling their efforts into dealing with risks to health such as cancer, circulatory diseases, environmental pollution and so forth. There are no borders when it cornes to man's pursuit of health. The international community also shared the pain felt by the citizens of the United States due to the terrorist attacks on the World Trade Center. The threat of bioterrorism is still imminent, threatening safety and health worldwide. In addition, there are international health issues, such as the yellow dust that blows over North-East Asia, which bas brought about an increase in respiratory diseases, and the international trade in unsafe food products threatens the health of aU countries. 1 would like to stress that in order to deal with risks to health, it is essential to focus on prevention. The worldwide change of focus for health systems from treatment to prevention is inevitable due to the increase in chronic diseases. Also, it is already proven that investing in disease prevention through regular health care can reduce the burden of high expenditure on treatment. So, prevention-focused health policies with the purpose of curbing the increase of health care expenditure on chronic disease cases are becoming more and more important as a means of reducing the total national health expenditure. In this respect, ali of us should focus our attention and efforts on strengthening international measures against risks to health, with WHO taking a central role, and 1 would like to make a few suggestions along those lines. I propose that WHO holds international forums focused on sharing the experiences of Member States from Europe and North America who have already faced many of the health risks. lt would help the other Member nations to deal with health issues in a cast-effective way. My second suggestion is on tobacco control. Smoking is definitely one of the major risks to health, and policies for tobacco control should be strongly promoted and enforced in order to protect the health of children and young people. The Government of the Republic ofKorea is planning to hold a tobacco-free World Cup in cooperation with Japan and WHO. We hope that henceforth WHO will continue to make every effort to ensure that ali international sports events are tobacco-free. We ali know that excessive drinking bas caused alcoholism, alcohol-related diseases and death. The Government of the Republic of Korea is now making every effort to hold the Korea-Japan FIFA World Cup games in June as a healthy World Cup, which infers it to be terror-free, tobacco-free and without any health risks. I hope that many Member States will support us in our efforts. Finaliy, 1 hope that the Fifty-fifth World Health Assembly will be the forum for many meaningful and informative discussions on world health. 1 wish good health to ali present. Thank you.

ASSNR/3 page 55

Mrs KEYURAPHAN (Thailand): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, first of ali, please allow me to congratulate the President on his election. 1 am confident that under his wise leadership, the Fifty-fifth World Health Assembly will be both productive and pleasant. 1 also wish to express my congratulations to Madam Director-General for her inspiring address yesterday that enhanced our awareness of risks to health and energized us to take common action against them. Last year in this plenary, 1 outlined the plans of the new Govemment of Thailand to ensure health for ali Thai citizens through a universal health coverage scheme. That plan is nowa reality. The purpose of this universal health coverage scheme is to guarantee that ali Thai citizens would enjoy equal access to basic health care since health is a basic human right in our 1997 Constitution. From the first of April of this year, ali 62 million Thai citizens are covered by this universal health coverage scheme. Every Thai citizen now pays an equivalent of only 66 US cents per hospital visit to receive medical treatment, from the common cold to cancer. The Govemment of Thailand has fulfilled its pledge to provide health care for ali Thaï citizens in just over a year after coming into office. Furthermore, the Govemment of Thailand has declared this year "The year of health promotion for ali". The nine components of health promotion policy have now been operationalized. The Primary Care Unit in every community played a crucial role to implement this policy. At !east one "Health Club" in every subdistrict is responsible for promotion of "Exercise for health" to achieve physical health for ali, in line with the World Health Organization's promotion of "Move for Health". In addition, we also focus on health promotion in schools, clean food, good taste, healthy markets, no drunk driving, campaigning against illicit drug use, prevention and control of heart disease, hypertension, diabetes, cancers, dengue fever and AlOS. Conceming the anti-tobacco campaign, we will soon issue a ministerial regulation for a graphie health waming label on cigarette packages, in spite of the threats of law suits by tobacco multinational companies. In doing so, Thailand will be the third country in the world to introduce this innovative measure. Conceming the war against AIDS, apart from the HIV control and prevention programme, the Pharmaceutical Organization of the Govemment of Thailand is now successful in producing antiretroviral drugs at a very low cost while strictly observing good manufacturing practices. The development of these antiretroviral drugs is carried out in compliance with the World Trade Organization and Trade-Related Aspects of Intellectual Property Rights agreements. As a result of the production of these inexpensive antiretroviral drugs, priee reduction and affordability have enabled the Govemment of Thailand to include the provision of antiretroviral drugs in the benefit package of the universal health coverage scheme. To provide financial support for our promotion of health for ali Thai citizens, the Thai Govemment has enacted the Health Promotion Funds Act which earmarks 2% of tobacco and alcohol tax for health promotion activities. Moreover, we are drafting the National Health Act, which will give priority in the health policy to health promotion and disease prevention. We believe this is a costeffective strategy to build health while reducing risks to health. In summary, the present Govemment of Thailand has translated our commitment to provide health for ali Thai citizens into action in only one year after we have taken office. The path has not been easy, just as Madam Director-General said yesterday, that forging real change is never easy. We were initially faced with scepticism when we announced that ali Thaï citizens would have to pay only an equivalent of 66 US cents per hospital visit to receive treatment from common colds to cancer, but we have done it in one year. We are willing to share our experience, as weil as our technology in producing low-cost antiretroviral drugs for AIDS patients, to fellow developing countries free of charge, for we are committed not only to providing health care for ali Thai citizens but also to do whatever we can to promote health for ali humankind. In this connection, we share Madam DirectorGeneral's conviction that "health for ali is vital to human security". We therefore are willing to do our part in enhancing common human security through promotion ofhealth for ali. Thank you very much. El Dr. GONZÂLEZ GARciA (Argentina): Buenas tardes a todos. Agradezco a mis distinguidos colegas el tiempo que me van a dedicar. Muchas gracias también a nuestro querido Presidente americano, que tan bien esta desempefiando su

A55NR/3 page 56 roi, y por supuesto, muchas gracias a nuestra Directora General y a la Organizacion por este momento, para hacer algunas reflexion es junto con ustedes. Dos ternas han sido centrales en las conversaciones de hoy y de todos estos dias, y me permito algunos comentarios vinculados con esos dos ternas centrales. Uno ha sido el tema que bernos empezado a tratar desde esta manana y que estamos tratando y seguiremos tratando: los riesgos para la salud. Creo que tanto el diagnostico como la gestion, como la comunicacion, como el tratamiento de los riesgos, es una estrategia esencial que necesita cualquier sistema polftico sanitario para la determinacion de prioridades. En ese aspecto, creo que la contribucion de los documentas marcos y de las discusiones es muy util, pero me permito agregarles que, ademas de los cambios vinculados a los estilos de vida y a las conductas y comportamientos saludables, creo que deberiamos hacer mas énfasis en algunas de las cuestiones que se vinculan con el otro tema de macroeconomfa y salud, que son los destinos de vida. Creo que debemos trabajar también intensamente en ese circulo vicioso de la pobreza y de la enfermedad, y la enfermedad y la pobreza, pero para muchos de los cuales la peor de las pobrezas es no poder modificar su destino de vida, y en eso creo que deberiamos reflejar el pensamiento universal y mundializado que siempre busca la Organizacion Mundial de la Salud y que tan seneramente nos ha servido en estos ultimos anos. En relacion con la segunda cuestion vinculada con la macroeconomia y la salud, creo que algunas de las crisis recientes, y particularmente la crisis que esta sufriendo mi pais, demuestran que verdaderamente esa relacion en la cual bernos lucbado tanto tiempo en los ultimos anos, particularmente en estos ultimos afios, por poner a la salud como un motor de la economia y no simplemente como una consecuencia, como parte vinculante y casi como locomotora del tren del desarrollo de la economia, y no simplemente como una consecuencia, tiene también que tener algun tipo de reflexion vinculado con las grandes catastrofes, las grandes crisis economicas como la que boy tiene mi pais. Es evidente que en la crisis que boy tiene la Argentina bernos pasado de una cierta euforia en la década de los noventa como pais que crecia mucbisimo y que mejoraba sus indicadores sanitarios y sus indicadores economicos, de ser uno de los mejores alumnos del sistema intemacional economico y financiero, a ser hoy uno de los peores alumnos. Creo que ni aquello era tan cierto ni esto es tan cierto. Pero si me parece que deberiamos reforzar nuestro conocimiento y nuestra accion para tener estrategias mas claras en momentos en que las crisis econ6micas repercuten tan fuertemente, por ahora felizmente no sobre la salud de mi pueblo, pero si sobre el sistema de salud que se ha enfermado de una manera brusca, aguda y muy fuertemente como consecuencia de algunos indicadores que, para simplemente ejemplificarles, bernos pasado de tener un gasto de salud de US$ 650 capita/ano a tener un proyectado para este ano, segun lo paso en el primer trimestre, de 185 dolares. Se dan cuenta que semejante diferencia implica un quiebre en el acceso a los insumos muy fuerte, que es el principal problema que boy tiene el sistema de salud de la Argentina. Felizmente, las politicas que estamos haciendo implican establecer prioridades, y estamos garantizando el funcionamiento de los servicios esenciales. Tenemos programas de provision de medicamentos para atencion primaria, y tenemos un programa general y leyes de medicamentos y prescripcion por genéricos. Creo, entre paréntesis, que es la mejor manera de honrar a la OMS en los 25 anos de su estrategia de medicamentos esenciales, bacer politica de medicamentos fuertes, importantes, en cada uno de nuestros paises y creo también que debemos en este tipo de casos asegurar, como dije antes, los servicios esenciales con toda la fuerza que implica mantener en funcionamiento uno de los sistemas sociales mas importantes que tiene cualquier pais, como es el sistema de salud. Hasta ahora no bernos tenido impacto sobre el estado de salud de los argentinos y, obviamente, nuestro esfuerzo, el esfuerzo de nuestro Gobiemo, nuestra decision, es que esto no impacte. Para eso bernos contado desde el primer momento con la colaboracion de la Organizacion Panamericana de la Salud, de su Director, el Dr. Alleyne, y por supuesto de la OMS a través de toda su estructura americana. En ese sentido, quiero agradecer especialmente la actitud de la OMS/OPS, y quiero solicitar dos cuestiones: una, que aprendamos de las crisis y aprendamos de la Argentina, en el sentido de que cuando se producen grandes catastrofes, quizas no tenemos los procedimientos. Tenemos procedimientos para pequefias catastrofes, los bernos agudizado, pero hoy no tenemos, cuando se produce una crisis estructural creo yo parecida a la que quizas unos afios tuvieron otros paises como Rusia, como México, como Turquia, creo que deberfamos acentuar este tipo de

ASSNR/3 page 57 experiencias de tai manera que las consecuencias sobre los mas débiles, los mas pobres, los mas enfermos, sean menores, o no ocurran. La segunda cosa, exhorto a que los organismos financieros internacionales actuen mas rapidamente que lo que estan actuando en mi pais, porque muchas veces son cuestiones vinculadas a c6mo se asientan las cuentas, y en ese sentido se pierden dias, se pierden meses, el Gobierno de la Argentina tiene cuatro meses y no ha logrado todavia recomponer el funcionamiento y la ayuda de los organismos internacionales, y en ese sentido el mejor medicamento puede no servir si no llega en el momento oportuno. Por eso agradezco a todos ustedes, reitero mi agradecimiento a la OMS/OPS por su actitud, y exhorto a que aprendamos de la crisis argentina. Sepan también que les agradecemos a todos los paises que nos han ayudado y que seguimos confiando en que mantener la mejor salud de los argentinos significa mantener el mejor recurso que tenemos los argentinos, que somos los argentinos mismos, para poder volver a ser una Argentina mas saludable. Gracias. Mr ENGQVIST (Sweden): Mr President, Madam Director-General, distinguished delegates, the statements by the Director-General and the invited speaker during yesterday's plenary session contained important elements of the potential breakthrough - for health, for children and for global justice. Health, with its strong links to poverty reduction, has been in focus at the recently held United Nations summits. Severa! of the agenda items at this year's Health Assembly challenge us togo from words to action on the global commitments made at these summits. The WHO report of the Commission on Macroeconomies and Health strongly argues the case for increased health investment, for the potential breakthrough in terms of economie development and poverty reduction. Evidently, economie considerations do not substitute the reasons for health that are based on the right of ali people to the highest attainable level of health. Social justice and economie development, however, must necessarily go hand in hand. The realization of the Convention on the Rights of the Child was discussed at the United Nations special session last week. Among those rights are the right to health. Better nutrition and access to basic health services, including reproductive health services, will have a major impact on the health of pregnant women, children and adolescents and in turn on socioeconomic development. Every year, 11 million children die from preventable and treatable illnesses. They die when they could have been saved by interventions at a low cost. I consider the commitments and recommendations for interventions made at the WHO/UNICEF Global Consultation on Child and Adolescent Health and Development held in Stockholm in March as a breakthrough for these children and young persons. Investments in reproductive health, including family planning and contraceptives, are crucial complements to disease control and nutrition. The need to develop reproductive health services and rights cannot be overemphasized, in particular, in the face of AIDS, unsafe abortions, sexual abuse and teenage parents who are too young. Real progress will to a large extent depend on WHO, as the international lead agency for health, fulfilling its technical role in supporting countries striving to develop better reproductive health services. Sweden, therefore, welcomes the renewed emphasis that the Director-General, in her report, gives to this programme area. My Government will increase development assistance considerably over the next few years. lt is estimated to reach 0.87% of the gross national income by 2004. Hopefully, more countries will do the same. The different global initiatives, for example, the Global Fund to Fight AIDS, Tuberculosis and Malaria, will mean more resources for the least-developed countries, but funds, of course, are not enough if health systems cannot respond by providing services that can reach the most affected groups of people. In order to achieve sustainability, it is necessary always to assess effects on health system infrastructures. It is also vital that the different global initiatives are implemented in countries in accordance with national priorities. The urgency for WHO to develop its country-leve} operations should also be stressed here. The increased demands and pressures on the health system affect ali countries, rich and poor alike. Citizens demand, and rightly so, a continuous improvement in the performance of health systems. Common access to effective health services is, however, only one pillar. The other pillar is broad-based public health policies. Smoking, eating habits, lack of physical activity, working life-related ill-health, alcohol and drug abuse are heavily manifested in the burden of

A55NR/3. page 58

disease. The goal must be to bridge gaps in health equity by involving ali people in building and sharing health bepefits. Thank you.

Dr. Zhang Wenkang

(·tf 00 )

*xll$* < tf oo ) t-:4ik ~ i. 1$ jb 4. ,' t-:4ik~-TIJ#;#~iff±,

~1i1~*'

::k:"±1f],

)b~dfJ:

~~~&m~~f•-r!J1t*~•±~1-+*M~*%,w~1~~n~m•~~ ~ff;t, ;;,. 4 +7rw ~ @J *-fR~iE 4- ro n~rlfWilffi ~t1t~;ft:!I.1t7r fpJ tf ®1~* ~f #

*•iE~~~-~tf~~~&m~iE•~~-~4.7rwm•~•h;ft:l•~~*•·*~ +A·-~~. iEM~·ffiAP~~~~lli.~~;ft:l~~~-~~~·· a4~4.-~ ~ lJ.x. 1;1, :&.Ji 1±ifk1ff ril fiJ ~f ïfk1ff ~ :t± m fR ~ ~ 1t * ~ JfJ f j:: # ~ • tf oo * i: *!Je m~ ~J

*1!f 1~~*·0 ~~~&m~*f*~~*~~&~•*~ili.~~A~••~~~!lft~~~~

tf1\.' 13 #,

~~~·~t:~~-*., 1.ê.~1@.~~*~4.4Yr~1Jt1ii~*~·{P~j/'·ffi ~t:

~~~*~~s*~t:~.#•ili1if~~••moo*1i~~*~4.4Yr~~*~*~~ ~1Df~~o ~1fHA.~, J!~~f#.ïE~if-Ji!~o tfOO!t-+~•tfOO*, .®.~•mAc

~J ;l~VIt%!1~, 1.ê.~Xt~1JJ~1ft:k., ~·!.~*' 1flj ~·ffi :ft ~1fJ if-J tf 1\.d:f:~o 4-~~ 00 ifk

JffiEI.~-%tf~ili1~~4.~~*~~À~~-o~~~~tfl!J*, ~ffi~~®~%

4S~~~*l!-~-~i:~~. #~·*·~~*-~ft~.~~~*~4.4Jr~,. !!h ~~tf oo *~•!.~ *, ~y- • m 0

~f-·ili~~*~·~4.~7J~.-Y'~f~~·~*·~4;ft:lft~~A~~ ~~~~~~-·~*•**~-~~~-~-~I.~,#~~~~*~*-4#~~t: .r!L xt Jtr.~1fJ+~JXi9!o ~ ~ ~· t:f 00 *iE~4.4Yr~ Wllffi;f" JX.t: ~:ft!., ft*~ •m*m '· ~~-~~~l.X*~~~-~~~*~~~~-o~~~*{PW~~~~-~~~

~JJt:1!1r~ ~&ifk•, xtf~~~-~4. 13 #, ~Y'!fo:.m ~ lli~f#f:~, :1!~~~

~~®iE~~~~{jï~;ft:l~:k.~~OO~~~~~~·~~~~~-off;tJtr.~··~iE·

~l;l,~-~~~-~.i.·~*~*4~-4~~~**00*~~1~~~·~o ~~~~m~~~*~~4.l~if-J~~.*~~~±~4.!~~~w~~7i~~1 it~*~~I.1to ~!l~·;Jt~a~;ft:l~~. Jt~•tfOO*ïmlf(oif-Ji:~f:f:Jf., ;{JJ!S~±

A55NR/3 page 59

~~~~*~~*~~~-~, ~oo~ft~~~~~~~~*ft~~w±w~~•,# JR1~ J t: 7::.~11±-'l, ~a.t-tt W11ffi it $- i#r~ Jl;JP!. ~111 ~lo '#Jk~tlt!t-~~ill ~,Rtf~~* !JE ~fl~wm*~I~, #M#*-â~~w~~~~*~t!t!f-~~-~~~~. ~)$_!~,

-k±111,

x~ 111:

-~~$~~~~~~~A~~~~·~·~~~~~,~~*~~%~#~~Jl~ ~:~*~· ~m•~~oo-~, ~~~~~~~ft*,~~~~~~~~~~~•, ~ tE±~~~~~~~m~~~~~W~h~4.-tt~~t!tJf-L~m~tE~~OO~~%W ~~fl~OO*~~~~, ~*~~~w~~~*~~~. l;rJ 'it.J.'J!t.l. 1 t~

Mrs BARTOS (Romania): Mr President, Madam Director-General, Assembly members, good afternoon, it is my great pleasure to address the message of our delegation to the Fifty-fifth World Health Assembly. In the short time available to me, 1 would like to present the position and the progress of Romania on certain major agenda items, which will be discussed and debated this week. Firstly, we appreciate the efforts of the World Health Organization in the direction of improving national and global health items, within each of the four strategie directions, mainly th ose addressed to poor and disadvantaged populations. In this context, Romania fully endorses the Millennium Declaration. We have already integrated the goals of the United Nations Millenniuni Declaration into our national strategy. Let me give you sorne examples: at the end of 2001, the Interministerial Committee for Combating Poverty was set up, under the coordination of the Prime Minister. The Committee has developed a national strategy, and health is one of its major components, aiming to ensure more resources for marginalized people. This year, legislation was revised in order to ensure a basic health benefit package for uninsured people. In the same context, Parliament approved a law guaranteeing a minimum income for ali Romanian citizens. AIDS, by setting up The Govemment has taken another important step in the fight against HIV1 AIDS in March 2002. This the National Commission for Surveillance, Control and Prevention of HIV1 Commission coordinates activities between the ministries involved and nongovernmental, international and other organizations in ali issues regarding the treatment, care, prevention, education and social rights of HIV/AIDS patients. Tuberculosis is another public health challenge in Romania and for this reason a national programme to combat it is being implemented. This programme includes, among other components, ali persons with tuberculosis, including uninsured ones, having full access to effective diagnosis and treatment. The special concern of the Romanian Ministry of Health and Family to reduce child mortality and improve maternai health is reflected in the national programme for child and family health, offering, for example, free access to health care services and drugs for ali children and young people under 18 years old. The Government of Romania and the Ministry of Health and Family have also defined regulatory frameworks in the following priority health-related areas: epidemiological surveillance of communicable diseases and rapid alert system; blood safety policy; promoting healthy lifestyles and combating tobacco, alcohol and illegal drugs; national pharmaceuticals and drugs policy; universal access to health care services for ali Romanian citizens. Ali the elements presented today, together with other concerns of our country related to health, are part of the Romanian efforts made towards the process of integration in the European Union. In this context, we appreciate the steps accomplished together with WHO and institutions of

ASSNR/3 page 60

the European Union, in order to contribute to the improvement of the overall health status of the population. Lastly, 1 would like to assure you that Romania will continue to support and participate in WHO efforts to advance health at a global level and will implement specifie strategie directions at national level. Thank you for your attention. Professor AL-CHATTI (Syrian Arab Republic): :(~;}_,..JI ~yJI ~.J~I} ~1 ~4J ~-- .JjiS~I -~ ~1 ,rd.•.JIJ d~l ,~WI ~.J:!.l.o..!l ~~~ ,~)1 ~1

- <..)AJ '• .. 14.JL.i....:i ryw , J ~'---....u'll , .

J.....~l .)l.!u .

.)~

.-:c:",ll

~ . Il~ ·-11 ~ ... -11 • .):J"""' , •..J""' ,.)~

~.)

•

û~ ,

.<1 r-

U""'

l:ii

·i u

'-rr"" ~

......l9

.WWI ~1 W::a.l..J ~L...i'll '. ' cbllw , , • J ~1 •. ul~~l ~J .. • ' -;11 ~WI o .-:~11 . .J W::a.l..JI ~Î ..ùU ~ · , 1 .ill ~ r.r J , ~ '-r lj . J (...)-'=~~ 4 .l;lall ~WI ~~.l.o..!l .li)tü.JY. ~.JjiS~I .._..~ W U.J:l~ CJc y~,) ~_il.J ,~1 ~1 ~ ~ ~ .J~~I .b............ ji-JI Jy!J ~"ji .J:l.l.o..!\ ~ J~ yo .fi.!JI J . ~.JH- 0-- l..t. _il J~ ~~1......11 J . ~. ..19']1 ~1 . .J ·.t ·WI c:r--:• ·--1J lj y '1 _;;;:w ··- 11 (.j '1 .) ')1 • • . '-r ~ •

ût:âl1û..o.ll \....u .c:"-: ,.../"""'

.J_,b~:!J '~.J_,..., lj~-} ~_,.J... LA~ ~1 ûl..ù=JI

tlb!

~ 'f":!fll .J~I ,~)\ ~1

d~\ ~ ~~~~ ~J ,(.)blyoll ~-} <Y'_,.J... ~ ~1 û~Î d~l..»'/1 o1\ ("Le. L...tc. Oi 0-- JyoWI .;-11 ..h...._,:ï... ~) ~ '.Jl.b'/1 11\ -} JJi:-JI ~\ )~ ~ ~_JAJj.ll u.....JÎ J_.SJ oUJ f f 0--> A.........WI ü.J~ JU.b~l ûysJ ,·,,os.:. ii.J ,Jl.....ll û!~l -} Ï....tc. V • ,A .)1 ''\V • i' ~l ''\V· i"Lc. fA 'l' 0-- û~YI û\.:!J J.A4 ~IJ , 'l' •• 'l' i"tc. ~\..9J 'l' • .)1 ''\ '\. i"tc. ~Jl.JA • • • • 'l' • • 'l' 1"\.c. ~_,1yo U.lÎ ~LA JS1 .l-.ili , ûi.J~I J..,.al _;l b.û... ~ d .J~\ l"\ .l...a.l 1jS y LA~ ~.J-""' tfo rl ,~ )1 ~1 .Jij-} ~i ~ ,~,J ~yt-JIJ F\ ~ I.Y'_'l-4·~ ~t 4-=üi.JA .0--J 'û:UtJ:.) ~~t û.é.l! ~ ~.J~ ~i .)1 YJ.JJÎ .)1 '1~ J <Y'.J\..9 . ..ùl:J ~l: I.JJ.JA ~~ ..,...-l.!t 0-- ü .J~I L.J:j\.c.IJ9J L..ü~~ ~ ~ ü..).....ll: \J.J~ JLAcl~ <Y'L ()A 1"~1 I.!J~ LAJ d)...à....JI ..ill:ll ~_,11 wL......).A.JI ~ (.)4 r.,;;iJb,,lôl\ ~y~ l/~1 ~llîi....J: LA~ 1~ ,~L.J~J ü~IJ ~lpu 4-=o-~IJ ,~~I.J f":!.illl ~.JtJI ~ ~ fi~ LA JS l4ïn 4.' û!\..9 _;11 ~ly...'jl uh...__....'jl J~J WLAJ ~~'1\J ~\J ~1 ûL.,..._;..JI 1..:-l:!.~ ~.lo...Q\.3 4:ï,:b,.\il\ û~IJ ·r.Y'A~Y ~lb::..-} ~WI O.J:!.l.o..!l ~~~ .ill~ ûfi~ ~ ~IJ ~l:b)u ~I.!J 4.Jy~ ~.)A~~ ~W'/IJ yL..A.J'/IJ J..Ali ' ' ûl~\~1 ~.J~I ~.J ~1 ü~J ~.J_,..JI ~yJI ~.J~I û.il~i .ill J.=J \J.ilJ 4}' "la ol\ ~1) .):!~._,!y~\ ~J yl..t..J'/1 C..W ~.fi\ ~ ~Y 'Jj ,4\J\.S..!.Î ~~~ J~YI o1\ ,JjcYI r.,;;;1 b,.lal\ ~~ ~ ûts~'li.J .Jjl;...JI CJc A.l.ots ~Jy....JI wly...)'l ~_,s....JI 1- -1 LJ ."\1 ... 1\ ~ · rr--J .• 1. _;; <.....ili.JI .J1 • 1 <.r . .J 4.lJ 1~ -;11 ~ '"·- · -11 ..)l.......:=o ~~~ J J~L-..11 ~.. UA ~ -~ . .J ~·' y r.,r

<Y'..f:.: lj~l ~1 '-'_;ill ~uY. y. ljy>JjJ ~\.1·~\JY. ~l.Ucl ~ ~ .~IJWI i~ Î;;:;;.,·, ~~)i JLAc.Î ~~~~. û4.~'11J ûy_,JJ~IJ ubA.~I ~-} ~1 A.S.J~ ~ ~J ,û~~l ~ ~L.:lc.'ll i~ L....~ L......;fo Uts r.,;; l.,él\ ~ -.r-l..ü;..'ll o\..9)\J lj~~;{\ ~_,]\~y~~~ ~ts .~ ···''-1 ..r· ·11 ~l.,. · Ï.AA c.,r-; 1...~ • t...r '1 .J~1 ~ 1- .11 C\:lj'JI .•.,-: ·.11 ~.::.JI.~.l\ ~ 1- ~L.:lc.'ll . UA • ~Î ,~ •.J..Y" L~ r.r

.J.....~I .J~ .JjiS~I ~.J~~ ~.J 0-- ~~ ~fo.J ..l:a~ ~~.:.....:JI·~~~ ~ 0-- LJts ~lp.JI ~U...-} <.)bi_,.Jl \~ LAL.ü.\1 ~.J-""'-} ~WI û~l ~ ..::..J) \~ .-ûbî <.r . .J A..ijLA -'- -'1 ~ · u~.::~o. n· ~~ ''. ~t.......:=o'lw · , _,_...,... .J ~ • 1..5"' • • 4.lull ,. ~Uc. J .._..L....l::u . ~\J:lc.'ll J ~ u~ . _ j J. . : . ,Il l:.. . le:" •• u ~\ ~\ ~tc.)\ . .J .-:Il ~ . .J ~\ ~1 , 1 ~ ~ ~ J (...)-'=~ ~ • J • , '-r t'""~ •.)_,.... '-r , . • ~

r!LJl

4il

-~.J~I ~y!JIJ o~l f""~IJ 0--~1 ~

dJ.fo. ,bjl.....ll

~.JC

A55NR/3 page 61

tL....:.::a}iy, • . oc <;~IJ ~ ~J_Ji.JI .)~1 ~'?Jii ~1 _)lyJI ~1 out- fi,i:i...ü 1....S ._)lyJI ~1 ülli ~~ ~1

YJJ~I tA.la...- J.-1_;.... ~~~ .)~ ~)1 ~\ o~~ ~.)_,..JI ~yJI ~.)~1 J l"t::JI r.} ~LiA ~.)~1 Î.l....+oJ .~-:U..l.o ~.)A J!JJ o~l ~~~ d).) ~ ~ ~t..:.J J~Lc ~ J)b.j r_} .~1

CENTENARY OF THE PAN AMERICAN HEALTH ORGANIZATION CENTENAIRE DE L'ORGANISATION PANAMERICAINE DE LA SANTE

... El PRESIDENTE: A continuaciém pasaremos al punto 8 del orden del dia, titulado Centenario de la Organizaci6n Panamericana de la Salud (documento ASS/4), y al examen del proyecto de resoluci6n que figura en la resoluci6n EB 109 .R9. Ahora tengo el placer de invitar al delegado de Co lombia a subir al estrado para pronunciar unas palabras. El Dr. RIVEROS DUENAS (C.olombia): Doctor José Francisco L6pez Beltrân, Presidente de la Asamblea Mundial de la Salud, sefiores miembros de la Mesa de la Asamblea, sefiora Directora General de la Organizaci6n Mundial de la Salud, doctora Gro Harlem Brundtland, sefiores ministros, sefiores delegados, sefioras y sefiores: Nada mas grato para la delegaci6n de Colombia, y en nombre del continente americano y del Caribe, que contribuir con emoci6n y admiraci6n a este homenaje que se le rinde a la Organizaci6n Panamericana de la Salud por los enormes logros alcanzados en prevenci6n y promoci6n desde su creaci6n en 1902. Sin exagerar puede decirse que la OPS ha sido una de las instituciones mas trascendentales para la salud en el continente americano por las diversas razones que voy a exponer: elev6 el estatus de la salud publica, lo cual no excluye el hecho de que antes existieran iniciativas con alcance local e intemacional; lider6 el adiestramiento de médicos e higienistas por considerarlo esencial; luch6 por incorporar a la agenda de los gobiemos los planes de salud como elemento esencial del desarrollo; desarrol16 modelos innovadores para la prestaci6n de los servicios de salud; organiz6 campafias continentales para el control de las enfermedades. Me haria interminable si pusiera ejemplos de los resultados de estas acciones, por lo que solamente comentaré unos pocos. La creaci6n de un cuerpo de higienistas y de especialistas en salud publica que honra hoy al continente por sus servicios a la humanidad. C6mo no recordar hoy a Gabald6n en sus luchas contra la malaria, a Soper por la batalla contra la fiebre amarilla, a la Escuela de México por ilustramos mas sobre el tifus exantematico y las diarreas, a Groot por sus aportes al conocimiento de algunas enfermedades transmitidas por artr6podos. El establecimiento de escuelas de salud publica en los paises latinoamericanos. Esto obvi6 la necesidad de acudir, cono en un principio se hacia, solamente a Harvard y a Johns Hopkins; estas escuelas, es el momento de reconocerlo ahora, jugaron el papel fundamental en la formaci6n. de higienistas durante la primera mitad del siglo XX. Las campafias contra el Aedes aegypti como contra la malaria, que si bien requieren ajustes en la actualidad, se desarrollaron con una perfecci6n técnica impecable, fueron exitosas y algunas todavia lo siguen siendo. Los esfuerzos por dotar a la América Latina de laboratorios para producir vacuna contra la fiebre amarilla culminando con el éxito del Instituto Oswaldo Cruz en Brasil y el Instituto Nacional de Salud en Colombia. Las campafias contra la viruela, la poliomielitis y el sarampi6n que, ademas de su éxito bien conocido, contribuyeron a la conformaci6n de redes de laboratorios de salud publica de alta complejidad. El establecimiento de centros de investigaci6n a lo largo de todo el continente. Es, en fin, una historia centenaria de la que hoy se muestra orgullosa la humanidad entera. Hoy en dia, la Organizaci6n enfrenta nuevos retos que resultan fondamentales para el desarrollo de la salud en las Américas. Sin entrar en detalle, quiero destacar las nuevas necesidades y demandas

A55NR/3 page 62

originadas a partir del acelerado proceso de transicion en salud: las nuevas epidemias ocasionadas por el cancer, las enfermedades mentales, las enfermedades cronicas y el trauma. No obstante, persiste un rezago inaceptable de pobreza y desnutricion. Resulta ironico que los enormes avances cientificos y tecnologicos para promover la salud y combatir la enfermedad no estén al alcance de todos. Por estas razones quiero convocar a todas las delegaciones a apoyar decididamente la resolucion propuesta en nombre de toda la humanidad. Muchas gracias. El PRESIDENTE: Gracias, sefior representante de Colombia. A continuacion ruego al delegado de Espafia que suba también al estrado a pronunciar unas palabras en esta importante ocasion. La Sra. VILLALOBOS TALERO (Espafia): Llevamos mucha tiempo hablando de los problemas de salud en el munda, analizando los problemas relacionados con la pobreza, con las enfermedades emergentes, diferentes estructuras, administraciones, internacionales 0 nacionales, han ido presentando a lo largo de muchas afios cuales son sus resultados a la ho ra de aplicar medidas. Yo hoy aqui, co mo representante del Gobierno espafiol, me gustaria que esta Asamblea apoyase decididamente esta declaracion sobre la Organizacion Panamericana de la Salud. Qué duda cabe de que es la muestra mas clara del trabajo en union, de la capacidad de unirnos paises diferentes para resolver problemas comunes y creo que es un gran dia hoy poder devolver a los que a lo largo de estos 100 afios han hecho posible la solucion de muchas problemas de la América Latina que hoy reciban el reconocimiento de los responsables de salud de todo el munda. Desde luego para mi, camo representante de un pais europeo pero con una absoluta vocacion iberoamericana, con una decidida vocacion de unir lo que es la Union Europea con la América Latina, para nosotros ha sido decisiva la presencia de la Organizacion Panamericana de la Salud. Creo que es un gran dia, creo que es una buena ensefianza también para los que hoy en Iberoamérica estan hacienda la salud, para los que en otras regiones del munda con problemas muy similares quieren enfrentarse a estos problemas, yo creo que necesitan nuestro apoyo. Desde luego, en lo que representamos, Espafia en este momento, les puedo decir que tienen nuestro decidido apoyo y estoy convencida que los paises hoy aqui presentes también van a respaldar esta peticion de la Organizacion Panamericana de la Salud. Muchfsimas gracias. El PRESIDENTE: Muchas gracias sefiora representante de Espafia por sus palabras. A continuacion tengo el placer de conceder la palabra a la doctora Gro Harlem Brundtland, nuestra Directora General. The DIRECTOR-GENERAL: Mr President, the centenary of an organization is a very special occasion, certainly in this case when it is a family member. The Pan American Health Organization was the first regional health organization in the world and, on the founding of WHO, therefore, set the pattern for our regional structure. During the 54 years that WHO has been in existence, the two Organizations have worked together as one. Yes, we are united. Each has been able to draw on the strength of the other for mutual benefit. lt is a quite remarkable example of international cooperation. PAHO has always had outstanding staff, has often been in the forefront and is excellently led by Sir George Alleyne. I want to pay tribute to George for his long and dedicated contribution to public health in the Americas. Today, as a symbol of WHO's congratulations and very best wishes, I would like to present this plaque to the President of the Health Assembly, as a representative ofthe Member States ofPAHO.

A55NR/3 page 63 The plaque says: "To the Pan American Health Organization, in commemoration of 100 years of extraordinary service to health in the Americas From the World Health Organization May 2002" (Applause/Applaudissements)

El PRESIDENTE: Muchas gracias colegas ministros, doctora Brundtland. En nombre de todos los paises de las Américas tengo el gran honor de aceptar esta hermosa placa, que la consideramos como un reconocimiento a todos los trabajadores de salud de nuestra Region, quienes han venido laborando muchas veces en condiciones dificiles durante todos estos anos para mejorar la salud de nuestra gente. Este reconocimiento a la Organizacion Panamericana de la Salud por su Centenario es un hito importante, no solo en la historia de la OPS, sino también en la historia de la salud publica. Fue hace 100 anos que los delegados de 11 naciones de las Américas se reunieron en Washington para elaborar acuerdos y normas para la Jucha contra la fiebre amarilla, la peste, el colera y otras enfermedades infecciosas. Hoy estamos reunidos aca en Ginebra siguiendo esta Jucha en pro de la salud con algunas de las mismas amenazas y otras nuevas, pero con la satisfaccion y el orgullo de haber avanzado mucho. Hemos erradicado la viruela en el mundo, senores Ministros, y vamos en camino hacia la erradicacion de la poliomielitis y el sarampion. Estos son acontecimientos muy importantes, que demuestran lo mas noble de la humanidad y seran siempre reconocidos entre los adelantos mas importantes de la ciencia y la medicina. Pero no podemos descansar en nuestros laureles. Ahora vamos en camino de salvar la vida de muchos ninos y nifias que mueren innecesariamente. Seguimos avanzando en muchos campos importantes. Como repito, tenemos mucho por hacer aun y espero que cuando nuestros descendientes estén aca, dentro de 100 afios, cele bren tantos o mas adelantos en salud publica como los logrados en este Centenario. Muchas gracias. Pasaremos ahora al examen del proyecto de resolucion incluido en la resolucion EB109.R9, que figura en el documento EB109/2002/REC/l. l,Desea la Asamblea adoptar esta resolucion? Al no haber objeciones, se adopta la resolucion. Antes de levantar la sesion, me permito recordarles que la proxima sesion plenaria se celebrara el miércoles 15 de mayo a las 9.00 horas y que en ella se examinara el informe de la Comision de Credenciales. A continuacion, la Comision A celebrara su segunda sesion, mientras se debate el punto 3 del orden del dia en el Pleno. Se levanta la sesion.

The meeting rose at 17:25. La séance est levée à 17h25.

A55NR/4 page 64

FOURTH PLENARY MEETING Wednesday, 15 May 2002, at 9:00 President: Dr J.F. LOPEZ BELTRÂN (El Salvador)

QUATRIEME SEANCE PLENIERE Mercredi 15 mai 2002, 9 heures Président: Dr J.F. LOPEZ BELTRÂN (El Salvador)

FIRST REPORT OF THE COMMITTEE ON CREDENTIALS1 PREMIER RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS 1

Se declara abierta la Asamblea. La Asamblea examinani hoy el primer informe de la Comision de Credenciales, que se reunio ayer, martes 14 de mayo, bajo la presidencia del Dr. F. Gracia (Panama). El informe figura en el documento ASS/42, que todos ustedes han recibido. L,Desea la Asamblea aprobar este informe? No habiendo ninguna objecion, se aprueba el informe.

ADDRESS BY THE DIRECTOR-GENERAL (continued) ALLOCUTION DU DIRECTEUR GENERAL (suite)

Ahora volveremos al punto 3, como anunciamos ayer. Quisiera comunicar a la Asamblea que la Comision A celebrara ahora su segunda sesion, mientras que la Comision B se reunira solo después de que hayamos concluido el debate sobre el punto 3. Los proximos dos oradores que aparecen en mi lista son los delegados de Indonesia y Marruecos. L,Puedo pedirles que suban al estrado? Tiene la palabra el delegado de Indonesia. Dr SUJUDI (Indonesia): Mr President, Madam Director-General, distinguished delegates, first of ali, allow me to take this opportunity to congratulate the newly appointed office bearers of this Fifty-fifth World Health Assembly on their election to conduct the work of this important gathering. lt is therefore an honour for me to participate in this meeting's debates and to share with you recent developments in Indonesia's approach to health risks. Before 1 continue, Jet me congratulate the Director-General of

1 1

See reports ofcommittees in document WHA55/2002/REC/3. Voir les rapports des commissions dans le document WHA55/2002/REC/3.

A55/VR/4 page 65

WHO for her excellent, comprehensive and inspiring report covering the four strategie directions of WHO, which will doubtless become a milestone for further global health development programmes. ln the last decade, significant progress bas been achieved in the field of health, leading to a much greater awareness and understanding of contemporary health risks. At this point, allow me to commend the Director-General for The world health report 2001 which mentions, amongst other things, that The world hea/th report 2002 will revolve around the topic of risks to health. ln this regard, 1 believe that this future report will help us move ahead in order to better address the risks to health. Consequently, it is our obligation to advocate the importance of these risk factors for disease prevention and control. ln lndonesia, because of the economie and developmental situation specifie to our country, the risks to health are twofold. The first involves the threat to the health services themselves, due to a lack of human or financial resources and to potentially disabling social and political restructuring programmes. ln this complex situation there is no doubt that the lack of fmancial resources will limit the Government' s margin of manoeuvre to improve the health status of the lndonesian people. The second health risk is that posed by emerging diseases, poor environment and sanitation, and by the reluctance to modify traditional behaviour patterns in favour of a healthier lifestyle. Faced with this new set of risks, two years ago, we, in Indonesia, initiated a new health paradigm focusing on greater health promotion and disease prevention. To reduce the burden imposed by this second risk, sorne initiatives have been implemented, which include: introducing the concept of healthy cities, healthy districts and healthy villages; strengthening the environment and sanitation programme by improving housing and sanitation conditions; encouraging the implementation of health promotion at home, as weil as in schools, health institutions, work places and public places; increasing awareness and use of micronutrients, especially iodine, iron and vitamin A; developing and implementing early warning systems in nutritional deficiency; and campaigning across the country on the merits of exclusive breast-feeding; initiating the tobacco-free initiative as part of health-promotion activities. Indeed, a national tobacco strategy bas been formulated and is in the process of achieving national consensus. These activities are fully supported by WHO, incorporating noncommunicable diseases as part of our national household survey in such a way as to reflect the priority concern of assessing common health risk factors. At this juncture, allow me to re-emphasize the importance of determining the various risk factors for health through technically appropriate and effective systems of surveillance, data collection and health information. We need to focus on cast-effective interventions that address the key risk factors, for which lndonesia continues to require support, both technical and financial. Finally, it is my sincere hope that this Fifty-fifth World Health Assembly will contribute to the formulation of a global health commitment and vision designed to significantly improve health prospects for ali in the coming years. Thank you, Mr President. Mr EL J(HIYARI (Morocco):

Mr BHANDARI (Nepal): Mr President, Madam Director-General, honourable ministers, excellencies, distinguished delegates, ladies and gentlemen, first of ali, on behalf of my delegation, I would like to congratulate

A55NR/4 page 67 the President on his election as President of the Fifty-fifth World Health Assembly. It is a great honour for my country to have the opportunity of serving the Fifty-fifth World Health Assembly as one of the Vice-Presidents. Our congratulations are also due to ali the Vice-Presidents and the Chairpersons of the Committees. We extend our appreciation and thanks to the Director-General of WHO, for boldly and innovatively putting forward the agenda items that concern the world, including my country. Let me begin by briefly introducing the existing situation of health development in Nepal. His Majesty's Government of Nepal is committed to sustained efforts for further improving the health status of the entire population through equitable access to quality health care services with full community participation. By July 2002, we will be launching the country's lOth Five-Year Health Plan. The Plan is geared to protecting ali the people from the risk of major causes of mortality and contributing to poverty reduction. The policy objectives are focused on: making essential health care services available to ali people, giving special emphasis to the rural, remote, poor, and disadvantaged population through the development of an effective and efficient health management system; establishing a decentralized health system with a participatory approach at every level; establishing public-private-nongovernmental organization partnership in the delivery of health care services; and improving the quality of health care provided by public-private-nongovernmental organization partnership through total quality management of human financial and physical resources. With a per capita income of US$ 220 per annum, and an incidence of poverty twice as high and a gender-related index twice as low in rural areas, achieving these policy objectives becomes a mammoth task. We ali know that poverty is a major risk to health; its implications extend far beyond individual suffering. It threatens social cohesion and fuels violence and mental stress in communities. Our challenge today calls for ensuring more equitable and gender-sensitive health and wellbeing, with minimum disparity among individuals and groups. Achieving such a health objective would require a judicious private-public response to enable a vast majority of people to escape from the vicious cycle of ill health, low productivity and poverty. The task is difficult, but not impossible. We are mobilizing a more coordinated multisectoral approach with shared accountability. I am pleased to report that in Nepal we have established a Commission on Sustainable Development under the chair of the Prime Minister. We are establishing a committee on macroeconomies and health within this Commission. Given such a political commitment and a vibrant democratie process in the country, backed by national and international support, I believe we can boldly and successfully confront such challenges. In this regard, Nepal's recently amended Civil Code is an important milestone towards promoting the overall empowerment and protection of women' s interests in several areas. In the area of health, abortion has been largely decriminalized for married women. This would contribute to saving many women from the risk of death from unsafe abortion, which is a major cause of maternai deaths in the country. Despite the harsh reality of poverty combined with a difficult terrain, and the current state of emergency, Nepal has covered much ground in protecting its people from major health risks. With sorne 48 000 village-based female community health workers, Nepal's basic health infrastructure is linked all the way to the villages. Infant/child mortality and total fertility rates have markedly declined. Poliomyelitis vaccine coverage has increased to 90% while that for ali vaccinations for infants under 12 months has gone up to 60%. Knowledge of HIV/AIDS among women and men has improved, but in view of the rising incidence of the problem, there is a need to step up the HIV/AIDS awareness campaign. I would like to highlight a few reform steps, which we have recently undertaken towards mitigating the critical concerns that I described earlier. A National AIDS Council has been established un der the chairmanship of the Prime Minister. The main purpose of this Council is to develop a robust public-private partnership to manage and implement an expanded response to improving the access, utilization and quality of services for the prevention and control ofHIV/AIDS. We have established a seven-member National Health Systems Reform Committee. The primary ai rn of this Committee is to develop and recommend a holistic reform package in line with the policy objectives of the lOth Five-Year Plan. The Committee's work has progressed weil through a much wider participation of public-private organizations, external development partners and nongovernmental organizations. The Committee has just successfully completed the task. The Ministry of Health has decided to decentralize the entire management of sub-health posts to concerned village development committees by the end of this fiscal year. A local health managing committee

ASSNR/4 page 68

consisting of equal numbers of men and women, including elected women ward members would be responsible for operating and managing the health care at the village level. Technical support, as required, will be provided by respective district health offices. The Local Self-Governance Act guides such a devolution process. I want to conelude by going back to the issue of wh ether by investing in health we could redu ce poverty in least developed countries like Nepal. lt ali depends on how seriously and willingly the international community will invest to close the existing gap in resources needed to meet the essential health care needs of the poor. We look upon the World Health Organization as a strong and lead partner in this crusade. We, in Nepal, appreciate the dedication and leadership of the Director-General in mobilizing the international community to implement the new global blueprint for development as recommended by the global Commission on Macroeconomies and Health. I believe that increased investment in health would lead to narrowing the gap between rich and poor, and would stimulate economie growth in the world's least-developed countries like Nepal. Thank you very much for your kind attention. El PRESIDENTE: Doy la palabra al delegado de Costa Rica, quien hablara en nombre del Grupo Centroamericano: Belice, El Salvador, Guatemala, Honduras, Nicaragua, Panama y la Republica Dominicana. El Dr. LOPEZ CÂRDENAS (Costa Rica): Sefior Presidente, sefiora Directora General, sefioras y sefiores delegados: permitame en primer término, sefior Presidente, felicitarle por su designacion. Constituye un honor para la region centroamericana el que uno de sus miembros presida hoy esta honorable Asamblea Mundial. Sefior Presidente, me siento honrado de representar al Consejo de Ministros de Centroamérica, integrado por Belice, El Salvador, Guatemala, Honduras, Nicaragua, Panama, la Republica Dominicana y Costa Rica, con el objetivo de dar a conocer los avances frente a las necesidades que en materia de salud publica existen en nuestra subregion. Atendiendo las necesidades de la poblacion centroamericana, los paises han instrumentado en sus fronteras acciones conjuntas de promocion, prevencion, reduccion y control de los riesgos en salud de esas zonas. En el ambito de la XVII Reunion del Sector Salud de Centroamérica y la Republica Dominicana (RESSCAD), se acordo la novedosa implementacion y desarrollo de un instrumenta de medicion del desempefio de las funciones esenciales de la salud publica, ejercido por la autoridad sanitaria en los paises de Centroamérica, hasta entonces inexistente. Este instrumenta, inspirado bajo la iniciativa conocida coma «La salud publica en las Américas» de la OPS/OMS, pretende mejorar las practicas sociales en salud publica y fortalecer las capacidades de la autoridad sanitaria con base en la definie ion y medicion de funciones esenciales de la salud publica en los paises de la region. La riqueza de este instrumenta estriba en la capacidad que tendra cada pais de disponer de un marco para la toma de decisiones que ayude a superar debilidades y sostener fortalezas. En los ultimos meses, la agenda ministerial del sector salud centroamericano ha englobado tematicas de salud de los trabajadores, sistemas de informacion y de control epidemiologico, control de plaguicidas, capacitacion de recursos humanos, compras de medicamentos, acciones conjuntas en materia de enfermedad, transmision sexual, tuberculosis, ordenacion de politicas de atencion maternoinfantil, y control de vectores y salud ambiental. Asimismo, en la prevencion y tratamiento del VIH/SIDA, los paises de la region esperan seguir contando con el apoyo de la Organizacion Mundial de la Salud, de la Organizacion Panamericana de la Salud y del Fonda Mundial para la Lucha contra el SIDA, la Tuberculosis y el Paludismo, no solo con asistencia técnica sino también en los proyectos que se encuentran sometidos a aprobacion en la esfera de sus competencias y que constituyen una alta prioridad para combatir de un modo sostenible y significativo la reduccion de estas enfermedades. Aprovechamos este foro para expresar nuestras felicitaciones a la Organizacion Panamericana de la Salud por el centenario de su establecimiento. A través de esta honorable institucion se

ASSNR/4 page 69 promueve la igualdad en materia de salud, se Jucha contra las enfermedades y se mejora la calidad y expectativa de vida de los pueblos de América. Senor Presidente, a pesar de la situacion economica, social y de eventos naturales, los paises de la region centroamericana bernos logrado avances importantes. Entre el los podemos mencionar que en Panama se ha logrado una cobertura de vacunacion del 95%; se redujo la mortalidad infantil en una tasa del 18 al 16 por 1000. La expectativa de vida en Panama ha alcanzado los 73 anos, y se ha logrado el acceso al agua potable a mas del 85% de la poblacion. En la Republica Dominicana se han reparado y equipado hospitales y clinicas rurales y se han implementado proyectos de capacitacion y servicios en epidemiologia y seguridad nutricional. Se han logrado importantes avances en la participacion comunitaria y del sector privado en la provision de servicios de salud y en la prevencion y tratamiento del VIH/SIDA. Se ha designado un plan estratégico para identificar a la mujer embarazada positiva y para administrar medicamentos antirretrovirales a la madre y al infante. En Belice se ha iniciado una reforma de las politicas publicas que pretende fortalecer la atencion primaria y ampliar el sistema de salud y establecer un sistema mixto de atencion publicoprivado. Ademas, se esta ampliando la cobertura del sistema de seguridad social y se ha dirigido con éxito el principal hospital nacional, Karl Hensner, bajo el concepto de independencia y autonomia publica. En Guatemala se ha implementado un programa de salud reproductiva, se ha fortalecido la extension de cobertura de los servicios basicos del primer nive! de atencion y se esta trabajando intensamente en un programa de promocion de la salud con dos estrategias bâsicas: municipios promotores de la salud y la paz, y escuelas saludables. En el tema de control del tabaco, el Congreso de la Republica de Guatemala aprobo una ley que regula el uso, la publicidad y la venta del mismo, en coordinacion con el sector privado y la sociedad civil. Esta implementandose un programa intensivo de combate del SIDA. En Honduras se ha avanzado en la descentralizacion y el desarrollo local, destacando la puesta en marcha del convenio marco AMHON. La Secretaria de Salud ha estimulado la conformacion de mancomunidades municipales y la firma de acuerdos y compromisos de cogestion de servicios de salud. En El Salvador se ha elaborado un documento de referencia titulado «Acceso acelerado de la Terapia Antirretroviral para salvadorenos con VIH/SIDA», para la atencion a este sector de la poblacion. La cobertura de vacunacion ha alcanzado el 97%; se ha introducido el uso de la vacuna polivalente y los sistemas bâsicos de salud integral (SIBAS!) alcanzan una amplia cobertura. En los primeros 100 dias del Gobiemo de Nicaragua se esta trabajando intensamente para mejorar la calidad de los servicios de salud y asegurar la disponibilidad de los medicamentos basicos, involucrando a toda la sociedad en salud preventiva, mediante campanas de vacunacion, el mejoramiento ambiental y servicios basicos. Ademas, con el fin de combatir la pandemia del SIDA a través de un plan nacional estratégico se han asignado US$ 4,5 millones para 2002 y 2003. En Costa Rica se redujo la tasa de mortalidad infantil del 14,2 en 1997 al10,8 en 2001. Aumento la expectativa de vida al nacer en un porcentaje importante con cifras similares a los principales paises desarrollados. En los ultimos anos se ha hecho una fuerte inversion en equipo e infraestructura de salud y se ha consolidado la reforma del sector mediante un fortalecimiento institucional, ampliando el marco legal. Cabe destacar que la nueva administracion gubemamental en Costa Rica ha incorporado dentro de sus politicas la actividad fisica y el deporte como instrumenta para disminuir los riesgos y promover la salud. Senor Presidente, todos los paises a los que represento queremos hacer patente nuestra conviccion de que la salud es un derecho universal que no tiene fronteras ni requiere un especial documento de identidad. Creemos que el pueblo de Taiwan, como cualquier grupo humano, debiera tener el derecho y la obligacion de participar en un sistema intemacional solidario como la Organizacion Mundial de la Salud, que busca mejorar las condiciones de salud de todos los ciudadanos del planeta. Por consiguiente, consideramos que ellos tienen derecho también a contribuir con sus aportes en medicina a esta Organizacion y esperamos que algun dia ese sueno se les haga realidad. Muchas gracias. Mr ABDULLAH (Maldives): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, 1 wish to congratulate the President and his office bearers on election to this august Assembly. 1 also extend

A55NR/4 page 70 warm felicitations to the Director-General for her innovative efforts to muster synergy for reform. I would also like to thank our Regional Director for his dedicated leadership in improving the health of our Region. Against the backdrop of emerging and re-emerging diseases in many countries, Maldives is fortunate in eliminating and controlling most of the common communicable diseases, but the scourge of noncommunicable diseases has emerged. We are faced with a growing risk of noncommunicable diseases in our country. Thus lifestyle-related diseases, such as hypertension, diabetes, cardiovascular diseases and of course, tension-related mental conditions, have become our worst threat to health. I would like to express our profound gratitude to our Director-General for her vision and courageous change. The choice of "risks to health" as the topic for our round tables is indeed very timely. Globally, noncommunicable diseases are taking a heavy toll. Health care systems and health insurance schemes are stretched to their limits to meet the ever-increasing demand. We hope that our collective will and resolve will enable practical solutions to reduce these risks to health. Technological advancements have revolutionized our lives. They have changed the way we work, eat and entertain ourselves. Development, I might say, is in many ways like a bitter pill wrapped in sugar coating. We are getting more used to time-saving, easy-to-use conveniences, from the electric tooth brush to the motor car. Most of these gadgets are useful but they have made us rather Jazy and inactive and unhealthy physically. Similarly, we are more prone to armchair sports. We are getting addicted to television and computers. The powerful commercials and their makers that indoctrinate us to use more gadgets and eat more processed foods are no Jess assertive than the tobacco industry. They wean children and youth away from healthy habits and nutritious foods. I reiterate our strong commitment and support to WHO's tobacco-free initiative. Maldives pursues a strong anti-tobacco policy. We have already implemented most -of the measures in the framework convention. A vigorous anti-tobacco programme in our schools has been very successful. More and more parents and others are leaving the packs behind, heeding the pleas of their children. That is why a healthy school is very important füï our future and for our health. Children develop their characters during school !ife. If we inculcate healthy habits and promote healthy living in our children it will be a valuable asset for our future and also for our health. To take maximum advantage of the opportunity we must bring health to the centre stage of student !ife. In Maldives we have given great importance to school health. I feel WHO should give more focus to this important issue and really make students a strong partner and leader in health. We are spending a large portion of our national budget on health. This policy of investing for health with a strong emphasis on prevention and health promotion has produced tangible results. It is a rewarding investment for our socioeconomic advancement. We are happy to say that, as part of the unswerving commitment by our President Maumoon Abdul Gayoom to health and quality of !ife, we have implemented ali the recommendations of the United Nations Millennium Declaration. Our responsibility to preserve a safe and healthy environment is paramount. Fifteen years after the United Nations Commission on Environment and Development broke new grounds by developing the concept of sustainable development, we are still wavering without taking concrete steps to reduce emission of green house gasses that cause global warming and endanger and pollute the environment, risking healthy human existence. The forthcoming World Summit on Sustainable Development to be held in Johannesburg will be a great opportunity for our work towards a healthy and dignified !ife. We must give health its ali important place in the Summit, we must stress the health risks and determinants beyond communicable diseases, and the impact of environment and globalization on health. I hope that WHO will seize the opportunity to send a powerful appeal across the world to save humanity from the shackles oftobacco when we kick off the World Cup, coinciding with World No Tobacco Day on 31 May. At the same time, we can organize tobacco-related messages throughout the toumament. Health challenges are numerous, but opportunities are not Jess. Let us ali join together to make use of these opportunities to ensure better health. Let us take a look at our future and also work together to save our children from harmful influences and help them to adopt healthy lifestyles so that they and future generations can grow and live in health and dignity. Thank you very much.

A55NR/4 page 71 El PRESIDENTE: Doy la palabra al delegado de Namibia, quien hablani en nombre de los Estados Miembros de la Comunidad del Âfrica Meridional para el Desarrollo: Angola, Botswana, Lesotho, Malawi, Mauricio, Mozambique, la Republica Democnitica del Congo, la Republica Unida de Tanzania, Seychelles, Sudafrica, Swazilandia, Zambia y Zimbabwe. Dr AMATHILA (Namibia): Mr President, Madam Director-General, delegates, on behalf of the 14 Member States of the Southern Africa Development Community (SADC), I offer you and members of your bureau our warmest greetings and congratulations on your election and wish you success in steering the business of this Assembly. I give you the assurance of our cooperation. SADC is made up of 14 sovereign States that have agreed to form a community for the purpose of ensuring development in our region. Our health sector, an integral part and a vital component of the community, has as its central objective the improvement of the health of ali our people. We are a diverse group of countries, with national populations ranging from 81 000 to more than 50 million. Despite differences in many of our indicators of socioeconomic development, we are bound by a common destiny and pursue our unity in diversity. We are faced with common challenges in the form of diseases, like malaria, tuberculosis and HIV1 AJDS, as weil as the rapidly increasing preval en ce of noncommunicable diseases. WHO and UNAIDS acknowledge that our subregion currently has the AlOS, while we also have high rates of tuberculosis and malaria. The existing highest burden of HIV1 mechanisms of the Global Fund to Fight AIDS, Tuberculosis and Malaria do not adequately reflect the fact that the epicentre of the epidemie is in our SADC subregion, nor do they adequately take into account the speeificities of our subregion. As a subregion we are actively addressing the challenges facing us. We have a coherent subregional strategy on HIV/AIDS. We are registering impressive gains through intercountry collaboration in the fight against malaria, using measures that are scientifically based. These measures are use of insecticides, including targeted and controlled use of DDT for indoor residual spraying, use of treated bed nets and better case management. We also subscribe to and implement the directly observed treatment, short course (DOTS) strategy for the control of tuberculosis in the subregion. At a time when we have to deal with sorne of the greatest challenges to our health systems, posed by the double burden of communicable and noncommunicable diseases, we also find ourselves increasingly vulnerable to the effects of the uneven relationship between the developing and developed world. In addition, we have to deal with the negative impact of globilization. Over the past three centuries, our subregion has provided resources and wealth that have contributed to the economie and social progress of what are now called the developed countries. We sacrificed not only our natural resources and our labour, but also our future and the well-being of our communities. Despite the end of colonialism and naked exploitation, we continue to provide a significant proportion of the global wealth but derive a Jess than significant proportion of the benefits. We train health professionals at great cost to our nations, only to find that a large number of them are lost to developed countries. Our overburdened health systems are left with less than adequate human resources. We support and applaud the move towards the development of an international code of practice in recruiting human resources for health. Such a code of practice should strike a balance between the rights of individual professionals and their obligations to their countries. Furthermore, we be lieve that movements of health professionals between countries should take place in an orderly manner and be regulated by means of government-to-government agreements. Initiatives that are meant to assist us, like aid, grants, loans, consultancies, technology transfers, global funds just to name a few, often have conditionalities, which act as barriers that we have to overcome to gain access to these benefits. We sometimes wonder who benefits most from these admittedly well-meaning efforts. And while we are constantly reminded of good governance and respect for human rights, we wish to remind the world that, denying people access to basic health care and the hope for a better !ife, is also an abuse of human rights.

A55NR/4 page 72 We have been reminded that the theme we need to address during this Assembly centres on the risks to health. In our view, the greatest risks to health are not so much those arising from natural forces and from micro-organisms, but the inequity that our countries and our communities face day in and day out. Poverty, hunger, despair, population displacements, poor infrastructures- these are the major risks to health. The woman dying after childbirth is not just dying from post-partum haemorrhage and sepsis, but from years of poverty and neglect and lack of access to basic health care. The child dying from cholera is not just a victim of a bacterium, but also a victim of the uneven development that left the community without safe water and basic sanitation. The long-term solution is not an antibiotic or a vaccine, but development, development that aliows us to hamess the resources that we do possess and utilize them to build stronger communities and address their needs for education, health, nutrition, sanitation and safe water supply, shelter and ali the things that people in affluent countries take for granted. Development depends firstly on our own efforts, but th ose cannot be nurtured and grown without an environment of equity, justice and peace. The SADC subregion is prone to drought. This year, due to poor rainfali, famine is looming. As the health sector, we will be advocating to our colieagues in the ministries of agriculture for more long-term solutions to the problem. In the short-term, we urge WHO to work closely with its sister organizations such as the Food and Agriculture Organization of the United Nations and the World Food Programme, to come to the assistance of our subregion to avert a human calamity that has potential catastrophic consequences for the health and lives of our people. We bring to the attention of the Health Assembly the New Economie Partnership for Africa's Development (NEPAD), which seeks to mobilize the efforts and resources of Africa and those of its partners for Africa's development. This strategy recognizes the central role of health in development and the improvement of the health of ali African peoples as a central objective of development. In SADC we believe in ourselves and we believe that through our own efforts we will improve the health of our families and communities. We acknowledge that our problems are not unique to our part of the world and we extend to ali struggling and suffering peoples our understanding and solidarity. We are encouraged by the retum of peace to Angola and the Democratie Republic of the Congo, our two SADC Member States who were plagued by civil strife. The retum of peace will afford us the opportunity to focus on our health agenda. As a subregion that experienced wars and violence in the past for a long time, we are acutely aware of the ir impact on the health of populations. It is for this reason that we are gravely concemed and distressed by the protracted war in the occupied Arab territories, including Palestine, as it directly affects the delivery of health services in the region and has led to unnecessary loss of life. We therefore cali on ali the parties involved to urgently seek solutions to this sad state of affairs. Our region has the honour to host the World Summit on Sustainable Development which will be held in Johannesburg from August 26 to September 4 this year. Arising from our conviction that health is an integral part of development, we cali on ali Member States of the World Health Organization to ensure that health is placed at the centre of national development efforts. One clear message that we must en sure cornes out of the summit is that there can be no sustainable development without health. On behalf of ali the members of SADC, I would like to thank you sincerely for your attention. Dr VIT (Czech Republic): Mr President, Madam Director-General, exceliencies, ladies and gentlemen, first of ali aliow me to offer my congratulations to the President on his election to the head of this important session and I wish him every success in the execution of this demanding office. It is a great honour for me to be present here with you today and to speak on behalf of the Czech Republic. I would like to thank the Director-General for the work she has carried out so far, for her personal approach and engagement, for which she deserves both our thanks and our admiration. In her opening address she has presented a lot of clear messages and inspiring new ideas. I would like to highlight sorne themes which are of particular interest to the Czech Republic. We share ali the priorities mentioned in the discourse of the Director-General as the Czech Republic is committed to the main objectives of WHO as stipulated in its Constitution. Thus we believe this Organization is the only global forum that coordinates the activities of ali responsible health

ASSNR/4 page 73

authorities to ensure that ali people around the world realize their unalienable right to the highest attainable standard of health. The most challenging problems the Czech Republic is facing are similar to other countries in comparable situations, that is the countries of the European region, the group of candidate countries for membership in the European Union, as weil as the so-called "emerging donors" such as the Czech Republic. In the last decad~ of the twentieth century the development of public health indicators in the Czech Republic set out on a long expected journey to improvement. It bas become possible after health care enhancement in terms of both quality and quantity, innovative approaches to eatinghabits and better accessibility of new medication. In sorne parameters, such as infant and maternai mortality, the Czech Republic even ranks among leading countries in the world. A regular increase in life expectancy bas become visible since 1990 with respect to men and even several years earlier with respect to women. The difference between the life expectancy of men and women is approximately seven years in favour of women; this relatively narrow gender margin places the Czech Republic in the first rank among the candidate countries. Cardiovascular diseases remain the most frequent cause of death in the Czech Republic. However, things are getting better. The total reduction of the standardized death rate for myocardial infarction reached 27% in the last decade. Lifestyle-connected diseases remain a significant challenge for public health. Therefore, a principal implementation document on public health care, the National Programme of Health in the Czech Republic, challenges major causes of disease as wrong eating habits, tobacco use, alcohol consumption and drug addition, physical inactivity as weil as limitation and control of excessive stress and related aspects in reproductive health, and so forth. In this context we are happy to state that the Parliament of the Czech Republic bas adopted a new Act introducing stricter conditions for tobacco advertising, in particular with respect to youth under the age of 18. It is prohibited to place billboard advertisements near schools and facilities designed mainly for minors, and only people older than 25 years can be shown in those spots. The National Programme of Health bas been approved by the Government of the Czech Republic and incorporated in the National Health 21 strategy. We believe that further development of the programme will bring about other positive changes in projected life expectancy and in public health in the Czech Republic. Ladies and gentlemen, thank you for your attention. Mr M'BAREK (Tunisia):

ASSNR/4 page 74

ASSNR/4 page 75

El PRESIDENTE: Ahora tiene la palabra el delegado de Dominica, quien hablara en nombre de Antigua y Barbuda, Bahamas, Barbados, Belice, Granada, Guyana, Haïti, Saint Kitts y Nevis, Santa Lucia, San Vicente y las Granadinas, Suriname y Trinidad y Tabago. Mr SARABOCHE (Dominica): Thank you Mr President, delegates. I have given thought to the notion that no society, no nation, no people can be healthy unless good will exceeds ill will, unless the spirit of cooperation surpasses antagonism. Sorne of us are sometimes healthy and happy. Sorne of us are sometimes unhealthy and even angry. But ali of us must think to take right action to make others healthy, happy and even angry. With these, my own thoughts, I am honoured to make this presentation on behalf of the warm, friendly and cricket-loving Caribbean Community, which includes countries stretching from Belize, located in Central America, to Guyana and Suriname sharing borders with oily Venezuela and footbali-loving Brazil in South America. I should note that, in addition to those countries listed in the programme, are the Bahamas, Belize, Guyana, Haïti, Jamaica and Suriname. I take this opportunity to congratulate the President on his election to the post and express gratitude to the Director-General for the continued support of the World Health Organization to our region. Much of this support has been delivered through the programmes and activities of the Pan American Health Organization and the accelerating access to care initiative formerly piloted by UNAIDS. It is only fitting that, in this connection, I extend the warmest gratitude to the Regional Director for the Americas for his remarkable leadership and for his unstinting endeavours for health in the Americas. The Pan American Health Organization started 100 years ago: many congratulations. Many of the issues on the agenda for this Health Assembly are of considerable importance to the Caribbean. We commend the World Health Organization on its initiative in establishing the Commission on Macroeconomies and Health and for the insightful report that it has produced. The mode! that establishes the intricate links between economie policies and health outcomes offers clear !essons for us in the Caribbean, yet its application seems to have overlooked the case of smali economies like those in the Caribbean, that are seriously affected by the unequal nature of global economie development, the harsh World Trade Organization rules that ali but destroyed the banana industry in sorne countries, and the high debt burdens confronting others. These are the circumstances that justify the appeal made by our political leaders in Kyoto and Monterrey for special and differentiai treatment without which we, in the health sector in the Caribbean, would not be able to sustain even modest levels of expenditure and thereby contribute to the good health of our populations. We continue to argue that development cannot be measured by gross domestic product only but has to take into consideration the relative levels of poverty, the fragile nature of the small island economies that are subject to recurring hazards due to natural disasters. It is for these reasons when we come to deal with the issues of affordability for pharmaceuticals and for universal coverage for health care, that we propose that consideration be given to a budgetneutra! approach to pricing. This is a concept whereby the costs associated with assessing antiretroviral drugs for the public sector should not be greater than the increasing costs of hospitalization and treatment of opportunistic illness in the absence of antiretroviral drugs. It also places emphasis on coverage rather than the convenient, but short-term, response of clustering diseases. In this regard, a recent meeting ofCARICOM's Council for Human and Social Development acknowledged the importance ofthe work of the WHO Commission. It recommended that CARICOM must establish a task force on macroeconomies and health to re-examine the issues presented in the Commission' s report, paying parti cul ar attention to the special and differentiai requirements of the smali economies in the Caribbean as they seek to promote and implement policies to achieve health in development. In this same context, we note with great disappointment that, of the six proposais submitted by the Caribbean for support for the Global Fund to Fight AIDS, Tuberculosis and Malaria, only one was funded in this first round of disbursements. The successful country, Haïti, is admittedly in greatest need of support, but this miserly allocation to the Caribbean appears at odds with the actual Caribbean

ASSNR/4 page 76

reality. lt is the region with the highest prevalence rate outside sub-Saharan Africa. Nine of the 12 countries with the highest HIV prevalence in the Americas are in the Caribbean basin; AlOS has become the major cause of death among men and women in the 15-44 age group in the Caribbean. By the end of 2000 sorne 390 000 adults and children were estimated to be living with HIV or AlOS. However, due to under-reporting, the figure is projected to be as high as 500 000. In the worst-affected Caribbean nation, 13% anonymously-tested pregnant women were found to be HIV-positive. The Caribbean has every intention of fighting back and thereby rolling back this devastating disease. To this end it has established a Pan Caribbean partnership against HIV/AIDS coordinated by the CARICOM secretariat, including a series of stakeholding groups, among which are the Caribbean Epidemiological Research Centre, the Caribbean Medical Research Centre, the Caribbean Network for People Living with AlOS, the University of the West Indies and UNAIDS, in addition to severa! international and don or agen ci es. It also includes the who1e network of national AIDS programmes. At the Health Assembly last year, the Secretary-General of the United Nations hailed the Pan Caribbean partnership as a mode! of cooperation in the strugg1e against HIV/AIDS. During the high1evel United States of America/CARICOM meeting on HIV1AIDS held in Guyana in April 2002, the Secretary for Health and Human Services signed the Pan Caribbean partnership commitment on behalf of the United States of America. The partnership is growing in stature. It is beginning to demonstrate the clear benefits to be derived from cooperation. lt places emphasis on accelerated access to care for people living with AIDS; it advocates for cheaper antiretroviral drugs. This HIV1 AIDS partnership is a manifestation of cooperation within a region that is moving steadily towards creating a Caribbean single market and economy by 2005 and that has established special relations with Cuba, Dominican Republic, Haiti, the French Antilles, the Netherlands Antilles and the British-dependent territories. lt is a system of integration that parallels that of the European Union in many ways. Another example is the Caribbean Cooperation in Health which focuses on a series of general health initiatives, including scaling up the responses to noncommunicable chronic diseases, mental health, environmental protection, food security and health and family life. Other achievements through cooperation include the elimination of poliomyelitis and measles. Although it is not strictly within the purview of this meeting, it seems relevant to mention a major problem that could undermine the attempts to achieve development through improved health status in the region. This problem relates to the migration of skilled labour, especially medical personnel and, in particular, those in the nursing profession. While pharmaceuticals and reagents are important elements of health care services, our skilled people are the most important asset; managing their migration is, at best, an act of frustration without the help of th ose to wh ose shores they migrate. We are, however, pleased to draw attention to positive discussions with the Governments of the United Kingdom and the United States of America on this subject and also the commitment by the Caribbean Heads of Government within the Nassau Declaration on Health 2001 for the establishment of a Caribbean task force on human development. As al ways, the Caribbean welcomes the assistance of the World Health Organization, its organs, collaborators and operatives and unequivocally supports your cali for greater support from the developed world for the Global Fund to Fights AIDS, Tuberculosis and Malaria. With adequate resources, we would indeed assure human development and build up health systems, which have gained prominence and commitment under the enlightened leadership inspired by the World Health Organization. There is a time to fee! healthy; there is a time to fee) unhealthy, but there is a time to take right action for the health of ail societies, ali nations, ail peoples. This is my time, this is your time, this is our time to fight for right action for the health of this generation and generations to come. On behalf of the Caribbean Community 1 say thank you. Dr DEGUARA (Malta): Mr President, Madam Director-General, fellow ministers, colleagues, it is, as always, a great pleasure to listen to the Director-General's clear and uncompromising vision for the improvements in health necessary for the achievement of health for ali. The way ahead has been made very clear to us and I am sure that each country, in its own way, is facing the challenges outlined by the Director-

ASSNR/4 page 77

General on Monday aftemoon. This forum provides us with the perfect opportunity to exchange views and leam from each other's experiences. In an environment where health issues have become an important item on a country's health agenda and, taking into consideration the ever escalating cost of health care, the sustainability of health care becomes a critical factor for us ali. While we continue to invest in health we are to ensure that we reap the greatest benefits from the employed resources. This is one of the underlying principles of the health care reforms that are currently taking place in Malta. We are currently investing in a new hospital to replace our existing acute hospital. This, together with changes being undertaken to align ourselves with European legislation, has served as the perfect opportunity for change. I am pleased to report that both the accession negotiations and the reforms in the health sector are progressing satisfactorily. The Ministry of Health is being transformed into an effective monitor and regulator of services. Service delivery is being devolved to autonomous agencies which will be under close scrutiny for the quality of care that they provide. lt is anticipated therefore that the necessary legislation will be enacted this year with its full implementation taking place on the official opening of the new hospital in 2003. We are actively addressing the mental health sector. While making the necessary structural and therapeutic changes within our mental hospital, we have spared no energy to try and reintegrate our hospital residents back into the community. This we are slowly achieving, having reduced our hospital population by about 20% over the past five years. We hope that over the coming years we will implement fully our community mental health strategy, which will ensure a multidisciplinary, seamless approach to mental health care. Apart from building new structures and reforming systems, my Govemment is investing heavily in human resource development. Through our university we are ensuring an adequate supply of health care workers. Furthermore, capacity-building initiatives are being undertaken in the pharmaceutical and the occupational health and safety sectors as weil as other areas in line with our future obligations within the European Union. Malta's health status indicators are among the best in Western Europe. My country is facing the same problems experienced by most developed countries. The prevalence of smoking and alcohol consumption remains high especially in our younger generation. Risk factors for circulatory diseases are also unfortunately high. These, together with our high prevalence of diabetes, contribute to the high morbidity and mortality from these diseases in my country. The Director-General's cali for action to address these risks to health endorses the initiatives being taken by my Govemment. We are drafting action plans for tobacco and alcohol backed by the necessary legislation. We are developing a sexual health policy. We have doubled our budgetary allocation for programmes aimed at health education and health promotion. One major problem, which I am sure affects most developed and developing countries is the illicit drug problem. This problem cannot and must not be ignored as it has a profound effect on our younger generations and will affect the future of our countries. This is where intersectoral and international collaboration is of paramount importance. My Govemment is committed to addressing this issue. Through a national commission against drugs, alcohol and other dependencies, it shall continue to combat this scourge. My Govemment is taking concrete action to improve the environment, and thereby reduce to a minimum, environmental health hazards. In this context, the Environmental Health Unit, together with the Ministry responsible for the environment, is embarking on comprehensive programmes of air and noise monitoring, radiation protection, as weil as proper and safe disposai of clinical, domestic and industrial waste. Public health protection through the strict surveillance of communicable diseases and food and water safety is an area that is very weil developed in my country. The growth in tourism, along with the changing lifestyles of the Maltese population has brought about the need to strengthen and intensify activities in this sector. Our reforms will continue to be directed towards a needs-driven, outcome-oriented and evidence-based service. A focus on quality and efficiency of services must remain a priority in each and every health sector. This is the only way we can ensure a sustainable improvement in the health status of our people. Thank you, ali.

A55NR/4 page 78 El Dr. JAMRISKA (Ecuador): Sefior Presidente, sefiora Directora General, sefiores ministros, sefioras y sefiores: deseo iniciar esta intervenci6n con un saludo cordial a usted, sefior Presidente, por su elecci6n, y por su discurso, sefiora Directora General, asi como para nuestro distinguido Director, el Dr. Alleyne, Director de OPS. Constituye un privilegio para mi dirigirme a ustedes en este marco de la 55" Asamblea Mundial de la Salud. Inicio mi alocuci6n como Ministro de Salud del Ecuador y como Presidente de los Ministros de Salud del Area Andina, integrada por Bolivia, Chile, Colombia, Perû y Venezuela. Mi pais, con 12 090 000 habitantes, ubicado en América del Sur y que hace limite de frontera al Norte con Colombia, al Sur y Oriente con Perû y al Este con el Océano Pacifico, donde se encuentran las Islas Galapagos, patrimonio de la humanidad; pais con importantes riesgos naturales en el que su diversidad poblacional determina distintas condiciones de vida para cada una de elias, el litoral, la serrania, la amazonia y las Islas Galapagos. Los afios 1999 y 2000 se caracterizaron por crisis importantisimas de gobemabilidad; en la actualidad el Presidente Dr. Gustavo Novoa ha conseguido la estabilidad democratica con un equilibrio econ6mico dentro del marco de la dolarizaci6n, siendo en el 2001 el pais con un crecimiento econ6mico del 5,1% en América Latina. Pese a ello, la pobreza ha crecido significativamente, lo que da como consecuencia problemas de alta inequidad, con desigualdades sociales en los distintos grupos y regiones geograficas, en areas rurales y urbano-marginales, donde el salario bâsico de US$ 146 se incrementa a US$ 163, pero la canasta basica se ubica en US$ 248 para lo que es pobreza. Una inflaci6n en el afio 2000 del 96,4%, y que ha disminuido para 2001 al 22% en dolarizaci6n. Igualmente, el desempleo ha disminuido del 9,6% al 8,4%. La condici6n de salud ecuatoriana presenta un complejo panorama donde se superponen las enfermedades infecciosas aûn no erradicadas con las enfermedades cr6nicas. La tasa de mortalidad infantil ha disminuido desde 1990 del30,3 por 1000 nacidos vivos al 17,6 por 1000 en el afio 2001, pero la neumonia sigue siendo la primera causa de mortalidad infantil. La tasa de mortalidad materna también descendi6: de 117,2 por 100 000 nifios nacidos vivos en 1990 a 55,4 por 100 000 en el2000. Son problemas comunes, atribuibles a la pobreza y que conllevan la malnutrici6n y deficiencia de micronutrientes con la posibilidad de alta vulnerabilidad. A pesar de este problema, y de todos lo que esto conlleva, tenemos fortalezas como el control del dengue en el afio 2001; una asistencia para efectos volcanicos, que ocasionaron alteraciones en las condiciones de vida de las varias regiones andinas y fueron atendidas oportunamente y con alta calidad por parte de los técnicos profesionales en salud con colaboraci6n directa con la ciudadania. El programa de inmunizaciones ha logrado altas coberturas de importancia significativa. Otro punto alentador constituye el incremento presupuestario en la salud, que en mi gestion hemos duplicado para el 2002. Hemos fortalecido el Consejo Nacional de Salud y se encuentra en el Congreso de la Repûblica el proyecto de ley del Sistema Nacional de Salud. Me encuentro empefiado en organizar la red de servicios en el marco de esta ley, fortaleciendo la rectoria del Ministerio de Salud. Las aplicaciones de la ley de matemidad gratuita, de medicinas genéricas, de vacunas y programas de nutrici6n como el Plan 2000, han permitido alcanzar servicios gratuitos en atenci6n a madres y recién nacidos, siendo ésta otra de nuestras fortalezas. Tengo también la satisfaccion de informar que mi pais ha liderado acciones importantes en la subregi6n. En la ciudad de Guayaquil se efectu6 la primera reunion de ministros del area andina y Cuba para enfrentar el problema del dengue que azotaba al litoral ecuatoriano y a las fronteras del Pen1 y Colombia. En Quito, capital de los ecuatorianos, se fortaleci6 el mismo grupo y se definieron politicas conjuntas en el marco de la REMSA, con nuestros problemas comunes analizados a fondo. Cartagena, en Colombia, y Sucre, en Bolivia, sirvieron para que este acercamiento se concrete en hechos reales, como la creaci6n del escudo andino epidemiol6gico y el fortalecimiento de la red andina de vigilancia y control sobre todo en lo que tiene que ver con dengue y malaria, con la participacion de técnicos de nuestros paises; asimismo, atenci6n hospitalaria, politica de medicamentos, cooperacion en los procesos de reforma, salud sexual y reproductiva, emergencias y desastres, y un seguro basico global para la poblaci6n indigena. La presentaci6n del Fondo Mundial

ASSNR/4 page 79

de Lucha contra el SIDA, la Tuberculosis y el Paludismo, en la que pretendemos se nos apruebe el proyecto, con su venia, sefior Presidente, con su decidida participaci6n en el marco de trabajo con el organismo andino del Convenio Hip6lito Unanue, denominado «Lucha contra la Malaria» en comunidades nativas y zonas fronterizas de los pafses andinos. Se definieron polfticas conjuntas para enfrentar la importaci6n del rebrote del virus salvaje del sarampi6n y se decidi6 que para el 2003 se fije una fecha para la realizaci6n de una vacunaci6n durante los dias necesarios en forma unificada para América Latina. Igual trabajo se impulsani en el ambito de la informaci6n y educaci6n en salud con los medios de comunicaci6n social; y para el mes de junio, en Argentina se celebrara la primera reunion del area andina, con Argentina, Brasil, Paraguay y Uruguay, en el ambito de la salud para un trabajo compartido con América del Sur. Podrfa seguir informando, sefior Presidente, pero en honor al tiempo y a su paciencia, distinguidos ministros y delegados, no me queda mas que agradecerles su atenci6n y paciencia. Muchas gracias. Mr LEVY (Israel): Mr President, Director-General, distinguished mmtsters and delegates, let me begin by congratulating the President on his election to the Chair of this important Assembly. I am confident that, under his wise leadership, this Assembly will achieve its important goals, which will benefit ali Member States. I would also like to take this opportunity to congratulate the Pan American Health Organization, which is celebrating 100 years of service and leadership in the field of public health and which has brought about considerable improvements in the health field to ali its Member States. Distinguished delegates, WHO members, including Israel, are committed to the principle of health for ali that was decided upon by this Organization. Our primary goals are promoting health and strengthening the health system for the benefit of ali our citizens, with special emphasis on weaker members, the elderly, the poor and the mentaliy disturbed. Last year, we dedicated our health programmes to improving and expanding our services to the mentaliy disturbed in our society, including diagnosis, treatment and rehabilitation. This year, the Ministry of Health is paying special attention to the prevention of noncommunicable diseases, such as diabetes mellitus and cancer, by increasing the struggle against the risk factors causing these diseases. We also continue to give special attention to women's health. We encourage the public's involvement in developing a healthy way of !ife, with a continuing campaign against smoking, promoting education for proper nutrition, and programmes for physical fitness. We are especialiy pleased with WHO's choice of physical activity as the central focus of the World Health Day, with its message of "Move for Health". The public health services in the Ministry of Health are conducting training programmes and sponsoring public service messages in arder to encourage and increase awareness of the importance of physical activity. Health education starts with the young. Through our mother and child clinics we advise young mothers; through our school system, we educate and inform our pupils; through our dedicated doctors, nurses and social workers we try to reach ali sectors of our adult population, to encourage them to be aware of the ir physical and mental health in arder to prevent possible diseases. Due to our emphasis on preventive medicine we have increased both the quality and the !ife span of our citizens from ali sectors of the population. Achieving peace in the Middle East will benefit the health of ali peoples in the region. Indeed, the State of Israel was in the middle of the peace process with the Palestinian people when, unfortunately, as the record shows, it was the choice of the Palestinian Authority not to consummate these negotiations conducted at Camp David in July 2000, nor later at Taba in January 2001, but rather to resort to a course of continuous violence in arder to force the Govemment of Israel to make further concessions, contrary to every previous agreement negotiated and signed between Israelis and Palestinians. Countless acts of terrorism, suicide bombings in the centres of Israeli towns and villages, drive-by shootings at Israelis travelling throughout Israel and the administered territories, suicide bombers blowing themselves up in crowded streets, in cafes and restaurants, in market places and shopping centres, in schools and in discotheques, dynamite charges and bombs placed in cities, villages and buses- ali these acts ofterror are part and parce! of the Palestinian Authority's campaign of violence against Israel.

ASSNR/4 page 80 The Palestinian Health Authority has been managing the health and medical systems in the West Bank areas for the past six and a half years and in the Gaza area for the past seven years. The friendly and professional relationship between the officiais of the Israeli Ministry of Health and the Palestinian Health Authority established a climate of professional as weil as persona! understanding and fruitful cooperation between the parties. Regrettably, the intensive professional relations as weil as the regular and routine work of the joint Palestinian-Israeli committees were arbitrarily stopped by the Palestinian side on 29 September 2000, when the current violent events and terrorist activities began. Until that date the intensive and fruitful Israeli-Palestinian cooperation included the foilowing activities: the Joint Committee on Public Health including Preventive Medicine and Epidemiology; the Joint Committee on Environmental Health; the Joint Committee on Food Control; the Joint Committee on Drugs and Pharmaceuticals; and complementary medical services provided to Palestinian patients at Israeli hospitals. Until the end of September 2000, the number of Palestinian patients who were admitted to hospitals in Israel averaged about 4 500 per year; the annual average of Palestinian patients referred to Israel for ambulatory and laboratory tests was about 9 000. Regrettably, since the end of September 2000, the number of referrals to Israel has significantly decreased, owing to the arbitrary Palestinian policy. We continue to treat Palestinian patients in Israeli hospitals, both during hospitalization and in the outpatient clinics. Irrespective of the Palestinian attitude towards Israel, our hospitals are always open to sick and wounded Palestinians, and Israeli medical teams are constantly ready to provide ali the medical assistance Palestinians need, at any time or place. Owing to the new political atmosphere and the new Palestinian po licy of reducing or eliminating the interaction between the two parties, cooperation between Palestinian and Israeli nongovernmental organizations has been almost totally paralyzed. 1 cali upon Dr Riad Zanoun, the Head of the Palestinian Health Authority, to renew the cooperation between our sides in the field of health and medicine, and to re-establish mutual professional committees in these fields. Israel continues to strive for the cessation of the violent clashes and a return to the negotiating table in the hope of achieving a peaceful solution. The Israeli Ministry of Health continues to believe that cooperation in the fields ofhealth and medicine will build a significant and stable bridge to peace. Thank you for your attention. Mr AZEVEDO MERCADANTE (Brazil): Ladies and gentlemen, speaking on behalf of the Health Minister of Brazil, I would like to congratulate the representatives ofMember States and ail those attending the Fifty-fifth World Health Assembly and to greet them ali. At a very timely point, the W orld Health Organization decided to highlight the importance of promoting physical activity as a factor of unity between countries and we are very proud that the celebration of this, which took place simultaneously in various countries, was based on the Brazilian programme of"Move for Health", which is based on promoting physical activity and reducing tobacco use. We are also very honoured to have had the presence of the Director-General of WHO in Sao Paulo last April on the celebration of the World Health Day in Brazil. The Minister of Health of Brazil has been trying to promote healthy lifestyles and practices through its national policy on food and nutrition. W orking together with nongovernmental organizations and regional organizations the programme is promoting the importance of 30 minutes a day of physical activity in Brazil. The programme has been making professionals aware of the need to provide continuity to these activities and to work together with WHO on this important programme. Brazil has been promoting this programme and will follow with interest in the Assembly the resolution on diet, physical activity and health to strengthen the recommendations in this area. Brazil has come to the Fifty-fifth World Health Assembly to contribute and to help us make progress in our discussions on resolutions for more just public health policies, based on the desires and the needs in a majority of countries. The former Minister of Health of Brazil, José Serra, has worked for access to medicines at fair and responsible priees. Brazil considered the approval of the resolution on WHO's medicines strategy as a significant step forward in this international framework, already made up of resolutions recently adopted within the United Nations Economie and Social Council and the Human Rights Commission, giving priority to this subject and focusing on the so-cailed "diseases

ASSNR/4 page 81

of poverty", such as malaria, tuberculosis, HIV/AIDS and infant and child diseases. Brazil has been developing a broad policy of pharmaceutical assistance in order to provide access to medicines, and recognizes the difficulties faced by countries with a low or medium leve! of development in developing a national policy in this area, given the major changes that have taken place in international trade and in the organization of the pharmaceutical industry. At the beginning of the twenty-first century a third of the world's population does not yet have access to essential medicines. Despite the obstacles, various measures have been taken in order to provide incentives for the production and availability of low-cost, high-quality medicines, the distribution of strategie medicines for endemie diseases such as tuberculosis, leprosy, AIDS, leishmaniasis and others, and chronic diseases, such as those that are used to treat diabetes and hypertension, is allowing us to have better control and to provide assistance to those suffering from these diseases. At the international leve!, we would like to stress the fact that Brazilian ideas have carried sorne weight at the World Trade Organization. Giving emphasis to public health over the rights of patents in this way, is bringing about major changes in the Brazilian market. More than 400 generic medicines for various therapeutic uses are now being marketed with the same quality as brand name drugs and at lower priees. We have lower priees on an average of 40% and we are also regularly monitoring the priee of drugs. The Fifty-seventh Session of the United Nations Commission on Human Rights adopted in April 2001 a crucial resolution for people who are living with HIV/AIDS. With the adoption ofthis resolution, access to antiretroviral medicines essen ti al for the control of HIV1 AIDS has become a human right, which expanded the possibility on the international stage of new progress in providing access to these medicines. Brazil has undertaken sorne unique actions. We are providing care with alternative models and free access to medicine of the latest generation of drugs for more than 100 000 HIV patients, and the number of deaths has been reduced by 50% between 1995 and 2000. In addition to reducing deaths, the models of alternative care adopted have provided priority to outpatient treatment which has improved the quality of !ife of the patient and reduced the cost of treatment. In June 2001, the special session of the United Nations General Assembly on HIV/AIDS understood the need to combat this pandemie by paying attention to special targets for treatment and human rights. The special session created the necessary momentum in arder to launch the Global Fund to Fight AlOS, Tuberculosis and Malaria. We are also working on the major challenge of developing a vaccine AIDS and we in tend to invest in the year 2002 about US$ one million in vaccine research. for HIV1 1 would also like to congratulate the Regional Director of the Pan American Health Organization on the occasion of its centenary. Dr Alleyne has played a crucial role, together with PAHO, in the Americas. We would also like to congratulate the Organization on the report of the WHO Commission on Macroeconomies and Health. Although this is a technical document, it has helped to make people and countries more aware of the political agenda for development, seeking a strategy on health financing for the neediest countries. The report was an important advance in evidence-based policy. Brazil is aware of the situation of many other countries and the need to benefit the least weil off. We find ourselves in a situation where we are facing a double challenge. We have to deal with the diseases of wealthy countries as weil as those of poor countries. The report, however, may not adequately deal with the fact that we have a two-fold challenge. The creation of WHO in 1948 and the Conference of Alma-Ata in 1978, with its Declaration on Health For Ail by the Year 2000, are historical landmarks in a long history of fighting for human rights and social rights, including the right to health. Brazil which, as a result of this, has created a national health system, and has many expectations from the proposais of the Commission on Macroeconomies and Health to deal with the multisectoral approach, the integration of the private sector, the decision-making process based on epidemiological, administrative and financial indicators. Brazil also has a dual role to play in developing policy, and in acting as a donor country, while at the same time receiving cooperation. In this way, the inclusion of intermediate countries in the proposed mode! could make it possible for us to gradually build a fair international social agenda. With these thoughts, the Brazilian delegation would like to reaffirm its willingness to participate constructively in the work of the Health Assembly and we wish you ail every success.

ASSNR/4 page 82 Dr EL NASSER (Jordan): '~)\ ~)\ .&\ ~ .:..e-Î.J ~l....j.J ô~L.......!I.J Jlx..JI y~Î ,Â....W\ ô.J:l~l ô~l ,~)\ ~

~~~,~_,_.!_,li~'

~Ll.JI o*-l ~~'J -..ï4:l11 ~~ ~l_,.i ô~WI.J iüÎ '.~)\ô~\_;.....~ ç-~Î 0i ~~ '• 1:;~1..... ô~h._... ~! ~'} ~_;ill o1\ ..J+l.iÎ .J ~l Â.1S_,.JI r4-JI ~ .} e: t.:;...lli.J ~_;JI JS ~ ~ ~.:y!)\ _;bu....JI t~-"" ~ ô.J.J~I o~ \.j:j\.c.W:;.-1 .J~· 0'i.J ~~ ~~ u~ ~yc. ~_,.JI 0'1 4J 1.?~ ~Ull J~l ~.J.J ~~ ~ ~~ ~.} ~~ ~! ..cll:l liy:.~.J ù\aaÎ?all ~~~")\ ~~.} 1.....~ L.~} ~ ~~.} .J~'J\ Il L.J..o .<- 1 u______6 û\...J:ü.JI ,;. l...J ., li...J:,.j 1~ c..s-'. • ~ .J (...)oQl:JI tl..bill 1. 't"' . ~1 ~JI • _,. ûl.cl..bill ~1 Y-" •.J ~1 •

. .J ·~1 1.A .J:l.)AJ ~. r.s-1- ~ :;~~.-:ILJ \J.WI . Â....W\ r. _,. i.j.J.JY-" ~~.J~ ~ .u} ,~)\ ~1

ç-L....JI t \..bill ~ 0Î 0~ ~ ~~ ûL.~\ ~ YW k _,Il û~l o1\ ~ ç-WI t \..bill '-:-Ù~ (.j"L......JI ~ .J ~;!' ...n .J~'il 1.?~\.i:J Â..!\.i.!. ~~ ûtsly!JI o~ ~ ~ ul~)'l .; (.)-":!-Î)I O.J.J~

û~~)'I.J ~1..,>-----o'il LJe- ~Ull ~WI ~ya.\1 ~ô~~ ~ =-·ol\ ~ ~ ~ ç-C-~.J \.j:jL.~ 0}9 ~ ~~.J~..)A d~.J ~.J..)1A ~.îi ~~~ ~ ~~ ~ JS~I (..)--4 · .l.l~l ~h ·" , (..) • \S.JI 1 - 1 · ~ · Î ·.< .. ..,,, ~1 • '-"t"' ~ (...)oQ ...r--- (..) (..)-""":! r.r . .J\.h;..)U l.j .l...a:ill LatA Ï .J.J~ WWI • ~

• . ~\.fol\ e-i' ~ c:l~ ~•;ii=- ~ \.!)l..bJI ,ô~WI '+;Î

lt---J l.?.l...o.i.\1 ~ 1~! ~~ ~~ e:~)'I.J yy!JI o~ ~_,.i lS~Y.J LJP..îili.J ~~~ ~.,....s ~1 ·L._ij'J\ .~ _JJ •.J c-:• A..,_ A'' ~ r.s-~- t..wt.:...JI ·· 1. ~u ~.J~ J"" .. 11 u~.c ~\.! • 1~ .N! '-' • _,.. •. . •• 1y ·i ~ ..)-l-1 'T', • • .J ~1 Y.J ûb.ül -- • .J-1-"" _;bu....JI t~-"" LJe- w~ ô~WI '+;Î t.l.a~ L..J .~ ~Ull ~I.JA'il ~h.a ~ ~~ 1.?~1 JWI t_,_...;o_,... JÀ 4-1 ~1 ~1 ..)A~J <.1 'J ~\ ~~ L. ~i 0Î ~ 'JÎ ~ ~1 ~ ~1 o4 .)~\.....-~ô~\ ûL._,i.a JS ..»"-Îi.J .r-~1 ~YY.'JI J:i!.J Y.J..rJ~ ~_,.JI Ul.J\ ~l:...J ._:iliJ\ _ 11. .:.11 ~ .•. 1.... C!:! ~ · ~- 1 .< • .,,, ~ J"" ·- .11 û\.!le-'JI ~~ ~'11 11 ÂJ\......::a' Jw • b........\ ç l>" r.s-- ~Y:! r.r • .J • .J 1..5"'. • • ~ e: .J ~~~ .J ~

r .. al\

~~ 0---o ~~~'il 0L...?.J ~I.JA'il .J~I.J ûys_,ll ~I~Î ô~yj ~l~.?~J:. ~ ~I~'JIJ .~l._.'JI

.JL.l:..iÎ W:..:i.J ~IJ Ul.J\ tl)~-* ôjé tlb!.J ~yJI ~\.} 0.J;iJb ... lsl\ "-;!.ï\.a.; L. 0) ..._j lSY" ._,ï;b.Jsll ~1 <\!ft\ ~~ 'J LJ't..-..~)'1 J_,b..J ~~~~~ I.?~~.J ~~I.J ô.J~I ..r~ ~I.e \__jj\j . .J . hi~\ >~ • G .uU. (...)"A"""' . . . >Il W:..J 4..J! > Gts..a ~ <. Â..e- .J..r-. •.. Il <Û~ .i,._, ~t.h.J • li..ùl:.. . . l>" • I....J .~ •. (..) • ~ •• r.r . • d~L..........JI ~ UljL..J t.l.a~ ~ ,~\ ~1 .Y. -..ïWI .&\ ~ .ill.a.\1 ~ ~ û~_is·U '0~.J'il .} .J~.îi..o.ll ~1 ~.;11 ~1 .J~YI ~ , a1s.;,·,ll 4..\.J~ .} ~ .} ~ ~ ô~y.J\ .,;:ë J ô~'+JI 4 1;b_,ll UJ...J\ ~~ ~ li~Jj Wp. ~ 1 ;1 b.Jol\ UJ...JI 06li..a.l WIY-")'1 û\_;11 e:~l ô~l.cl LJe- f"?"Ull ~~J i.j.Y!- ~ ~~~ dy;.~.; ... Jl ~.J.J~I.J Â....j)lll ~1 d~I.J ~l..ojt.....JI.J ~I_,.J~ ~JiJb ... làl\

.&1 ç-I.JJ ~L.....i ~.lA ~l ~1 ~1 ûL.~\.J ~\ ô)j.J ~ û~ Jl....Jl ~l Â..!\......::a)'~ '!.?Y. ûl al:.Ll\J ~~I.J 49JG.t.ll J.J~I ~ -.,iJb.Jol\ ~ ~\ d~WI J.....a.:)' 01~1 ~\ \....S .J.J~ j....-:p ô_J--i_,.JI 1 s·.1• ""?- ~ ,~4-11 ~~.J'il ~~ ~.J t"'~ ylbÎ ~1-9 ~~~ 1~.0 ·~.J~I • L...a~l ~ 4-:!cL...-...o JW.J '-il ;1b ...lal\ ~ Â....j)ll\ ûi~WI (':!~.} ~WI ~1 ~

ô~ ~I.J ~~~_,li .JJÀ.îi ~l~.?~Y _;JI I.A.J:lè.J ~fo.-.11 ~1~1..>?-J ~ ~_,l ~IY-")'1 .~.;

<:le ~ 'J .J ~ ~\ JÀ J.l_,h11 .Jl..=J\ J)l.:.. ~ ~1 y ~1 ë:!_p.:j 0} ,ô~WI ~Î ,4 , . .,!\~~ô~ .,;bL...:...a.J 0L...? ~ ~WI 11\_.j û..?-Î y~ ~.JJ ~ly.ll ~~la.; L. ·.JL:..:JI \~ ~ ~_,l ô~L,..ll ô_,c~l ~l ~ liy:.~ ~~)'\ ~l_,li.J

A55NR/4 page 83

El Dr. CARBONE CAMPOVERDE (Pern): Sefi.or Presidente, sefi.ores representantes: Reciban un cordial y afectuoso saludo del pueblo peruano. Hasta hace pocos meses el trabajo de salud en mi pais priorizaba las intervenciones dirigidas a la prevenciôn y control de las enfermedades transmisibles; en ese campo tenemos algunos logros significativos. En el Pern, la tuberculosis aun constituye un problema de salud publica a pesar de los logros obtenidos al haber implementado con éxito la estrategia DOTS. La OPS/OMS distinguiô al Pern como modelo en la lucha contra la tuberculosis para las Américas y el mundo. Hemos logrado: diagnosticar el 100% de los enfermos con tuberculosis pulmonar y baciliferos; la curaci6n del 93% de los pacientes con tuberculosis nunca tratados previamente en el afi.o 2000; una cobertura de vacunaci6n del orden del 93% para el afi.o 2000. En el caso de la malaria bernos logrado: la reducci6n de las tasas de morbilidad en un 60%; la implementaci6n de la estrategia de tratamiento supervisado (DOTS-Malaria); una cobertura de tratamiento mayor al 98%, haber reducido la tasa de abandono al 3,4% y mejorado la tasa de curaci6n al 96%. Introdujimos nuevos esquemas terapéuticos basados en evidencias mediante estudios de susceptibilidad a fârmacos usados y alternativos. Somos el primer pais que usa dos esquemas diferenciados para ambitos diferentes de terapia combinada, permitiéndonos asi diferir la aparici6n de resistencia al tratamiento. Estos avances en salud son satisfactorios pero no suficientes y, cuidado, necesitamos seguir invirtiendo fondos de cooperaci6n externa para hacer que sean logros permanentes. Aun tenemos 25% de desnutrici6n cr6nica en menores de cinco afi.os. Como en el caso de muchos de ustedes, el perfil epidemiol6gico de nuestro pais se encuentra en proceso de transici6n. A pesar de haber disminuido la mortalidad por enfermedades transmisibles, siguen siendo la primera causa de muerte en nuestra poblaci6n. Al mismo tiempo, reconocemos a los accidentes de transito, los malos habitos alimenticios, la violencia familiar y social, el envejecimiento y la vida sedentaria como factores sobre los que urge intervenir por el impacto que empiezan a tener en la morbimortalidad de nuestra sociedad. Nuestro abordaje a la salud publica, colectiva e individual necesita una respuesta diferente a solo lo biomédico, en donde el componente de promoci6n de la salud sea el que disefi.e las politicas y estrategias para abordar una carga mixta de enfermedades transmisibles no resueltas y la creciente presencia de las no transmisibles. Permitanme ahora una mirada mas alla de nuestras fronteras: la brecha entre quienes acceden a la salud y quienes no lo hacen, lejos de decrecer creee en diversas partes del mundo. Los acontecimientos recientes nos muestran que las enfermedades no solo no reconocen limites fronterizos: boy no hay limites eticomorales a su utilizaci6n como armas de agresi6n. Eventos de violencia irracional que afectan a colectivos pacificos de distinto orden nos sorprenden cada vez con mas frecuencia. L,Sera tai vez que una insania mental colectiva como reacci6n final a nuestra incapacidad de entendernos como sociedades locales, nacionales o regionales, se va extendiendo cual nueva epidemia silenciosa por nuestro mundo? Sefi.ores representantes, el tiempo apremia. Hay una linea de no retorno luego de la cual las sociedades se pueden ver ahogadas por procesos de deterioro sociosanitario violento dificiles de detener y revertir. Hay quienes creemos que nos acercamos colectivamente y peligrosamente a estos limites. Es hora de reiterar principios basicos racionales para construir una saludable convivencia en paz. Reconozcamos que la dignidad de la vida humana merece una atenci6n integral de salud en todos sus ciclos de vida, desde antes de nacer hasta su fin natural; propiciemos politicas de salud de largo plazo que se coloquen en el primer lugar de las agendas publicas nacionales al menos durante dos o

ASSNR/4 page 84

tres décadas, como un compromiso de sacrificio generacional de toda la sociedad nacional para sostenerlas en el tiempo sin importar quién es el gobierno de turno; construyamos el acceso universal a accesos de salud; defendamos que los presupuestos en salud sean protegidos; apostemos a cambios · generacionales que implican inversion en salud por un mediano o largo plazo y que garanticen cambios sanitarios positivos y permanentes; hagamos de la promocion de la cuttura de la salud una prioridad que respete la cultura originaria de los usuarios de los servicios; promovamos la solidaridad como principio fundamental sin el cual no se puede lograr el acceso universal a servicios de salud dignos; cultivemos la calidad, calidez y humanidad en el trato al usuario de los servicios de salud, sin las cuales la eficiencia y la eficacia son logros efimeros; promovamos a la familia como la unidad basica de nuestros esfuerzos en salud, pues en ella se producen los auténticos cambios que se incorporan a la cultura de los individuos; reiteremos que las organizaciones internacionales estan al servicio de los paises que forman parte de las mismas, y que su accionar por tanto debe reflejar en cada uno de sus actos la voluntad y los deseos de esos paises, estar al servicio de los mismos y respetar sus actos soberanos; reafirmemos que la nifiez es primero, protejamos las acciones de salud de toda forma de violencia, provenga de donde provenga, que pretenda atentar contra elias; y propiciemos politicas y acciones de salud regionales concretas para enfrentar los problemas de salud que transcienden las fronteras nacionales. Sefior Presidente, sefiores representantes: No auguremos a nuestros hijos ser la generacion de un mundo mejor: construyamos ese mundo mejor para ellos hoy. Muchas gracias.

Mr SOTHINATHAN (Malaysia): Mr President, Madam Director-General, distinguished delegates, well-being can only be maintained if people live healthily, and this means, among other things, avoiding risks to health. There are a multitude of health risks, and the most avoidable of them are those related to lifestyle. The Malaysian Lifestyle Campaign which began in 1991, 1 must say, has seen positive changes. The scope for risk management and its role in disease prevention is so broad that it is impossible for me to describe it adequately here. Allow me, therefore, to focus on the three major issues that are increasingly becoming a threat to our well-being. The first risk is that of tobacco use. 1 am very pleased that WHO is making impressive progress in the framework convention on tobacco control. Developing countries, including Malaysia, are continuous1y being targeted by the unscrupulous marketing strategies of tobacco companies and, unless there is optimal political will, those countries will fall prey to them. The end result will be premature, tragic and unnecessary loss of human lives from lung cancer and other tobacco-related diseases. 1 observe that developed countries are not being spared either, where very subtle, finelytuned marketing strategies are targeting women, especially younger women. 1 hope that we, as custodians of health for the people of the world, will continue to give strong commitment to tobacco control and Malaysia will do ali it can to make the framework convention on tobacco control work effectively. The enforcement of the Control of Tobacco Products Regulations, which were enacted in 1993 (CTPR93) continues to be the most important activity carried out in Malaysia. The Control of Tobacco Products Regulations came into force in May 1994. Among other provisions of the CTPR93 are the prohibition of ail direct advertising and sponsorship, a requirement for fixed health warnings, and also fixing ceiling levels of tar at 20 mg and nicotine at 1.5 mg per cigarette. Numerous public places and other designated areas have been appointed as no-smoking zones while tobacco sales to minors and possession and smoking by any person under 19 years old is prohibited. The CPTR93 will be amended to tighten most of the provisions. Among these will be a total ban on ail forms of promotion related to tobacco products, requirements for more effective health warnings, a limitation on the availability of cigarettes to the public by restricting sales only for retailers with licences, lowering tar and nicotine levels and widening existing no-smoking zones. The next risk that 1 would like to mention is that of food safety. 1 am very pleased that WHO has given due importance to this public health problem. Food safety requires the full cooperation and coordination of severa! government agencies and nongovernmental agencies. 1 look back with sadness, and even with horror, at the crises we faced in the recent past. From the dioxin scare of 1999 to mad

ASSNR/4 page 85 cow disease in 1996, we had our hands full trying to manage them, identifying the risks, communicating the risks to the public, and developing strategies for human protection. One of the major challenges in these experiences was trying to get our act together among the many agencies. 1 would like to report a positive development this year in Malaysia where we have formed the National Food and Nutrition Council, with members from 15 relevant agencies including a consumer representative body. At the inaugural meeting in February, the Council appeared to be on a firm footing, and we expect much progress in the coming years in the area of food safety. In the same area of concern, 1 would like to ask whether genetically modified foods are really safe. Although much has been said about the safety status of genetically modified foods, it is still an issue of concern that has created confusion amongst governments, as different countries abide by different rules and regulations. Malaysia recognizes the efforts of WHO in ensuring the safety of genetically modified foods, but WHO can play a more prominent role in a concerted effort for capacity building, which includes laboratory capabilities, training, and harmonization of laws and regulations. This will ensure that the health of consumers is not compromised in the interests of trade. Malnutrition is another area that poses a challenge to many countries. Malaysia has put in place a national plan of action for nutrition which represents Malaysia's commitment to the global eradication of malnutrition. The plan of action provides the multisectional nutritional framework for national development. The objective of this plan is to achieve and maintain the health and nutritional well-being of ali Malaysians through access to a nutritionally adequate diet, safe food and healthy living conditions in a manner that is environmentally sound and socially sustainable. The percentage ofunderweight children in Malaysia has decreased from 25% in 1990 to 12.4% in 2001. As in many countries, occupational injuries are of concern in Malaysia. In 1999, the number of accidents reported increased by 7.9% compared to the previous year. The average accident rate per 10 000 active workers has increased from 197 in 1998 to 200 in 1999. The Ministry of Health has embarked on a healthy workplace programme. We have increased efforts to reduce the incidence through strengthening promotional activities as weil as increasing awareness through primary health care and nutritional campaigns with a special focus on safety and health. We are also improving our health care workers' knowledge and skills in preventing and managing injuries in the workplace. Malaysia acknowledges the need to identify risks that affect health and to manage effectively these risks in our efforts to promote health and minimize the burden of disease in the community at large. We urge WHO to direct research to the impact of electromagnetic waves and address ethical issues of genome research as priority activities. Thank you. Le Professeur ABOUO-N'DORI (Côte d'Ivoire): Madame le Directeur général, Monsieur le Président, Mesdames et Messieurs les Ministres, honorables délégués, Mesdames et Messieurs, je voudrais, au nom du Gouvernement ivoirien et en mon nom propre, vous exprimer ma gratitude pour l'occasion qui m'est offerte de présenter à cette haute Assemblée l'organisation du système de santé de la Côte d'Ivoire. Je voudrais également féliciter le Ministre de la Santé du Cambodge, qui a dirigé avec compétence la Cinquante-Quatrième Assemblée mondiale de la Santé. Je voudrais enfin adresser mes vives félicitations au Ministre de la Santé d'El Salvador pour son élection à la présidence de la Cinquante-Cinquième Assemblée mondiale de la Santé. Madame le Directeur général, la Côte d'Ivoire vous adresse ses vifs remerciements pour les appuis tant techniques que financiers que vos services apportent à son Ministère de la Santé publique. Monsieur le Président, le Gouvernement de la deuxième République de Côte d'Ivoire a hérité d'un système de santé confronté à d'énormes difficultés pour diverses raisons, dont la suspension des appuis extérieurs. L'état des lieux révèle que le profil épidémiologique reste dominé par les maladies infectieuses et nutritionnelles. Les principaux indicateurs de santé sont mauvais en dépit des efforts d'investissement consentis et consacrés au secteur de la santé au cours des 30 dernières années. Ce tableau est aggravé par la paupérisation grandissante de la population, dans un contexte de récession économique. Le Gouvernement a pris toute la mesure de la situation et des enjeux de la santé du peuple ivoirien. C'est pourquoi, tout en maintenant et consolidant les acquis, il s'attèle à réformer le

ASSNR/4 page 86

système sanitaire pour en améliorer la performance et garantir des soins équitables et de qualité à toute la population. La Côte d'Ivoire a élaboré depuis 1996 un plan national de développement sanitaire (PNDS) pour la période 1996-2005. Ce plan, dont la mise en oeuvre a connu d'énormes difficultés, poursuit l'objectif général suivant: améliorer l'état de santé de la population par une meilleure adéquation qualitative et quantitative entre l'offre des prestations sanitaires et les besoins de la population. Cet objectif général se décline en trois objectifs spécifiques : réduire la morbidité, la mortalité et les incapacités liées aux grands problèmes sanitaires, accroître l'efficacité du système et améliorer la qualité des prestations sanitaires. La réalisation de ces objectifs repose sur plusieurs stratégies, qui sont: l'amélioration de l'accessibilité aux services sanitaires; la promotion des soins de santé primaires par la mise en oeuvre du paquet minimum d'activités (PMA) selon les niveaux de soins; l'amélioration de la gestion du système et la promotion de la multisectorialité et du partenariat; la rationalisation et le développement des ressources humaines ; la . promotion de la recherche opérationnelle; et l'élaboration de normes en matière d'infrastructure, de ressources humaines et de gestion. L'organisation du système sanitaire de la Côte d'Ivoire est le reflet de l'offre de soins disponible pour répondre à une demande de soins de mieux en mieux structurée. L'offre de soins concerne les secteurs moderne et traditionnel. Le secteur moderne comprend le secteur public et le secteur privé. Au niveau du secteur public, le système est organisé sous la forme d'une pyramide des soins à trois niveaux - primaire, secondaire et tertiaire - regroupant 1324 établissements de soins et employant environ 17 000 agents, toutes catégories confondues. On compte 1 médecin pour 9000 habitants, 1 infirmier pour 3850 habitants et 1 sage-femme pour 1950 femmes en âge de procréer. Le secteur privé, en pleine expansion, constitue un complément nécessaire au secteur public. Le secteur traditionnel est en cours d'organisation et de réglementation, avec la création d'un programme national. Ce programme a déjà recensé 4223 tradipraticiens, dont 110 ont été formés en hygiène et en anatomie. Le recensement a concerné seulement 7 régions administratives sur les 19 que compte le pays. La demande de soins est évaluée à travers deux structures administratives, qui sont la Direction de la Santé communautaire et l'Observatoire des Bénéficiaires. Sur le plan du fonctionnement, les objectifs du PNDS sont mis en oeuvre notamment par la politique des soins de santé primaires à travers le PMA, qui bénéficie de l'appui des programmes nationaux orientés vers les principales pathologies. Par ailleurs, il convient d'indiquer que le fonctionnement du système de santé ivoirien fait une large place à la déconcentration, voire à la décentralisation des services. C'est ainsi que la mise en oeuvre du PMA repose sur des districts sanitaires dont les actions sont coordonnées par des directions régionales. En outre, 13 établissements sanitaires nationaux, dont 4 centres hospitalo-universitaires et 2 instituts spécialisés, jouissent de l'autonomie de gestion. Le financement du système sanitaire ivoirien est assuré par quatre sources: l'Etat, les ménages, les partenaires au développement et les mutuelles et assurances privées. Le budget de santé en 2001 a représenté 8% du budget total de l'Etat, et 40% de l'enveloppe sanitaire ont été affectés au niveau primaire. La contribution des partenaires au développement se fait sous forme d'appuis budgétaires, de dons ou de prêts pour le financement des projets et programmes de santé. Il s'agit d'une contribution majeure, que le Gouvernement de la Côte d'Ivoire apprécie à sa juste valeur. Les ménages contribuent au financement de la santé à hauteur de US $20 millions dans les établissements publics de soins. Cette contribution est plus importante au niveau du secteur privé, soit environ US $1 72 millions. La contribution des mutuelles et assurances privées est tout à fait marginale par rapport aux financements de l'Etat et des ménages. Environ 15 % de la population seulement est couverte par ce mode de financement. Cette faiblesse de la mutualisation du risque maladie a amené les nouvelles autorités à créer l'assurance-maladie universelle. Les perspectives du système sanitaire ivoirien se présentent comme suit : la prioritisation des interventions de santé intéressant davantage les couches de la population les plus vulnérables ; la décentralisation des pouvoirs décisionnels des services de santé ; la viabilité financière à long terme du système sanitaire ; la multisectorialité, le partenariat et la contractualisation ; l'amélioration de l'accessibilité géographique et financière par la densification des structures de soins, d'une part, et la mise en oeuvre de l'assurance-maladie universelle, d'autre part (cette assurance-maladie est

A55NR/4 page 87 obligatoire et ambitionne de couvrir toute la population vivant en Côte d'Ivoire, y compris bien entendu les non-nationaux); l'amélioration de la disponibilité des médicaments essentiels ; le développement des capacités institutionnelles et des ressources humaines ; la promotion de la recherche médicale et pharmaceutique ainsi que le développement de l'industrie pharmaceutique; et, enfin, le développement de la médecine traditionnelle. En conclusion, il convient d'indiquer que le système de santé ivoirien est en pleine mutation pour s'adapter au contexte épidémiologique nouveau et aux exigences internationales. Le souci des autorités ivoiriennes est d'assurer des prestations sanitaires de qualité de façon équitable, avec la participation et la collaboration de tous les acteurs. La Côte d'Ivoire sait compter sur la solidarité internationale pour relever ces défis. Elle pourrait disposer de plus de ressources pour le financement de son système de santé afin de le rendre performant si elle pouvait être soulagée du poids de la dette extérieure. Nous saurons gré à la direction de l'OMS des dispositions qu'il lui plaira de prendre pour le plaidoyer en vue de l'annulation de la dette de la Côte d'Ivoire et de tous les pays en développement afin que ce fardeau cesse d'être un handicap majeur dans leurs efforts de développement. Mr NGEDUP (Bhutan): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, I bring you all greetings from all the health workers spread across the north, south, east and west of my country. They asked me to convey their very best wishes for a very successful Fifty-fifth World Health Assembly. In a short while, after the completion of the Health Assembly, back in the capital of Bhutan ali the health workers will send their representatives to the annual health conference. The purpose of the annual health conference is to promote efficiency, transparency and accountability in health. It gives partnership and a sense of involvement to our health workers. This year, at the annual health conference, I will be required to make a report about the happenings of the Fifty-fifth World Health Assembly. At that time, I will tell the annual health conference about the dynamic leadership of our Director-General, of the many initiatives she has taken over the years to bring health to the centre stage of development, to foster partnership so that health is not isolated from the other development sectors. Of the many initiatives, the ones that I can immediately recall are the anti-tobacco initiative, Roll Back Malaria, Stop tuberculosis, the fight against malnutrition. Slowly eliminating leprosy, filariasis, so on and so forth, the task is endless. Therefore I will tell my colleagues, the health workers, that we ought to pay tribute to the Director-General and to WHO for ail the good they are continuing to do to serve humanity. I will also tell them about the risks to health, the main focus of the Health Assembly this year. Regarding risks to health, I will also tell them that we need to identify risks that are typical of cultures and communities so that we can address them locally. We need to also take into account the Director-General's wise statement that we need to collect evidence and then take action. Evidence is something that the Director-General has promised that she will take care of and action we ali must take care of. Another very interesting theme this year is "Move for Health." We are celebrating "Move for Health" in our country with gusto. It is so simple, so straightforward and so cost effective. And in order to support "Move for Health" I will be taking a 560 kilometre walk from the eastern tip of my country to the capital and promoting health and wellbeing. We will share the messages of risks to health, but not without profit. I aim to profit from it, I aim to make this a sponsored walk where I will ask countries, multilaterals, communities within the country, to sponsor me so that I can sustain primary health care. So that we will be able to divert much-needed resources towards noncommunicable diseases as weil as the new dimension of risks to health that we need to tackle and find solutions for, Bhutan has started an initiative health trust fund. Here in the very corridors of the World Health Assembly in 1998 and ever since we've been trying to promote the health trust fund and this is what l'rn going to walk for mainly. I will be having brochures outside for you ali to see more details about the trust fund, about the walk and the web site. 1 would like to request you ail to please have a look. Give it a try. 1 would prescribe a similar venture for you ali too, especially for smaller countries like Bhutan. 1 know my time is up, but 1 feel that 1 ought to give at least one single minute to the South-East Asia Region and to our Director whom we lovingly cali Bopa. In Indonesian it means "father". He has

ASSNR/4 page 88

given us leadership. He has fostered solidarity in our Region and he has been just and equitable with ali of us, be it small or large in our country. This is his last year and we are already feeling emotional in losing him. But we know that the spirit will linger and, from the bottom of our heart, the Bhutanese delegation would like to say thank you Bopa, thank you Regional Office for what you have clone to promote health and well-being in our Region. Thank you very much for giving me this golden opportunity. Dr AFRIYIE (Ghana): I wish to extend the fraternal greetings of the Government and people of Ghana to this Assembly. It also gives me great pleasure to join earlier speakers in congratulating the President on his election. We have every confidence in his ability to steer proceedings here to a successful conclusion. The Ghana delegation further congratulates other distinguished members of the Bureau and assures its fullest support and cooperation. The Ghana delegation would like to commend the Director-General for ber determination and dynamism which has contributed in no small way to the international recognition of health issues as being developmental issues also. Indeed, we find this meeting to be very important in the sense that many of the agenda items touch on severa! issues which are of interest to Ghana. Due to time constraints, I would like to highlightjust a few ofthese issues. Human resources for health delivery in Ghana are critically low, and this is threatening the country's health system's ability to deliver. After nearly three decades of training 200 medical doctors per year, Ghana bas about 1 500 doctors- almost exactly the same number of doctors she bad when she undertook the training programme. In the meantime, the population of the country bas more than doubled. Unfortunately, the· brain drain continues to be on the ascendancy and bas grown to include young doctors, experienced nurses, and pharmacists. We are aware of the complex nature of this problem, especially with regard to international conventions on migration and free movement of people. However, Ghana is appealing to this Health Assembly to adopt a direct approach to solving this problem. We call on the Health Assembly to consider sorne agreed minimum health indicators for sorne countries, below which recruitment agencies would .be discouraged by their home governments. Diseases such as hypertension, diabetes, obesity, which were thought to be prevalent in developed countries, are emerging as important public health issues in our country. This bas been attributed to changing eating habits, sedentary lifestyles, lack of exercise, smoking and many other factors. There is an emerging adult endemicity of the above diseases which are likely to overwhelm our health care delivery system. We believe that a crusade of the same magnitude as bas been waged against communicable diseases is desired in this arena. We notice that the Assembly is tackling this issue and Ghana lends its fullest support to this endeavour. The global economie situation is having a negative impact on developing countries, resulting in deteriorating social services and the breakdown of water supply and sewage systems, among others. Also, activities of mining companies have led to degradation of the environment, dust and gaseous pollution as well as pollution of water bodies. These environmental changes have contributed to the causation of communicable and sometimes chronic diseases. There is a need, therefore, for the Health Assembly to look at the issue of these negative environmental changes on health. We also appeal to the Health Assembly to urge mining companies from the developed world to adopt the same strict environmental codes which prevail in their home countries to their operations in the developing countries. The Government's po licy of cost-sharing in health delivery which Ghana adopted as part of the conditionalities attached to the structural adjustment programme in the 1980s bas led to decreased accessibility to curative services for a greater number of Ghanaians. Indeed, the cash and carry system, as it was th en, a po licy of up-front, out-of-pocket payment for services at the point of service delivery, bas been so efficient in denying access that 20 years after the structural adjustment programme, outpatient attendance bas declined from 0.7 to 0.3. In other words, only three out of 10 patients are able to access health care services instead of seven at the start of the structural adjustment programme. Ghana is pursuing private sector participation in the curative sector in order to free sorne resources to fund health promotion, preventive, and rehabilitative programmes. The Government's presence in the curative arena will now be focused more on the poor and the socially excluded. Following a

ASSNR/4 page 89

comprehensive policy dialogue, Ghana has decided to abolish the cash and carry system, and a health insurance scheme will be introduced this year. Over 80% of the population in the rural areas of Ghana use traditional medicine wh en ill, in one form or another. In urban areas, over 40% use both orthodox and traditional medicine. This is to highlight the importance of this form of medicine in the country, which has come about as a result of the high cost of orthodox medical practice, loss of confidence in it, and the acceptance of the efficacy of traditional practices. Herbai medicine has been found to be very important. Unfortunately, sorne companies, especially from the developed countries, are clandestinely engaged in bio-piracy which includes exploiting the useful traditional health practices from our parts of the world, th us depriving our countries of the opportunity to benefit from traditional medicine. We therefore cali upon the various international bodies dealing with intellectual property issues, particularly the World lntellectual Property Organization and the World Trade Organization, within the context of the Agreement on Trade-Related Aspects oflntellectual Property Rights, to address this issue. These are sorne of the cardinal issues that we want this Assembly to critically look at. 1 thank you ali for your very kind attention. Dr NAUMAN (Poland): Mr President, Madam Director-General, honourable ministers, distinguished delegates, ladies and gentlemen, allow me first of ali to extend on behalf of the Polish delegation and on my own behalf, our congratulations to the President on his election to preside over this Health Assembly. 1 would also like to extend our congratulations to ali other distinguished officers elected to the high offices of this Assembly. We have listened attentively to the reports of the Director-General and of the Chairman of the Executive Board, which provided us with an overview of the situation that exists within our Organization and with problems facing the health care systems in Member States today and ali the challenges and threats of tomorrow. My intervention will focus on the problem of risks to health, their identification and, consequently, to the action that should be taken by the health care systems irrcspective of the level of existing financial constraints in which they operate. The rapid socioeconomic and political transition ali over the world, apart from unquestionable beneficiai achievements, brings also new health challenges. Within this changing pattern of diseases and risks to health, we have at hand old, unsolved health problems, old re-emerging and completely new health problems. The latter already appear as AIDS or bovine spongiform encephalopathy (BSE), but more new diseases, for example HIV1 importantly, as potentially serious new health risks. The subject of risks to health deserves our particular attention and consequently, specifie po licy guidelines for action. We have already identified many risk factors to health and even initiated sorne specifie action programmes, but generally we are far from being satisfied with the situation that exists today. We are fully aware of the continuing threat of communicable diseases. We are also aware of the main factors that account for the re-emergence of many communicable diseases. We know that among these factors are economie and environmental changes, increased migration of people and goods, inadequate water and sanitation systems, poverty and poor health infrastructure. We are also fully aware of the growing threat caused by noncommunicable diseases. Although major risk factors for chronic diseases are improper diet, physical inactivity and smoking, our knowledge in this regard is far from satisfactory and much more research needs to be done to elucidate genetic and lifestyle related factors. We should congratulate the Director-General for her initiative to establish the Commission on Macroeconomies and Health which has already published its first report. We hope that the outcome of the Commission's deliberations will provide evidence that by improving health we also contribute to the reduction of poverty. But poverty is only one of the macro risks we face today. The others are natural calamities and disasters and most importantly, man-made risks for health, among which we should identify terrorism, acts of aggression, armed conflicts or environmental degradation. 1 am not sure whether we are ready yet to identify by name these new pathways conveying pathogenic or potentially pathogenic influences, which are or may become harmful to our behaviour. My personal suggestion is that we should at least consider the role played in this regard by electronic vectors -

A55NR/4 page 90 television, radio, internet, print media - as weil as lobbying pressure by sorne groups or others. If you agree that there is a potential risk to health coming from electronic vectors, these new pathways conveying not only influences which are desirable for our health but also pathogenic influences, theo our Organization should initiate prompt preventive action in this regard too. Taking the opportunity of addressing this Assembly, the most distinguished worldwide health forum, I would like to mention that in Poland we are currently in the process of introducing a newly designed, community-oriented health policy, the National Strategy for Health Care. The Strategy presents a comprehensive approach to ali aspects of modem public health concept, compatible with up-to-date trends of health developments and adopting the WHO strategie princip les of the Health for Ali policy. The Govemment has recently adopted the programme which, it is our hope, will prove to be patient-friendly, less expensive and more efficient in health services delivery and accessibility. The programme restores the responsibility of the State for the health of the population and, by doing so, treats health as a prominent part of social po licy as a who le. I would like, from this rostrum, to thank the Director-General and the Regional Director for Europe for their support to our country for the continued development of our health sector. Madam Director-General, I would also like to say that the WHO European Ministerial Conference for a Tobacco-free Europe held in Warsaw in February was a notable success of the Organization, a tangible example of intercountry cooperation for better health and a milestone for the future WHO framework convention on tobacco control. Thank you very much. Dr MICOVIC (Yugoslavia): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, may I first greet this distinguished gathering and convey sincere and deepest respect on behalf of the Govemment of the Federal Republic of Yugoslavia, that is, on behalf of the govemments of the Republic of Montenegro and the Republic of Serbia, who are endeavouring to implement the agreement on a new State and the legal status of the State union of these two old European States as it was settled and harmonized with the international and European communities. I believe you share our optimism and hope that, in view of that, we shall be able to carry out in a more precise, efficient and rational manner, the exercise of rights and duties, and particularly reach our expectations stemming from our membership in this distinguished Organization. Also, on behalf of the members of the delegation I head, and on my own behalf, may I convey congratulations and wish successful work to members of this Assembly entrusted with important and responsible mandates for this session. Permit me as weil to express my compliments and satisfaction too at the programme-related ideas and commitments Dr Brundtland conveyed in her statement. In view of that, allow me to offer, on behalf of our Govemments and on my own behalf, full support to objectives established and initiatives launched that shall make it possible for WHO to reach goals set forth by the United Nations Millennium Declaration. Namely, we consider, first, that only in that way can current health issues and priorities facing the world today be addressed best and, second, that such a concept gives us courage, supported by WHO to pursue and achieve our projects towards resolving current issues which, however authentic they may be, do not go beyond the context of objectives set. I should like to briefly make a few remarks about the health situation of the population and overall situation in Montenegro and Serbia. As you know, we are countries in transition. The transition process we are going through has, although expected, adversely and painfully affected ali fields of social, economie, and political life illustrated in the serious material, social and, particularly health situation of the population with no sign of certain betterment in the near future. Moreover, in view of the fact that disconcerting issues prevailing in other domains, in greater or lesser extent, additionally affect the health of the population, furthermore burdening and complicating the role and expectations of the health care system. In that context, 1 should like to highlight problems burdening particularly the sole functioning of the health care system imposing an increase in provision of health care: an ageing of the population; a rise in incidence and prevalence of massive noncommunicable diseases; a considerable incidence of mental health-related diseases; and increase in the number of HIV/AIDS-affected persons; complex issues pertaining to education and work motivation of health professionals and lack of adequate health

ASSNR/4 page 91

care management; and Jack of accurate insight as to the importance and structure of particular health problems due to non-existence of an integrated information system. Taking into account the complex and diverse nature of the aforementioned problems, competent mini stries and relevant complementary institutes exert efforts to secure conditions for a system-like approach to solutions. Both Republics adopted documents for implementing national health care policies providing for the character, dynamics and reform development within the health care system. With that in mind, new laws on health care and health care insurance were drafted in line with WHO, World Bank and European Union recommendations. We expect that, while implementing these strategie and reform-like activities, the said institutions will offer the necessary technical, material and other support, without which implementation would take more time and be more uncertain. In conclusion allow me to emphasize once more that our Governments are whole-heartedly committed to cooperating in a close and constructive manner with WHO. They also wish to contribute, through reforms and achievement of objectives, to the improvement of the health situation of our own population, thereby making concrete input to overall programme activities established by WHO and the United Nations with the aim of attaining the goals outlined by the United Nations Millennium Declaration. Thank you very much. Mr SUNGAR (Turkey): Mr President, Madam Director-General, ladies and gentlemen, it is indeed a great honour for me to address the Fifty-fifth session of the World Health Assembly. It gives me great pleasure to congratulate the President on his election as the President of this eminent body. 1 would also like to congratulate other distinguished officers, to whom I wish every success in their important work. We have read the introductory document of The world health report 2002 with due attention. I wish to express our thanks to the Director-General for highlighting and addressing the major risks to human health. ldentifying the existing and potential risk factors for health is one of the most important steps in our efforts to improve health care systems and to tackle them in an efficient way. There is a growing consensus that environmental degradation, natural disasters, unsafe drinking water, Jack of access to sanitation, poverty, malnutrition, inappropriate dietary patterns, alcohol and tobacco use, are major determinants of risks to human health. An effective response to risks and threats to human health requires agreement on, and understanding of, its causes. Establishing wider national and international standards for the common definition of major risk factors will improve the effectiveness of work on health systems for disease prevention and control. Young people are at a higher risk of tobacco and substance abuse including alcohol. Governments in many parts of the world have been taking legislative and educational initiatives to control the use and addiction of tobacco and alcohol. The health problems arising from tobacco consumption, and the human and financial costs of tobacco use can be avoided. We believe that the framework convention on tobacco control will provide us with an important instrument in our struggle against tobacco use and addiction. We look forward to the earl y conclusion of the convention. Turkey' s National Health Po licy 21 prepared under the leadership of the Ministry of Health guides decision-makers to take effective measures to reduce the use of tobacco, alcohol and psychoactive medicines. We have actively participated in WHO's "Quit and Win" campaign by involving both policy makers and civil society. Globally, women and children are among the most vulnerable groups for the major risk factors for human health. In view of this reality, a broader perspective as weil as a more focused approach is essential to meet the needs of children and women. Turkey does not only provide routine services to children and women but also implements sorne special programmes to enhance the quality and the effectiveness of our national services. Our project entitled "Prevention of mother and child mortality" aims at raising the awareness of our citizens to better understand the needs of these vulnerable groups and to reduce the risk factors through comprehensive services. We have been working closely with WHO, which plays a proactive leadership role, to eradicate and control different communicable diseases. We have already seen many positive developments within severa! countries. For example, poliomyelitis has not been seen in Turkey for the last four years, due to the strong commitment of our Government to eradicate this disease. We should continue to do further research to develop new vaccines against infectious diseases. Evidence shows that

A55NR/4 page 92 vaccine-preventable diseases cause an estimated 1.8 million deaths every year. Although there is good progress in tackling communicable diseases, we face growing challenges in responding to noncommunicable diseases due to mainly sedentary lifestyles and inappropriate dietary patterns. Govemments need to adopt effective measures to respond to the challenges posed by this type of disease. There is an undeniable link between poverty reduction and health. Health is central to the achievement of sustainable development. The key findings of the Commission on Macroeconomies and Health established by the Director-General indicates that health is not only a priority goal in its own right, but also a crucial input into economie development and poverty reduction. We ali know that the risk factors for human health are rapidly growing. We need to respond to these risks by defining the core variables for risks to health and by developing a common approach and strategy to build a new and better partnership. In this endeavour, WHO has a major role to articulate consistent norms and standards and to stimulate greater cooperation globally. I thank you very much Mr President. Mr KRISTJANSSON (lceland): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, allow me to congratulate the President and the officers of the Fifty-fifth World Health Assembly on their election. Congratulations are also extended to the Vice-Presidents, the Chairmen of the main committees and other officiais. My delegation would like to congratulate the Director-General and her staff on their excellent work in meeting new challenges and planning for the future. In our view, initiatives such as the report of the Commission on Macroeconomies and Health, which was published in December last year, has perhaps mu ch of what is needed to bring real benefits in the coming years. The Commission has put forward a comprehensive approach, with concrete goals and specifie time frames, which we hope will break new grounds for the future work of WHO - for the future work of each and everyone of us. By putting forward ideas, thoughts and by analysing the bearing factors regarding macroeconomies and health in a way that is clone in the report, we are now able to move in the right direction. Globalization is put to the test as never before, and we must, and we can, reduce poverty and improve health. It is our obligation to our children and grandchildren to use the best of our modern science and technology and the wealth of the rich countries to improve health. We are a unified organization as our Director-General declared when she said four years ago: "WHO is one". With the extensive report on macroeconomies and health, the Director-General has again set the agenda for the future. This framework is now clearly reflected in the Report of the Director-General for 2001, where the following four strategie guidelines are identified as specifie areas of work in the coming years: reducing excess mortality, morbidity and disability; promoting healthy lifestyles; developing health systems; and strengthening the institutional environment of the health sector. These guidelines also formed the basis of the General Programme of Work for 2002-2005, and the Programme Budget for 2002-2003, adopted by the Health Assembly last year. This is a rational basis for WHO to be able to act effectively at the country levet, the regional levet and globally through skilled presence at the country levet, guidance by the regional offices and global direction by headquarters. Finally, I would like to conclude my address by assuring you, once again, of the commitment of the Government of Iceland in contributing to constructive efforts to fulfil WHO's noble mission to improve health for ali people of the world. Because WHO is one, because WHO means equality, we are not only improving health - we are creating a better world. Thank you, Mr President. Mr ASLAM (Pakistan): Mr President, Madam Director-General, excellencies, ladies and gentlemen, on behalf of the Pakistan delegation, I wish to extend my warm felicitation to you and other members of the Bureau on your well-deserved election to the Fifty-fifth World Health Assembly. We are confident that under your inspiring leadership, the World Health Assembly will realize outstanding results. We welcome the report of the Director-General presented on Monday. The report reflects the high standards of efficiency and effectiveness that WHO continues to maintain in the United Nations

ASSNR/4 page 93

system. 1 hope that the Organization will continue to maintain these high standards through constant evaluation and refinement of its strategie programmes and directions under the overall guidance and direction of the Health Assembly. Humanity has made great leaps in combating disease and improving health standards. Unprecedented progress has taken place in the development of technology to improve human health and the quality of life and longevity. However, as the world makes progress in accumulating technolgical know-how and acquiring expertise in the medical field, new ethical and moral challenges inevitably arise. Breakthroughs in health sciences and technology are yet to benefit ali humanity. The gap in health standards between the haves and have-nots is widening, both in quality and quantity. Millions do not have access to affordable medicines and other health interventions. Sadly, research on diseases afflicting developing countries is declining although these needs are greater in terms of numbers and gravity. During the last decade, severa! United Nations conferences were held where the international community made commitments to promote global solidarity. Unfortunately, these commitments have remained unfulfilled. In recent years, international financial and technical assistance in health and other social sectors has undergone a rapid decline even as the financial difficulties of developing countries, many trapped by unsustainable debt servicing, have grown significantly. The poor countries cannot, therefore, provide quality health care to their populations. They are gradually losing the battle against controllable diseases. The recently released report of the WHO Commission on Macroeconomies and Health provides an interesting and welcome approach to overcome the impediments in combating disease, improving health standards and raising the quality of life of millions of people around the world. As the principal United Nations agency in the health field, WHO should take a lead role in further developing and implementing the proposed action agenda for investing in health for economie development. In this context, WHO should focus its efforts on the following objectives: making health a priority within the global development agenda. This should encompass measures to enhance equity in world health and the establishment of affordable and accessible health infrastructures in the developing countries; ending the oligarchie control of technologies in the health field, which deprives billions from the benefits of the latest technology. Intellectual property rights should not become an impediment to the production and availability of life-saving drugs at affordable costs. WHO should lead an international campaign to ensure the availability of essential drugs at affordable priees, including production and distribution of generic drugs in developing countries; promoting intensive and expanded research and drug development for diseases afflicting developing countries and developing affordable medicines. WHO itself should also sponsor research projects with long-term benefits for developing countries. In this context, we fully endorse the proposai for the creation of a global health research fund with an initial outlay of US$ 1.5 billion as weil as generation of an equivalent additional amount through existing institutions; and generating adequate resources to fill the gaps in global funding mechanisms in the health sector. In collaboration with the United Nations and the Bretton Woods Institutions, and based on the principle of solidarity, WHO should elaborate a sustainable and reliable strategy for financing health sector programmes in the developing countries and at the regional and international levels. The aim should be to secure donor commitments of a !east US$ 27 billion in 2007, going up to US$ 38 billion in 2015, as recommended by the Commission on Macroeconomie and Health. In this context, the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a welcome development. However, the funds generated so far are hardly adequate for the task. We hope that the pledges made will materialize. We also hope that the richer countries will contribute more generously to the Global Fund in response to the growing needs of the developing countries. It will be essential to ensure, however, that the Global Fund does not replace other bilateral and multilateral funding mechanisms and that contributions to the Fund are not made at the expense of health assistance to the developing countries. Last year, I had recommended that the Organization should develop plans of action for implementation of the commitments undertaken by the international community in social development. Ali action plans should be made and implemented with the full involvement of Member States and take into account the perspectives of the developing countries. The main objective of such action plans should be to build capacity in the developing countries, to strengthen their national mechanisms, and to make them self-sufficient in meeting the needs of the ir peoples.

A55NR/4 page 94 WHO itself needs to become more democratie and open to the interests and views of the developing countries. We attach great importance to the ongoing process of reform of the Executive Board. In this context, we shall seek to: enable non-members to participate more fully and equitably in the Executive Board; rationalize the agenda of the Board, inter alia, to ensure that it does not become a parallel decision-making body to the Health Assembly; ensure equitable geographical representation and increased participation of developing countries in the subsidiary bodies of the Board, as weil as in expert panels and committees; and improve the representative character of the WHO Secretariat by recruiting more staff from developing countries, especially at the decision-making levels, and improve transparency in appointments and decision-making. Pakistan, together with a group of like•minded countries, has submitted detailed proposais in the form of a working paper for consideration; We have high expectations of the reform process, which has been slow so far. We should find ways and means to expedite the work of the Ad hoc open-ended intergovernmental working group to review the working methods of the Executive Board, including holding inter-sessional meetings. Let me conclude by expressing our appreciation for the commitment of the Director-General to the noble goals of the Organization and leading WHO with dedication and perseverance. Pakistan's commitment and support to this Organization and its objectives remains as strong and unflinching as ever. I thank you, Mr President. Dr MUBARAK (kaq): .

A55NR/4 page 95

dj ~~-1 1 L...ojl! ~

· · (..)A-'4

~~ ·.t-: ·-'1 ~ . ...iû...... ~ ..<-tl ~ •.~. ,~li:lll ô.<"-, J ~~ô· ,. .Jf-?''JI. J ül..o~ , LoW ~ ..;--

~_,li ~~y:. ~ l.!\...4)'4 ,_fol ~J ~~~ ~J ô\Jla.JI .J~I ~ L- ~~_;.JI rl~'il 11-1 ,~4~1 .J4::JI t:j.fJJ ~_; ~.J~IJ ~ u~IJ y~ ~1 o4-JI _;:!_; <.} rWI ~1 ~_,i .W -L.jt.J ~~ ~ .uc .Jt..-.11 ~.J .JA JI yJI <.} ~1 ~_,li ~ <.} *_,li J:JI 0~ . ,y.'JI wJ;- d).) ~~ ~ ~J_;WI .oûl..ol .;J4 l..o 0JJ l.!\S ü'i4--JI <.} ~WI ~1 ~ t"' 0JW11 ~ JlyJI W4..?- .lil ,~)1 ~1 J~ ~"'/ .l ol;,;Jl ~"'ji ~1 ~IJ ,~ .l...oWI ô~.l.JI '.lÙtl.i.JY. r.al).A JY:. ô.J_;6.lll .oû~Î '.' ·a; JI r~I.J.>.jll ~1 .Jt:J'll ~I.J.ll ~~~ ,y. '(,i.Jij;JI Jlj)l ~ ~ .J_;6.lll ,.1.....,_,:l.JI ~ ô~4 ~WI .J\5.!'11 ~l...:t::.:J)' <)l_;a.ll .l!_,ll t"' ü_?.o- ~1 ül.h4-Jl ~~ ~1-.?.t .li.:aï .)l <.S~t ~J.J .• JIJ ~y.!..JI W4yJI ~~~,y. 0l.J .Jiy.ll ~ 01J.WI <.} '.'~a;4JI r~I.J.J:!ll rl~l .Jl:JÏ 1 - 11 ~ 1 ,il •.~. U)l:..'JI l..J..Ja.\1 tU..lc.L.....u ~1 ~ J <.-'...)"'-' '1 ·-'1 I..);H · 4.5.~ .-:•.11 ~ ~ , ~ . WWI , .J..r. ~ , J , ....__._~ ol.ll ·L..u'JI ~1 ~ ,.~. ..lS· jjl -1.11 ·L..u'JI J-jl 1~ üL~ :uuï· · ~J r.r . ..r..?. ~ (,$ c...- r.r • , , J ~J .Juï 0~ thWI J.!.l.li4J ~~~~J ~~ wHIJ üLI.J.lll \+i..lSl ô~ JSt..!w.J üy~ rLot ~J (.5 ~t L.....w Jl...;--.11 ~ ~.fo-.11 \..a.,jyL.c. <.} , J ;, ;411 r~I.J.J:!ll r-1~4 y.;~Y.J ô~l ü\.:'i _,11 rYi ~.l...c:. ~ ~ ~J .~ l..j.J~J ~l..a...!.j w_,li .)j :y!ly.ll ~\.J'JI ()A ~IJ übl.....w ~~ .)j ~j-L-Jl.4j L>.HL-.JI ~4Î <.} '.'~;,;411 r~I.J~I d.Jj ~..?.J ,y. ~IJ ~_,.JI ü'iWI 0"" r+"" .u -tlJI Y.F · ~ · -'1 ~ '\.:l.lll ~ l.!:J" , ...)""' -L.ji_J.le. J ~l.i..ll ~~ J>M)'I ~'il d~ ~~..?.- ()A 0_,i~. ~ <.} ~~Î LJ1 ,~)1 ~~ ~~~ ô~L;ill >-t ü.l....._ij ,~L.,..j)'IJ ~_,ill \+i\.:h~ ~ ÜAJ ,Jiy.ll ~.J~ 0JJ .~1 ü~~'J\ (j'l · Î~ ~ · ' c.r":1\ ~~ ' .;Il ûlw. ·· ·'- t; ...,-. .J ~ ~'JI .l.-..ti..J ,. <.-'.JA" , \..oS ~ 1 J .l\1 J ~ ljajl ~~ ~ . ,',!!;; ,.1 LoS ,4,5.).~.JI ~I.Ui'il ~~ ~1 ül..o~l f':!~ ~.J'JI ü~ (.5~j <.} J-jj ~1 ~1 ü4\S..o)'IJ üL.......aL.Al::..'JIJ t.)S.Lo'JI ~ ü~J ~.r.JI ,y. ô~ û~J ~ly.ll d.zï.~.;".oll oi.-.\ ~ ()A , lüJJ .~.lll.!J_;-.11 J ô~l J ~1 \JiJ_;.l:. JS ~ .J ~ ~ ul ~ ô.)jl.JI )-......J~\ ,y.~~ (,ijjl ~1 vi.:\..".lëll ~ ~~)'IJ rc-.lll ~ ~L.4c.'JI JJ.lll ~ _,c.~ '~Jy.-11 .~1 ~y.ll ~I.J'JI ~ ~~ ~~~ LJIJ.WI ~J ~ ~l·ô~l ~~)'IJ ~1 •L....i'JI 1"\1•'. 1 c:•\al ~.Jt"'i""' ··-'1 (j'l • ,lJ'·-'1 ~~ ~ \.jj_,c. .lJ •l Ô.)A ..,;,(j_;J (..) • ~~ ,...)""' J~ . WWI , . (.5 ..?.y,_,.....!JI .)c. v-""y..JI jl:fo.'JIJ ..t.a.....;:Jj ~_,s. •.oûts:.•>U .ill ~.JJ ~ ~IJ

Dr GAMKRELIDZE (Georgia): Madam Director-General, ladies and gentlemen, let me greet the participants of the Fifty-fifth session of the World Health Assembly and assure you that for me, as a representative of a small country which gained its independence just 10 years ago, it is a great honour to address such an · honourable audience. It is not a secret that health, as one of the basic components of human capital; is an important precondition for economie development. Besides improving the economie welfare of individual families, good health of the population is important in reducing poverty and ensuring the long-term economie development of society as a whole. It was important that the Millennium Development Goals adopted at the Millennium Summit of the United Nations in September 2000 called for a dramatic reduction in poverty and marked improvements in the health of the poor. WHO actively participated in a large-scale international campaign against poverty at the Fifty-first session of the

A55NR/4 page 96 WHO Regional Committee for Europe in September 2001, where the main topic of discussion was the relationship between poverty and health. It was a bright example of WHO activities in this direction. During the last decade in Georgia, like in the other countries with a transition economy, the level of poverty greatly increased. Shifting to the principles of market economy created favourable conditions for the development of only a small part of the population. However, for the majority of people, these processes caused unfamiliar economie problems and an uncertain future. In countries with a transition economy, unlike most developing countries, the poor are mainly represented by the well-educated and professionals. This situation makes their life more complicated and causes moral' degradation and loss of self-esteem. In recent times, the issue of poverty eradication became very topical for the Georgian Government. The Poverty Reduction and Economie Growth Programme of Georgia has been elaborated in cooperation with the international organizations. Improvement of the health status of the poor is one of the most important goals of the programme. Unfortunately, in present economie conditions, our country cannot provide adequate funding of set goals and we are in great need of external assistance. The Conference on Poverty and Health in Georgia held on 29 January 2002, with the support of the WHO Regional Office for Europe, was dedicated precisely to these issues. The Conference resolution supports the Georgian Government's initiative, health in exchange for debts (Tbilisi Initiative, 2002), which calls on international creditors to write off a portion of the country' s foreign debt on the condition that saved financial resources will be solely invested in the social sector and in health care. Currently, the country's external debt is US$ 1.5 billion. Annually the State budget pays US$ 100 million in interest to foreign creditors in debt servicing. For comparison purposes, total State funding of health, including central and municipal programmes, will not exceed US$ 37 million in 2002. Therefore, the Government of Georgia spends almost three times more servicing the external debt than on health care for its own population. If even a part of these funds was used for health needs, the Government would significantly improve the condition and health status of the poor. I am sure that Georgia is not the only country in such a situation. That is why we cali on the international fmancial institutions and developed countries to listen to our proposai and begin to discuss this issue with ali stakeholders. I hope that the Health Assembly will support our initiative. The text of the resolution of the Conference on Poverty and Health in Georgia was distributed among participants. Thank you for your attention. Dr AL- SHARIF (Palestine):

A55NR/4 page 97

A55NR/4 page 98 Dr THAKUR (India): Honourable President, Madam Director-General, excellencies, ministers of health, ladies and gentlemen, at the very outset, I bring you greetings from the Honourable Indian Prime Minister, Mr Atal Behari Vajpayee. I congratulate the President on his election to this august office. I also congratulate the Director-General for giving a very inspiring address yesterday and also for establishing the Commission on Macroeconomies and Health. As a medical practitioner and a researcher, I have been a regular visitor to the various meetings at WHO, but this is a moment of great privilege for me to lead the delegation from India to the Fifty-fifth World Health Assembly. It is a big opportunity for ali the nations to share knowledge, experience, shortcomings and limitations. I had the honour of chairing the ministerial round table on risks to health yesterday. From the presentations made by the health ministers yesterday, one can broadly categorize the type of risk into three groups, depending on the leve! of income in the country. However, in many developing countries, such as India, characterized by diversity of socioeconomic factors and epidemiological transition, ali the risks exist to a certain degree. In fact, in India, and also in many developing countries, the burden of re-emerging communicable diseases such as malaria and tuberculosis is compounded by the emerging noncommunicable diseases. In India, a working group for noncommunicable diseases appointed by the Planning Commission for the lOth Five-Year Plan has identified six key sets of risk factors for this, which are: smoking and tobacco use, alcohol abuse, inability to obtain preventive health services, lifestyle changes, environmental risk and stress. Though we have been running focused disease control programmes for malaria, tuberculosis and HIV1AlOS, it is rapidly becoming evident to the policy makers that a strong prevention programme based on an effective disease surveillance on the one hand, and health promotion activities through information, education and communication networks on the other, is much more cost-effective than any curative programme. In our AlOS control programme, the main thrust is on prevention of potential infection through creation of awareness and targeted intervention for identified high risk groups. We have started the prevention of mother-to-child transmission and this is going to reach about 30 million pregnant women in the country, one of the largest interventions in the world. Similarly, for tuberculosis, under the directly observed treatment, short-course strategy we are going to cover the whole country, that is a population of more than a billion. As part of the tobacco control programme, a multi-dimensional approach of legislative intervention, an information, education and communication campaign, and community awareness through nongovemmental organizations have been adopted. The Director-General of WHO has emphasized in the opening address to the Health Assembly that improved health conditions can considerably increase economie growth. We ali appreciate the vision of the Director-General in establishing the Commission on Macroeconomies and Health to assess the place of health in global economie development. The findings of the Commission's report can provide the basis for new policy initiatives by individual countries and world organizations to contain the risks to health. In its 2002 health policy, India has envisaged increasing health sector expenditure to 6% of the GDP, with the Govemment contribution increasing from the present 0.9% to 2% by 2010, thereby doubling the public expenditure on health from the present 17% to 33%. Govemment expenditure on medical research is also going to increase from 1% of total health spending by 2005 and thereafter, to 2% by 201 O. More than one-third of the Member States of WHO are spending Jess than US$ 100 per capita on health every year. At the other end, there are many countries who spend more than US$ 3000. Such being the enormity of the gap between the "haves" and the "have-nots" in the field of health, there is little wonder that vast differences exist in health outcomes between the regions and nations. But diseases know no boundaries. Vectors and viroses do not respect international borders. Humanity cannot have a future when a small island of prosperity and health exists in the mi dst of seas of misety and disease. The global threat of HIV and AIDS is a wakeup cali for ali of us, and here cornes the role of WHO. It may not be enough if WHO works only as an umbrella. It must work as a seal to protect world populations from deadly disease. It must persuade the developed nations, multinational agencies and donor foundations, to direct the resources where diseases of death are wiping out humanity. In this context, 1 would like to mention the constitution and functioning of the Global Fund to Fight AlOS, Tuberculosis and Malaria. Although India has the second highest burden ofHIV/AIDS, it is yet to get any funding support from WHO. WHO has to be

ASSNR/4 page 99

proactive in deciding how su ch global funds should be administered. The report of the Commission on Macroeconomies and Health also ca11s on WHO to work in cooperation with the World Bank, the World Trade Organization, the International Monetary Fund, the Organisation for Economie Cooperation and Development and the private sector, to look at the opportunities and facilitate much higher investment in health in developing countries. India, along with other developing countries, had been fighting against the restrictive provision of the Agreement on Trade-Related Aspects of Intellectual Property Rights. The Doha Declaration acknowledges this by allowing developing countries to protect public health white implementing their patent laws. We hope that WHO will continue to work actively to secure access to affordable drugs for the poor and help reduce risks to health. Protecting and developing the traditional system of medicine can play an important role in increasing access to essential health. India has been fortunate to have a well-developed traditional system of medicine, namely Ayurveda, Sidha, and so forth. We are willing to share our research work and educational infrastructure with interested countries for collaborative arrangements. We have especially organized a presentation-cum-exhibition for the delegates of the Fifty-fifth World Health Assembly at 6 p.m. on 15 May 2002, which is today, at Hotel Movenpick in Geneva, and 1 personally ask distinguished delegates to attend the presentation and look at the exhibition. Finally, there is a need for a healthy combination of and cooperation between good govemance by the State govemments, the cooperation of civil society and nongovernmental organizations, compassionate help from don or agencies and a more proactive role by WHO to wipe tears from the eyes of the poor and needy. Thank you very much. Dr PEZESHKIAN (Islamic Republic oflran): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, it is an honour to address the Health Assembly. Let me first congratulate the President on his election to lead this important meeting. In my country, Iran, for a variety of reasons such as socioeconomic changes, industrialization, urbanization, demographie transitions, change in lifestyle and nutritional habits and an increasing access to health services, the health pattern has significantly changed. On the one hand, most of the endemie communicable diseases have been controlled, eliminated or eradicated. On the other, due to reduced mortality, increased !ife expectancy and an increasingly elderly population, noncommunicable diseases are on the top of the list of causes of death. Based on the available information, the three leading causes of death are cardiovascular diseases, injuries, and cancer. According to the death registration reports, cardiovascular diseases cause 35% of the deaths. It is obvious that the rapid rise in noncommunicable diseases represents health challenges to global development in the twenty-first century. This growing challenge threatens economie and social development as weil as the lives and health of millions of people in both developed and developing countries. lt is a well-known fact that most of the noncommunicable diseases are linked by common preventable risk factors related to lifestyle. These factors are tobacco use, unhealthy diet, physical inactivity and general carelessness. Hence, addressing the major risk factors has been given the highest priority in our national strategy for prevention and control of noncommunicable diseases. We ali know that noncommunicable diseases are to a great extent preventable through interventions against the major risk factors and their environmental, economie, social and behavioural determinants in the population. lt is also a wellknown fact that we can revise the advances ofthese diseases if appropriate action is taken. To this end, we have launched an information, education and communication campaign aimed at increasing awareness of the frequency and magnitude of noncommunicable diseases so as to ensure proper response from the general population, professionals and media in dealing with the problems of noncommunicable diseases. We have integrated our national noncommunicable diseases prevention and control programme, including surveillance activities and demonstration projects, into the primary health care system. As an example, 1 refer to the integration of mental health within primary health care as part of general health care services. The initiative started as a pilot project in two districts in 1987 aimed at promoting mental health knowledge and making essential mental health available to ail.

ASSNR/4 page 100

Tobacco use is a serious problem in my country. The social, economie and health consequences of tobacco are significant and cali for high-level political commitment, close coordination and cooperation among different governmental sectors and active participation of nongovernmental organizations. The Government of the Islamic Republic of Iran, in accordance with the provisions of the framework convention on tobacco control and in line with the regional plan of action, has developed its own national plan for tobacco control. A multisectoral committee on policy formulation and planning for tobacco control was set up in 1994. According to a presidential executive order, tobacco use has been banned in public places and on public transport. A wide range of information, education and communication activities including seminars, press releases and television spots have been implemented with the aim of preventing smoking among adolescents, youth and women. A bill on the prevention and control of smoking was drafted by the Cabinet and soon will be submitted to Parliament for its final approval. Despite ali these achievements, we have a long way to go. We are of the opinion that it would be difficult for most of the developing countries to tackle the problem of noncommunicable diseases alone, without international solidarity and partnership. Accordingly, the active involvement of the organizations of the United Nations system, international agencies, nongovernmental organizations, professional associations, and research institutions would be crucial to the successful implementation of national noncommunicable disease prevention and control programmes. I cannot conclude without mentioning the ongoing horrendous health situation of the Palestinian people in the occupied territories. While we talk of enhancement of access to health services and other standards of well-being worldwide, Palestinians suffer from a lack of very basic health services denied to them by the occupying power. lt is incumbent upon us, as participants of the Health Assembly, to mandate a mission to the occupied territories to investigate the atrocities and systematic obstruction of health services committed by the Israeli forces against defenceless Palestinians. Let me conclude by emphasizing the fact that there cannot be health for ali without a universal fight against the root causes of the evils of injustice, aggression, war and terrorism. Thank you, Mr President. Dr MAUCEC-ZAKOTNIK (Slovenia): Mr President, experts and participants from 15 western and eastern European countries and representatives of WHO and the European Commission, had decided, at the International Conference on promoting health through physical activity and healthy nutrition, held in Radenci, Slovenia, from 18-21 April2002, to create the Radenci Declaration: "We are concerned that unhealthy diets and inadequate levels of physical activity are contributing to high levels of preventable disease in the population. We believe that a healthy life is the right of every member of society and that action should be taken to give everyone access to healthy choices. This declaration builds upon the princip les of earlier declarations such as the Ottawa Charter and supports ali calls for action to promote health and prevent disease. We, the delegates of the International Conference on promoting health through physical activity and healthy nutrition in Radenci, Slovenia, recognize that there is international agreement about the scientific evidence for the health benefits ofhealthy nutrition and physical activity, and the prevention of related illness in the population. Our goal in the promotion of well-being, prevention of various chronic diseases and improvement of quality of life is to encourage people to: eat more healthily by increasing the quantity of fruit and vegetables consumed, eating more starchy carbohydrate foods, eating smaller amounts of meat and meat products and increasing the quantities of fish, especially oily fish, using lower fat clairy products and reducing consumption of sugary and fatty foods; be more physically active by aiming to be active for at least 30 minutes or more, preferably every day. This includes activity for transport (like cycling and walking), during work (such as stair climbing), nonoccupational, domestic activities (su ch as gardening) and sport and recreational activity (like brisk walking, jogging, swimming, playing football or dancing). More physical activity than mentioned may be needed to prevent weight gain on high fat intakes. It is of very great importance to balance daily energy intake with daily energy consumption to pro vide enough es senti al nutrients to maintain the energy equilibrium of the body.

A55NR/4 page 101

As we believe that healthy food and nutntwn and physical actlv1ty have a synergistlc relationship, combined action will be more effective in promoting health than tackling each behaviour separately. We especially emphasize the need for: training of public health professionals in the areas of the promotion of healthy food and nutrition and health-enhancing physical activity, we emphasize the need for more and better data on food intake and leve) and pattern of physical activity in the population, the need for innovative ways of tackling these issues across the whole lifespan, and the need for further research into the effectiveness of promotion efforts in these areas. We declare that action to promote healthy food and nutrition and health enhancing physical activity needs to: be intersectoral and multidisciplinary; use an integrated, multilevel approach working across the whole lifespan; focus on supporting changes to lifestyles and to the environment; and work in different settings such as schools, workplaces and primary health care, using different approaches for different sections of the population. Achieving our goal will require political and public commitment and support, investment and resources. Lack of action will increase the burden of disease and subsequent economie and environmental costs for this and future generations. That is why we cali upon the following groups to accept our challenge to promote healthy food and nutrition and health enhancing physical activity: public health professionals, to recognize the need for and to develop competencies in the new area of public health nutrition and health enhancing physical activity, which is a specialized field of public health; to monitor trends in risk behaviours and protecting factors and to assess the impact of policies in ali sectors on health of the population; to provide leadership and to act as advocates for health promotion through regular health-enhancing physical activity and healthy nutrition; to develop new research and information to support the development and implementation of policies which focus on healthy nutrition and healthy-enhancing physical activity; to respond appropriately and promptly to the media's and public's need for adequate and newsworthy information; and to coordinate and support the efforts of other agencies to improve · health through physical activity and nutrition; academie institutions, to support national work by encouragement of use of evidence-based methods for interventions; to support and conduct baseline surveys, using internationally recognized methods, and evaluation of interventions; and to encourage international networking with colleagues in the area; civic societies and nongovernmental organizations, to advocate that health should be included as a priority goal in ail public policies; to mobilize various local community organizations to participate in decision-making processes at the local level and to actively support ali appropriate and verified investments towards implementation of healthy nutrition and health enhancing physical activity policies and efforts; to contribute actively in the process of reviewing and evaluating of health promoting initiatives at the local level; industry and commerce, to adopt the best possible practice in their role as employers; to work with local authorities to support community initiatives aimed at improving health through healthy nutrition and health-enhancing physical activity; to use as much as possible company assets for the greater and wider social and health benefits of local populations; media, to help create a positive climate of public opinion for health promotion actions through healthy nutrition and health-enhancing physical activity and to reach as many people in society as possible, to provide support and endorsement for those who take action in health promotion, to allow various types ofmedia's printed space/broadcasting time to be used to promote health by advertising the importance and positive impact of healthy nutrition and health-enhancing physical activity on the population's general well-being and better quality of life, to be aware of their moral and ethical responsibility concerning media marketing of products in the sense of this Declaration, especially in vulnerable groups like children and adolescents; political decision-makers, to recognize the specialized area of public health nutrition and health-enhancing physical activity and the need for governmental support for training and research in the field, to consider the health impact of ali governmental policies and to create an appropriate environment for healthy food and nutrition and health-enhancing physical activity to be taken into account when drawing up and implementing other policies, to provide targeting information and support to enable the population to make informed choices about healthy food and nutrition and health-enhancing physical activity, international bodies like the World Health Organization and the European Commission, to provide practical evidence-based guidance and advice, to develop efficient mechanisms of knowledge, expertise and experience transfer between Member States, to facilitate an integrated approach to health promotion through health-enhancing physical

ASSNR/4 page 102

activity and healthy food and nutrition within and between countries by further building of stronger partnership also with various other international bodies, agencies, intergovemmental organizations, nongovemmental organizations, commerce and industry." We hope and believe that this Declaration will find a place and will have a positive impact at ail levels for better health, not only in my country Slovenia, but worldwide. Dr HOSSAIN (Bangladesh): Mr President, Madam Director-General, honourable mtmsters, excellencies, distinguished delegates, ladies and gentlemen, Assalamu Alaikum. lt is indeed a great honour for me to address this august gathering. Please accept warm greetings from the people of Bangladesh. May 1 join those who have spoken before me in congratulating the President on his well-deserved election, and also the other members of the Bureau on their elections. 1 am confident that you will steer our work in the coming days to a successful and fruitful outcome. 1 assure you of my delegation's full support in your work. May 1 also thank the Director-General for her commitment and untiring efforts to place health issues at the centre of the global development agenda. Her report which we have before us has rightly identified critical issues that deserve our attention. 1 sincerely hope that we would be able to give concrete guidelines in these areas in our deliberations. The Govemment of Prime Minister Begum Khaleda Zia places the highest priority on the social sectors in Bangladesh. We recognize the critical linkage between overall social development and health. Special emphasis had been placed on health, education, women's development and poverty eradication programmes. The areas of adolescent health, mother and child health, family planning, the Expanded programme on immunization and nutritional programmes are also receiving particular attention in our development programmes. Within our national development paradigm, we have placed health among our highest national priorities. We have concentrated on providing a comprehensive public health network for widening and improving basic health care services. We have established new medical and nursing schools for increasing the number of doctors, nurses and midwives. As a part of our pro-poor drug policy, the private sector is encouraged to establish pharmaceutical factories to provide essential drugs and medical supplies at affordable priees. The essential service packages scheme provides essential health services throughout the country. Our efforts are beginning to show concrete results. Our life expectancy at birth has risen from 47 years in 1975 to 60 years at present. The infant mortality rate has also reduced to 57 from 150, and this favourable trend is continuing. We consider our maternai mortality ratio of over three to be too high, and are making efforts to improve the situation. Our success in reducing the fertility rate is well-recognized. We have succeeded in bringing it dawn to three from six (in 1971), and this is continuing to register a decline. The contraceptive prevalence rate has risen to 54 from 7.5 in 1975. The population growth rate has dropped to 1.60% from 2.48% in the same period. Our greatest success, possibly, has been in the eradication of poliomyelitis and child immunization. We are almost on the verge of declaring Bangladesh "poliomyelitis-free". The Expanded programme on immunization coverage is almost universal. Similar positive indicators also mark our efforts in reducing malnutrition. These achievements were possible through unwavering political commitment, increased investments in the social and health sectors and effective collaboration of the public and private sectors. 1 would like to recognize here the role of the private providers and nongovemmental organizations who have been our active partners in ali these efforts. While we forge ahead in tackling existing diseases, we are beginning to face new challenges. 1 re fer to the emergence of HIV1AIDS, the re-emergency of malaria, dengue and tuberculosis, and diseases associated with environmental degradation and poverty. Tuberculosis remains a formidable challenge for us. Of the 22 highly burdened countries, Bangladesh is ranked fifth. Recognizing the magnitude of the problem, we have put in place a fairly comprehensive strategy for tuberculosis control (DOTS) which has been lauded as an effective model of govemment-nongovemmental AIDS is not yet at an organization collaboration in this area. In Bangladesh, the prevalen ce of HIV1 alarming level. However, in this globalized world today, we can hardly shut out the disease from our borders, particularly given its intensity in countries around us. A National AIDS Committee has been set up under the patronage of the President of Bangladesh. We have adopted a National Strategie Plan

ASSNR/4 page 103

for addressing HIV/AIDS and a National HIV/AIDS Programme has been drawn up for the effective implementation of this Plan. The Global Fund to Fight AIDS, Tuberculosis and Malaria can contribute to tackling these health menaces, provided there are sufficient resources available and the Fund is administered properly. Bangladesh would welcome support from the Fund to fight these diseases. 1 would now like to share with this august Assembly our thoughts about the public health menace that has emerged from arsenic contamination of ground water. This problem has assumed the proportion of a human tragedy in Bangladesh. A recent estimate indicates that about 30 million people are now exposed to arsenic contamination. lronically, the tube-wells that we had painfully installed for ensuring safe drinking-water have become the source of arsenic-contaminated water. Urgent steps are being taken to treat those suffering from arsenic contamination. To date, 2000 doctors and 15 000 field workers have been trained to deal with this crisis and more are being trained. As part of the programme, mapping of contaminated tube-wells is under way and people are being made aware of the problem and advised to avoid drinking contaminated water. Alternative technologies are being developed. lt is critical for us to receive urgent international support, both in mitigation and in research and development activities. We still face many challenges. It is only through sincere, concerted and collaborative efforts that we can strive to overcome sorne of these challenges. 1 would like to cali on the international community and our development partners to be more forthcoming in their support and assistance to the developing countries. Support for capacity-building, sharing of technology and training would be of particular relevance and our timely efforts and actions, distinguished delegates, may save the lives of many and !essen the sufferings of more. 1 thank you very much for your kind attention. Mr DOSKALIEV (Kazakhstan): f-H .lJ:OCKAJIHEB (Ka3axcTaH): YBIDKaeMbiÜ r-H IIpe,ll,Ce,ll,aTeJib, yBIDKaeMbie ,ll,aMbi u rocno,ll,a, 3.lJ.OpOBbe HBJIHeTCH O.lJ.HOÜ H3 rnaBHbiX QeHHOCTeü KaK OT.D.eJibHoro qenoBeKa, TaK u o6I.QeCTBa B QeJIOM. B TO )l(e BpeMH 3.D.OpOBbe HBJIHeTcH pe3ynhTaToM u npou3BO.D.HOÜ o6ne.D.HHeHHbiX .D.eücTBHÜ u ycunuü Bcero o6I.QeCTBa. B 3TOÜ CBH3H CJie,ll,yeT Onpe,ll,eJIUTb OCHOBHbie pHCKH H MX npuopuTeTHOCTb ,li,JlH 3,ll,OpOBbH, qTo6bi a,ll,eKBaTHO CKOOp,ll,HHHpOBaTb ,ll,eÜCTBHH. Ka3axcTaH nonHOCTbiO noMep)I(HBaeT cTpareruiO pa3BHTHH 3.D.paBooxpaHeHHH, npe,li,JlO)I(eHnyiO BceMupHoÜ opraHH3aQueü 3.D.paBooxpaHeHHH. Oco6eHHO noMep)I(HBaeT Te npo6neMbi u nyTH perneHuH, KOTOpbie 6hiJIH 03ByqeHhi Bqepa B .D.OKJia.D.e feHepanbHoro .D.HpeKTopa B03 r-)I(H fpy XapneM EpyH.D.TJiaH,ll,. CBu,ll,eTeJibCTBOM 3TOMY HBJIHeTcH To, qTo c 1995 r. B Ka3axcTaHe cyi.QeCTBYeT no.D. naTpOHIDKeM BceMupHoü opraHH3aQuu 3,ll,paBooxpaHeHHH BbiCrnaH lliKOJia o6I.QeCTBeHHoro 3.D.paBooxpaHeHHH. KpoMe Toro, YKa30M Ilpe3H,ll,ema Pecny6nuKu Ka3axcTaH HbiHelliHHÜ ro.D. 6hiJI 06'hHBJ1eH [O,li,OM nOMep)I(KU 3,ll,OpOBbH rpa)l(.lJ.aH, KOTOpbiH Onpe,ll,eJIHJI CJie,ll,yiOI.QUe npuopHTeTbi: ynyqrneHue cocTOHHHH 3.D.OpOBbH Hapo,ll,a, noMep)I(Ka cucTeMhi 3,ll,paBooxpaHeHHH, nponaraH.D.a 3,ll,opoBoro o6pa3a )I(H3HH. B TeqeHue 3Toro ro,ll,a 6y.lJ.YT no,ll,Bep)l(eHbi yrny6neHHOMY OCMOTPY u ,ll,HCnaHcepH3aQHH ,ll,eTU B B03pacre OT 12 ,ll,O 18 JieT. IJo HallieMy MHeHUIO, UMeHHO 3TOT B03paCT CJie,ll,yeT paCCMaTpHBaTb KaK no,ll,pOCTKOBbiH. YBIDKaeMbie ,ll,aMbl H rocno,ll,a, n03BOJ1bTe MHe OCTaHOBHTbCH Ha O,ll,HOÜ H3 aKTYaJibHbiX npo6neM COBpeMeHHOCTH - Ha npo6JieMe 60pb6bi C ry6epKyJie30M. IJo o6pa3HOMY BblpiDKeHHIO HeKOTOpbiX aBTOpOB, ry6epKyJie3 HBJIHeTCH O,ll,HHM H3 OCHOBHbiX HHcpeKQHOHHbiX KHJIJiepOB ,ll,eTeÜ H B3pOCJ1biX, KOTOpbiH e)l(erO,ll,HO YHOCHT OKOJIO Tpex MHJIJIHOHOB )I(U3HeÜ. Üco6y10 TpeBOry Bbl3biBaeT TOT cpaKT, qTo B nocne.D.HHe ro,ll,bi Bee qai.Qe BcrpeqaeTCH coqeTaHue ry6epKyne3a u CIIH.lJ:a, u 3TO cnOC06CTByeT yBeJiuqeHUIO CMepTHOCTH. B 1993 r. B03 npoBo3rnacuna ry6epKyne3 rno6anbHOÜ KpuTuqecKoü curyaQueü Ha nnaHeTe. Oco6eHHO cTpeMuTeJibHbiÜ poeT 3a6oneBaeMOCTH ry6epKyne30M B Ka3axcTaHe HaqancH c 1995 ro,ll,a. TeMn pocTa 3a6oneBaeMOCTH B nepuo,ll, c 1995 no 1998 ro.D. yBenuquncR c 12 .D.O 30%. TeMn npupocTa CMepTHOCTH B 1995 r., no cpaBHeHuiO c npe.D.bi.D.YI.QHMH ro,ll,aMu, cocTaBun 44,5%. K 1998 r. curyaQHR no ry6epKyne3y oco6eHHO o6ocTpunacb u npuHRJia xapaKTep 3nH.D.eMuu. B QeJIRX KOpeHHOrO U3MeHeHUH CJIO)I(UBllieÜCH curyaQUH B CTpaHe C 1998 r. CTaJIH npHHUMaTbCR

ASSNR/4 page 104 umpoKoMacuna6Hbie Mepbi 6opb6bi c ry6epKyJJe30M, HaLJaJJOM KOTOpbiX ~BHJJc~ YKa3 I1pe3H.IJ.eHTa "0 nepsooqepe.IJ.HbiX Mepax no ynyqrueHHIO cocTO~HH~ 3.IJ.OpOBb~ rpa)!()l.aH Pecny6JJHKH Ka3axcTaH". Ilo peKoMeH)l.aQH11 B03 c 1998 r. 6biJJO HaLJaTo BHe.n.peHHe B Pecny6JJHKe nporpaMMbi DOTS. ,[(.rŒ 6aKTepHOCKOlli1H JJa6opaTOpHbie CJJy)K6bi Me)l.I1QI1HCKI1X opraHH3aQ11H 061IJ,eH JJeLJe6HOH CeTI1 H npOTI1B01)'6epKyJJe3HbiX yqpe)K)l.eHI1H 6biJ111 o6ecneLJeHbl COBpeMeHHb!MI1 6HHOKYJJ~pHbiMI1 MHKpOCKOnaMI1 Bb!COKOH pa3peruaiOlll,eH cnoco6HOCTI1, ll03BOJ1~10lll,11MI1 BbŒBJJ~Tb 3apa3Hbie cpopMbl ry6epKyJJe3a. Ha 3cpcpeKTI1BHOCTI1 na6opaTopHoH .IJ.I1arHOCTI1KI1 CKa3aJJI1Cb TaK)Ke no.n.roTOBKa Ka)l.pOB, )l.HcpcpepeHQ11pOBaHHbiH OT60p J111Q C CI1MllTOMaMI1 ry6epKyJJe3a, HanpaBJJ~eMbiX Ha 6aKTep110CKOll1110, QeHTPaJJI13aQI1~ BO MHOfi1X 06JJaCTSIX KpynHbiX JJa6opaTOp11H. 3a nep110)l. C 1999 r. KOJJI1LJecTBO 6onbHbiX, nonyLJI1BWI1X neLJeHI1e B pe)KHMe DOTS, cocTaBI1JJO oKoJJo 132 000. BMecTe c TeM nporpaMMa DOTS He YLJI1Tb!BaJJa B noJJHOH Mepe oco6eHHOCTI1 Ka3axcTaHa. C ee BHe.n.peHI1eM llO~BI1JJaCb npo6JJeMa B OTHOWeHI111 Be)l.eHI1~ aM6yJJaTOpHb!X 60JJbHbiX C XpOHI1LJeCK.HM11 cpopMaMI1 3a6oneBaHI1~, KOTOpbie 11 .n.an11 Bnocne.n.cTBI111 peQI1.IJ.I1Bbi, poeT MYJJbTI1- 11 non11pe311CTeHTHbiX cpopM ry6epKyne3a. HcnoJJb30BaHI1e B KaLJeCTBe )l.l1arHOCTI1KI1 TOJJbKO 6aKTep110CKOlll111 MOKpOTbi np11Beno K yBeJJI1LJeHI1IO KOJJI1LJeCTBa .n.ecTPYKTI1BHbiX cpopM ry6epKyJJe3a. MeTO.IJ. npaKTI1LJeCKI1 OKa3aJJC~ Henp11eMJJeMbiM npH HaLJaJJbHbiX cpopMax 3a6oneBaHI1~, KOTOpbie xopowo onpe.n.en~JJI1Cb np11 cpniOoporpacp11LJecKOM o6cne.n.oBaHI111. Y .n.eJJbHbiH Bec .n.ecTPYKTI1BHbiX cpopM B03poc .n.o 45%. B 3TOH cB~311 CTpaTerl1~ 6opb6bi c ry6epKyJJe30M, npe.n.JJo)KeHHa~ B03, MI1HI1CTepCTBOM 3.IJ.paBooxpaHeHI1H 11 HaQI10HaJJbHbiM QeHTPOM npo6neM ry6epKyne3a 6biJJa a.n.anT11poBaHa K ycnoBI1HM Ka3axcTaHa. BonepBbiX, CTaJJI1 aKTHBHO BbŒBJJ~Tb 3a6oneBaHI1~ c noMOlll,biO cpmooporpacp1111, oco6eHHO B rpynnax p11cKa. Bo-BTOpbiX, np11 OTCYTCTBHI1 ycnoBI1H )l.Jl~ npoxo)K)l.eHHH aM6ynaTopHoro neLJeHI1H noMep)K11BaiOlll,I1H KYPC CTaJJI1 npoBO.ll.11Tb B CTaQ110HapHbiX ycnoBI1~X. 3To npHBeJJo K pocry 3a6oJJeBaeMOCTI1 ry6epKyJJe30M, HO COOTHOWeHI1e HaLJaJJbHbiX cpüpM npeBaJJ11pOBaJJO Ha)l. .n.ecTpyKTHBHbiMH, LJTO, B CBOIO oqepe.IJ.b, noTpe6oBano MeHbW.HX 3aTPaT Ha neLJeHI1e. KpoMe Toro, 3TO np11BeJJo K yMeHbWeHI1IO cMepTHOCTI1 OT ry6epKyne3a. I1paKTI1LJeCKI1 CMepTHOCTb oT ry6epKyJJe3a CHI1311JJacb c 20 .n.o 7 ,2%. KpoMe Toro, B 3TOH CB~311 npoBe)l.eHI1e peryn~pHbiX cpJJIOOporpacp11LJeCKI1X o6cJJe)l.OBaHI1H HaCeJJeHI1~, HanpaBJJeHHbiX Ha e)KefO)l.HbiH OXBaT C QeJJblO paHHero BbŒBJJeHI1~ ry6epKyJJe3a, Mbl CLJI1TaeM Ba)KHOH COCTaBHOH LJaCTblO CTa611JJI13aQ1111 ynyqrueHI1H cHryaQI111 no ry6epKyJJe3y. B Pecny6JJI1Ke OKa3b!BaeTcH 60JJbWM cp11HaHCOBa~ noMep)I(Ka co cTopoHbi rocy.n.apcTBa, OHO nOJJHOCTbiO B3~J10 Ha ce6~ rapaHT11pOBaHHOe o6ecneLJeHI1e .IJ.OpOrOCTOHlll,I1M11 npoTI1Bory6epKyne3HbiM11 npenapaTaMI1. Bee np11HI1MaeMbie Mepbi no3BOJJHIOT cero)l.HH CKa3aTb o HaMeTI1BWeifc~ cTa611JJI13aQ1111 c11ryaQ1111 no ry6epKyJJe3y B Pecny6n11Ke. TaK, TeMn np11pocTa 3a60JJeBaeMOCTI1 ry6epKyJJe30M CHI1311J1C~ C 30 )l.O 1,6%. I1oKa3aTeJJb 3aKpb!TI1~ nOJJOCTeH pacna)l.a cocTaBI1JJ 71%, npeKpameHI1e 6aQ11JIJJOBbi.IJ.eJJeHI1~ - 6onee 88%. Ha ocHoBaHI111 BbiWe113JJO)KeHHoro Mbi CLJI1TaeM, LJTO 6onee aKTI1BHOe BbŒBJJeHI1e ry6epKyJJe3a, Hap~.IJ.Y C 6aKTep110CKOnl1eH 11 )l.11cpcpepeHQ11pOBaHHbiM llO)l.XO)l.OM B onpe.n.eJJeHI111 CpOKOB CTaQI10HapHOfO JJeLJeH11~ 11 llO)l.)l.ep)K11BaiOlll,eH cpa3bl 3a6oJJeBaHH~, )l.aeT B03M0)KHOCTb nepeBeCTI1 ry6epKyJJe3 B pa3pH.IJ. ynpaBJJSJ.eMbiX 11HcpeKQ11H. Enaro.n.ap10 3a BHI1MaHI1e. El PRESIDENTE: Doy la palabra al delegado de Kiribati, quien hablara en nombre de los paises del Pacifico Sur: Estados Federados de Micronesia, Fiji, lslas Cook, Islas Marshall, Islas Salomon, Nauru, Niue, Palau, Papua Nueva Guinea, Samoa, Tokelau, Tonga, Tuvalu y Vanuatu. Mr MOOA (Kiribati): Mr President, Madam Director-General, honourable ministers, distinguished delegates, ladies and gentlemen, I speak on behalf of the Pacifie island nations namely: Cook Islands, Fiji, Kiribati, Federated States of Micronesia, Marshall Islands, Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu, and I would like to extend to you ali our

A55NR/4 page 105

warm greetings. Allow me to congratulate the President on his appointment. We are confident that he willlead this Assembly through constructive deliberations to a fruitful conclusion. Pacifie island nations are quite small, but span and occupy the wide and immense Pacifie Ocean. Population ranges from only about 2000 in very small Pacifie island countries to about 4.5 million in the largest country of Papua New Guinea. Most have a relatively poor economie base, but ali have a strong desire for better health and are quite determined to do that through a number of ways including active participation in international health forums such as this Assembly. The Pacifie island nations, like other island nations in the world, such as those in the Caribbean and Indian Ocean, are vulnerable because of the very nature of the ir existence, to environmental disasters that are either man-made or subject to the whims ofmother nature. We talk of global warming and rising sea levels, which according to scientific evidence, has been the result of developed countries' relentless race for progress. Our environmental vulnerability therefore will continue to be a detrimental factor in our developmentand while natural disasters may be beyond many countries' control, those that are created by man can only be solved by human kind, collaboratively in the spirit of one peaceful global family such as this. Most Pacifie island nations suffer from a chronic shortage of highly trained health personnel: most have opted to go and work in developed countries like Australia, Canada, New Zealand and the United States of America, another indication that we could not meet their high expectations, which again is a reflection on our economie status. We are thankful that this is now being discussed at various levels including that of the Commonwealth Health Ministers meeting in the document entitled: Commonwealth Code of Practice for International Recruitment of Health Workers. The Pacifie island countries are undergoing rapid changes in health trends. Most are experiencing a rise in noncommunicable diseases. Others are still struggling with infectious diseases but at the same time witnessing an increase in the incidences of diabetes, hypertension, heart diseases and cancers. These are part of an epidemiological transition and we have put great emphasis on health education and health promotion as a means to address them. Through the support of WHO and assistance from various development organizations, the concept of healthy islands has become the strategy framework to address a number of our unique health problems including noncommunicable diseases. The Director-General indicated tous in her keynote address on Monday that 30 minutes of physical activity each day is a safe, free and effective remedy against the risk of developing noncommunicable diseases from unhealthy consomption habits. lt highlights this year's World Health Day theme of "Move for Health". As a further preventive measure, ali Pacifie island nations are actively participating in the WHO-led effort to curb the increasing use of tobacco through the development of the framework convention on tobacco control. A number of Pacifie island countries have already developed their tobacco policies and legislative measures to address these issues, small as we are, to fight the giant tobacco companies. When talking about infectious diseases 1 am reminded of the contribution made by a number of developed countries to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Our gratitude goes to these countries and donors. Further donations from them to this important global health cause will not in any way harm their strong and stable economy. We used to believe that because of our relative isolation HIV/AIDS would not pose any problem to our people. Sadly, that was not the case. Pacifie island co un tries now are beginning to see the negative impact that HIV1 AIDS brings to us and to the very fabric of our culture. For a share of the assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria, we are overwhelmed by the array of criteria and rules that need to be fulfilled in order to be considered under the Fund. This is very restrictive. lt should not be forgotten that the Fu nd is now geared to address the aftermath of the AIDS epidemie in co untries that have been mostly and worst affected. To allocate funds, we should not only look at the devastation that AIDS has already brought to a number of countries, we should also look at the epidemiological evidence in Asia and Pacifie island nations where the AIDS epidemie, although late in making its appearance, is increasing at an alarming rate and will continue to do so unless drastic action is taken now. The Executive Director of UNAIDS rightly mentioned in his address during the ministerial meeting on HIV1AIDS and development in Asia and the Pacifie in Melbourne, Australia, in October 2001 that the shadow is lengthening but with ali the experience and !essons learnt so far, countries in Asia and the Pacifie are in the best position to address the HIV/AIDS pandemie now, in order to prevent the same devastation that it has already brought to other countries. In other words this Fund should be allocated

A55NR/4 page 106 equitably to address primary prevention as applicable to Asia and Pacifie island nations, and tertiary prevention as applicable to countries that have already experienced the full impact and consequences of the pandemie. Most Pacifie island countries have a youthful demographie structure and there is a tendency that the needs of this section of the population may not be adequately addressed or forgotten completely in our quest for rapid economie development and perhaps misguided priorities. We pride ourselves in having, as a subregion, one of the lowest infant mortality rates in developing countries, although sorne of us, including Kiribati that 1 represent, need to work extra hard to improve those indicators in line with the goals of the World Summit for Children, 1990. We extend our gratitude to the Executive Director of UNICEF for her encouraging and visionary address that highlighted the focus and direction UNICEF will take to fulfil the goals of the World Summit for Children. Until quite recently, mental health in the Pacifie island nations has not been accorded the attention it deserves. This may arise from ignorance of the extent of the problem and, further, from the stigma associated with this health problem, cultural taboos and the traditional belief that those who suffer from this ailment must be institutionalized. Families and the community at large have an important role to play in addressing mental health and the focus in management now should change from being custodial to that of community-oriented, and community-based. We are grateful that mental health has for a number of years now been on the agenda at regional and international health forums including this Assembly. Pacifie island nations are currently undergoing health reforms at variàus levels, identifying health needs in a more focused manner and allowing for more participation from civil society, the community and nongovernmental organizations to participate more actively and respond more positively to those needs, We are also increasingly recognizing and acknowledging positive contributions resulting from consultation among ourselves at the regionallevel. Now we gather here as one family in the name of better health for the people of the world, or Health for Ali and we should not lose sight of the fact that working together makes our work easier. We, as Pacifie island nations, are proud to contribute to this forum in our own unique way and become part ofthis global family. 1 would like to take this opportunity to thank the Director-General of WHO for her excellent leadership on the global health frontier and her clear vision and focus on key health issues that are common to ali of us. On the regional level we would like to acknowledge with sincere and profound appreciation the outstanding leadership of the Regional Director for the Western Pacifie; with his dynamic and down-to-earth approach and foresight we will certainly get the job done according to our expectations and to the satisfaction of the people of the Pacifie island nations. El PRESIDENTE: Quisiera transmitirles el programa de la Asamblea para el resto del dia de hoy. A las 14.30 horas el pleno se reunira nuevamente para proseguir el examen del punto 4 (Oradores invitados). El Profesor Jeffrey Sachs, Director del Center for International Deve1opment, de la Universidad de Harvard, y Presidente de la Comisi6n sobre Macroeconomia y Salud, recientemente nombrado Asesor Especial del Secretario General de las Naciones Unidas en lo concerniente a los objetivos de desarrollo de la Declaraci6n del Milenio, pronunciara una alocuci6n ante la Asamblea. Después de ello, la Comisi6n A celebrara su tercera sesi6n, mientras que en el pleno haran uso de la palabra los demas inscritos en la lista de oradores en relaci6n con el punto 3. El lunes, la Mesa de la Asamblea decidi6 que cuando termine el debate del punto 3 y se levante la sesi6n plenaria, la Comisi6n B se reuniria y retomaria el punto 18 (Situaci6n sanitaria de la poblaci6n arabe en los territorios arabes ocupados, incluida Palestina, y asistencia prestada). Esto se aprob6 en el entendimiento de que el pleno podria terminar el examen del punto 3, aproximadamente a las 16.00 horas. Sin embargo, a(m nos quedan 25 oradores en nuestra lista. Para respetar las intenciones que motivaron la decision de la Mesa de la Asamblea, levantaré esta sesi6n exactamente a las 16.00 horas, para que se pueda seguir adelante con las importantes cuestiones de la Comisi6n B. Si es necesario, propondré esta noche a la Mesa de la Asamblea que convoque una nueva sesi6n plenaria mafiana por la mafiana, para que puedan expresarse todos los inscritos en la lista en relaci6n con el punto 3. La Comisi6n B podria luego reanudar su trabajo después de la clausura de la sesi6n plenaria. Esta tarde, después de que la

ASSNR/4 page 107 Comisi6n B haya terminado su examen del punta 18, la Mesa de la Asamblea celebrani su segunda sesi6n en la sala VII. Se levanta la sesi6n.

The meeting rose at 13:30. La séance est levée à 13h30.

A55NR/5 page 108

FIFTH PLENARY MEETING Wednesday, 15 May 2002, at 14:30 President: Dr J.F. LOPEZ BELTRÂN (El Salvador)

CINQUIEME SEANCE PLENIERE Mercredi 15 mai 2002, 14h30 Président: Dr J.F. LOPEZ BELTRÂN (El Salvador)

INVITED SPEAKER INTERVENANT INVITE

El PRESIDENTE: Muy buenas tardes tengan todos. Se declara abierta la Asamblea. Comenzaremos nuestro trabajo de esta tarde con la continuaci6n del punto 4 del orden del dia (Oradores invitados). En nombre de esta Asamblea, tengo el honor de dar la bienvenida al Profesor Jeffrey Sachs, Director del Center for International Development, de la Universidad de Harvard, Presidente de la Comisi6n sobre Macroeconomia y Salud, y recientemente nombrado Asesor Especial del Secretario General de las Naciones Unidas en lo concerniente a los objetivos de desarrollo de la Declaraci6n del Milenio. Profesor Sachs, tiene usted la palabra. Professor SACHS (Director, Center for International Development, Harvard University and Chair, Commission on Macroeconomies and Health): Mr President, Director-General Dr Brundtland, ministers of health, distinguished ladies and gentlemen. It is a very profound honour for me to be here before you. Indeed, it is quite an awesome thing, 1 think, for anybody to address the Health Assembly. First, 1 am deeply conscious of the great leadership that you, as ministers of health, show in the struggle for the well-being of your people, often in countries besieged by disease and poverty and therefore challenged to find a way ahead in the most difficult straits. But 1 am also awed to be at the Health Assembly for what it represents of our common aspirations in the world. 1 was thinking to myself whether there is any other body in ail the world that so fully and so ideally represents the shared aspirations of our common humanity. Where else do we have a gathering where there is such a will of global partnership to face the most essential challenges that people in ail parts of the world experience? My message to you is really so simple and so straightforward that 1 think it does not need much translation. My message, in essence, is that we in the world today for the first time in history, have the capacity within our hands to end the suffering of absolute poverty and the millions of deaths per year that are associated with absolute poverty, and you, ministers of health and distinguished representatives of the international organizations and leaders in the cause of global health, will be in the front )ines of this dramatic progress that we will make in this generation. The message is simple and yet it may seem either preposterous or utterly paradoxical. We are meeting, after all, in what, surely, is one of the greatest urgencies of history in health. We are meeting in the mi dst of the greatest

A55NR/5 page 109

pandemie of modern times, when the scourge of AIDS is killing millions, is infecting millions around the world every year, and when resurgent diseases, such as malaria and tuberculosis, are reconquering ground that they had )ost in past decades, and yet my message is simple. Des pite the appearance of )ost ground or despite the appearance to sorne of the hopelessness, we have an opportunity that is unmatched in history, not only to confront these challenges, but to end, and I mean literally to end, absolute poverty in our generation. What do I mean by absolute poverty? 1 could give you fancy definitions but 1 will give you a simple meaning. Absolute poverty is poverty that kills. When 1 went to school, 1 was taught that poor people live on the edge of survival. When I was honoured by the Director-General's request to chair the Commission on Macroeconomies and Health, 1 saw more graphically than 1 ever could have imagined that that is not true. Poor people are not living on the edge of survival, they are falling right over the edge by the millions. We are living in a world where millions of people are dying every year of the ir impoverishment, but the paradox is that we are living in the midst of the greatest affluence in the history of the world, with the greatest technological capacity in the history of the world, the combination of which has rendered th ose deaths absolutely unnecessary, absolutely avoidable and you, ladies and gentlemen, can lead the way to overcoming these tragedies. The world will quickly say "can't be done, how naïve," as they have said about eradicating smallpox or as they said about rolling back African river blindness or leprosy or trachoma, conditions that seemed immutable and yet are being conquered by the leadership in this hall. 1 am asking you to take on a bigger challenge, because you are the people to lead it. That is the challenge of ending absolute poverty in our generation. Why do 1 think it can be done? Because, if 1 have any talent at ali to justify my being here, 1 have my doubts, but if 1 do, it is because 1 can add up the dollars, because 1 am trained to put a priee tag on what it would cost to meet this challenge, and because 1 happen to come from the rich est country in the world and in the history of the world, and 1 know the means that we have in this world to address these challenges. Because 1 know that we do not have to talk in millions of dollars for health when we live in a world of trillions of dollars of income in the rich world. Because 1 know that with the progress that has been made in economie development in so much of the world, when progress has been made not only in the richest countries, but also with billions of people in Brazil, China, lndia and Mexico and in so many countries that have achieved marked economie progress. The absolute poor now with us can be saved. The richest of the rich constitute about one sixth ofhumanity. The poorest of the poor, those living with the absolute poverty that kills, constitute about one sixth of humanity now. Two hundred years ago, it was ali of humanity, we ali struggled for survival. The miracles of technological progress, the wonders of economie growth, have reduced the share ofhumanity markedly, remarkably, to a point where we can honestly talk about ending this suffering and make no mistake about how rich the rich world is. With average incornes of US$ 25 000 per capita, the billion people in the rich world command an income each year now ofUS$ 25 trillion. We discovered in our study in the Commission on Macroeconomies and Health over the last two years, that to extend the life-saving health interventions to the poorest of the poor, to enable them to have reliable coverage of immunizations, of insecticide impregnated bednets, of directly observed tuberculosis strategy short course (DOTS), and yes, ladies and gentlemen, of antiretroviral drugs, to keep the 40 million people alive that are suffering from HIV infection. That this would require from the rich countries an annual outlay of about US$ 25 billion a year; it sounds Iike a lot until you do the long division: in a US$ 25 trillion world of annual income of th ose countries, the US$ 25 billion needed amounts to one thousandth of that income every year. That is one penny out of every ten dollars of rich world income and that, we found in our Commission, would be enough, one penny out of every ten dollars would be enough, to save eight million lives per year of our brothers and sisters around the world. Eight million lives; twenty five thousand deaths per day averted for one penny out of every ten dollars of income in the rich countries. We learned a few things more along the way that 1 would like to share with you, especially the ministers of health. Accomplishing this investment in the life-saving technologies for your countries, is the sine qua non of ending the poverty trap which afflicts so many of the poorest countries in the world and is the sine qua non of the economie progress that you so ardently desire and deserve. If we do not end the AIDS pandemie, we will not see economie progress in Africa, make no mistake about it. Ali of the good wishes, ali of the good will, ali of the investments in the other sectors will come to nought if the killer pandemies are allowed to run their course as they have been for the last generation.

A55NR/5 page 110 We see the devastation everywhere; in January, I stood in the fields and villages outside Lilongwe, Malawi, talking to the grandmothers, tending to their 15 orphaned grandchildren, because the generation of their mothers and fathers has been !ost to AIDS. And I stood in those sun-parched, drought-ridden fields as the grandmothers told me how they had carried their children on their backs for 15 kilometres the day before to try to find the antimalarial drugs at the district hospital and had walked back because the drugs were not there and were on their way by foot again the next moming. And I stood in the fields as they opened up the apron-strings to show me the crumbs of millet infested with maggots that they would feed their hungry grandchildren that night because, with the farmers dead and the aged grandmothers looking after their wards and the drought-ridden climate of southem Africa, there are no grains on the vines; there is hunger and there is death now. What we leamed in this Commission, ladies and gentlemen, is that there is no solution to these problems except through partnership of the rich and the poor. And what we leamed (as muchas sorne want to deny it) there is no solution to these problems except by a marked increase of financial contributions of the rich countries to the plight of the absolute poor. You can do the arithmetic in every direction as weil as I: Malawi's average incarne is US$ 200 per persan per year. As the Commission found, the life-saving interventions that Malawi needs to fight AIDS, tuberculosis, malaria, diarrhoeal disease and respiratory infection, to immunize the children, to provide vitamin A, to have skilled attendants at childbirth (so that mothers do not die in childbirth in the startling numbers that they do still today), that those interventions are the biggest bargain in the world. US$ 40 per persan per year could extend those interventions, US$ 40, and I am including the antiretroviral drugs. And yet for a country at US$ 200, per capita, US$ 40 is 20% of the gross national product, it is more than the en tire budget of the country, it is more than al! of the spending, not only on ali of health but education and roads and infrastructure and power, public administration, police. This is not a matter of using the resources better; this is not a matter of waste and corruption; this is a matter of poverty that kills because at US$ 200, the resources are not available inside Malawi to fight these diseases - that is the simple fact and that is why we need a partnership of rich and poor. And we found another thing, ladies and gentlemen: that if we make that partnership, the benefits are staggeringly high. Of course, first and foremost in human terms. Have you been to villages where there are no mothers and fathers? I had not. Have you been to hospital wards in hospitals where people are dying by the hundreds every day, in the hospital - not because there are not doctors, not because there is no infrastructure but because somebody has not deemed it to be cost effective to keep a human being alive at a dollar per day? So, first is the retum on our simple humanity, the kind ofworld we want to live in, but the second is the economie retum. Economie growth cannat succeed in a world of rampant disease. The countries that have escaped from poverty did so because they were able to make great progress on reducing infant mortality, limiting fertility, investing in the health and well-being of their children. But they were the lucky ones, they were countries that did not face holoendemic malaria, with the uniquely powerful vectors that so much of Africa suffers. They were the countries that did not face the pandemie of AIDS that is devastating the health systems of the se countries, even as - I hate to say it - the world has sat back for 20 years and been unable to fashion the partnerships to curve this unique and curvable pandemie. We found that the technologies exist to succeed. The eight million lives that could be saved for the penny on every US$ l 0 are not lives depending on a new miracle. The ir lives are not applying the knowledge that you people have in this room, and that you know better than any. In that hospital ward in Malawi that I went to after the village, where 1 saw on one si de of the room the medical ward so-called- a true misnomer because there were no medicines there- where I saw 450 people dying in a scene that I had never seen before, three to a bed, head to foot in the bed and somebody on the floor undemeath the bed to stay out of the way. Four hundred and sixty people in the room for 160 beds, ali of them dying. In that same hospital on the other si de of the hall was the outpatient clinic where the few people who could afford the US$ 1 a day were getting the drugs and were walking home and were being the mothers and fathers and the farmers and the teachers and the doctors and the nurses and the politicians of their country. We have the technologies, we can do this job. We can cure tuberculosis, WHO has shawn, persistently, in ali parts of the world, if we have the resources. We can curb the AIDS pandemie. We can immunize the people as that wonderful Global Alliance for Vaccines and Immunization is proving. We can do this job. The future, therefore, is not to be found in the stars, it is

ASSNR/5 page Ill

not to be guessed at, it is not to be discovered in sorne differentiai equations of a theoretical analysis predicting whether we have doom or success. The future depends wholly on human agency, whether we are able to recognize our wealth in this world, whether we are able to recognize our common stakes, whether we are able to bring to bear our vast scientific knowledge and whether, therefore, we are able to get the job clone. This is a question of human agency, not a matter of forecast. This is our choice. Everyone in this room can be the leaders in this unprecedented historical breakthrough. We need ali hands to succeed. For the ministers of health of the poor countries, 1 co mm end to you the central recommendation of the Commission report, that is th at the findings of our report at the global level were so startling in what can be accomplished, that we urge each of your countries to establish a national commission to plan for the next 15 years your conquest of these killer diseases, to make the budgets, to help analyse the approach ahead, and on that basis to cali upon the rich world to be your full partners to get this job clone. And 1 want to say to you, that for any minister of health in any developing country, 1 promise you personally, and to the extent that 1 can institutionally, as Special Adviser to the Secretary-General of the United Nations, that 1 will do everything within my means to help you succeed in that national commission, to have it undertaken, to have it work at the full scientific potential, to find partners for analysis, and then yes, the bottom line, to help to round up the funding so that we can look back and know that we got the job clone. To the ministers of health in the rich world, 1 ask, is this an opportunity we can conceivably pass up? Do we have any doubt that in our countries, our countrymen would jump at the chance for a penny out of every US$ 10 to spare humanity this suffering. 1 have not the slightest doubt about my own country. A country of tremendous generosity that does not yet understand fully what we can accomplish with the remarkable tools we have at hand. 1 have no doubt for the rich world as a whole, that one thousandth of its income could not be better spent. This is the best investment opportunity human society has ever faced. The chance to end such enormous suffering at such extraordinarily low cost. To the international institutions, and especially to the World Health Organization, first, 1 want to salute you for the incomparable work that you do, and sometimes not under the ideal circumstances. 1 know that so much of the world does not appreciate the astounding professionalism of these institutions and how much of the world depends on their effective operation. And over the last two years 1 have watched as an outsider with awe and admiration of WHO, from what 1 think is the incomparable leadership of the Director-General, through to the incredible knowledge and professionalism of the staff, to know that we can get the job done. What 1 would appeal to aU of you is to leave here resolved to succeed, to put the extra effort, to go home and explain to the political leadership how little it would take and how much can be accomplished, and to tell them the deep truth that no speech ever ended an epidemie by itself, that no good words are going to curb AIDS, that no amount of hand-wringing is going to stop mosquitos transmitting malaria. Only bednets, antiretroviral drugs, anti-tuberculosis drugs can do that job. There are no shortcuts, but there do not need to be shortcuts anymore. We have the means, we have the knowledge, we have the wealth and 1 am utterly convinced we have the humanity to get the job do ne. 1 salute you. Thank you very much. El PRESIDENTE: Antes de brindar los agradecimientos de rigor al Profesor Sachs, el Ministro de Salud de Botswana y Vicepresidente de esta Asamblea desea dirigirse al Profesor Sachs. Ms PHUMAPHI (Botswana): Thank you, Mr President, Director-General, distinguished ministers of health and delegates. As the current Chairperson of the African region, 1 have found that it behoved me to stand before this General Assembly to thank the Director-General for having appointed this Commission. But most of ali, for having allowed Professor Sachs to chair it. Those of us who have had the privilege and the opportunity to benefit from Professor Sachs' tutelage will agree with me that the product of his particular contribution to the global community cannot be valued in any monetary terms, but that its

ASSNR/5 page 112 value will best be determined by the manner in which the world receives it. I would like on behalf of the African Region to appreciate this commendable contribution, not only to global health but to the whole of humanity. And I would like, on behalf of Africa, to assure the Professor and the DirectorGeneral that they can consider the national commissions formed, because the ministers of health of Africa are committed to saving the !ife of every mother, of every child, of every human being. We would like to record our appreciation, on our behalf and on behalf of the suffering mass of humanity the world over, of this first step in the right direction and communicate our confidence in the commitment of WHO and the Member States of this Organization to this noble cause and this noble goal. We are deeply indebted. Thank you. El PRESIDENTE: Muchas gracias, Profesor Sachs, por su inspiradora presentaci6n y profundo mensaje. En nombre de la Asamblea, le agradecemos cordialmente que nos haya honrado con su presencia. Gracias.

ADDRESS BY THE DIRECTOR-GENERAL (continued) ALLOCUTION DU DIRECTEUR GENERAL (suite)

El PRESIDENTE: Ahora volveremos al punto 3 del orden del dia. Al mismo tiempo, la Comisi6n A celebrani su tercera sesi6n en la sala XVIII. Como anuncié esta mafiana, levantaré esta sesi6n plenaria exactamente a las 16.00 horas, para que la Comisi6n B comience su trabajo. Por consiguiente, permitanme recordarles una vez mas que, de conformidad con la resoluci6n WHA50.18, las intervenciones de los delegados no pueden durar mas de cinco minutos, para que podamos avanzar Jo mas posible con el punto 3. Ahora proseguiremos con el punto 3 de nuestro orden del dia. Los pr6ximos dos oradores que figuran en mi lista son los delegados de Australia y Brunei Darussalam; les ruego que suban al estrado. Doy la palabra al delegado de Australia. Professor SMALLWOOD (Australia): Mr President, Director-General, distinguished ministers of health, distinguished delegates, ladies and gentlemen, Australia commends WHO for its leadership in highlighting the many technical and policy questions to be faced in tacking the ever-present risks to the health of our populations. Since its groundbreaking work in developing the global burden of disease estimates, WHO has done much to increase our understanding of the risks to health, as weil as in identifying prevention strategies and monitoring their effectiveness. Australia particularly welcomes WHO's work in developing a global noncommunicable diseases information base which will pro vide estimates of the preval ence of major risk factors in each of our countries. We look forward to the launch of the first global status report on noncommunicable disease tisk factor surveillance, in conjunction with the launch of The world health report 2002. Australians are fortunate to enjoy a relatively good standard ofhealth. However, we remain vigilant in confronting the risk factors that threaten our well-being, particularly those that contribute to chronic disease. Australia has identified as national health priority areas six major causes of ill-health: cardiovascular disease, cancer, injury, mental health, diabetes and asthma. Many of these have common behavioural risk factors such as smoking, poor nutrition, Jack of physical activity, and alcohol abuse. Environmental factors also present risks to health, specifically contributing to asthma and sorne cancers. And poor water quality and sanitation are particular problems for sorne indigenous communities. However, tobacco smoking is probably the single biggest risk factor contributing to the

ASSNR/5 page 113

burden of disease in Australia. Seven years ago, tobacco accounted for 12% of the burden of ill-health in Australian men and nearly 7% in women. Through our National Tobacco Strategy, we have made significant inroads into controlling tobacco use. We now have one of the Iowest rates of smoking in the developed world, with only 20% of Australian adults smoking tobacco. We commend the Director-General and the team at WHO for focusing world attention on the impact of tobacco smoking on the global burden of disease and for moving us ali forward in the negotiation of the framework convention on tobacco control. While measuring risk is an important step in formulating health po licy, we have an equally important task to identifY and support the interventions that will most effectively !essen those risks. But identifYing a disease burden attributable to a particular risk does not of itself indicate what action policy makers should take to avert that risk. And of course, even identifYing the best course of action does not, of itself, guarantee that that intervention will be supported with adequate resources. In health care, Australia has a good record in applying evidence, including evidence on cost-effectiveness, in assessing which pharmaceutical products and which medical technologies are to be publicly subsidized. But in the case of population health, there remain many difficulties in identifYing the most useful preventive interventions: methodologies for assessing effectiveness in this area are poorly developed; there are often difficulties in isolating the impact of confounding factors which might influence the health of the population at the time of the intervention; and the assessment of effectiveness is often hampered by long time lags between intervention and effect. Having said that, the potential gains are great from effective population-wide interventions in response to sorne of the major risks to health. Moving beyond the surveillance of health risks, the identification, monitoring and evaluation of new interventions remains an important task we still face in Australia. And importantly, we need to reap the gains that can be made from the wider implementation of strategies already known to work. Clearly, there are opportunities for Australia and ali countries to benefit from the technical work of WHO in these areas. One thing we have come to realize in Australia is that, in measuring risk to the population as a whole, we must not neglect to measure the distribution of risk amongst vulnerable populations. Australia has made, I believe, good progress in reducing overall exposure to severa! behavioural risk factors, but there is more work to be done to ensure that those who experience greater socioeconomic disadvantage, particularly our Aboriginal and Torres Strait islander peoples, are not left to bear these risks disproportionately. In conclusion, let me congratulate WHO for the breadth of its work in tacking risks to health, not only in the technical aspects of risk surveillance, but also in the development of appropriate po licy responses, preventive programmes and health services. Australia looks forward to working with WHO on these important issues which confront us ali. El PRESIDENTE: Por favor, antes de que inicie su intervenci6n, deseo rogar a los delegados que van a presentar su discurso el dia de mafiana que entreguen una copia del mismo en la oficina A.656 Io mas pronto posible. Muchas gracias. Mr AZIZ (Brunei Darussalam): In the name of God, the Compassionate, the Merciful, Mr President, Madam Director-General, ladies and gentlemen, I wish, first of ali, to associate myself with those who spoke before me in expressing and congratulating the President and other office bearers on the high offices conferred on them. Health development in Brunei Darussalam is undertaken as part of a holistic approach in the overali socioeconomic development of the country, with the goal of improving the quality of life of the people. Since the early 1950s the overall progress made, resulting from the combined implementation of sound public health programmes and basic infrastructure development, bas led to a significant rise in the living standards of our people especialiy in health. Consequently, the country has achieved almost ali the global health indicators set by WHO. Our infant mortality rate is six per thousand live births and our !ife expectancy at birth for males is 75 years and for females, 78 years.

A55NR/5 page 114 The progressive improvement in health status is also reflected by the increase in the total population of those aged over 65 which now constitutes 3.3% of the country's population: a two-fold increase since 1971. This figures is expected to double in 20 Il and to increase by nearly six-fold in the year 2021. Brunei Darussalam recognizes quality of !ife as being important at ali ages, especially in the elderly. Ali citizens above the age of 60 years are eligible to receive a monthly non-contributory old age pension and are provided with comprehensive health services, free of charge. Guided by the projected increase in number and anticipated demand for better health care in the coming years, initiatives in full support of healthy ageing continue to be strengthened, including promotion of awareness of the health care needs of older persons and the concept ofhealthy ageing. Our gathering he re is about addressing the threats to the health of the world' s population, sorne of which may be from self-inflicted agents such as unsafe sex and cigarette smoking. The intricate dynamics of these threats, albeit preventive in nature, cali for us to address them utilizing ail possible means available to us, may they be social, economie, political or legal. At this juncture, 1 would like to highlight the particularly harmful behaviour of smoking. In Islam, smoking generally is taken to be "makruh" or undesirable. By the same token, anything causing harm to one's body is considered "haram" or prohibited. In consideration of the deadly impact of cigarette smoking, it is therefore appropriate for us to term tobacco as "haram". Labelling cigarette smoking as "haram" may be a strategy to relate it to something harmful, thus promoting its prohibition. Of course, the way in which the prohibition is enforced is left to the individual government. ln Brunei Darussalam, the menace of tobacco is being taken seriously by the Government. The State Mufti Office, which is the highest Islamic authority in the country, in collaboration with the Ministry of Health and the Ministry of Education is organizing an international seminar entitled "Tobacco or Health - New Hope" in July this year. The involvement of the State Mufti Office in this subject reflects the con cern and commitment of the Government over the issue of tobacco use and health. This seminar, which is aimed at enhancing knowledge, sharing !essons learned and exploring new solutions in the fight against the menace of tobacco, will bring together leading international Islamic scholars and scientific experts who will deliberate their thoughts and experience. On behalf of my Government, 1 invite ali of you to Brunei Darussalam to parti ci pate in this seminar in our collective effort to address, and in support of the leadership by WHO, the impact oftobacco use. The pandemie of HIV1 AIDS has been with us for over 15 years now, inflicting immeasurable human suffering and significantly burdening health care systems worldwide. Although the prevalence is low in Brunei Darussalam, HIV1 AIDS is of concern to us. Preventive initiatives targeting youth, in particular, as weil as parents and the general public is being pursued actively, involving ali sectors of society. The theme chosen for World Health Day 2002 "Move for Health" is very timely and appropriate. This theme is in line with our National Health Care Plan 2000-2010 whereby health promotion and disease prevention is strongly emphasized. Our effort in materializing this Plan has been greatly boosted by the support given by His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam who himself set a very good example by leading the country's Walkathon in March this year. A national committee on health promotion has also been established consisting of government and nongovernmental agencies. The committee has identified seven priority areas, namely: nutrition, tobacco control, physical activity, mental health, women's health, environmental health and food safety for action. The significance of risks to health, the subject of our round table discussion yesterday, cannot be overstated. In this regard, 1 would like to commend the Director-General for successfully formulating this important work. Brunei Darussalam, in its efforts towards achieving the vision of Health for Ali, has greatly benefited from the guidance provided by WHO and looks forward to continuing support and assistance. In September 2001, Brunei Darussalam was privileged to have the honour of hosting the fifty-second Regional Committee for the Western Pacifie. 1 would like to take this opportunity to put on record my country's sincere thanks and high appreciation to the Regional Director of the Western Pacifie Region and members of the secretariat for their continuous and untiring technical support, assistance and collaboration rendered to Brunei Darussalam to ensure the success of the Regional Committee. Thank you.

ASSNR/5 page 115 El PRESIDENTE: Ahora tiene la palabra el delegado del Senegal, en representaci6n de Benin, Burkina Faso, Madagascar, Mali, Niger y Togo. Le Professeur COLL SECK (Sénégal) : Je vous remercie, Monsieur le Président. Je voudrais ajouter le Gabon à la liste des pays que vous avez cités et au nom desquels je vais faire ma déclaration. Monsieur le Président, Madame le Directeur général, chers collègues Ministres de la Santé, Mesdames, Messieurs, permettez-moi d'axer mon propos autour des orientations stratégiques que Mme Gro Harlem Brundtland a si pertinemment définies dans son allocution. Concernant la première orientation stratégique, je voudrais mettre l'accent sur le VIH/SIDA, le paludisme et la tuberculose, pathologies qui font certes des ravages dans le monde entier mais sévissent surtout dans les pays en développement, et plus particulièrement en Afrique. A cet égard, je voudrais souligner le tragique impact du VIH/SIDA sur tous les secteurs d'activité de l'humanité. Cette pandémie déstructure le tissu socio-économique en raison de la tranche d'âge touchée. Le paludisme, autre fléau, entrave également le développement de nos économies. C'est pourquoi les dirigeants africains, à l'issue des Sommets d'Abuja de 2000 et 2001 consacrés à ces pathologies, ont adopté des déclarations d'engagement et ont, entre autres, institué une Journée africaine de lutte contre le paludisme et un cadre d'action pour une meilleure gestion de ces pathologies. A cet égard, il est encourageant de noter que la lutte contre ces endémies a été prise en compte en tant que composante essentielle des documents de stratégies de réduction de la pauvreté, notamment au Bénin, à Madagascar, au Niger, où le programme spécial du chef de l'Etat est cité en exemple, et au Togo. En tout état de cause, nous demandons que le Fonds mondial mis en place pour lutter contre ces maladies contribue très fortement à aider nos pays dans leur combat. Nous espérons que les préoccupations émises par les pays africains seront prises en compte. Nous signalons dans ce chapitre, pour mémoire, les maladies non transmissibles, qui progressent également dans nos pays. Monsieur le Président, comme vous le savez, les mécanismes de lutte mis en place font une large part aux services de prévention, grâce notamment à la mise en oeuvre de programmes nationaux de vaccination. C'est le lieu de se féliciter de l'éligibilité de nos pays au programme de l'Alliance mondiale pour les vaccins et la vaccination. C'est dans ce cadre que nous allons accueillir une réunion de cette Alliance au Sénégal en novembre 2002. Ce sera la première fois qu'une telle rencontre se situera en terre africaine. Quant à la deuxième orientation stratégique consacrée à la promotion de modes de vie sains, il faut renouveler l'engagement de nos pays dans le processus d'élaboration de la convention-cadre pour la lutte antitabac. C'est dans cet esprit que le Sénégal va accueillir en 2003 la consultation régionale africaine préparatoire à la sixième session de l'organe intergouvernemental de négociation. La salubrité des aliments dans un contexte de pénurie perpétuelle de denrées alimentaires constitue par ailleurs un danger permanent pour nos communautés. Je voudrais également m'appesantir sur les problèmes liés à l'approvisionnement en eau potable, à l'assainissement et à la pollution de l'air à l'intérieur des habitations qui, dans nos pays, est due notamment à l'utilisation de la biomasse comme source d'énergie. L'orientation stratégique N° 3, quant à elle, me permet d'insister sur la nécessaire restructuration de nos systèmes de santé pour en améliorer la réactivité et l'équité dans la contribution des communautés au fonctionnement desdits systèmes, et de rappeler l'importance de l'information sanitaire bien ciblée sur les communautés et la nécessité de renforcer les systèmes de surveillance épidémiologique des maladies afin de mieux lutter contre les épidémies, si fréquentes dans notre sous-région. Il faut d'ailleurs noter, pour s'en inquiéter, la survenue d'une épidémie de méningite à méningocoque W135 dans un de nos pays, en l'occurrence le Burkina Faso. Ce fait est suffisamment grave à cause surtout de la difficulté d'obtenir le vaccin efficace, d'où la nécessité d'un appui technique et scientifique de notre Organisation.

ASSNR/5 page 116

Le médicament, élément stratégique, est également une préoccupation majeure pour nos pays. Dans ce cadre, il faut se féliciter de l'avancée que constitue la Déclaration de Doha relative à la santé publique. Les personnes du troisième âge doivent également être prises en compte par nos systèmes de santé. Certains de nos pays, comme le Mali, ont d'ailleurs érigé un département ministériel pour gérer cette population si délicate et si fragile. Monsieur le Président, Mesdames, Messieurs, permettez-moi, au nom de mes pairs, de féliciter le Dr Brundtland pour avoir ancré davantage notre Organisation dans le processus du développement durable, comme le suggère l'orientation stratégique N° 4. La santé d'une communauté, faut-il le rappeler, est un intrant incontournable pour tout développement socio-économique harmonieux. A cet égard, la création de la Commission Macroéconomie et Santé est une initiative heureuse qu'il faut apprécier à sa juste valeur. Cette option, faut-il le rappeler, est en adéquation avec la vision de nos chefs d'Etat qui, à travers le Nouveau partenariat pour le développement de l'Afrique (NEP AD), mettent la santé au coeur du développement. Pour terminer, mes collègues et moi-même renouvelons nos encouragements au Directeur général de l'OMS pour sa haute vision des problèmes de santé qui, sous son magistère, sont plus que jamais considérés comme des déterminants stratégiques du développement socio-économique de notre planète. El Dr. RIVEROS DUENAS (Colombia): Sefior Presidente, miembros de la Mesa, permitanme en primer lugar saludar la intervenci6n que hoy en la mafiana hiciera el Ministro de Salud de la Republica del Ecuador como Presidente del organismo andino de salud Convenio Hip6lito Unanue. Colombia tiene la firme convicci6n de que en el proceso de integraci6n subregional existe un enorme potencial para solucionar problemas. Sefior Presidente y amigo: es cierto que todo ciudadano del mundo tiene derecho a la salud. También es cierto que los Estados tienen la obligaci6n irrenunciable de proporcionar esta salud dentro de los mas altos niveles de calidad, de la manera mas oportuna y eficiente, asi como de la forma mas equitativa con sus ciudadanos. Para cumplir con estas premisas, en los ultimos afios los Estados, en términos generales, han determinado que el mejor camino es la descentralizaci6n de su sistema de salud. Esta descentralizaci6n consigue, primero, aproximar la comunidad a las decisiones politicas en materia de salud; segundo, vigilar que éstas sean gestionadas en forma apropiada y, tercero, corregirlas y modificarlas de acuerdo a su curso. Este paso se ha dado en forma mas o menos regular en una buena cantidad de paises hoy en dia. De esta evoluci6n se han generado multiples mecanismos de implementaci6n de las responsabilidades, a través de constituciones y por medio de leyes, y de manera que los Estados reconocen sus deberes y los ciudadanos sus derechos. Surge entonces la inquietud (,Cuales son y qué tan flexibles deben ser los deberes de los ciudadanos respecto a su propia salud, respecta a la salud de su familia y aun respecto a la salud de la comunidad? (,Qué decirle a un padre que fuma frente a sus hijos? (,Qué decirle a una madre que no se interes6 por la vacuna contra el sarampi6n para su hijo o hija que le suministra gratuitamente un Estado y que posteriormente genera costos en esa familia y en la comunidad? Finalmente (,qué actitud tomar con la comunidad que no atiende las instrucciones de eliminaci6n de desechos facilitando los vectores? Sefior Presidente, no se busca ni se aceptaria eludir la responsabilidad del Estado en el tema de salud. No existe duda sobre la obligaci6n que tienen los Estados en la educaci6n sanitaria de su poblaci6n. El reto hoy consistiria entonces en lograr una educaci6n no basada exclusivamente en los derechos sino en el equilibrio entre éstos y las obligaciones del individuo frente a su salud. Los paises en desarrollo deberemos por lo tanto hacer el maximo esfuerzo por invertir adecuadamente en la educaci6n sanitaria de nuestros pueblos. Consideramos que la Organizaci6n Mundial de la Salud debe incluir el tema de la responsabilidad en el desarrollo de politicas de educaci6n sanitaria que permitan lograr el mayor impacto donde los mas beneficiados seran seguramente los mas pobres. Sin duda, sefior Presidente, en la medida en que se asuman los deberes de los individuos se lograra incrementar las satisfacciones de sus propios derechos. Muchas gracias por su atenci6n.

A55NR/5 page 117 Dr DAYRIT (Philippines): Mr President, Madam Director-General, your excellencies, ladies and gentlemen, first of ali, let me congratulate the President on his election as President of this Health Assembly. Let me further congratulate the Director-General for her leadership in global efforts to improve the health of ali people. Let me begin by appreciating the work of WHO in the four areas where its leadership has been brought to bear: first, the area of disease prevention and control; second, the area of the performance of health systems; third, the area of health risks; and fourth, the area of macroeconomies and health. Allow me to make a few observations on how our own collaboration with WHO has impacted on the health of the population in the recent past. First, in the eradication of poliomye1itis. In the year 2001 a vaccine-derived po1iomyelitis virus emerged in our country. Working with WHO, UNICEF, Rotary and various organizations in our country, we conducted two rounds of poliomyelitis immunization in February and March this year. We achieved practically 100% coverage of 12 million children of Jess than five years of age in both rounds. We are very proud of this achievement. We acknowledge the support of the Regional Office for the Western Pacifie in this collective effort. Second, in the area ofhealth risks. Taking the eue from the evidence about the main risks to health, the Philippine Department of Health has embarked on an aggressive media advocacy campaign to set a climate within our society for healthy environments and healthy behaviour. Last year, we had aggressive campaigns for dengue control, proper disposai of solid wastes and the prevention of firework-related injuries. This year, we are pursuing our media advocacy campaigns to include measles, fake and substandard drugs, responsible parenthood and smoking. We have seen very promising results from wide media exposure. We will match our media advocacy efforts with efforts to improve preventive and curative services at the front line. Third, in the area of health systems performance. We are currently taking steps to improve our pharmaceutical regulatory systems, and are particularly focusing on improving the efficiency of drug registration. Also, we need to improve our laboratory capabilities and our capabilities for inspection of manufacturing companies and retail drugstores. Furthermore, we are moving aggressively to make low-cost essential medicines available to our population. We are doing this by importing quality low-cost medicines. By this strategy we hope to increase competition in our local market and eventually put downward pressure on the priees of medicines. Finally, the Government of the Philippines, under President Gloria Macapagal-Arroyo, has made elimination of poverty in our country the battle-cry of her administration. To this end, ali efforts of Government, the private sector and civil society are being galvanized. Thus, there are initiatives to improve free trade, asset reform, primary education, agricultural modernization, and health and welfare services with a bias for the poor. On this score, an aggressive programme to enrol indigents and social in surance is un der way. Our target is to achieve universal health insurance by the year 201 O. The Government of the Philippines is committed to improve the health and welfare of its citizens. We shall continue to work with the other Member States of the World Health Organization and ali people of goodwill to achieve this end. Thank you. El PRESIDENTE: Como habiamos dicho antes, exactamente a las 16.00 boras se levantani esta sesi6n plenaria para que la Comisi6n B pueda comenzar su trabajo. Esta noche propondré a la Mesa de la Asamblea que convoque una nueva sesi6n plenaria para mafiana a Jas 09.00 horas, a fin de que puedan hacer uso de la palabra los demas inscritos en la lista de oradores en relaci6n con el punto 3. La sesi6n plenaria se anunciara en el Diario mafiana por la mafiana.

ASSNR/5 page 118

La primera sesi6n de la Comisi6n B se celebrani inmediatamente después de haberse levantado esta sesi6n plenaria. La Mesa de la Asamblea celebrara su segunda sesi6n en la Sala VII, después de que hayan terminado los trabajos de la Comisi6n B. Se levanta la sesi6n.

The meeting rose at 16:00. La séance est levée à 16 heures.

ASSNR/6 page 119

SIXTH PLENARY MEETING Thursday, 16 May 2002, at 9:00 President:Dr J.F. LOPEZ BELTRÂN (El Salvador)

SIXIEME SEANCE PLENIERE Jeudi 16 mai 2002, 9 heures Président: Dr J.F. LOPEZ BELTRÂN (El Salvador)

ADDRESS BY THE DIRECTOR-GENERAL (continued) ALLOCUTION DU DIRECTEUR GENERAL (suite) El PRESIDENTE: Se abre la sesi6n. Habida cuenta de que ayer tarde no pudimos terminar el debate acerca del punto 3 del orden del dia, seguiremos ahora con nuestra lista de oradores para poner fin a nuestros trabajos con relaci6n a· ese punto. Me permito recordarles que, de conformidad con la resoluci6n WHA50.18, los delegados deben limitar la duraci6n de sus intervenciones a cinco minutos. Los dos siguientes oradores de la lista son los delegados de la Republica Democnitica Popular Lao y del Yemen, a los que rue go que suban al estrado. Tiene la palabra el delegado de la Republica Democnitica Popular Lao. Dr BOUPHA (Lao People's Democratie Republic): Mr President, Madam Director-General, excellencies, ladies and gentlemen, we gather here annually to talk and to share experiences in terms of the health and well-being of humanity. In this spirit ofprofessional solidarity, on behalfofthe delegation ofLao People's Democratie Republic, may we express our warm greetings to the Fifty-fifth World Health Assembly. On this auspicious occasion, we would also like to present our sincere appreciation to the Director-General for her untiring efforts towards the improvement of health of the world communities. As a Member State of WHO, Lao People's Democratie Republic is very concemed that more than two million deaths in the world each year are directly or indirectly attributable to physical inactivity. Therefore, World Health Day 2002 is striking our conscience to increase the campaign to "Move for Health". lt is indeed not only an advocacy platform for policy change at the highest leve!, but the scientific way in which organizations, communities, families, and individuals can improve health. Thus, on World Health Day 2002, Lao People's Democratie Republic organized an exciting aerobic programme with the public, led by the Vice-Minister of Health. Lao People's Democratie Republic is one of the !east developed countries. We are faced with both communicable and noncommunicable diseases; however risks to health in the context of Lao People's Democratie Republic have marked differences in urban and rural areas. Major risks to health in rural areas relate to poverty, illiteracy, Jack of hygiene and safe water, 80% home delivery without any technical assistance, sleeping without mosquito nets, smoking and eating raw meat. Belief in ghosts and

A55NR/6 page 120 superstitions still persist, and, after giving birth, a mother is obliged to observe a number of taboos; she has to stay near the fire in an overheated and smoky room for up to one month, and is restricted to eating on1y rice with salt or with young galingale. Ali these factors combined have a profound impact on children. According to a national health survey in 2000 15% of the children were moderately or severely wasted, 41% stunted, and 40% underweight. Despite intensive efforts since the revolution to overcome male domination, gender inequity remains a serious problem in remote areas. Unexploded ordnances are a constant threat to the population of at !east two provinces. In Xieng Kuang province alone between 31-89 accidents occur every year, of which more than one third are fatal. Many accidents involve children who are not aware of the. danger and often mistake the bombs for toys. These phenomena, which are related to tradition, culture, and history contribute to the mental and physical ill-health of Lao people in remote areas. By contrast, major risks to health in urban areas are related to modernization and lifestyle. Many injuries and deaths are caused by traffic accidents: for example, three central hospitals in Vientiane Municipality reported almost 13 500 accidents in 2001, with more than 3500 seriously injured persons and 62 deaths. In summary, the country has been ravaged by war for decades. In addition geographie, social, economie, cultural and lifestyle factors pose constant health risks for the Lao population, and most of the victims are women and children, especially in remote areas. Civilization and modernization in urban areas add a new dimension to health risks, with traffic accidents taking the lead. Ali these obstacles slow down the development of the country in many ways. So, more time, continuous advocacy, multidisciplinary approaches and great efforts are needed not only from the Government, but also from ali members of society, as well as assistance from the international community. Finally, on behalf of the Lao delegation, once again we would like to take this opportunity to express our sin cere thanks to the World Health Organization as the main catalyst and promoter, and to other international donor agencies for their continuous technical and financial contribution for health development in Lao People's Democratie Republic. May we wish the Fifty-fifth World Health Assembly a brilliant success for the benefits of the world health community. Thank you very much for your kind attention and cooperation. Dr AL-MUNIBARI (Y emen):

ASSNR/6 page 121

L...J ."\l -'1 -~

1-~1 ''ô_L:.<: .~l....~l~l:i...J\..c.)l~~--11-û~\.!·-<:-: Lê . ...?J ~J • • • . • ..?-' i.J__,.... ~ f'1....l::J y. . . L'ô ~ ~..)"-" -~'1 0~ .Jt-1-l • "Î ."\l -'1 ~ ~1 'ô .)~b \..li\..9 ~1 ~ J i.J • .) • J 'G -~ ~ . . .l.l..1i • • ~1 •

ü--J ·'.'

··-~1 ~yJI

c~l ~ ~h..JIJ ~)~YI

LJS.lJ

~~J ~ ~1 ~.J~I ~

~J ~~'j~ ~WI ~1 ~ ~~~ ~l.....à.o ~ y_;)WI t:...!~ ~~Y. C~ ~~'ji wl_y!.y.ll 1 1 G ."\l -'1 • '_jl___a.j '----.:Jj~ ~\..::.. :i...J\..c. .~NI .IWI (jJ • .ll....JI 0" . ~ L-: • i 1 GlliÎ (..}--'~ .... • Y. (.J-Io!IJ1 J -~ J .) • t:.J\.S.J t..r" i.J (J.4

.~ ~ J_.JIJ y_;)WI ~

J___S ~ y~IJ l)ldJ'jl ~ "'tli.J:/IJ ~fi 'ô~ ~_jj JA liA.~ '-:?~\..li lA lJl ,~)1 '-:?~ C;SL.......J.I J~J f'~ LJ.a ~J LJ.a "'";Jb.Jsll ~~ ~ J.l,ily..oJ 4.......)-....:i lA LJS.lJ 'ô.J~I "'h.ii ,4 J!bll ùL........y.ll u....a.!J u-=--..r.JI Ji; tl"J wb'jl wl)._~.... ..»'>ÎlJ ) ......o..:o.J C;:l~J ~l.ftj w_p..J 0-----a o_»..JIJ "'WIJ Jli..b~l CJIA~J ~~y~l ~\.jjJ ~1 Jl...?-~1 .JJA.fl u-lJ (..)~i ùl....)..,.Q..JI .illi JS -~1_,11 ~Jy...J~ ~Jt......WI t~J~I o~ é"' J..,t...:l.ll ~~ ~\..b.iJ ~ lli}J ~~ ~\..c.)l.h....) L.oWI 'ô.)--:1~1 '.lÙtùJY. ~.JIA J..;é 'ô.Jfo.ill J.lj.:;JI ~~ f'~i üÎ :/} ~ :1 'f'\.J..:JI ~J ' s Js.;.·,J y~l 4 , "'! ~~~ J.?,i LJ.a ~l_jj..JIJ AJJ~I ~1 ~~ ,~WI ~1 ~ ''-i~lj.:;JI Jlj)l .l.)C ~ .Jfo~l t)U U~ CJC yy..i CJÎ ,~U..JI o~ ~ ,~i ~) t...s .LtJUI......a d.....-.l:..ll .J---:1# J..-;,.i LJ.a 'ô~l ~~~ ~ ,~1 ~ ~JI......a JSJ .h...._jj..JI J~ ~'ji y,~l

~~ :1 t...s -~'ji JJ~ ~J ~1 ~.J~I ~ ~1 .~hll (..),fiil '-ijl.JI ~1 "'W ~ ~ldJ'jl JIAÏ ~ _,.:o.J 'ô~I.J 'ô~J 'ô~ 'ô.JJ~I ù;/JI~ üfo CJÎ ~Î 'f'\.J.:JI ~J -LJ.a~IJ ~~.o~.J"":! ~~y~l lJ.a Jl:.. r-l\..c. -~~:li~J ,~ ~IJ

~ ~y~l CJI~ ~1 ~ ~i

M. BEASSOUMAL (Tchad) : Excellences, Monsieur le Président de la Cinquante-Cinquième Assemblée mondiale de la Santé, Madame le Directeur général de l'Organisation mondiale de la Santé, Mesdames et Messieurs les Ministres, honorables délégués, Mesdames, Messieurs, c'est pour moi un réel plaisir et un agréable devoir de prendre la parole devant cette auguste Assemblée. Aussi, je voudrais associer ma voix à celle de ceux qui m'ont précédé pour féliciter le Président et les membres de son bureau pour leur brillante élection au présidium. Qu'il me soit également permis de transmettre au Dr Gro Harlem Brundtland, Directeur général de l'OMS, la gratitude et les félicitations de S. E. M. Idriss Deby, Président de la République du Tchad, pour les efforts qu'elle n'a jamais cessé de déployer en faveur de la santé des populations en général et de celle des pays en développement en particulier depuis sa brillante élection à la tête de l'Organisation. L'Histoire retiendra de ses quatre années passées à la direction de l'OMS une avancée significative de la promotion de la santé dans le monde. En effet, il sera mis à son actif, entre autres réalisations, la réduction très importante de la poliomyélite et du tabagisme, la limitation du paludisme et des maladies mentales, la création du Fonds mondial de lutte contre le SIDA, la tuberculose et le paludisme, et la facilitation de l'accès aux médicaments. Madame le Directeur général, le Tchad adhère totalement à votre démarche; aussi, je voudrais vous assurer que nous saluons fortement vos nouvelles orientations, qui consistent à améliorer la santé dans toutes les couches sociales, renforcer la lutte contre les maladies liées à la pauvreté, et réduire les risques pour la santé en vue d'augmenter l'espérance de vie des populations. Le Tchad, avec l'aide de la communauté internationale, a défini clairement sa politique de santé articulée autour des douze orientations stratégiques qui sont traduites en plans d'action, dont le financement est assuré par 1'Etat et par les partenaires au développement. Cela a conduit le Gouvernement à accroître chaque année de 20 % le budget du Ministère de la Santé publique. De plus, sous l'impulsion personnelle du chef de l'Etat, plus de 1000 points d'eau ont été créés à travers le pays, on a assisté à une nette augmentation des infrastructures sanitaires, sept centres de formation initiale du personnel de santé ont vu le jour depuis bientôt trois ans, et la décentralisation des services

ASSNR/6 page 122

de santé, dont la gestion incombe en grande partie aux communautés locales, a été instaurée. Le but recherché est d'étendre la couverture sanitaire sur l'ensemble du territoire national, tout en assurant l'amélioration de la prestation des services de santé. Le Tchad a apprécié à sa juste valeur le thème retenu pour les tables rondes de cette Cinquante-Cinquième Assemblée mondiale de la Santé. A ce propos, je voudrais porter à la connaissance de notre auguste Assemblée que Je Tchad dispose présentement d'une zone pétrolière qui compte plus d'un million de personnes et qui s'étend depuis la frontière soudanaise jusqu'à celle de la République soeur du Cameroun. Malheureusement, cette zone s'avère être une zone de forte endémie où coexistent 1'onchocercose, la trypanosomiase, le ver de Guinée, le paludisme, la tuberculose et le VIH/SIDA, pour couronner l'édifice. C'est aussi une zone de brassage de nombreuses populations venues de différents pays. En outre, sur une grande partie de son territoire, de février à juin, le Tchad connaît chaque année un phénomène climatique qui se traduit par une sévère canicule (45 à 50° à l'ombre) entraînant dans la plupart des cas des morts subites dues à de fortes insolations. A cet égard, Madame le Directeur général, je voudrais solliciter de votre autorité politique et technique un soutien conséquent auprès des différents partenaires au développement afin de mobiliser les ressources nécessaires à la lutte contre ces fléaux auxquels le Tchad est confronté. Je ne puis finir mon propos sans parler du partenariat en général et de celui dans le domaine de la santé en particulier. En effet, comme il a été souligné par Mme le Directeur général dans son allocution, l'amélioration de la santé des populations ne peut se faire que sur des bases factuelles avec l'aide du partenariat. Dans le cadre de ce partenariat, nous, pays Membres de l'OMS, collaborons avec cette institution sur la base de sa stratégie institutionnelle et de ses réformes, qui contribuent grandement à l'amélioration de la santé de nos populations. C'est pourquoi, nous déplorons très sincèrement que la question de l'admission de Taïwan à l'OMS en tant qu'entité sanitaire ne soit pas examinée au cours des présentes assises. Je souhaite plein succès aux travaux de la Cinquante-Cinquième Assemblée mondiale de la Santé. Vive la coopération internationale ! Vive la santé pour tous ! Mr KET SEIN (Myanmar): Mr President, Madam Director-General, honourable ministers, distinguished delegates, ladies and gentlemen, on behalf of the Govemment and the people of Myanmar, 1 would like to convey warm greetings to you ail. Allow me to join the other delegations in expressing my heartiest congratulations to the President on his unanimous election to the presidency of the Fifty-fifth World Health Assembly. Congratulations are also extended to the Vice-Presidents, Chairpersons of the main committees and the other officiais who have been elected to lead this Assembly. In embarking on programmes for ali round national development and promoting the quality of !ife of the people health plays a pivotai role. Investment in health is considered sound investment. Like ali developing countries, Myanmar is facing the double burden of diseases, both communicable and noncommunicable. Infectious diseases still dominate the disease pattern in the country and noncommunicable diseases are rising. Therefore the Ministry of Health has developed national strategies that have targeted prevention and control of major noncommunicable diseases. Healthy lifestyles are becoming part and parce! of ali health programmes being implemented in Myanmar, encompassing those in early childhood to the elderly. It is clearly evident that poverty is the world's most ruthless killer and the greatest cause of suffering and misery. As 70% of the population of Myanmar resides in rural areas, a five-year rural health development plan has been launched throughout the nation. This plan includes five major tasks, namely, development of education, health, economie livelihood including agriculture and livestock breeding, safe water supply and transportation. Myanmar strongly supports the development of a framework convention on tobacco control and looks forward to a practical and effective convention that can easily be implemented by ali countries. Tobacco advertisements have been banned on television and in newspapers. The National Health Committee has also banned advertising billboards near schools, at major public crossroads in the cities and smoking has been prohibited in schools, hospitals, public places and on transportation. A national tobacco control committee has been formed and drafting of a tobacco law is in progress.

A55NR/6 page 123

Under the guidance of the National Health Committee, the highest policy-making body on health in Myanmar, an ali-out effort has been sustained in preventing and controlling HIV1 AIDS. A joint action plan for prevention and control ofHIV/AIDS in Myanmar has been drafted by the national AIDS programme and UNAIDS. lt contains technically sound strategies and is comprehensive in nature, covering ali aspects, that is: preventive, curative and rehabilitative. However, there is still a considerable shortfall of funds to fully operationalize the plan. Myanmar welcomed the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria set up by the United Nations. In conclusion, the delegation from Myanmar wishes to express its appreciation to WHO, other organizations of the United Nations system and international organizations for their support and cooperation in strengthening the health sector in Myanmar. I would like to take this opportunity to recognize the leadership and efforts of the Director-General in steering global action for health and making WHO more responsive to countries' needs. Myanmar will continue to fully support and work closely with WHO in facing the critical challenges of the twenty-first century. Thank you. Dr FEROZ (Afghanistan): In the name of the Almighty Allah, Mr President, Madam Director-General, distinguished delegates, first of ali I would like, on behalf of the Government and people of Afghanistan to thank the Director-General for welcoming Afghanistan to the Health Assembly. I would like also, to thank ail Member States for their support of the peace building in Afghanistan, for the reconstruction of the health sector. The Interim Administration of Afghanistan has placed the health sector among the top five priorities in the reconstruction process. The people of Afghanistan understand that without a healthy population the entire recovery of the country may be threatened. The !ife expectancy of the average Afghan is just 46 years. In Afghanistan, a woman stands one chance in seven of losing her life in the process of creating new life. Very few women or their husbands are aware of, or have access to, the necessary means of spacing their pregnancies. The result is an average of seven children per woman, most often delivered by untrained attendants in unhygienic conditions in their homes. One quarter of Afghan children die before they reach their fifth birthday. Diarrhoeal diseases and measles are wiping out - in tens of thousands - children who should rightfully live to be part of the renewal of the country. Instead, it is nearly impossible to meet a family in Afghanistan who has not suffered the pain of losing an innocent child, most often from diseases that have long been brought under control in the developed world. So yes, the challenge is great. But we are, with the support of the international community, now meeting this challenge. An assessment carried out under the leadership of the Ministry of Public Health and conducted by the United Nations Children's Fund, the United Nations Development Programme, the World Bank and WHO at the beginning of the year, has recommended immediate and long-term programmes for the recovery and rehabilitation of the health care sector. These assessment findings were presented at the International Conference on Reconstruction Assistance to Afghanistan held in Tokyo in January 2002. One of the major achievements of the Ministry of Public Health since the establishment of the Afghan Interim Administration has been the formulation of a national health policy. The main objective of this policy is equitable access to health for ali Afghans, based on the concept of social justice. Regardless of gender, mobility, social status, it is our aim that Afghan men and women and their children will be provided with an essential package of health services. Maternai and child care, immunization, nutrition, control of communicable diseases, mental health services, support for the disabled, and essential drugs pro vide the basis of this package. Our emphasis must be on reaching Afghanistan's rural areas, such as one remote western province where half a million people rely on the services of just one physician. Building basic health centres and rural hospitals is crucial for the survival of Afghan people. The development of human resources in the health sector is another key component of the national health policy. We express our appreciation to WHO, which has been serving as a leading agency in the effort to restore quality medical education. The Afghan Ministry of Public Health was gratified by the contributions of nearly 300 nongovernmental organizations, organizations of the United Nations system, and public health sector workers during a national planning workshop in March 2002, which brought together representatives

A55NR/6 page 124 of ail 32 provinces of Afghanistan for the first time in a decade. Through a bottom-up effort, the workshop formulated detailed regional and provincial work plans for the year 2002 and 2003 and it is our hope that the international community will actively support these plans. At the same time, in a true collaborative effort, workshop participants agreed that the major priorities for health care recovery must be the control of communicable diseases, mother and child care, nutrition and mental health. Already, programmes are being put into place to respond to these priority needs. With the support of WHO and international donors, Afghanistan's current coverage rate of directly observed treatment, short course, (DOTS) for tuberculosis control of just 18% will double in the next two years. This is a first step in controlling this devastating disease that kills 23 000 Afghans a year, the majority of who rn are women. We are also extremely proud of the commitment of the Afghan people to the eradication ofpoliomyelitis. Tens ofthousands ofvolunteers have confronted periods and pockets offighting over the years to ensure that every Afghan child has a chance to be immunized against this scourge. Afghanistan has just one confirmed case of poliomyelitis this year, less than 10% of last year's number. We are on our way to Afghanistan's first major health victory and this will encourage and sustain us as we strive to wipe out many other diseases which plague our children. Finally, 1 would like to share with you my gratitude for the invitation to speak at this prestigious Assembly. The attention of the world has been focused on Afghanistan for the past severa] months. You have doubtlessly seen images on television of the Afghan people struggling to survive despite decades of deprivation. This is our reality today, but we are determined to change this reality. 1 am confident that, with the continued support of organizations of the United Nations system and the international community, Afghanistan can and will begin to build a new future for itself, and that we may one day reach our ultimate goal of health for ali Afghans. Thank you very rouch. Le Dr KAMIL (Djibouti) : Monsieur le Président, Madame le Directeur général, Mesdames et Messieurs, je voudrais tout d'abord, à l'instar de ceux qui m'ont précédé, présenter mes vives félicitations au Président de cette auguste Assemblée mondiale, appelée à discuter des problèmes qui font encore obstacle à la promotion de la santé dans le monde. Je suis convaincu, Monsieur le Président, que votre expérience, votre savoir-faire et vos qualités personnelles contribueront au succès des débats de cette CinquanteCinquième Assemblée mondiale de la Santé. Mes félicitations vont aussi à l'endroit des Vice-Présidents. Je voudrais aussi profiter de cette occasion qui m'est offerte pour féliciter le Directeur général de l'OMS, le Dr Brundtland, pour son action et pour le dynamisme qu'elle a pu imprimer à notre Organisation. Le rapport, qu'elle a nous a si brillamment présenté, ne fait que témoigner de sa détermination à conduire le peuple du monde vers une santé meilleure et accessible à tous. Qu'il me soit aussi permis, Monsieur le Président, d'adresser en mon nom personnel et en celui du peuple djiboutien mes vifs et sincères remerciements au Directeur régional de l'OMS pour la Méditerranée orientale, le Dr Gezairy, pour le soutien qu'il n'a jamais cessé d'apporter à notre pays. Djibouti est un pays pauvre en voie de développement et, par conséquent, il n'échappe pas aux difficultés auxquelles sont confrontés les pays africains en matière de santé. En effet, le poids des maladies transmissibles continue non seulement à peser lourdement sur notre système de santé, mais aussi à freiner notre développement. A ce sujet, je citerai le VIH/SIDA, la tuberculose et le paludisme, dont nous aurons certainement l'occasion d'évaluer l'impact sur le développement socio-économique de nos pays, et j'évoquerai les moyens qu'il faudra dégager pour mieux combattre ces fléaux. Dans cette perspective, nous nous félicitons de la mise en place du Fonds mondial de lutte contre le SIDA, la tuberculose et le paludisme, qui constitue un moyen de plus à la disposition de la communauté internationale pour faire face à ces terribles maladies, qui, comme vous le savez, sont responsables du plus grand nombre de décès enregistrés dans le monde. Alors que la première session pour l'octroi des fonds a déjà eu lieu en avril 2002, une autre session est prévue d'ici la fin de cette année. Notre vif souhait est que le Fonds mondial puisse servir à faire avancer la cause de tous les pays, grands et petits. Il ne faudrait pas, en effet, que les petits pays comme Djibouti soient pénalisés par la taille de leur population. Depuis plus de deux décennies, le monde entier est confronté à une pandémie sans précédent je veux dire le VIH/SIDA. Même si aucun pays du monde n'en a été épargné, la triste réalité est que

ASSNR/6 page 125 certains pays sont plus touchés que d'autres. Le rapport de l'ONUSIDA et de l'OMS, publié en décembre 2001, indique que 70 % des personnes vivant avec le VIH et 76 % des décès proviennent de l'Afrique subsaharienne, alors que 80 % des moyens consacrés à la lutte contre cette pandémie sont disponibles dans le monde dit occidental. Il s'agit là d'un problème non seulement de santé et de développement, mais aussi d'ordre moral, qui pèse sur la conscience de la communauté internationale, la seule capable de mettre fin à ce déséquilibre. Alors que très peu d'attention avait été réservée aux maladies non transmissibles dans les pays en développement, l'émergence des maladies cardio-vasculaires et du diabète, qui témoigne entre autres du déséquilibre alimentaire et du manque d'activité physique chez une partie de nos populations, soulève de sérieuses préoccupations, dont désormais nous devons tenir compte. Evoquant les maladies cardio-vasculaires, il me paraît essentiel de souligner la consommation du tabac dans nos pays, qui devient de plus en plus inquiétante, surtout chez les jeunes, alors qu'elle est en régression dans le monde dit développé. Tout en tenant compte des effets et des conséquences de la globalisation, telle que nous la connaissons aujourd'hui, j'ai des raisons d'espérer qu'à l'issue des discussions de cette Assemblée, des résolutions claires et accompagnées de stratégies applicables seront adoptées et les moyens pour faciliter leur mise en oeuvre clairement définis. La santé de l'enfant et de la mère reste l'une des premières préoccupations de la République de Djibouti. La mise en place des programmes visant la protection de la santé de l'enfant et de la mère, tels que la maternité sans risque, la planification familiale, la prise en charge intégrée des maladies de l'enfant et le programme élargi de vaccination, ne fait que traduire la volonté de notre Gouvernement de garantir le droit à la santé de ce groupe vulnérable. Dans le même ordre d'idées, l'accessibilité aux soins à travers la bonne gestion des services de santé et la disponibilité des médicaments essentiels grâce à un processus de gestion décentralisé constituent la plate-forme d'une politique pour assurer la promotion de la santé de notre peuple. Pour ce faire, notre Gouvernement vient d'adopter une réforme du système de santé sans précédent, qui s'articule autour de sept axes : la réorganisation de l'administration centrale et périphérique, avec comme éléments essentiels la décentralisation, la mise en place de districts sanitaires découpés en secteurs et l'autonomie des principaux établissements hospitaliers ; la mise en oeuvre d'une politique pharmaceutique et l'approvisionnement des structures de soins du secteur public en médicaments et matériels essentiels et génériques ; la participation financière et gestionnaire des usagers aux dépenses des services de santé ; l'amélioration de la santé de la mère et de l'enfant, y compris la lutte contre les mutilations génitales ; le renforcement de la lutte contre les maladies transmissibles, en particulier le VIH/SIDA et les infections sexuellement transmissibles, la tuberculose, le paludisme et les maladies diarrhéiques ; le développement et la valorisation des ressources humaines par la formation initiale et continue; et, enfin, la diversification de l'offre de soins, assurée par des établissements publics, parapublics à gestion autonome ou à but non lucratif reconnus d'utilité publique, et la promotion du secteur privé. Pour s'assurer des moyens de mise en oeuvre de cette réforme, assortie de plans de développement sanitaire à court et à long terme, une table ronde présidée par le Premier Ministre a été organisée en février 2002, à laquelle ont assisté l'Organisation mondiale de la Santé, la Banque mondiale, ainsi que d'autres partenaires dans le secteur de la santé. Je voudrais donc saisir cette occasion qui m'est offerte par l'Assemblée de la Santé pour déclarer l'engagement du Gouvernement de Djibouti d'utiliser tous les moyens disponibles et mobilisables afin d'améliorer le niveau sanitaire de la population, en appliquant les recommandations de l'OMS. Je ne voudrais pas terminer mon intervention sans avoir une pensée pour le peuple palestinien frère dans les territoires occupés, où toutes les infrastructures sanitaires ont été détruites. Au nom de mon Gouvernement, je lance un appel ardent à tous les peuples épris de paix pour qu'ils entreprennent tous les efforts possibles afin que cessent ces violences et pour aider à rebâtir ce qui a été détruit. Je voudrais finir sur une note d'espoir inspirée par la solidarité et la globalisation positive que prône le monde d'aujourd'hui pour le bien-être de tous les peuples.

ASSNR/6 page 126 Mr MUHWEZI (Uganda): Mr President and distinguished members of the Assembly, I wish to thank you for giving me the opportunity to address this august body. I also wish to commend the Director-General and World Health Organization staff for the excellent arrangements made for this year's Health Assembly. The Govemment of Uganda, through the Ministry of Health and in collaboration with stakeholders, nongovemmental organizations, districts, development partners and the private sector has developed a national health policy and a five-year health sector strategie plan. Implementation of the health sector strategie plan started in the fiscal year 2000-2001. lt had been established through various surveys that the people of Uganda carry a heavy burden of disease and that the quality of services in unsatisfactory. The national health policy and health sector strategie plan were therefore developed to respond to this state of affairs and to address the poor health indices. The health sector strategie plan is being implemented through a sector-wide approach and aims at achieving defined outputs and targets. A minimum package of services and a set of indicators were agreed upon for monitoring the performance of the health sector. After the first year of implementation of the plan, there have been achievements as weil as constraints: the health sector strategie plan and national health policy were launched on 23 August 2000 and a sound start has been made. The Ministry of Health headquarters and districts prepare annual work plans with clear outputs against which progress is reviewed quarterly and annual performance reports are published. Coordination of development assistance between the Ministry of Health, other sectors and development partners is managed through established sector-wide approach structures. These mechanisms are working very weil. During the first year of implementation, policies, guidelines, standards, structures and systems for implementing the health sector strategie plan have been put in place. The majority of the health sector strategie plan monitoring indicators registered improvements during this year. There was a significant increase in the utilization of health facilities during the year. HIV prevalence rates which had already been brought down from 32% in the early 1990s to 6.8% in the year 1999, by the year 2000 had been brought down to 6.1 %. Declining immunization coverage rates were arrested and reversed during the year by revitalizing the routine immunization programme. The malaria control programme has been revitalized. The national drug policy was revised and a strategy for the home management of fevers was developed. Use of insecticide treated materials was promoted. Malaria epidemies in south western Uganda were controlled. There was an increase in tuberculosis treatment success rates using the community-based directly observed treatment short course strategy. The health sector has developed significant capacity to manage outbreaks and epidemies. An Ebola outbreak during the year was successfully controlled, achieving the lowest fatality rates in the world of 53%. Epidemies of malaria and cholera, mass accidents, and other complex emergencies were successfully managed. There has been a dramatic decline in the cases of guinea worm and eradication has almost been achieved in Uganda. The Uganda blood transfusion services continue to provide safe blood in the country, and the facility is nowa regional training centre for east, central and southem Africa. About 65% of the targeted primary health care workers are recruited. Professional councils took a series of disciplinary action and anticorruption measures in the sector, and closed illegal clinics and unprofessional health training institutions. Construction was carried out in 120 health centre type II, 45 doctors' houses and 45 theatres at health centre type IV. Sorne laboratory and theatre equipment was procured. The supervision system was strengthened and monitoring of primary health care grant money was carried out in ail districts. There was a significant improvement in the completeness and timeliness of health management information system reporting. In spite of the se achievements, the sector still faces many challenges. Gross underfunding of the public health sector, mainly due to a narrow tax base is the problem. To deliver the Ugandan national minimum health care package, there is still a need for a substantial increase in the Govemment's financial allocation to the sector in order to close the funding gap. This is being compounded by the macroeconomie issues which restrict the size of the Govemment's resource envelope. The flow of funds to service delivery points has serious delays, understaffing is acute at alllevels, especially in the districts and in the hospitals. The infrastructure is still poor in a number of districts. Availability of

ASSNR/6 page 127 adequate stocks of drugs and supplies stiJl poses a serious challenge. Responsibility of households and communities for their own health is stilllow. Apart from the President at the very top, the involvement of political and community leaders in mobilizing for health is stiJl weak. Maternai health services are stiJl unsatisfactory. The leve! of performance according to standards set is stiJl low. The morale and attitudes of health workers are unsatisfactory, basically due to low remuneration: again, due to budgetary constraints caused by the narrow tax base. May 1 now, at this point, talk about the narrow tax base: it is now an established fact that illhealth brings poverty just as rouch as poverty causes poor health. That is why 1 keep talking about the narrow tax base because if Uganda could balance its budget, health industries would be better than they are now. We therefore appeal to the international community, especially the development partners in their efforts to support the health sector, to include removing the trade barriers for our countries, for the developing countries. If people have better incomes, they will naturally lead better lives and also will be able to afford good treatment. On this note, 1 would like to salute the United States of America for the enactment of the A.frican Growth Opportunity Act which allows the very poor countries to access United States markets without tax and without quota. We also appreciate the opening of the European markets to Africa for everything except arros which was passed by the European Union, notwithstanding the subsidy for the European farmers. Be that as it may, we are committed to address ali the above constraints. Strategies and action plans are being put in place to achieve this. Ali in ali, the health sector in Uganda has laid a sound foundation for rebuilding the national health system so that it can contribute positively to poverty eradication and to the socioeconomic development of the country. Significant progress had been made during the first year. Given the necessary support from ali the stakeholders, further improvements in the service delivery and health status will be attained. 1 thank you. Professor MOSKALENKO (Ukraine): Ilpo<j.>. MOCKAJIEHKO (YKpmma): YsiDKaeMhiÜ r-H IIpeACeAaTeJih, ysiDKaeMaH r-)I<:a feHepanbHbiÜ AHpeKTop, ysiDKaeMbie AeJieraTbi, KOJIJierH, Ilpe:>KAe scero, H xoTeJI 6hi no6JiaroAapHTh r-)1(}' feHepaJibHOro AHpeKTopa 3a my6oKHÜ COAep:>KaTeJibHhiÜ AOKJiaA, CHCTeMHOe npeACTaBJieHHe CTPaTerHH B03 Ha 6JIH:>Kaüume rOAhi H oqeBHAHbie no3HTHBHbie pe3yJihTaTbi pa6oTbi OpraHH3aQHH 3a nocJieAHee speMH. 3To no3BOJIHJIO nOAHHTb BOnpOCbl 3AOpOBbH Ha 6oJiee KaqeCTBeHHbiÜ, IIJiaHeTapHbiÜ ypoBeHb. oJiarOAapH BarueÜ HOBOÜ nOJIHTHKe no Bbipa60TKe COBpeMeHHbiX nOAXOAOB K npo6JieMaM cHcTeM 3ApasooxpaHeHHH, oxpaHe o6IIIeCTBeHHoro 3AOpOBhH npaBHTeJibCTBa CTPaH Teneph HMeiOT B03MO:>KHOCTb qeTKO BHAeTb nepeA co6oü TPH OCHOBHbie 3aAaqH, Ha KOTOpbiX AOJI:>KHa CTPOHTbCH HaQHOHaJibHaR nOJIHTHKa 3ApaBOOXpaHeHHH. ÛAHa H3 3THX 3aAaq - yBeJIHqeHHe HHBeCTHpOBaHHH B 3ApaBOOXpaHeHHe Ha CTpaHOBOM ypOBHe, H 3To oqeHb BIDKHO! B BarneM BbicryiiJieHHH TaK:>Ke ynoMHHaJIOCh o TOM, ~o noJIO:>KHTeJibHhie pe3yJibTaTbl B COCTOHHHH 3AOp0BbH HaCeJieHHH AOCTHraiOTCH H B CTPaHaX C HeAOCTaTOqHo <j.>HHaHCHpyeMbiMH CHCTeMaMH 3ApaBOOxpaHeHHH. K TaKHM cTpaHaM OTHOCHTCR H YKpaHHa. B Harneü cTpaHe OCHOBHbiM HCToqHHKOM <j.>HHaHCHpOBaHHH OTpaCJIH 3ApaBOOXpaHeHHH HBJIHIOTCH 6IOA:>KeTHhie cpeACTBa. K CO:>KaJieHHIO, OHH ceroAHH ellie oqeHb orpaHHqeHbi. HMeHHO no 3TOH npHqHHe Mbi nocTaBHJIH nepeA co6ou ocHOBHYIO QeJib - HCnOJib30BaTb HX HaH60Jiee 3<j.><j.>eKTHBHbiM CnOC060M. oJiaroAapH nOMep:>KKe co CTOpOHbl IIpe3HAeHTa, IlapJiaMeHTa H IIpaBHTeJibCTBa B YKpaHHe 6biJIH onpeAeJieHbl HaQHOHaJibHbie npHOpHTeThi: oxpaHa 3AOpOBbR AeTeÜ H :>KeHIIIHH penpOAYKTHBHOrO B03pacTa; 6oph6a C HeHH<j.>eKQHOHHbiMH (OHKOJIOrHqecKHMH H cepAeqHoCOCYAHCTbiMH) H HH<j.>eKQHOHHhiMH (ry6epKyJie3, BI11I/CIIH,Z:O 3a6oJieBaHHHMH; oxpaHa nCHXHqeCKOrO 3AOpOBhR; o6ecneqeHHe KaqeCTBa :>KH3HH JIIOAeÜ nO:>KHJIOrO B03pacTa H ApyrHe. ,[(JŒ perneHHH 3THX npHopHTeTHbiX 3aAaq 6biJI pa3pa6oTaH H npHHHT pHA HaQHOHaJibHbiX H rocyAapcTBeHHhiX nporpaMM. HaH60Jiee BIDKHbiM CTpaTerHqecKHM AOKyMeHTOM HBHJiaCb KOMnJieKCHaH rocyAapCTBeHHM nporpaMMa "3AOpOBbe HaQHH ÛHa onpeAeJIHJia cneKTP AeÜCTBHÜ BCeX npaBHTeJibCTBeHHbiX 11 •

ASSNR/6 page 128 CTPYKTYP no 3auune M yKpenJieHMIO 3.LI.opoBMI HaceneHI1» Ha 6niDKaiiwee .D.eC»TI1JieTI1e. Xoqy

11HtPüpM11pOBaTb .D.eJieraTOB, qTO B OCHOBy :HOH nporpaMMbl 6b!Jll1 nOJIO)I(eHbl rJiaBHbie nO.D.XO.D.bl 11

np11H~I1nhi

B03.

Cepbe3Hbie

MeTO.D.OJiomqecKI1e

peKOMeH.D.a~l111

speM»

pa3pa6oTKI1

rocy.D.apcTBeHHOH nporpaMMhi

"3.LI.oposbe Ha~1111" 6hiJII1 npe.D.OCTasneHbi YKpa11He EsponeiicKI1M

peri10HaJibHbiM 610po B03, 11, noJih3y»cb cnyqaeM 11 B03MO)I(HOCTbiO, pa3pern11Te no6naro.D.apMTb np11CYTCTBYIOI.Qero Ha cecCMMr-Ha ~aH30Ha 3a nocTO»HHYIO no.D..D.ep)I(KY scex MHM~Manm YKpaMHbi. IJpocJiyruaB BbiC'fYnJieHMe reHepaJibHOrO .D.MpeKTOpa, MHe 6hiJIO np1151THO OTMeTMTb, qTO

Ha~MOHaJibHa» noJII1TMKa YKpaMHhi B o6nacTM 3.D.pasooxpaHeHM» M.D.eT B Hary co cTpaTerMeii B03. HüBbiM onpe.D.eJIMJIM 11 nO.D.XO.D.OM K

pa~MOHaJibHOMY MCnOJib30BaHMIO tPMHaHCOBbiX pecypcOB Mbl TaK)I(e nJiaHMposaHMe.

nporpaMMHO-~enesoe

Bo-nepBbiX, 3TO .D.aJIO B03MO)I(HOCTh CKOH~eHTPI1POBaTb HamM orpaHI1qeHHhie pecypcbi Ha perneHMM Hal16onee Ba)I(HhiX 3a.D.aq oxpaHbi 3.D.OpüBMI B Harneii CTPaHe. Bo-BTOpbiX, - .D.OCTMqh XOTH M He6oJihlliMX, HO noJIO)I(MTeJihHhiX pe3yJihTaTOB B ynyqrneHMI1 nOKa3aTeJieH 3.D.Op0Bb51: CHM3MTb MJia.D.eHqecKyiO M MaTepMHCKYIO CMepTHOCTb, 3a6oJieBaeMOCTb OT nyTeM

MHtPeK~MH, na~MeHTOB

ynpaBJIHeMhiX

MMMYHM3a~MI1,

ynyqrnMTb

~eJIOM

CaHMTapH0-

3nM.D.eMMOJIOrMqecKOe 6JiarononyqMe, C.D.eJiaTb 6oJiee .D.OC'fYnHhiMM OCHOBHbie Me.D.MKaMeHTbl .D.Jl5I 11 MHoroe .D.pyroe.

Y Ba)l(aeMbie KOJIJierM, KaK y)l(e ynOMMHaJIOCb B npe.D.bi.Ll.YI.QMX BbiCrynJieHMHX, O.D.Ha M3 TPeX rno6anhHhiX 3a.D.aq, c<PopMyJIMposaHHhiX B .D.OKJia.D.e my6oKoysa)l(aeMoiir-)I(M 11

EpyH.D.TJiaH.D.,

3aCJIY)I(MBaeT oco6oro BHMMaHMH.

5I o~eHKe.

MMeiO B BM.D.Y pa6ory C "<PaKTOpaMM pHCKa .D.J151 3.D.üp0Bh51

M CMCTeMHbiH nO.D.XO.D. K MX

Bee Mbl He COMHesaeMCH B 3Haqi1MOCTM npOtPMJiaKTMKM, HO MMeHHO TaKa51 nOCTaHOBKa Bünpoca 0 püJIM nepBMqHOH npOtPMJiaKTMKM, KOTOpa51 np03Byqana B BbicrynJieHMM reHepaJibHOrO .D.MpeKTOpa BO BpeMH .D.MCKYCCMM Ha 3aCe.D.aHMM Kpymoro CTOJia MMHMCTPOB, - 3TO CBOero pü.D.a npüpbiB B .D.e»TeJibHOCTM B03. <f>aKTOpbi pHCKa .D.J151 3.D.Op0Bb51 B pa3JIMqHbiX CTpaHaX 5IBJI51IOTC51 CaMbiMM pa3H006pa3HbiMM M MHOroqMCJieHHbiMM. Mx onpe.D.eJieHMe M o~eHKa 6y.D.YT cnoco6cTsosaTb BhiXO.D.Y npo6neM 3.LI.OpOBhH 3a paMKI1

KOMneTeH~I1M cne~MaJIMCTOB 3.D.paBOOXpaHeHM51. PelliMTb TaKyiO 3a.D.aqy MO)I(HO TOJlbKO nocpe.D.CTBOM cosMeCTHbiX yci1JIMH B03, rocy.D.apcTBeHHoro ceKTopa 11 rpa)I(.Ll.aHcKoro o6I.QeCTBa Ha CTPaHOBOM ypüBHe.

J1,

qTo

oqeHh

Ba)I(HO,

KOJIMqeCTBeHHO

onpe.D.eJIMTb

3TH

<t>aKTOpbl

O~eHMTb

3tPtPeKTMBHOCTb 3aTPaT Ha Mepbl no MX COKpai.QeHMIO. l1ü3TOMY Hama CTPaHa C HeTepneHMeM 6y.D.eT û)I(M.D.aTb ~OKJla.D. 0 COCTOHHMM 3.D.paBOOXpaHeHM51 B MMpe 3TOrO ro.D.a 0 <t>aKTOpax pHCKa .D.JI51 3.D.Op0Bb51, KOTOpbiH, KaK OTMeTMJia r-)l(a reHepaJibHbiH .D.MpeKTüp, 6y.D.eT ony6JIMKOBaH OCeHbiO TeKyi.Qero rO.D.a. Mbl noJiaraeM, qTO OH nOCJI~MT OCHOBOH .D.J151 npMHHTMH nOJII1TMqeCKMX perneHMH no ynpaBJieHMIO 11 CHM)I(eHMIO pHcKoB .D.JIH 3.D.opoBhH s Ka)I(.Ll.OH CTPaHe. Ysa)l(aeMbiH ITpe.D.Ce.D.aTeJih, ysa)l(aeMbie MMHMCTpbi, ysa)l(aeMhie KOJIJierM, Pa3pernMTe ocTaHOBMThCH ei.Qe Ha O.D.HOM Ba)I(HOM acneKTe BbicrynneHMH r-)I(M EpyH.D.TJiaH.D. 3TO Me)I(.Ll.yHapO.D.HOe napTHepCTBO no BOnpocaM 3.D.paBOOXpaHeHM5I, OC06eHHO B qacTM M06MJIM3a~I1M M KOH~eHTpa~I1M pecypcos cTpaH .D.JIH perneHMH mo6anhHhiX 3a.D.aq B 3TOM MexaHM3Mhi tPMHaHcMposaHMH, KOTüpble MOrYT peanmosaThCH qepe3 pH.D. ceKTope. <PoH.D.OB HoBhie (r ABH,

fJI06aJibHbiH tPOH.D.), 5IBJI5110TC5I cepbe3Hh!M MCTOqHMKOM .Ll.Jl5I JIMKBM.D.a~MM rJI06aJibHbiX 3nM.D.eMMH 11 HOBOH MO.D.eJiblO KOJIJieKTMBHOH OTBeTCTBeHHOCTI1 3a 6e3onaCHOCTb B MMpe M 3.D.üp0Bbe. PoJib B03 s co3.D.aHMM M .D.eHTeJihHOCTM 3TMX <PoH.D.OB cero.D.HH TPY.D.HO nepeo~eHMTh. YBa)l(aeMaH r-)l(a reHepaJibHbiH .D.11peKTOp, B 3aKJIIOqeHI1e xoqy 3asep11Tb, qTo YKpaMHa nO.D..LT.ep)I(11BaeT BCe MHM~MaTMBbl 803. B 3TOH o6JiaCTM. )l{eJiaiO BCeM KOJIJieraM ycnelliHOH pa60Tbl no npeTBOpeHMIO 11X Ba)I(Hb!X 11 CJIO)I(Hb!X 3a.D.aq no yKpenJieHI1IO 3.LI.OpüBhH HaceJieHMsr, nocTasneHHhiX B .D.OKJia.D.e r-)I(M EpyH.D.TJiaH.D.. Enaro.D.apiO 3a BHI1MaHMe.

ÜHM nOJIHOCTblO OTBeqaJOT COBpeMeHHbiM 3a.D.aqaM, KOTOpb!e

CTOHT nepe.D. HalliMM 3.D.paBOOXpaHCHMeM M yqMTbiBaiOTC5I np11 onpe.D.eJieHMI1 Ha~MOHaJibHOH nOJIMTI1KM

ASSNR/6 page 129

Dr COLEMAN (Liberia): Mr President, Madam Director-General, distinguished delegates, the Liberian delegation would like to congratulate the President on his election as President of the Fifty-fifth World Health Assembly. We would also like to extend our sincere thanks and appreciation to the Director-General for the excellent report and also take this time to congratulate her for her stewardship of WHO and the many innovative initiatives and reforms that she has instituted since incumbency. We would like to report to this august body the many achievements of the health sector in my country in the following areas. The global initiative to eradicate poliomyelitis has been very successful in Liberia with more than 95% of children under five immunized. The excellent results obtained in the national immunization days have also strengthened the routine Expanded Programme of Immunization and together with the Global Alliance for Vaccines and Immunization-funded programme have increased the overall immunization coverage against the six childhood preventable diseases from 23% in 2000 to about 57% in 2001. The efforts exerted by the health workers in Liberia culminated in giving the Africa Task Force on Immunization A ward to Liberia for the year 2001. We would like to express our gratitude to the Secretary-General of the United Nations for the establishment of the Global Fund to Fight AlOS, Tuberculosis and Malaria. We would like to recommend that the World Health Organization as the lead agency in health should play a more prominent role in the management and implementation of programmes of the Global Fund. We would also Iike to recommend that governmental organizations and civil society groups should secure funds only through the country coordination mechanisms and that national governments should manage these funds as is the case with the funds of the Global Alliance for Vaccines and Immunization. Liberia has suffered an enormous brain drain over the last 10 years. Many doctors, nurses and technicians have left the country in search of greener pastures. This poses very serious risks to the health of our people. However, over the last three years, thanks to the many fellowships offered by WHO to training institutions on the African continent, we have started the process of training a new core of health experts. We appeal to WHO for more fellowships, now that fellows trained at these institutions in Africa have begun returning home. The most important risk to health for Liberia is the continuous instability in the north-western region of our country that has caused massive displacement of our people: almost a quarter of the 3.5 million population of Liberia are internally displaced and this has led to a breakdown in the health system in this part of the country. The continuous instability poses a threat to the gains made in the revitalization of basic health services over the last three years. We appeal to the international community to bring an end to these cross-border incursions. The Government and people of Liberia are grateful to the following donors and agencies for their continuous support to the health care delivery system of Liberia, namely the United States Agency for International Development, the European Union, the Department for International Development ofthe United Kingdom of Great Britain and Northern Ireland, the Government of France and the Government of the Netherlands. Special appreciation is extended to the Republic of China (Taiwan) for the enormous assistance rendered to the Government and people of Liberia in the areas of: rehabilitation of hospitals and clinics; care of the disabled; and HIV1AlOS awareness and the provision of antiretroviral drugs and condoms. The WHO Constitution proclaims that health is a fundamental right of ali peoples. WHO is the only forum mandated to direct and coordinate global health matters. To deny the people of the Republic of China (Taiwan) access to information and knowledge about health matters disseminated by WHO and to preclude their participation in global efforts to combat disease is to deprive these 23 million people oftheir fundamental rights to health granted under the WHO Constitution. Given the possibility for the rapid spread of disease in our increasingly interdependent global community, such exclusion threatens the well-being of peoples around the world, regardless of their country of residence. We urge that the Republic of China (Taiwan) be admitted access to WHO as a health entity. Thank you for your attention.

A55NR/6 page 130 El Dr. AGOSTINHO DAS NEVES (Santo Tomé y Principe): Sefior Presidente, sefiora Directora General, ilustres delegados, sefioras y sefiores: Permitanme, excelencias, en nombre del Gobiemo de la Republica Democnitica de Santo Tomé y Principe y en el mio propio, felicitar al sefior Ministro de Salud de la Republica de El Salvador por su eleccion a la Presidencia de la 55a Asamblea Mundial de la Salud. Mis felicitaciones son también extensivas a los Vicepresidentes y Relatores de esta reunion. Estoy convencido, sefior Presidente, de que bajo sus oportunas orientaciones nuestros trabajos concluinin con éxito. A pesar de que mi nominacion coma Ministro de Salud es reciente, he seguido con interés los cambios acontecidos en el seno de la Organizacion Mundial de la Salud, y con especial atencion, el nuevo dinamismo de las relaciones entre la Organizacion y los Estados Miembros, intensificado después de la eleccion de la Directora General, Dra. Gro Harlem Brundtland. Estos cambios ya se vienen materializando en la mas rapida y mas adecuada resolucion de los problemas de salud que enfrentamos en nuestros paises. Por esta razon, no puedo dejar de felicitar y agradecer a la Directora General de la OMS por el trabajo desarrollado en favor de la salud de todos los pueblos del mundo y en particular, de aquellos que continuan soportando diariamente los sufrimientos que la ignorancia, la pobreza y las enfermedades les imponen. Permitame, sefior Presidente, aprovechar esta oportunidad para dar las gracias a todos los paises amigos, a las organizaciones del sistema de las Naciones Unidas y las organizaciones no gubemamentales que vienen apoyando desde hace afios a mi pais en la implementacion de nuestros programas de salud. La, Republica de China (Taiwan) es uno de estos paises que vienen contribuyendo con el esfuerzo del Gobiemo a mejorar la salud y la calidad de vida de la poblacion de Santo Tomé y Principe. Creemos que la entrada de la Republica de China (Taiwan) en el seno de esta Organizacion podria no solo reforzarla, sino también ampliar esta alianza a otros Estados Miembros. Estas son, sefior Presidente, las razones que nos hacen apoyar la entrada de la Republica de China (Taiwan) en el seno de la OMS. Sefior Presidente, ilustres invitados: Consideramos la decision del Consejo Ejecutivo, por la cual se recomienda a la 55a Asamblea Mundial de la Salud debatir sobre el tema «Riesgos para la salud», ya sea en la plenaria, o bien en las mesas redondas ministeriales, como una clara manifestacion de la firme voluntad de la OMS y de los Estados Miembros de afrontar las innumerables amenazas a la salud y al bienestar de los pueblos. Manifestamos nuestras felicitaciones a los miembros del Consejo Ejecutivo por esta decision y por las pertinentes resoluciones sometidas a la 55a Asamblea Mundial de la Salud. Entre los principales factores que condicionan el bienestar de los hombres y causan problemas para la salud, queremos referimos a la malnutricion proteicocalorica, asi como a las carencias de micronutrientes, en particular la vitamina A, el yodo, el hierro y el acido folico, cuya insuficiencia aumenta la vulnerabilidad frente a enfermedades infecciosas y conduce a situaciones de apatia fisica y mental. La mala calidad del agua, junto con un insuficiente saneamiento del medio, estan en el origen de las enfermedades diarreicas, incluidos el colera y la disenteria. La mala gestion del agua estancada proporciona un ambiente favorable a la proliferacion de mosquitos vectores del paludismo. Ciertos estilos de vida y de comportamiento pueden, bien ser la causa directa de la enfermedad, bien predisponer a enfermedades y accidentes. Asi, el tabaquismo es la base de algunas enfermedades cardiovasculares y de ciertas neoplasias. El consumo de alcohol y de drogas esta muchas veces ligado a accidentes de aviacion. La promiscuidad sexual mantiene un peso considerable en la propagacion de las enfermedades de transmision sexual, y en particular del VIH/SIDA. Sefior Presidente, en calidad de Ministro de Sanidad de un pais en desarrollo del Africa subsahariana, que padece un bajo nivel de vida, debo afirmar que la pobreza es uno de los mayores riesgos para la salud en Africa hoy en dia. En esta perspectiva, la definicion e implementacion de politicas de reduccion de la pobreza deberian constituir la prioridad de los gobiemos y de sus aliados en la cooperacion al desarrollo. Destacando el beneficie que se podria obtener para la mejoria de la salud, con el conocimiento del impacto de los diferentes riesgos para la comunidad, y siendo evidente que la implementacion con éxito de cualquier politica de desarrollo debe implicar la participacion

ASSNR/6 page 131

activa de las comunidades a quienes se dirige, quisiera, al terrninar, solicitar a la OMS que estas inforrnaciones sean ampliamente difundidas para el conocimiento del gran publico. Muchas gracias. La Dra. LOPEZ (Uruguay): Sefior Presidente, sefiora Directora General de la Organizaci6n Mundial de la Salud, sefiores Ministros y Ministras, excelentisimos delegados, sefioras y sefiores: La Republica Oriental del Uruguay es un pequefio pais latinoamericano situado en la parte sureste de América del Sur, con fronteras limitrofes con la Republica Federativa del Brasil y con la Republica Argentina. Cuenta con 3 300 000 habitantes. La composici6n de edades muestra una tendencia progresiva al envejecimiento, con un proceso conocido como «feminizaci6n de la vejez». Existe un alto grado de urbanizaci6n. La tasa bruta de natalidad es de las mas bajas del mundo. La tasa de mortalidad general es de 9,3 por 1000. La mortalidad infantil en el trienio 1993-1995 oscilaba en alrededor de 20 por 1000 en menores de un afio, muestra una tendencia progresiva al descenso en los ultimos afios, situandose en 14 por 1000 para el afio 2001. La disminuci6n de la mortalidad infantil se debe fundamentalmente a la disminuci6n de la mortalidad postneotanal en la poblaci6n asistida en los servicios publicos. Al comienzo de la década de los afios ochenta la tasa de mortalidad infantil en el sector publico era cuatro veces superior a la del sector privado, y se redujo en el sector publico en un 50%, en tanto que en el sector privado solamente en un 9%. Mas del 90% de la poblaci6n accede al agua potable y al saneamiento. El Uruguay se ha caracterizado hist6ricamente por un alto indice de alfabetizaci6n. La esperanza de vida al nacer es de 73 afios, en promedio, para ambos sexos. Nuestra poblaci6n ha completado el proceso de transici6n epidemiol6gica como consecuencia de los importantes cambios sociales y de atenci6n a la salud que se han dado a lo largo del siglo. El perfil epidemiol6gico muestra el predominio de las enferrnedades no transmisibles, asociadas fundamentalmente a los estilos de vida y al comportamiento humano. La mortalidad por causa especifica desde hace varias décadas muestra el predominio de las enferrnedades no transmisibles: aparato cardiovascular, neoplasias, accidentes, violencia y, mas recientemente, suicidios. La mortalidad materna es baja, de Il por 1000, y el enfoque de género esta presente en todos los programas de salud. La prevalencia del tabaquismo y el consumo de alcohol contribuyen a la mortalidad y morbilidad en tendencia creciente. En la poblaci6n infantil persisten las enferrnedades transmisibles como primera causa de consulta y de ingresos hospitalarios, en particular vinculados al aparato digestivo y respiratorio. De las enferrnedades prevalentes destacan las meningitis supuradas, en las que se observa un marcado descenso de la tasa de incidencia de meningo A-C, resultado de la eficacia del plan de inmunizaci6n, y el reciente aumento de casos acumulados de meningo B. Los casos de sarampi6n mantienen la tendencia decreciente, lo que ha llevado a iniciar una estrategia para la eliminaci6n de la enferrnedad. En las enferrnedades transmisibles se asiste a la presencia de las enferrnedades emergentes y reemergentes como el SIDA, la leptospirosis y la provocada por el virus Hantaan. No tenemos casos aut6ctonos de dengue en el pais, pero si la presencia del vector Aedes aegypti, y un alto riesgo considerando la situaci6n epidemiol6gica de la region. La transici6n ambiental se manifiesta en la presencia de nuevos riesgos y problemas como la contaminaci6n por plomo, el asbesto y la toxina Don en el trigo. El pais no ha completado la transici6n en la atenci6n médica, por lo que existe una brecha entre las caracteristicas demoepidemiol6gicas y los servicios de salud. Sefior Presidente: El Uruguay cuenta con buenos indicadores sanitarios. No obstante, no esta ajeno a los riesgos para la salud. Existen factores que aumentan la probabilidad de su gente de tener efectos adversos, de enfermar o morir. Es un pais con altos indices de alfabetizaci6n, que ha emprendido multiples campafias educativas orientadas a grupos vulnerables. Cuenta con una estrategia del sector salud que adopta un criterio sistematico e integrado para mejorar el acceso a la atenci6n clinica. Sin embargo, la poblaci6n no ha incorporado la cultura de autocuidado de la salud, no ha incorporado cambios significativos en el comportamiento, si bien los riesgos estan bien definidos. La poblaci6n no tiene una percepci6n adecuada de la magnitud de los riesgos. En los

A55NR/6 page 132 ultimos afios el pais se ha enfrentado a una disminucion de la produccion con deteriora progresivo del ingreso per capita, que ha afectado a las familias y a las comunidades, postergando el desarrollo humano. El sistema de salud del Uruguay es complejo, mixto y segmentado. Se destina a la salud el 10% del producto bruto interna. No obstante, el sistema de salud es inequitativo, ya que el 70% de los recursos son asignados al sector privado y el 30% al sector pùblico, que es el mas carenciado social, cultural y economicamente. De esta distribucion se destaca que la mayor asignacion de recursos es a la asistencia, con el consecuente predominio del modelo curativo. Asimismo, el sistema presenta debilidades en la gestion, carece de indicadores de evaluacion del desempefio y de métodos sistematicos. Presenta problemas en el financiamiento. Carece de un sistema de prioridades de factores de riesgo y de analisis de costo/eficacia, lo que no permite establecer un adecuado financiamiento del sistema y limita tanta las acciones de prevencion camo el tratamiento costoeficiente de las enfermedades. Sefior Presidente: El poder ejecutivo ha aprobado recientemente la reestructura organizativa de nuestro Ministerio. La Direccion General de la Salud se propane dar cumplimiento a las funciones esenciales de la Salud Publica y a ejercer el roi rector en el sistema de salud. Existe la voluntad politica de reorientar los recursos hacia la prevencion y promocion, teniendo en cuenta la gestion de los riesgos a la politica de salud. Se han priorizado los ternas de politica de acceso, eficacia, seguridad y uso racional de los medicamentos; la mejora continua de la calidad de la atencion de los servicios de salud publicos y privados, el desarrollo de los recursos humanos y el fortalecimiento de los programas de inocuidad de alimentas y evaluacion de tecnologia médica. Para disefiar politicas de salud debemos fortalecer el sistema de informacion a la poblacion y a las autoridades, el sistema de vigilancia considerando los factores de riesgo, asi como el de las enfermedades. Finalmente, consideramos la salud camo un proceso multicausal, en el cual es necesario optimizar la coordinacion intersectorial con educacion, municipios, agricultura, fuerzas vivas, grupos comunitarios, organizaciones no gubemamentales, entre otros, con el proposito de crear un entomo institucional adecuado sin limites a las infraestructuras ni a las capacidades. Debemos dar respuesta a situaciones humanas promoviendo una politica cultural, social, ambiental y economica que contribuya al desarrollo a escala humana sostenible. El proceso de comunicacion, informacion y educacion junto a la gestion costoeficiente sera la piedra angular para hacer frente a los problemas de salud de los mas vulnerables y al mejor desempefio del sistema de salud. Finalmente, queremos agradecer la oportunidad de poder dirigimos a esta Asamblea y felicitar a la Directora General por su gestion en la Organizacion Mundial de la Salud, que refleja el compromiso y la solidaridad de la Organizacion con todos los pueblos del munda. Gracias. El Dr. MuNOZ (Chile): Sefior Presidente, sefiora Directora General, sefioras y sefiores delegados: Como en afios anteriores la delegacion de Chile se presenta a esta 55a Asamblea Mundial de la Salud con el anima de contribuir desde nuestra experiencia a la construccion de orientaciones que sirvan a los propositos compartidos de avanzar hacia el logro de mejores y mas equitativos niveles de salud para nuestros pueblos. Este afio nuestra participacion adquiere un caracter especial, ya que junto a la totalidad de los paises de las Américas celebramos el Centenario de la Organizacion Panamericana de la Salud coma un eventa de profunda significacion para la Region y para el munda. Los logros de la Region en materia de disminucion de los riesgos derivados de las enfermedades infectocontagiosas, en especial los de las inmunoprevenibles, son evidentes. Y a ellos la OPS, en su doble roi de Oficina Sanitaria Panamericana y de Oficina Regional de la Organizacion Mundial de la Salud, ha contribuido en forma significativa. Sin embargo, todavia tenemos que reconocer inaceptables y desiguales cargas de enfermedad y muerte evitables o controlables en muchas de nuestros paises. Elias son resultado de la pobreza, la falta de educacion efectiva y la falta de proteccion derivada de sistemas de salud desiguales, en los que quienes tienen mas acceso a los bienes y servicios obtienen a cambio la educacion que les permite cambiar sus estilos de vida y el acceso al tratamiento cada vez mas costoso de sus enfermedades.

ASSNR/6 page 133

La prioridad que la salud tiene para los tomadores de decision en materia de politicas publicas y el lugar que la preocupacion por la salud ocupa en las decisiones de asignacion de recursos son aun insuficientes. Por ello, Chile respalda activamente los esfuerzos que la Directora General ha realizado con el fin de ligar las decisiones macroeconomicas de los paises al objetivo de hacer realidad el derecho a la salud que muchas de nuestras Constituciones reconocen en la letra. Chile también respalda plenamente los esfuerzos por medir cada vez mâs adecuadamente el desempefio de nuestros sistemas de salud. En la medida que logremos contar con indicadores adecuados y compartidos podremos avanzar todos sobre la base de la extension de las buenas prâcticas detectadas. Nos estimularemos a avanzar y pasaremos de la discusion de la metodologia al reconocimiento de nuestras valencias, paso necesario para alcanzar la superacion. Solo asi, cada vez que nos reunamos la discusion serâ propositiva y contribuirâ al logro de nuestro ideal comun de mâs y mejor salud para todos. Los procesos de reforma de salud son eminentemente politicos. En ese sentido, el Gobiemo de Chile ha declarado su decision de avanzar en un cambio estructural del sistema de salud, constituyéndose éste en la reforma mâs significativa de las que se inician en la gestion del Presidente Ricardo Lagos. La reforma chilena apunta a avanzar hacia objetivos nacionales de salud a largo plazo, los que han sido definidos a través de un proceso participativo. Estos objetivos apuntan a disminuir cargas de enfermedad y a introducir mayor equidad y calidad en el acceso a los servicios. Con el fin de avanzar hacia el logro de los mismos, el que serâ medido a través de la definicion de metas especificas, el Gobiemo ha decidido iniciar los cambios del sistema de salud por la via de explicitar los derechos de atencion de salud individual y colectiva, mediante una priorizacion de aquellos problemas que indican la mayor carga de dafio para las personas y que repercuten fuertemente en los presupuestos familiares, y para los que contamos con intervenciones costoefectivas adecuadas. A esta priorizacion intencionada que se diferencia claramente de la logica de los paquetes bâsicos de prestaciones garantizadas, la hemos denominado sistema de Acceso Universal con Garantias Explicitas (AUGE). El sistema AUGE serâ obligatorio para los prestadores de seguros y servicios de salud y se constituirâ en la medida del avance del conjunto de sistema de salud hacia los objetivos de largo plazo antes resefiados. Por definicion, la garantia se entiende como incrementai y perceptible de acuerdo con el avance del conocimiento sanitario y de los recursos que el pais esté en condiciones de asignar al sector. La reforma chilena implicarâ también modificaciones sustanciales a la regulacion de los seguros y prestadores privados, asi como una mejoria significativa de la gestion del sistema publico de salud. Luego de la sefiera reforma de 1953, que se manifesto en la creacion del Servicio Nacional de Salud, el pais ha experimentado un modelo de organizacion de la proteccion de salud que introdujo seguros privados, a los que han tenido acceso las personas de mayores ingresos y menores riesgos manteniendo a la mayoria de la poblacion y a los mâs pobres y riesgosos en el Sistema de Salud Publico. Como consecuencia, hoy existe insatisfaccion en ambos sistemas. En el primera, por la presencia de exclusiones, carencias y preexistencias que limitan la proteccion de la clase media, y en el segundo, por las condiciones de atencion y la espera para obtenerla. De Jo que se trata hoy es de superar esta desigualdad inaceptable, complementando los esfuerzos publicos y privados y disminuyendo la carga de gasto directo de los hogares en atencion de salud. Conscientes de que la reforma obliga a un roi preponderante del Estado en la conduccion y regulacion del conjunto del sistema de salud, asi como en el estimulo de los esfuerzos de los otros sectores responsables de las politicas publicas dirigidas a atenuar las inclemencias ambientales que determinan el estado de salud, consideramos que el apoyo de la Organizacion Mundial de la Salud al fortalecimiento de la capacidad rectora y al desarrollo de la infraestructura de salud publica es fundamental para el desarrollo de Estados modemos y fuertes capaces de velar con prestancia por los derechos de las personas en salud. Esas personas deben tener cada vez mâs espacio para participar en las decisiones que los paises tomamos respecta a la organizacion de los servicios, por Jo que nuestros Estados deben colaborar, ademâs, a la construccion de ciudadania, para la decision democrâtica en salud. Este desafio es fundamental y hacia él debemos también avanzar con el apoyo de instituciones y organizaciones como la que hoy nos cobija. Muchas gracias, sefior Presidente.

ASSNR/6 page 134

Mr NURANI BAKAR (Somalia): Mr President, Madam Director-General, excellencies, ladies and gentlemen, 1 am honoured and humbled to have been accorded this privilege to address this esteemed Health Assembly and I am pleased to extend to you my warmest greetings and to express in my name and on behalf of the transitional national Govemment of Somalia our sincerest gratitude and appreciation to the World Health Organization for ali the efforts it exerts in the alleviation of the suffering of the people ali over the world. I must also extend the gratitude of the transitional national Govemment and the people of Somalia to the Director-General of WHO and the Regional Director of the Eastern Mediterranean for their continuous support to the cause of countries in the third world in general and that of the people of Somalia in particular. The events of the Arta, Djibouti peace process led to the establishment of the transitional national assembly and transitional national Govemment in Somalia. The Arta peace process was conceived to include ali Somalis from ali walks of life; it was comprehensive and it excluded no individual groups or regions. The interim constitution, one of the most important achievements of the Arta peace process, emphasizes the respect of human rights, the establishment of democratie govemance and the restoration of peace and stability in Somalia. We believe that these important issues will have a positive knock-on effect on the stability of the entire Hom of Africa. The Somali people are now finally determined to bring about law and order in their country after a decade of brutal civil war. Moreover, the transitional national Govemment is likewise determined to pursue a constructive dialogue with ali political opponents of the Govemment in order to complete the process of reconciliation that commenced at Arta. 1 am glad to inform you that the transitional national Govemment has assumed its rightful place in the United Nations, the Organization for African Unity, the Organization of the Islamic Conference and the Inter-Govemmental Authority for Development and ali the decisions that have emanated from these organizations have re-affirmed their commitment and support to the transitional national Govemment as the sole legitimate govemment of Somalia. My Govemment is also committed to undertake vigorously the process for the rehabilitation and reconstruction of the infrastructure that is required for the socioeconomic development of the country. The people caught in conflicts and crises, such as the military occupation in Palestine or civil war in Somalia and other countries where the perpetrators of war are the real terrorists, innocent people, women, children and the elderly need an international guarantee of unhindered humanitarian assistance and establishment of life-sustaining infrastructure such as food, water supplies, sanitation, basic health care and security. Of particular importance is the fact that we are faced with enormous challenges in the health sector. The civil war has utterly destroyed the entire public health infrastructure in our country: hospitals, medical clinics and public health laboratories need rehabilitation and relevant medical supplies and equipment to make these health institutions operational. The importance of a healthy society is not only a basic human right but also has direct bearings on national socioeconomic development. The Ministry of Health's strategy is to improve health services, both in the preventive and curative fields with particular emphasis on the foliowing: tuberculosis control; maternai and child health care; primary health care programmes; malaria, schistosomiasis and AIDS and HIV; the Extended Programme of Immunization; health education; nutrition; outbreak surveillance and cholera. Although HIV and AIDS may be reported at the border areas, strict measures have to be initiated as soon as possible. We are looking forward to receiving WHO's assistance in the re-establishment of our health institutions and services at this crucial time. Technical assistance is of paramount importance at this stage if we are to provide modest national health services which can in tum contribute to the aspirations and the realization of socioeconomic development in my country. In conclusion, 1 would like to appeal to the international community through this esteemed Health Assembly to assist Somalia in its health projects in order to overcome the present difficulties in the implementation of the basic health projects for a nation that is slowly emerging from a civil war that has been raging on for the past decade. 1 thank y ou Mr President.

ASSNR/6 page 135

El Dr. LEMÛS BOJORQUEZ (Guatemala): Sefior Presidente de la ssa Asamblea Mundial de la Salud; sefiores Vicepresidentes, sefiora Directora General, sefioras y sefiores ministros y viceministros de los Estados Miembros, distinguidos jefes de delegacion, sefioras y sefiores: Deseo se me permita en primer lugar felicitar al Ministro Lopez Beltnin por su honrosa eleccion como Presidente de esta Asamblea. Es motivo de orgullo y satisfaccion para la Region Centroamericana, y para mi en particular, que un amigo dirija el trabajo en esta Asamblea Mundial. El Ministerio de Salud Publica y Asistencia Social, dentro del marco del programa del Gobiemo 2000-2004, dirigido por el Presidente de la Republica, Licenciado Alfonso Portigo, asumio el compromiso de contribuir a la reconstruccion del tejido social del pais a través de un adecuado manejo del proceso de atencion en salud, con la finalidad de que la poblacion guatemalteca tenga acceso a los servicios y reciba atencion de calidad, equitativa, eficiente y eficaz. Las estrategias y politicas establecidas en el plan nacional de salud constituyen las directrices para la ejecucion de los programas y el funcionamiento de la red de servicios, y para satisfacer la necesidad de salud de los guatemaltecos. Para cumplir con esas politicas bernos fortalecido y desarrollado programas especificos que contribuyen a disminuir la mortalidad y morbilidad, que repercuten con mayor magnitud en el grupo matemoinfantil. Hemos desarrollado una politica nacional de salud reproductiva con sus diversos componentes, que nos ha permitido un mejor control de la morbimortalidad de este grupo. Esta misma politica ha servido de base para la promulgacion reciente de la ley de desarrollo social, que nos permitirâ un mejor cumplimiento de los acuerdos de paz en lo que respecta al campo de la salud. Esta ley nos sirve de marco para cumplir con nuestra misi6n como rectores del proceso de atencion mejorando los niveles de salud y bienestar de la poblacion guatemalteca con énfasis en los grupos de mayor postergaci6n y riesgo biologico y social. Hemos, asimismo, ampliado la cobertura de los servicios bâsicos de salud brindando un paquete bâsico de atencion, especialmente del grupo matemoinfantil, los grupos indigenas y la poblaci6n migrante, priorizando las âreas de mayor ruralidad y postergacion. Estamos implementando un programa .· intensivo de promocion, prevencion y atencion de pacientes con VIH/SIDA en consonancia con la Declaracion del Milenio sobre la erradicacion de la pobreza y el objetivo de que para el afio 2015 se haya conseguido detener y reducir la propagacion de tan ingrata enfermedad. En este sentido estamos trabajando en equipo con los paises de la Region Centroamericana con el decidido apoyo de la OPS. Hemos también fortalecido la vigilancia epidemiologica a nivel local con un buen sistema de informacion nacional, que nos ha permitido el control de enfermedades infectocontagiosas al desarrollar un sistema adecuado de alerta y respuesta, que se ha manifestado en no haber tenido ningun brote importante de enfermedades como el colera y el control de enfermedades vectoriales como el dengue. Como reflejo de nuestro problema socioeconomico de pobreza y pobreza extrema, agravado por situaciones climâticas que han afectado a la agricultura de nuestro pais, se han agudizado los casos de desnutricion cronica. Para el combate de este flagelo relacionado a la pobreza se estâ ejecutando, por instrucciones del Presidente, una politica de seguridad alimentaria y nutricional que enfatiza en la disponibilidad y acceso a alimentas. En ese mismo marco, el Ministerio de Salud ha fortalecido centros de recuperacion nutricional en mâs de 70% de municipios priorizados. Deseo destacar el trabajo coordinado que el Ministerio de Salud ha hecho con el Ejecutivo y Legislativo en seguimiento del cumplimiento de la ley que regula el uso, la publicidad y la venta del tabaco. Hemos formado grupos juveniles a nivel municipal que promocionan entre los estudiantes j6venes el no consumo del tabaco. Se regula estrictamente la publicidad en medios de comunicacion y la comercializacion de los cigarrillos, y se han exigido âreas publicas de no fumadores. Para los logros alcanzados ha sido de enorme importancia el decidido apoyo y asistencia técnica de la OPS, cuyo Centenario celebramos. Merece especial reconocimiento el trabajo de su Director, Dr. Alleyne. Esperamos seguir contando con esta necesaria cooperacion para la facilitacion de nuestro trabajo en beneficia de la poblacion guatemalteca. No quiero dejar pasar la oportunidad sin mencionar que, teniendo presente, dentro de otras consideraciones, la necesidad de recursos adicionales para afrontar los riesgos para la salud que tanto nos preocupa, Guatemala y otros Estados Miembros de esta Organizaci6n, dos de los cuales también

ASSNR/6 page 136

forman parte del Consejo, solicitamos que se incluyese en el orden del dia provisional de esta Asamblea el tema sobre invitar a Taiwan como observador. La discusion sobre el fondo del tema no era competencia del Consejo sino de esta Asamblea. Sin embargo, su inclusion en el orden del dia no solo era su competencia sino su obligacion, conforme al articulo 5 del Reglamento Interior de la Asamblea. El Consejo, en contravencion de esa norma tras una impropia consideracion del tema, adopto una decision que impedia a los solicitantes hacer valer su derecho como Miembros. Esta accion del Consejo, en contra de sus propias normas, no debe ni puede constituir un precedente. Guatemala desea manifestar su malestar y preocupacion por la decision aprobada por el Consejo, esperando que en el futuro este organo respete las normas de los reglamentos que le obliguen a atender las solicitudes que los Estados hacen de conformidad con las mismas. Guatemala y los paises de la region Centroamericana nos hemos beneficiado de la cooperacion taiwanesa en nuestros programas y proyectos de salud. Es por ello, y sin buscar ninguna implicacion politica, que hemos apoyado desde hace seis afios su ingreso como observador en esta Organizacion; consideramos que Taiwan, como importante entidad de salud, puede aportar recursos y cooperacion a esta Organizacion y sus Miembros en momentos en que ello es necesario y urgente, tanto para abordar riesgos y aspectos de salud sobre los cuales Taiwan tiene normas y exitosa experiencia como para la Jucha contra el SIDA, la malaria, la tuberculosis y la erradicacion de la poliomielitis. Consideraciones politicas ajenas a los ternas de salud no deberian ser obstâculo para la presencia en esta Organizacion de una estructura de salud de una magnitud y recursos de significativa importancia en el mundo. Muchas gracias. El Dr. ARMADA (Venezuela): Presidente, sefiora Directora General y colegas delegados y delegadas: Deseamos compartir con ustedes algunas reflexiones acerca del tema de los riesgos. A la idea de riesgos en salud llegamos una vez que comenzamos a preguntamos por qué se enferman unos individuos y otros no. Tai abordaje nos ha permitido realizar avances importantes. Debemos, sin embargo, seguir en la busqueda de explicaciones e intervenciones y para ello es importante escoger bien las preguntas que hacemos acerca de los determinantes de la calidad de vida. Los riesgos son factores claves para explicar la aparicion de las enfermedades pero wor qué aparecen los riesgos? Porque los riesgos, al igual que las enfermedades, estan desigualmente distribuidos; no solo entre individuos sino también entre sociedades. Las respuestas a algunas de estas interrogantes pueden ayudar a avanzar en la mejora de la calidad de vida, pero aun no es suficiente. Estamos obligados a seguimos preguntando las causas de enfermedad y sobre todo de la salud, especialmente a nive} de los colectivos. Las respuestas que ya otras personas han aportado demuestran que la desigual distribucion de recursos entre las sociedades y las personas es una de las principales causas del deteriora de la calidad de vida. Entonces, tai vez estemos equivocados cuando identificamos la malnutricion, las practicas sexuales de riesgo, la hipertension arterial y el consumo de alcohol y tabaco como las principales causas de morbilidad. Tai vez estemos equivocados cuando afirmamos que son unas pocas enfermedades responsables de gran parte del déficit de salud. Al apuntar unicamente a esa corta lista, ironicamente corremos otro riesgo: el de no mirar los procesos politicos, economicos y sociales que explican la ocurrencia de esos riesgos y de los que esas pocas enfermedades son expresion. Colegas delegados: Corremos también el riesgo de centrar todos nuestros esfuerzos en estas enfermedades, pues ésta seria la consecuencia logica de un enfoque basado en los riesgos individuales. El problema es que incluso si logramos una victoria rotunda contra esas enfermedades podriamos encontramos ante una sociedad donde persistan grandisimas desigualdades entre paises, y entre las personas de acuerdo a género, etnia y clase social, pero expresadas ya no por las pocas enfermedades que identificamos sino por otras distintas. Tenemos varios ejemplos de situaciones como esas en la historia. L,Qué hacer entonces dentro de 10, 20 o 30 afios? Diremos que otros pocos riesgos y enfermedades son las principales responsables del déficit de salud y continuaremos repitiendo la historia. Esperamos que no.

ASSNR/6 page 137 No nos oponemos de manera alguna en la Jucha contra esos riesgos y esas enfermedades, al contrario, la suscribimos y hacemos votos sinceros por su éxito, y estamos empefiados en nuestro pais en su disminucion y de ser posible en su eliminacion. Apoyamos, por ejemplo, un Convenio Marco para el Control del Tabaco con claras y fuertes restricciones al consumo y la publicidad del tabaco, asi como la identificacion clara de responsabilidades de aquellos que a(m se atreven a ir comerciando con estos productos. A lo que si nos oponemos es a la peligrosa ingenuidad de no marcar esta Jucha contra las enfermedades dentro de politicas sociales y economicas que tienden a una mayor justicia en la distribucion de la riqueza y de los recursos en general entre las personas. Tenemos entonces, desde el sector de la salud, la obligacion de formular y ejecutar politicas sociales dirigidas a la construccion de sociedades mas justas; tenemos la obligacion de opinar e intervenir ante la formulacion de politicas economicas que reproduzcan o acentuen las desigualdades. De lo contrario, la lucha contra un grupo particular de enfermedades o de riesgos dificilmente obtendra resultados sustentables, y uno de los mejores ejemplos en esa mala direccion ha sido la orientacion neoliberal de varias de las politicas sociales que han conducido a un aumento de las desigualdades y a un deteriora de la calidad de vida a pesar de contar en algunos casos con intervenciones dirigidas al combate de riesgos y enfermedades especificos. En este mismo orden de vida pensamos que esta reflexion de ampliar los analisis también corresponde a la necesidad de mayor amplitud al mirar los indicadores macroeconomicos. Tenemos que preguntamos las causas de la pobreza e incorporar otras variables al analisis, tales como la deuda extema: uno de los indicadores de la transferencia de recursos de las sociedades mas pobres a las mas ricas. Igualmente, incorporar indicadores en la creciente desigualdad mundial en la distribucion de la nqueza. Sefior Presidente, colegas delegados y delegadas: el aporte que estamos tratando de presentar desde Venezuela esta dirigido a demostrar altemativas posibles. De esta manera, reconocemos en nuestro pais a la salud como un derecho constitucional y como un derecho social fundamental de todas las personas. Y aunque aun estamos lejanos de la materializacion efectiva de este derecho, hemos logrado avances importantes en esta direccion, como una importante disminucion de la mortalidad infantil. Las claves de estos avances en la politica social han sido en primer lugar una concepcion de la salud a la que hemos afiadido los aspectos biologicos, los culturales, politicos, sociales y economicos, que nos obliga ademas a un abordaje intersectorial de la salud. De esta manera hemos logrado constituir una comision integrada por los ministros del area social y el area financiera bajo la conduccion del Ministerio de la Salud; alli tratamos las politicas de salud en un amplio contexto y definimos responsabilidades y metas. En segundo lugar, estamos avanzando en el disefio de un sistema nacional de salud con integracion de los servicios publicos de salud, de financiamiento exclusivamente publico y de prestacion fundamentalmente publica. Finalmente, y es tai vez lo mas importante, hemos enfatizado la concepcion de una democracia participativa con el fomento de la intervencion comunitaria en los distintos niveles de decision del area de salud, desde la formulacion hasta la evaluacion de las politicas sociales. Sefioras y sefiores: Aspiramos a contar con una OMS promotora de politicas, que favorezca una mas justa distribucion de recursos entre las personas como la politica mas saludable para todos, y que sea, en consecuencia, vigilante del impacto en la calidad de la vida y la salud de las politicas economicas impulsadas de otros foros intemacionales. En resumen, deseamos contar con una OMS comprometida con la salud como derecho social y humano fundamental de todos y todas. Muchas gracias. Dr OSMAN (Sudan):

A55NR/6 page 138

4 .,. . all ~_yU o.L. .c.j 0---C- Û:l.l:JI o.J.JyA ~j 1.ll~ 1~ J..J.J . r"~\ ~tc. i) ~ 0 tt4:! 'J .J ~I.J 4......J_,..... --11 4.S...?- '·- ~ ..i'1 c..r ·.1\ w\ ..Y.:J •hJ\ ~.J · '• ~ · • ·'1 ~ ~ 1- y •.}l •• c..r -;1\ w\..a..b\1ll\ .J (JoQ '\ ~il ~ l(' l...lC • "i""""" • ~ .Ct:lii'J I.J d • ~Q ~l J.-j ~ 'J .U1! '~ ~j JY"4)1 ~ (,?ill Ü;lpl CJc. .):ùll L!~.J ~ d.J.fll ~ jS.fo (,?ili.J r~l ~I.J J..J.J d~l JS i) 4....1~ ~~~~ A~<\1i .J:U~-j l.J.J~ 'ôt!l~~ · •~ '- ~ ~~. wl .J? .::11 ~~~ (j" · Î-'WI w~ 1-llë.i •~ w~ • ~ . c..r-:. . . (" ~ •. 4.11! • . "" ~t • r-~1 oy~~~l ~~~ ~fo CJ.4 ~j.JI ~j ~ r~l ~tc. i) .J._,.b::JI ~ (,) ~.J .w~l ~~~ \~ • ,.l.!,~ ~lj ,~ .~1\ 1.~-: 1\ . .J w\ .':1\ ~~~ . • . .J 4J\~ 1..5". 1\ J Y"4 y-'\ ~ ,J. • 4..ot.A ~ il\ (j" • . • ..?" ~ <..r .J? C;:.J.JJ <..r . • "" 4...........lAiy.~WI ~\ ~0i ~l.P.i.J .op\ w\.a·.... Qil~~ ~y0i ~1 w~l ,~\ Ï_,..ü J!\'1 J.J.lll ~ ~j_iJ.J ~\.J ~\.li\ J.J.lll CJ.4 Jfol\ ~i y_,lb.JI JS.J ·.J.J.lll 1~ ~ ~ 0\t J_........JI.J yYLJI ~.Jh.J ~tc., J.J~ r. L!..ij e;c. e;lc.f, ~~ Ïfo \.b._) .ill.J . ..foli.J ~_;.JI ~.Jh.J ~ (,i.J~ 'J.J .~ 0b_,...ll ~I.J ~-1\tl ~\ Wc.j.J ~~'ô~ J.oi ~ ~i ~Î 'Jj ,j~'JI.J LA.foi.J !~_)\tl .JI.h!\'1 ~Î ~.J \.:i:!.)i i) yYLJI.J j~'JI y)..::..i ~.J'il ~ ~1 .JÀ 0~ CJA _foi, eJ.:o;,.;.J ~ Jj4iJI ~ .;bL!..i.J ~_)Î J.J~ ~ U.J.Jl;.:i ,~)\ (,?~ ,~ .IJ.?. A .,.,al\ 4 Q\;jQ 0fi:i 0i yl\.hj .yk..J .~y.. e;;j_ill\ ~ 0fi:i 'J 0i ~ .).~\ J.J~ LJA ~'J 1(' 4..:..ku 4....\.::JI 1 -··• ·- -' JI · ~W ~.J J .J.lll ~ · • AJL... <..r . .J .) ·lS.J .)'JI 4..bi.i <.,p. J. WWI (...)--"' • . . ~ ...;--' Y'\tl ~~~ C;:.J.JJ • . w~yu.a.J ~1 yi w~jill ~ ~ O.J.J.lll ~~~ ~~~)'\ ~ ~WI oy..\'1 ~i ~~~~ i) ~~ ,~)\ (,?~ ~ J---.ulJI J) CJI ~ .'ô.J.J.ll\ ~~~ ~.J_p...a 4.,bijS ~1 ~ _>hG...JI t~_,..J ~.J~\ ~.J ~~i....A ~~.J CJA).:...: ~ ""i ~l..iA ~ 4.W.J .~~ 4.l.J~.J .;bG...JI ~~~ ~ uyUll .JÀ ~~ .~ ~-+i c;JI .;bG...JI .l-I~ IL . . .J ~1 . ~ • ~ • ' (..);l-4 . ~ . -: -'1 (..);l-4 . Wl ~ N . . .J 'lla.b:i......l ~ ' . b - '1 . .J ' . . • u~ -r (" ~ -r.J u _,....... -r (.).::o..l.J

'0b~l ~ ,lla.b:i.....,l 4.l_,ibll u.:.:.lyJ ~4-<> Jt........ ~ .~1 ~ ~-+i ~1 ~~~ ~4-<>.J y .J~ ~ ~ 0i 0b_,.JI t t.b:L...I .ill J\.ib\tl JU ~ r.l..àill ~WI ~\ Jt........ i) 1 _».& 1 .J.J~ ~ ~ ~ 0b_,...ll J~ J..J.J .~_;.JI 1~ ~ ~ ~ ~1 yk\1 ~1 ~ ~WI ~ r-~1 ~ CJI~_,.JI d.J~ i) ~WI ~ ~ J~ GAVI ~I.J wht:illl J...,Î CJ.4 ._..JWI u.lb:lll .~_;.JII~ ~

WWI ~1 ~ <..r . ...!'ô y. ·~1 (j" · .)~ (.)~.J · 1..iS.Al 4J.~u1 ·1 ·• ·.11 J4,..... . ...!.J • ~ (..)-'=~ y Î~ . . ~. c::-. <..r .l.....l' '1 ~~ w'J~ o~w · (j'I.J · ~ ..-:11 41...1...J 4..U.::...:lll Wl · .b...._,...... .-:.11 "-' •->""' • r--. -·'~'J • .;; ~ 1..5". • • .) -~ • • . ~~ • o~tc.l • (j" Llli .L.i1a.i. ..J .. u: • • (..) ·ts ~ •1 y ~\ 1-llé.Î . • ~ (..);l-4tc. ~ ~ ~· • .;; 'J ~\ • 1...5 ~ •• (..)-'=~ . (j" ~ 0

zo. ,_

ï."· ,_

0-- illlil (,?~WI.J ~1 ~.ll\ ~1 l~j ~~WI ~WI ~ ·. ____i ~ ·." -WI ~

ï.' • • y .J~ J.lll...o.ll \~ ~y 0i ~ .~WI~I~

or. ~ 'ô~wjl wl~. ~ o.)~ i~.Jt-7" ~l..iA (..), ·lj 4.l _,......... _:: (..)-'=~ · 1y ~1 ~I.S..u ,~ w • . .....-----. . ~i ~.J o~'J~I.J ~1 ~yaL. Jt........ i) ~~1 CJ.4 ~j.JI J~ L..S. .0b_,...ll wy'J.J, sl·,:>Q; JI.;...JI 1~ -11 .~li)

4nf•ljl............81 ~~~ ~ o~l)l .J\.h!~l CJ.4 CJI~_,.JI ~Î ~ AJ_,ibll ~ly\t J.ots:WI ~:WI Jt........ ~~ illll..iA 0i 'Jj w'JI.;...J\ ~~~ i) ~(,?ill V'ya.WI r~l 1~ CJ.4 ~)1 ~ ,~)1 (,?~ 4.......:..6. ______!- (..) ·b·'1 <..r . ...! - WÎ ~ c..r ·.11 .J L-: ..b..J (.YI,...-(" --'- ~ ~ ,~ ~ • Î-1 c..r ·.1\ ~~ ·'-G...JI (j" · . ~ _,....... ~. . ~

.\A.J~Ï t.} ~ (,?~WI.J ~1 0P4......~ 1·,, QI\ 4;ï;l,,.lol\ ~I.J\'1 i) .J.JÀ.llJI ~1 ~_,11\..iil! e;c. yyù ~} ,~)1 ~1 ,~tl:;., Qi ... JI~~ ~j ~

~'J.J 'J.J.lll ~1 ~ 0.Jt..ü.ll e;;_;.o.ll .J.JÀ.fll\ ill\~ i) ~ ~1 ~1~)'1 J)\.h'JI d..bl.... .l.!.~.J

_»--!_ill ~.J.lll ~

ll,;;.J ~.JI.....Î..JI Ù.J~\ ~A~) ,~WI ~1 ~ .4JiJl,,,loll ~}1 ~1 ~~A ~1 :U...,WI ~1 d .....,\.:h'JI

.~)\ ""~

'çSJ lfo!.

ASSNR/6 page 139 Le Dr HAMUKW AY A (Angola) : Monsieur le Président, Madame le Directeur général de l'OMS, distingués délégués, permettezmoi tout d'abord, Monsieur le Président, de vous féliciter pour votre brillante élection à la présidence de la Cinquante-Cinquième Assemblée mondiale de la Santé. La délégation de l'Angola souscrit entièrement à la déclaration faite par S. E. Mme le Ministre de la Santé de la Namibie au nom des pays de la Communauté de Développement de l'Afrique australe. Néanmoins, par le fait de la nouvelle conjoncture de paix et de perpectives de développement en Angola, j'aimerais au nom de mon Gouvernement faire cette déclaration. D'abord pour féliciter le Dr Gro Brundtland, Directeur général, de son rapport annuel2001, qui reflète les progrès réalisés par l'OMS selon les grands axes de la stratégie institutionnelle et qui met en exergue les bienfaits des réformes qu'elle a lancées depuis le début de son mandat. Ensuite, Monsieur le Président, je rappelle que l'Angola a vécu une longue guerre désastreuse sur le plan social : plus de quatre millions de personnes déplacées, de nombreux réfugiés dans les pays voisins, un nombre élevé d'enfants orphelins et abandonnés, les handicapés par des armes de guerre, la destruction des infrastructures sanitaires, la réduction considérable du réseau de prestation de soins de santé, 30% seulement de la population ayant accès aux soins de santé essentiels. Ces effets sont parmi les plus saillants et déterminants dans la crise humanitaire qui frappe le pays. La pauvreté des populations, la faim et la malnutrition, 1' approvisionnement inadéquat en eau potable, la crise de l'habitat, la faiblesse de l'assainissement de base et la dissémination des mines antipersonnel constituent des facteurs aggravants auxquels nous devons faire face. Dans le cadre de la paix, l'Angola a déja pris un certain nombre de mesures clés et établi les priorités dans le sens du réaménagement du territoire et de la réinsertion sociale des populations déplacées dans les foyers d'origine, du déminage des zones les plus touchées par la guerre, de la réhabilitation des infrastructures, de la reconnaissance de la priorité accrue à accorder à l'éducation et à la santé, et de l'intensification de la lutte contre les grandes endémies du pays, notamment le VIH/SIDA, le paludisme, la tuberculose et la trypanosomiase. Il y a un engagement national à changer dans les meilleurs délais la situation encore très préoccupante dans mon pays. L'Angola compte sur les partenaires africains et du monde entier pour le soutenir dans ses efforts de reconstruction nationale. Le contexte social et humanitaire demeure grave, comme en témoignent les indices de développement humain et les indicateurs de l'état de santé de la population : couverture sanitaire de 30 %, mortalité infanto-juvénile de 275 pour 1000 naissances vivantes et mortalité maternelle de 1580 pour 100 000 naissances vivantes. Malgré les niveaux préoccupants de ces indicateurs, l'Angola s'est sérieusement engagé dans l'initiative d'éradication de la poliomyélite en l'an 2005, et je suis sûre que mon pays parviendra à réaliser cet objectif. Au nom de mon Gouvernement, je voudrais remercier chaleureusement l'OMS pour le soutien qu'elle n'a cessé d'apporter à l'Angola pendant toutes ces années difficiles. Nous comptons sur la solidarité internationale et la coopération multilatérale et bilatérale, y compris des organisations non gouvernementales, pour la réhabilitation des infrastructures sanitaires et le renforcement du système national de santé en vue d'apporter à tous et à chacun les soins essentiels pour une vie sociale et économique plus productive. Professor ONGERJ (Kenya): Mr President, Madam Director-General, ladies and gentlemen, on behalf of the Kenyan delegation, 1 would like to congratulate the President on his election as President of the Fifty-fifth World Health Assembly together with his very able team. May 1 take this opportunity to also express our gratitude for the excellent work the Director-General and ber team are doing with regard to finding solutions to major health problems, especially those faced by the developing countries.

ASSNR/6 page 140

My address will be confined to the progress Kenya has made in the past one year in the priority technical areas listed on the agenda. The World Health Organization estimates that globally, proteinenergy malnutrition is the leading cause of disease, especially in developing regions. For instance in the year 2000, conditions such as malnutrition and associated micronutrient deficiencies accounted for up to one-third of the burden of disease in the African Region. Unsafe sex was the next highest risk with much of this disease burden concentrated in the African Region. Four risk factors: high blood pressure, tobacco use, alcohol consumption and unsafe water; sanitation and hygiene were ranked next, followed by high cholesterol and indoor air pollution. A number of challenges face Kenya with regard to the management of risk factors for ill-health. Sorne of these inelude inadequate information re garding the consequences of underlying factors, weak management policies and inadequate capacity to install and monitor surveillance systems. This year, Kenya joined the rest of the world in taking part in World Health Day wh ose th erne was "Physical Activity: Move for health". This came at a time when, throughout the world, governments are seeking ways of stimulating debate on the public health importance of conditions which are predominantly caused by lack of physical exercise. Ali of us gathered here will acknowledge that in most parts of the world, noncommunicable diseases, which are primarily preventable, have become a major epidemie. This is due, in part, to a rapid transition in lifestyles leading to reduced physical activity, changing diets and increased tobacco use. We recognize that inculcating a culture where everyone recognizes the importance of physical activity requires not only the commitment, action and cooperation of the health sector but also other sectors in our system. Given the importance Kenya attaches to primary health care programmes, the Ministry of Health established the department of preventive and promotive health services a few years ago as part of the restructuring exercise in the ongoing health sector reforms. The department provides a framework for addressing activities related to primary health care including risks to health and the underlying factors. With regard to the progress Kenya has made in the area ofHIV/AIDS, tuberculosis and malaria, may 1 assure this Assembly that we are committed to the various international and regional resolutions and declarations that target these conditions. We wish to take this opportunity to thank WHO and other agencies as weil as the international community for spearheading efforts within the health sector to strengthen preventive, promotive, supportive and research initiatives aimed at addressing these killer conditions. Sorne of Kenya's recent efforts in the fight against HIV/AIDS include: the launching of four important policy documents in December last year, namely: a national condom policy and strategy; antiretroviral guidelines; policy guidelines on blood transfusion; and voluntary counselling and testing guidelines. These documents are a follow-up of other three important policy publications, namely: the session paper No. 4 of 1997 on AIDS in Kenya; the Ministry of Health' s strategie plan for the Kenya national HIV1AIDS and sexually transmitted diseases control programme for the period 1999-2004 and the national AIDS control council strategie plan for the period 2000-2005. Kenya has made attempts to link the current national HIV/AIDS strategie plan for the period 2000-2005 to the national development plan and the national poverty eradication plan whose theme is social change to reduce HIV/AIDS and poverty. Other developments in the area of HIV/AIDS include the establishment of 70 voluntary counselling and testing sites in different parts of the country, 3 5 sentine} surveillance sites to track the epidemiological trends of HIV1AIDS and streamlining of blood transfusion services in ali regions. There is no doubt that the fight against malaria, tuberculosis and HIV/AIDS requires enormous resources. We thank the G8 group of countries, UNAIDS, United Nations, the World Bank, WHO among other international institutions, for spearheading the fight against those diseases. Before 1 conclude my remarks, let me touch on two important subjects which are at the core of health care delivery in Kenya. First is the issue of quality of care and patient safety. Kenya values highly the issue of the provision of quality health care to its citizens as encapsulated in the vision, mandate and po licy documents of the Ministry of Health. Second is the issue of efficiency in health care delivery. According to the sector strategie plan covering the period 1999-2004, studies on efficiency in the health sector in Kenya have shown that the public sector could save up to 30% of its annual resources by running services efficiently. My country appreciates the role of WHO for playing an important coordination role with regard to the identification and quantification of risks to health. Specifically, WHO has been of great help in setting up appropriate task forces to respond to such

A55NR/6 page 141 threats and in providing technical guidelines as weil as technical expertise, where necessary, to facilitate effective response. lt is our vision that WHO, in collaboration with Member countries, continues to play this important role in finding solutions in order to address the major risks to health. In an effort to redu ce HIV1AIDS, malaria and other diseases associated with poverty, WHO has collaborated with the Kenyan Government and other stakeholders in the preparation of a poverty reduction strategy paper. May 1 register our appreciation to the Director-General for setting up the Commission on Macroeconomies and Health headed by Professor Jeffrey Sachs who gave us a very stimulating discussion yesterday. Finally, as we strive to get solutions to address multiple problems the majority of our countries face, we need to broaden our strategies to include developing joint action against poverty and poor economie performance as weil as addressing the underlying causes for diseases since these are the principal factors responsible for ill-health in our society. Thank you. Dr KASSAMA (Gambia): Mr President, Ministers, Madam Director-General, distinguished delegates, ladies and gentlemen, let me first and foremost congratulate the President on his election to guide the proceedings of the Fifty-fifth World Health Assembly, an election weil deserved. Let me also congratulate the Director-General for her outstanding address to the Assembly. Once again the World Health Organization is flagging topical issues that should be of major concern to ali health authorities the world over. The topic of the ministerial round tables, nam ely risks to health, is apt. It is unfortunate that, as the Director-General appropriately stated in her report to this Assembly and I quote "on the one side are the millions who are dangerously short of the food, water and security they need to live. On the other hand are the millions who suffer because they use too much. Ali of them face risks of ill-health". This situation is unacceptable. My country, Gambia, like most developing and poor countries is exposed to sorne of these risk factors, namely high body mass index, physical inactivity and so on. Apart from these risks that have already been identified, my delegation wishes to suggest that the risk of the negative impact of television on our children with regard to violence, sex and tobacco use, especially in developing countries, should not be forgotten. My country stands ready to coliaborate with the world community to help find solutions to known and emerging risks to health. Let me seize this opportunity to remind this Assembly that even though the risks to health identified for the ministerial round tables are appropriate and affect most countries, we should AIDS, malaria and tuberculosis. These not forget the goals we already set ourselves to address HIV1 diseases still remain diseases of major concern to most developing countries. In my country, and foliowing the Abuja Declaration, the President of the Republic, His Excellency Dr Yahya Jammeh, directed that no effort be spared to ensure that deaths caused by malaria are drastically reduced and that adequate and timely information be provided for ali Gambians with regards to HIV/AIDS and tuberculosis. To this end, Gambia has a functional national AIDS council chaired by the President and a national nutrition council chaired by the Vice-President. In the area of human resource development, we have a vibrant University of Gambia, and a faculty of medicine which is fully supported by the World Health Organization in technical and material terms. Under item 1.4, the President reported that the General Committee recommended that a proposed supplementary agenda item, entitled "Inviting the Republic of China (Taiwan) to participate in the World Health Assembly as an observer" not be included in the agenda. The Assembly approved this recommendation of the General Committee. My delegation and 1 wish to place on record that Gambia fully supports the bid of the Republic of China (Taiwan) to rejoin or participate in the World Health Organization as a health entity. This support is premised on the following reasons: given the relatively large population of the Republic of China (Taiwan) of 23 million, and the rapid and widespread nature of diseases in the world which calls for prompt, effective and efficient control measures, it is prudent to allow Taiwan to participate fully in world health matters. Denying her the chance is tantamount to placing the lives of such a huge number of people in jeopardy; the active participation of this country in world health matters can benefit the Members of the World Health Organization to a large extent by according them the opportunity to learn from her, as the Republic of China (Taiwan) has made major achievements in health such as the eradication of malaria and the

ASSNR/6 page 142 establishment of an effective health insurance scheme. These are major issues challenging the health service delivery systems in most developing countries; as enshrined in the Constitution of the World Health Organization, health is a fondamental right to ali people. Thus, isolating this country with regard to health matters means denying her people their basic rights, which contravenes the very laws of this reputable Organization; with the call for globalization, which is rapidly gaining momentum, it is not equitable to leave out a country such as the Republic of China (Taiwan), particularly in health matters, most of which demand a global approach. Therefore denying her the chance to jo in WHO has nullifying effects on her health sector; and the health capabilities of the Republic of China (Taiwan) are amply manifested by the fact that she has her own universal public health insurance system which is the first of its kind in Asia; enjoys one of the highest levels of li fe expectancy in Asia; succeeded in eradicating infectious diseases such as plague, smallpox, rabies and malaria in the 1950s; is the first country in the world to provide children with free hepatitis B vaccines; and has a pharmaceutical industry which is currently exploring new drugs for cancer and HIV1 AIDS, all of which being areas that Member co untries of WHO can bene fit from. On top of the above-listed achievements the Republic of China (Taiwan) has also contributed immensely in cash and kind, and works in close collaboration with the international community and organizations in the areas of international medical and humanitarian relief, with the Republic of China (Taiwan) Government and nongovernmental organizations providing up to US$ 110 million as financia1 support to promote international health efforts between 1995 and 2001. More recently, assistance has been provided to countries such as Cambodia, Viet Nam, and severa! countries in Africa, Asia and the Middle East in the global fight against poliomyelitis and HIV/AIDS as weil asto build hospitals and clinics, train medical and health personnel and support pharmacies and public health programmes. Furthermore, the Republic of China (Taiwan) Government and nongovernmental organizations have been working hand in hand with international organizations such as Médecins sans frontières, Médecins du Monde, Care International, World Vision and the International Council of Nurses in the areas of international medical assistance and humanitarian relief, all of which are equally commendable. Considering ali this, it is unfair to assume that with the development of the information superhighway, it is enough for this country to access information on or from the World Health Organization from the internet, whilst that country is in a position not only to contribute in the generation of such information but also to participate actively in the programmes and policies developed in sorne Member countries as a result of such information. The Republic of China (Taiwan) is a full member of international organizations in the area of customs, fisheries, trade and sports, demonstrates her willingness to interact and work in perfect harmony with the international community. My country believes that the Republic of China (Taiwan) should be allowed to do so. With these remarks, I thank you for your attention. M. HILAIRE (Haïti): Monsieur le Président, la délégation haïtienne profite de sa prise de parole d'abord pour vous féliciter de votre brillante élection à la tête de cette Cinquante-Cinquième Assemblée mondiale de la Santé. Elle profite aussi de l'occasion pour transmettre à Mme le Directeur général de l'OMS, le Dr Brundtland, et à tous ceux qui ont rendu possible cette importante réunion les salutations du peuple et du Gouvernement d'Haïti. Cette réunion donne l'occasion à la délégation haïtienne de fournir quelques informations sur les risques pour la santé encourus dans le pays. Il s'agit principalement des maladies infectieuses, notamment les infections sexuellement transmissibles, le SIDA et la tuberculose. Il s'agit encore de la malnutrition et d'autres affections morbides, plus spécifiquement liées à la pauvreté. En réponse à ces éléments de risque, le Gouvernement haïtien a pris un certain nombre de mesures devant aboutir principalement à la réduction de la mortalité maternelle et infantile et à l'endiguement du VIHISIDA et de la tuberculose. D'autres mesures concernent surtout le renforcement du système de santé, l'amélioration du réseau hospitalier, l'augmentation du nombre de services de santé de premier échelon, la fourniture d'équipements et d'intrants nécessaires à la prise en charge des utilisateurs de soins.

ASSNR/6 page 143

La garantie du droit à la santé étant un des objectifs majeurs du Gouvernement, en dépit des limites de ses moyens de financement, le Gouvernement a investi une part substantielle de son budget dans le domaine de la santé. Ceci a été également possible grâce au soutien de partenaires internationaux qui, pour la plupart, n'ont pas ménagé leurs efforts à l'endroit du peuple haïtien. Nous en voulons pour preuve les récents efforts du Gouvernement cubain, qui nous a fourni des ressources humaines et des moyens de formation, et la contribution financière de Taïwan, qui a appuyé la mise en place d'infrastructures sanitaires et de matériels destinés à l'assainissement public. Et plus près de nous, le grand apport du Fonds mondial de lutte contre le SIDA, la tuberculose et le paludisme. En outre, le Gouvernement haïtien souhaite le déblocage des fonds déjà approuvés par les institutions internationales de financement pour continuer la réorganisation du système de santé. Dans cet esprit de coopération, ou dans le contexte de cette vaste alliance pour la santé dont parlait Mme le Directeur général dans son allocution, la délégation haïtienne considérerait positivement l'ouverture du réseau mondial de protection et de jouissance du droit à la santé pour tous à d'autres entités ayant manifesté à cet égard un intérêt certain. Mr BERMEJO (International Federation of Red Cross and Red Crescent Societies): Mr President, Madam Director-General, distinguished ladies and gentlemen, the International Federation of Red Cross and Red Crescent Societies welcomes the opportunity to bring the views and the knowledge of sorne 100 million volunteers, many of them in isolated corners of this world, to this Health Assembly. Ultimately it is the role of governments to ensure that risks to health decrease and that health systems meet the needs of their populations, particularly the most vulnerable. With the experience gained in our daily contact with the most vulnerable people we can testifY to recent achievements in improving the public health of many communities around the world. However, in spite of this progress, health inequities across and within countries in the region continue to be unbearably high. This reflects that the health messages, commodities, tools and infrastructure that are there are· not reaching those most in need. National health systems are finding it difficult to make effective use of civil society organizations from whom the poor receive much oftheir support and care. New partnerships and new ways of doing business are needed. We have beard at this Assembly about the Global Fund to Fight AIDS, Tuberculosis and Malaria as weil as of other public-private partnerships that clearly represent a leap forward. The next leap forward, we believe, depends on finding meaningful ways to build true partnerships with civil society at the international, national and locallevels. National Red Cross and Red Crescent Societies can play an important role in this respect. HIV1AIDS, for instance, has reminded us in the most dramatic way that the battle to reduce risks to health needs to be waged at a very persona! level. It concerns individuals and the circumstances of our intimate relationships, our families, our workplaces and our local communities. That is where the difference must be made. Civil society organizations can help to till the gap that will always exist between vulnerable households and the formai health delivery system. With networks of volunteers working from within vulnerable communities, the Red Cross and Red Crescent Societies can put knowledge and tools in the bands of the people. It can support processes that reduce vulnerability and build caring communities. The Red Cross and Red Crescent Societies' volunteers have demonstrated their capacity to provide care and support to individuals and family members in communities in many countries. Coming back to HIV1AIDS, evidence is clear that only responses that successfully mobilize civil society will be effective in containing the AIDS epidemie. Unfortunately, the proposais that have been presented and approved by the Global Fund fall short of civil society involvement. This was probably, as has been repeated many times during this Assembly, because of the time pressure to meet the deadlines, but we cali upon you to genuinely partner with Red Cross and Red Crescent Societies and other civil society organizations in the implementation phase. If we look into securing a safe source of blood, poliomyelitis eradication or the much needed move towards accelerated measles mortality reduction, we see that the same is true, and the Red Cross and Red Crescent Societies are proud to be playing a greater role in these areas. This enhanced role is complementary to the one the

ASSNR/6 page 144

Red Cross and Red Crescent Societies has traditionally played in emergency response. ln her addrcss to this Assembly on Monday, the Director-General highlighted the need for WHO to emphasize exceptional action for health in emergency and crisis situations throughout the world, working in synergy with ali concerned partners in improving access to essential health commodities, equipment and personnel. Let me say here that the International Federation of Red Cross and Red Crescent Societies, which recently launched an appeal for support to the Palestinian Red Crescent recovery programme, looks forward to working with WHO for the health of the Palestinian and the Israeli people now and in the future. The International Federation is entering a new phase of collaboration with ministries of health and WHO. In this new phase we will focus on building strong partnerships around efforts to scale-up community awareness and mobilization. This is the focus for example, of the Memorandum of Understanding to improve collaboration for health in the Americas that was signed yesterday by the Director of the Pan American Health Organization and our Secretary-General. 1 want to thank you, Mr President for having highlighted, with your presence at the ceremony and that of many ministers from the Region, the added value that such collaboration can bring to the Region of the Americas. Red Cross and Red Crescent brings to the table large volunteer networks, a weil respected emblem and proven ability to mobilize the power of humanity and additional resources. We believe that this is a significant addition to the mandate and the technical capacity that ministries and WHO have. Let me reassure you that wherever ministries of health and United Nations organizations are willing to team up with the Red Cross and Red Crescent Societies, you will see thousands of volunteers advocating, for example, fighting the discrimination and stigmatization of people living with HIV/AIDS. Y ou will see mothers from Red Crescent clubs taking their children and those oftheir neighbours to be vaccinated against measles. You will see Red Cross and Red Crescent volunteers working alongside others, reaching out to those in greatest need, helping them to decrease their vulnerability and improve health, but we can only do this together. Thank you, Mr President. Monsefior LOZANO BARRAGÂN (Santa Sede): Sefior Presidente, sefiora Directora General, distinguidos delegados, sefioras, sefiores: Los saludo cordialmente de parte de la Delegaci6n de la Santa Sede, que me honro en presidir. Hemos escuchado muchos de los grandes riesgos que corre la salud hoy en dia: actualmente, 17 millones de personas han muerto por enfermedades infecciosas y deficiencias nutricionales; 2, 7 mill on es por el SIDA, 2,2 millones por diarrea, 1,7 millones por tuberculosis, y 1 mill6n por paludismo. Al cuadro infeccioso se suman el mayor numero de muertes por tabaquismo y alcoholismo, por el cancer, por otras enfermedades degenerativas, por habitos de vida equivocados, por falta de higiene, por la droga, por accidentes de tnifico y laborales, por abuso de los medicamentos o por ausencia de los mismos, debido a altos precios, y por enfermedades mentales, como es hoy el aumento de la depresi6n. Es de sefialar como un ries go patente contra la salud la mentalidad neomaltusiana contra la vida (dado que salud y vida se identifican), presente en proyectos de salud reproductiva especialmente propuestos para el tercer mundo, y en particular el equivoco en la concepci6n de lo que es la calidad de vida, que ha llevado en algunos lugares a la legislaci6n de la eutanasia. No podemos olvidar la poluci6n ambiental, el hambre, los conflictos armados, las catâstrofes naturales. Sefior Presidente, hay un riesgo que quisiera subrayar. Existe hoy una unificaci6n «microbial» del mundo, donde las enfermedades infecciosas, dada la movilidad creciente de las poblaciones, estân presentes dondequiera, tanto para ricos como para pobres; como se ha dicho aqui, los virus y las bacterias no tienen fronteras. Ademâs, debido también en gran parte a la globalizaci6n econ6mica e informâtica, los habitos de producci6n constituyen cuadros laborales homogéneos que conllevan un desgaste también homogéneo de la poblaci6n, llevan a enfermedades tumorales, degenerativas y psiquicas similares. Aqui mismo, en la Organizaci6n Mundial de la Salud, se han sefialado tres âreas de prioridad para reconducir la globalizaci6n a favor de la salud: l) la necesidad de una gobernabilidad global mas efectiva, que sea capaz de asegurar, al crear los consensos y decisiones politicas, que se tomen en cuenta las necesidades reales de la gente en materia de salud; 2) la necesidad de generar y diseminar el conocimiento adecuado para informar a los que toman decisiones y a la gente en general acerca de su

ASSNR/6 page 145 salud; 3) el apoyo a la globalizaci6n en el area de la salud, promoviendo acciones en el ambito local y nacional, para lograr una mejor salud, en especial para aquellos de los que se prescinde en la globalizaci6n econ6mica. Nos colocamos ya no s6lo en los riesgos sino en soluciones a los mismos. Sefior Presidente, precisamente para desarrollar una gobernabilidad global mas efectiva, nuestra delegaci6n quisiera aportar una colaboraci6n: En Alma Ata se habl6 de tres aspectos de la salud: fisico, mental y social. Un riesgo importante es que se consideren cerrados en si mismos, o que se le dé mas importancia a uno que a otro. Son vasos comunicantes. Podriamos decir que la salud consiste en su armonia. Esta armonia impele a salir de si mismo y emplear la capacidad fisica y la autotransparencia psiquica para crear la solidaridad social y ambiental. El proyecto global de vida y de salud que armoniza todo es Jo que algunos llamamos espiritualidad de la salud. Consiste en vencer el encerramiento individualista y vivir para los demas. Es una tension dinamica hacia la armonia, para crear nuevas condiciones de vida y por tanto de salud para toda la humanidad, prefiriendo a los mas pobres y necesitados. Consiste en crear el «Bien comun internacional» de la salud. Muchas gracias. Dr VLAHUSIC (Croatia): v '

Allow me this oppo11unity to congratulate the President and other members of the bureau on their election. Health is an essential factor of quality of life, economie and every other development and social stability of a society, and thus investing in health is one of the key investment strategies of the Republic of Croatia. Such health po licy is a radical shift from currently prevailing practice. The shift is most clearly observable in the population's orientation, and in the awareness emphasis on health instead of a focus on diseases. The new health policy is in line with the health policy of developed countries accepted as Health for ali in the 21 st century, and in line with desires for the democratie development of society and the prosperity of ali citizens of the Republic of Croatia. The fundamental object of Croatia's strategy of health policy is improvement of the leve) of public health, which includes the promotion of a healthier way of )ife or elimination of health risks that can be prevented, as weil as the further development of health services. In line with that, the new health po licy, based on a national vision and global objective in the health sector, identifies as key objectives the preservation and improvement of health and longer and improved li fe of the population and individuals, in terms of quality of life. Introduction of a stable and quality health system, adoption of and provision for a healthy lifestyle and improvement of health care are three fundamental courses of action. Their implementation is directed to the appropriate reorganization of the structure of ali health services, adequate planning and education of health professionals, improvement of research and science in the health sector, measures of early identification, control and better quality treatment of diseases, prevention and early detection of diseases, health promotion, and prevention of general and individual health risks aiming at extending li fe expectancy and improvement of quality of )ife. Among the leading health problems in Croatia, according to mortality rates, are cardiovascular diseases, representing 53.2% of ali deaths in the year 2000. Next are malignant diseases with 23.3%, injuries and poisoning with 5.8%, diseases of the digestive system with 5% and respiratory system diseases with 4.1 %. In the year 2000, 26,822 persons died from the 10 leading causes of death. The first four causes of death are circulatory diseases and refer to cerebral stroke and heart diseases (chronic ischaemic heart disease, infarction and cardiac insufficiency), while in fifth place is cancer of bronchi and lungs. The priority health problems in the Republic of Croatia just mentioned are chronic noncommunicable diseases. They are characterized by long duration, frequently for Iife. They may diminish the quality of life, lead to disability and premature death and they place a significant burden on health insurance funds. The demographie trend, characterized by the growing number of older persons and a contemporary way of life marked by mechanization, automation at work and computerization with progressively fewer physical strains, as weil as the way of life, are responsible for significant upward trends of these diseases in recent decades. The spread of risk factors for leading 1 The text that follows was submitted by the delegation ofCroatia for inclusion in the verbatim records in accordance with resolution WHA20.2.

ASSNR/6 page 146

health problems in our population is significant. The pattern of causes of death and poor state of health of inhabitants in the Republic of Croatia point to the high presence of health problems for which there are proven ways of tac ki ing. Insufficient activities in the past in the area of health promotion, primary and secondary prevention, in terms of ear\y identification of diseases when they still may be cured with minimal consequences and lower costs of medical treatment, indicate the necessity of recognizing health problems as being of general social concern since systematic prevention is not possible without inclusion of the State and society. With regard to mortality and morbidity rates in the Republic of Croatia, it is undeniable that expertly harmonized action programmes are required and that their implementation, together with the necessary strengthening of public health services, would work in favour of the principles of primary prevention in terms of adoption of healthier ways of life, reduction of incidence of preventable diseases and avoidable deaths. Accepted measures of tackling health risks that have been adopted and directed towards health problems in the Republic of Croatia caver health education and training, a multisectoral approach, adequate information by the mass media together with the creation of a social environment which supports the adoption of a healthier way of !ife, and also the enactment of appropriate legislation, as weil as utilization of integrated programmes of health promotion and disease prevention. Contemporary perceptions especially stress the significance of health promotion with the aim of raising the leve! of health and not only preventing the occurrence of disease. The measures of intervention refer to fondamental determinants of health. One of the most important is a healthier lifestyle, that is modification of harmful habits such as smoking, incorrect nutrition, alcohol consomption, physical inactivity, sexual behaviour, exposure to injuries, etc. Reduction of one risk factor fun etions at the same time in terms of the prevention of severa! diseases or groups of diseases. Intensive programmes of health promotion to adopt a healthier lifestyle together with training to maintain good health have been shawn in individual countries (for example, Finland and the United States of America) to be effective not only in terms of reduced incidence of disease and mortality but also in terms of improved health in general. It is also important to prevent by early detection and timely treatment of diseases in their early stages, the development and progress of a disease and its complications, disability and premature death as well as to aim at preserving the quality of !ife of sick people. The health strategy in the Republic of Croatia in the twenty-first century is based on prevailing attitudes with regard to achieving health which are part of the international and national health po licy. The key objective of the integrated policy of Health for ali in the twenty-first century is healthy and long-living mankind. Fondamental strategie actions comprise prevention and control of ali factors which imperil health. The primary strategie leve! includes the promotion of healthier ways of !ife, reduction or elimination of health risks, and education and active inclusion of the population in preservation of its health, while the secondary strategie leve! includes provision of quality procedures of treatment. Thank you, Mr President. Mr ELTAIF (Libyan Arab Jamahiriya):l ~I.JJJ 0_,..._,~1 ô~L...J\ ,L....,W\ ô.J:l.l.JI ~.)h.JI ô~\ ,~WI ~\ ~.J f'.)h.JI ~\

JL.......c.i ô~L..fol ~L...:..::û\ u-1c ~)\ô~\_;.... y~~ 0\ ~) ~\~\.} '.Jy.4:JI ô~l..JI_, d~\ ,~\ 4 h ·.,_, â~'j\ ôlp.J ô.JJ~ _, 1 .)Î tA _;si_, ~_,.lll w~l ~~ LJ.a ô~\ _,l ~1_, ~WI ~\ The text that follows was submitted by the delegation ofLibyan Arab Jamahiriya for inclusion in the verbatim records in accordance with resolution WHA20.2. 1

ASSNR/6 page 147

0--:1~1 J-Sl0LJ:l...YI.J .J.Jy.JI ~ l.JC ~\ ;)c ~fo. ~ -~ l.J:lyû.}JI ~ .)c J~ 4..iÎ ~y.J .1..\~t:b..iY ~\..l.J\ Ù.Jp\ ~ÎJ&Î.J a.).J.l\1 o-4l ~~~)'\ .} \~\..., ~ ~ ~\ ~i l.J.a ~\ o~ ~ ~~ _;JI 4 .,joli ~~4 o_,.iÎ 0i ~\..l.JI o~ .} ~..#.l Y.J ~ ~ ~ (,?~\ y"JI ,~WI c..5_;l.....JI .)c 0~ ~\ c..5_;l.....JI ~.J ~ly"JI l.J.a ~~\ . 'L.:ill .J .b............._-:_,, , • _.lëi\ ~ ~~ <or '.J Lu L .. ~• L~\ . L-:~lâl .< >:1\ '~ ~ • U:i..aYG ~ ~ c.-'..Y-" ~· • • ~.J'T' ~.J'T' , ~ ~ . .J u . ~~\ ~1.;---"JI .}c ~~\ .} ~\ o~ .).J~ .);!joU o4-:i\ .} ~~ 0Î \~ Uyû.}J ~Y.J -~ ~~\ LJ--..4 Î,.r-i! y..._.s."JI ~WI J.J~ ~~YI a~yj.J 4.J 4} d~)'l ~.);!joU o'+il t.,i.J A.S\:i.i.l\.J ~\.tU..........\ 0.J~.J ~\ ~ ..)_iJ J ~ ~\ 0~ l.J.ay (,?~ 0} '.)~\ r,~L.J\ '~ )\ ~\ ~~ ~\ ) . h~"J\ 4...a~.} _;b _;li ~ly"il ~ r,~\.J ~.} '.A.l_po..fJ.J ~~\ ..)1.......:o:i ~ l.J.a :~i ~~\ l.J.a ~~\ ~ l.J.a ~~ ~.J -~~~ 'l..j , • ol\ ~~ .} \Jijjl\ ~jS _)AY .J bjb; j)\ ~jS _)A ~~ J-j\ : ~~ (.$ ~~ .)c ;Y) J.l-...a.A ~lli.J\ :~ l.J.a ~~ ~.J ~.»\~4 ~\~_,li~ 4...aj)ll\ ~\ d~ly:-)'1 ~W\ ~l ~~.JA ' • • • JSJ ~)\ Jl.ib"il ùl;!.J J~ ~lli.J\ ,y .)j 0\.S...JI l.J.a ' • • • JSJ ~WI ùl;!_,ll J~ ~lli.J\ , f • , ' .)j ~ ).JA ' • • • JSJ yaJI l.J.a ~WI 0.J~ Jtib"JI ùl;!.J J~ ~lli.J\ , " f, f ~L..i:....l\ '' ~ ~' 4..l.... il,., Jl.ibi Jlll Â..lh (ji ~ fy ~ 'f • .)j ~_,l.J-4 ù.li ' •• JS.l ù~"il ùl;!.J .0\.S....JI l.J.a ù.lÎ ~\..... JSJ Â..lh i • .)j J.J4 ~~)'\ J~ ~\Y.~~,~~\ ~ly"JI Wts.J ~.)"il jSyJI ~L!..iJ :~WI.J ~')'\ c..5_;l.....JI .)c :~~ '~.J~"il 0.a ~t...."il t+ï~4hl .;:i.fJ.J J.J.lll 0.a ~~~ ~~,~.)"il J.J.lll 0.a ~~~ .} t:YLJI w~ ~L.!..iJ ~ l.J.a J:,.JI ~~~.)"il a}.ill J.J~ LJ:Ht...-.J.l (J.JI.J j~YI.J yyt....ll) ~.J~i _;:!_iJ .)c J-jl -~~t.J ~W4 ~.J~"il ~~ fo.Î 0.a .JA.J ~\ ~.»\~4 ~.Jh.l ~\)\ ~ ~.J ~YI.J r,ut.-.11 t---i.J.J ~I.J )foY\ ~ 0.a Yl 4.fJ Y ~\ 0i ù,..J..:î r,~L.JI ~t ~ 4 J,'<,l\ t~.J"JI ~j ~.J W r.....:a..hl ~~ ~ ~WI ~\ ~\ \~.} \_jj}.J .)......::t.::o..li.J r,~1 , ..,!\ f':l~ ~ ~.JC.li.J .;~1 J)l.:b.YI d j 4.....1.JW \.....~\y:. 0.a ~\ 41;1b.nlïl\ ~I.J"JI . ;.b ...!il\ (.,> *'

-~1

~~.J ~~ ~ 0i .)W .&1 .JC~t 0i Yj o~ ~ ~'-f.j.} ~Y ,~)\ r,~~ y I~Î.J -~.J CJ.aÎ .} ~\ ~.J ~W\ ~ M. RI TCHEUL (République populaire démocratique de Corée) :1 J'ai vivement apprécié le rapport que Mme le Directeur général a présenté à l'Assemblée et je suis sûr qu'il contribuera au développement de la santé mondiale. Dans ce document, elle a clairement énoncé les risques pour la santé et les mesures à prendre pour régler les sujets de notre débat. Les risques pour la santé ne cessent de croître chaque année à 1' échelle mondiale et constituent un défi pour l'Organisation. Afin de réduire ces risques et de donner l'impulsion nécessaire au développement sanitaire, il est essentiel de concrétiser la volonté politique et l'engagement de l'Etat. Grâce aux idées du camarade Kim Jong Il, dirigeant bien-aimé, selon lesquelles le peuple est doté de la suprématie totale, dans notre pays, 1' environnement et les conditions sociales sont favorables à la santé publique. Aujourd'hui, le Gouvernement de la République populaire démocratique de Corée ne ménage aucun effort pour améliorer la santé et le bien-être de la population, malgré les difficultés causées par les catastrophes naturelles que nous subissons depuis plusieurs années.

~ .ll ~.J ~\ • '-'~ " " "'

,·, __ ,,

Le texte qui suit a été remis par la délégation de la République populaire démocratique de Corée pour insertion dans le compte tendu, conformément à la résolution WHA20.2.

ASSNR/6 page 148 L'an dernier, le Gouvernement a accordé 38% du budget de l'Etat pour favoriser sa politique populaire visant à dispenser gratuitement 1 'enseignement et les soins médicaux et à garantir l'assurance et la sécurité sociale. La cinquième session de la dixième Assemblée populaire suprême de notre pays, tenue récemment, a pris la décision d'augmenter les subventions supplémentaires de 102,5 %, celles de l'enseignement de 106,3 %, celles de la santé publique de 105,1 % et celles de l'assurance et de la sécurité sociale de 106,1 %. Tout cela permettra sûrement d'éliminer les risques et d'améliorer la santé publique. Le Gouvernement de la République populaire démocratique de Corée continuera à mettre en application sa politique visant à promouvoir la santé de son peuple. Au nom de ma délégation, je voudrais adresser nos remerciements les plus sincères à l'OMS et aux autres organisations internationales ainsi qu'aux pays donateurs, qui ont bien voulu accorder à notre peuple qui traversait une période difficile une aide et un soutien pour le développement de la santé publique. Nous avons constaté avec plaisir que Mme le Directeur général a pu visiter l'année passée notre pays à l'occasion de la cérémonie d'ouverture du bureau de l'OMS, car cela a permis de donner une nouvelle perspective au développement de la coopération entre notre pays et l'Organisation. Professor ASADOV (Uzbekistan): 1 I1po4>. ACA~OB (Y36eKHCTaH): 1

Y Ba)J(aeMbiH rocno.[IHH ITpe.r:~ce.[laTeJib, ysa)J(aeMhre .[laM bi H rocno.r:~a, TipH COBpeMeHHOM ypoBHe )J(H3HH npo6JieMhi 3,L10pOBMI KaK maBHOrO Ka'-leCTBa )J(H3HH qeJIOBeKa He MOryT pernaTbC5I BHe CB5I3H c o6rn.HM pa3BHTHeM KYJihTYP H Tpa,LIHQHH o6rn.ecTB. TaKHM o6pa30M, BCeMHpHOe B3aHMO.[IeHCTBHe KYJibryp npe.[lnOJiaraeT B3aHMO.[IeHCTBHe B o6JiaCTH pa3BHTH5I 3.LIOPOBhiX npHBhr'-leK H Tpa.LIHQHH HaceJieHH5I pa3HhiX cTpaH. Hac, scex co6pasrnHxca 3.[1ecb, 06'be.[IHH5IeT HMeHHO 3Ta 6JiaropO,L1Ha5I QeJih - 03,L10pOBJieHHe HalliHX HapO,LIOB. 0.[1Ha H3 npo6JieM, CT05Illi.HX Ha nOBeCTKe .[IH5I .[laHHOrO <t>opyMa, - 6opb6a C Ta6aKOKypeHHeM - 3TO OC06aa npo6JieMa MHposoro coo6rn.ecTBa. Y36eKHCTaH pa3,LieJiaeT CTpeMJieHHe BceMHpHoif opraHH3aQHH 3.LipasooxpaHeHH5I K .[IOCTH)J(eHHIO nporpecca no · QeJIOMY p5I.LIY BOnpocoB, 3aTPOHYThiX B npe,LIJIO)J(eHHOM npoeKTe PaMO'-IHOH KOHBeHQHH no 6oph6e npoTHB Ta6aKa. Ha'-IHHaa c 1999 r. Pecny6JIHKa Y36eKHCTaH aKTHBHO COTPY.LIHH'-IaeT co BceMHpHoif opraHH3aQHeif 3.LipasooxpaHeHHa B pa3pa6oTKe npoeKTa PaMO'-IHOH KOHBeHQHH no 6opb6e npoTHB Ta6aKa. ~a pa6oTbi Ha.[l npoeKTOM PaMO'-IHOH KOHBeHQHH no 6opb6e npoTHB Ta6aKa B Pecny6JIHKe C03.[1aHa Me)J(Be.[IOMCTBeHHa5I pa6oqaa rpynna, BKJIIO'-IaiOIII.a5I npe,LICTaBHTeJieH BCeX 3aHHTepeCOBaHHbiX MHHHCTepCTB, Be.[IOMCTB H opraHH3aQHH. ~aHHOH pa6oqeif rpynnoif nOCJie MHOrOKpaTHbiX o6cy)J(.[IeHHH npoeKTa PaMO'-IHOH KOHBeHQHH, c y'-leTOM 3aMe'-laHHH CTopoH, no.r:~roTOBJieH npoeKT no3HQHH ITpaBHTeJibCTBa Pecny6JIHKH Y36eKHCTaH no 6opb6e npoTHB Ta6aKa, KOTOpbiH 6brJI BbiHeceH Ha paccMoTpeHHe Ka6HHeTa MHHHCTpos Pecny6JIHKH, a 3aTeM yTsep)J(.[IeH KaK no3HQWI ITpaBHTeJibCTBa Pecny6JIHKH Y 36eKHCTaH npOTHB Ta6aKOKypeHH5I. ~aHHhrif .LIOKyMeHT 6bm npe.r:~cTaBJieH Ha paccMoTpeHHe Cosern.aHHa cTpaH CHr B ceHTa6pe 2001 r. B r. MocKse, r.r:~e o6cy)J(.[IaJiacb PaMO'-IHaa KOHBeHQH5I B03 no 6opb6e npoTHB Ta6aKa. B Y36eKHCTaHe Ha'-IHHaa c 1977 r. Ha'-laJIH npoBO.LIHThC5I HCCJie.[loBaHH5I no onpe.r:~eJieHHIO ypOBH5I 3,L10p0Bb5I HaceJieHH5I, KOOp,LIHHHpyeMbie B03. ~aHHbie 3THX HCCJie.[IOBaHHH nOKa3biBaiOT, '-ITO cpe,LIH My)J(CKOrO HaCeJieHH5I B B03pacTe 16 JieT H Bbillie KypaT OKOJIO 1/3 H OKOJIO 5% )J(eHIII.HH. I1o.r:~aBJI5IIOIII.ee 6oJihlliHHCTBO Kyparn.Hx )J(eHrn.HH OTHOCHTca K ropo,LICKHM )J(HTeJiaM.

1 The text that follows was submitted by the delegation of Uzbekistan for inclusion in the verbatim records in accordance with resolution WHA20.2. 1 _naHHhiH TeKCT npe.ucTaBJieH .uenerauHeH Y36eKHCTaHa B cooTBeTCTBHH c pe3oiiiOUHeH WHA20.2 .Lliill BKIIIO'!eHHll B CTeHorpaMMhl BhiCTynneHHH.

ASSNR/6 page 149 E)l(ero,nHo B Y36eKHCTaHe no npw-mHe, o6ycnosneHHOH Ta6aKoKypemteM, YMHpaiOT OKono TbiC514 YenoseK, 11 ecn11 He 6y,nyT npHH51Thi cpoYHhie Mepbi, 3Ta L(H<flpa K 06I.L(ee Yl1cno KYPI1J1bLL(I1KOB no Pecny6n11Ke Ha HIOJlb

2020

r. y.usoHTC51.

MeC51L(

2001 r.

cocTaBI1J10

3 662 499

YeJlOBeK (B

2000 r. - 3 422 642

YeJlOBeKa) 11J111, no cpaBHeHI1IO C npe,Ubi,UYI.L(HM fO,UOM, CHrapeT B ,UeHb COCTaBJ151eT: Ha Ka)I(,UOfO

B03pOCJ10 Ha MY)I(YHHY B

7%. Cpe,nHee KOJ111YeCTBO BbiKypHBaeMbiX 13, Ha Ka)I(,UYIO )l(eHLL(I1HY - 10. 2000

nocne,UHHe ro,Ubi 3aMeTHO MeH51eTc51 Cl1ryaL(H51, CB513aHHa51 c

oqmL(HaJlbHbiM HMnopTOM

cHrapeT. TaK, ecn11 B nepsoM nonyro,n1111

r., cornacHo ,naHHbiM TaMO)I(eHHOH cTaTHCTHKH, 6bmo

o<flm~l1aJ1hHO 3aBe3eHo scero L(11<flpa COCTaBI1Jla Kyp51LL(ee cHrapeT. B

11,8

MI1J1J1110Ha naYeK c11rapeT, TO 3a nepsoe nonyro,n11e

2000 r.

3Ta

26,2

MI1J1J1110Ha naYeK. Y36eKI1CTaHa noKynaeT e)l(eMeC51YHO 6onee

HaceneHHe

MHJ1J1HOHOB

naYeK

cTOJ111L(e Pecny6ni1KI1 ropo.ue TarnKeHTe noTpe6n51eTC51 cymecTBeHHa51 YaCTb scero 06beMa CHrapeT. ne3aKL(l13Hbie ( TO eCTb KOHTpa6aH,UHbie) C11rapeTbl, no

pecny6J111KaHCKOfO

pe3yJ1bTaTaM o6cne,UOBaHI151, noTpe6J15110T OKOJ10 Y36eKI1CTaH 113 coce,nHHX CTpaH.

25%

Kyp11J1bLL(I1KOB. B ,UOJ151 c11rapeT

OCHOBHOM 0Hl1 nocrynaiOT B pean113yeTCR He B CI1CTeMe

3HaYI1TeJ1hHa51

o<fl11L(I1aJ1bHO 3aperi1CTPI1POBaHHbiX npe,nnp1151TI1H, a Yepe3 HeopraHI130BaHHbiH pbiHOK.

Y ,UeJlbHbiH

Bec 3Toro KaHana c6biTa c11rapeTHOH npo,nyKL\1111 cocTaBn51eT, no pe3ynhTaTaM o6cne.uosaHH51, B YI1Cne ocHOBHbiX 3a_uaq npe,UJlo)l(eHHoro B03 npoeKTa PaMOYHOH KOHBeHL(I111

57,3%. CTOI1T

npe,noTBpameHI1e KypeHI151 cpe,n11 Mono_ue)l(l1. KYPHTb.

Mbi pa3,nen51eM 3TO MHeHI1e:

Mono_ue)l(b He ,UOJl)I(Ha 3To

TipocThiX OTBeTOB Ha perneHI1e npo6neMhi KypeHI151 cpe,n11 MOJ10,Ue)l(l1 He cyi.L(eCTByeT.

CJ10)1(HbiH COL(I1aJlhHhiH BOnpoc, Tpe6YIOLL(I1H npHH51TH51 KOMnJleKCHbiX ycHJlHH CO CTOpOHhl L(eJlOfO p51,na yYpe)I(,UeHHH H opraHH3aL(HH. Cpe.uu HaceneHH51 CTPaHhi, B nepBYIO oqepe,Ub cpe,n11 Mono_ue)l(l1, npoBO,UHTC51 aKTHBHa51

pa3b51CHI1TeJ1bHa51 pa60Ta 0 TOM, YTO KypeHHe cerO,UH51 He npeCTI1)1(H0 11 Bpe,UHO 11 OHO npHYHH51eT Bpe,U He TOJlhKO KypHJlbLL(HKy, HO H OTHI1MaeT npaBO Ha YHCThiH B03,Uyx y OKpy)l(alOLL(I1X ero 6J1H3KI1X H pO,UHbiX JliO,UeH. ECTh MHOfO o6CT051TeJ1bCTB, cnoco6CTBYIOLL(HX pa3BHTI1IO Bpe,UHOH npHBhiYKH K KypeHHIO. He3aMeTHoe BT51rHBaHHe B npHBhiYKY TaHT B ce6e rnaBeyiO ncuxonorHYecKyiO ocHosy pa3B11TH51 Ta6aYHOH 3aBHCHMOCTH. I10H51THO, YTO TaKOH MexaHI13M pa3BHTH51 Ta6aYHOH 3aBHCHMOCTH KOBapeH ll 6opoThC51 c HHM HenpocTo. Oco6eHHO B ycnoBI151X, 6naronpH51TCTBYIOLL\HX pacnpocTpaHeHHIO

KypeHH51 B 06LL(eCTBe.

3To CTaBHT nepe,U He06XO,UHMOCTbiO nOCT051HHOH Hanp51)1(eHHOH pa60Tbl CO

cpe,UCTBaMH MaCCOBOH HH<flopMaL(I111 ll nOHCKa ,npyrHX cpe,UCTB np11BJ1eYeHI151 BHI1MaHH51 JliO,UeH K 3TOH npo6neMe. 11MeHHO 3THMH coo6pa)l(eHH51MH MI1HHCTepcTBO 3,UpaBooxpaHeHH51 noJ1h3yeTC51 np11

nJ1aHHpOBaHI1ll pa3J1H4HhiX MeponpH51THH, HanpaBJleHHbiX Ha C03,UaHHe 3,UOpOBOfO o6pa3a )I(If3HH. ,0:ByxThiC51YHhiH ro.u B Pecny6nHKe Y36eKHCTaH no HHHL(HaTHBe npe3H,UeHTa 6biJ1 06b51BJ1eH KaK 'To_u 3,UOpOBOfO nOKOJ1eHI151 11 •

11.A.

Kap11MOBa

ÜYeHb MHOe 6hiJ10 C,UeJlaHO B TOT fO,U ,UJ151 ,ll;a)l(e B

npe,UOTBpaLL(eHH51 <flaKTOpOB, KOTOpbie MelliaiOT pe6eHKY HOpMMhHO paCTH ll pa3BHBaThC51.

ManeHbKHX cenax 6hmH C03,UaHhi cnopT11BHhre nnoma,UKH, a B ropo.uax noKpynHee - cTa,UHOHhi H TeHHI1CHbie KOpTbl. B 3TOM ro.uy B Pecny6nHKe 3annaH11pOBaH p51,U MeponpHRTHH, nocBRLL(eHHhiX BceMHpHoMy B qacTHOCTI1,

,UHIO 6opb6hi npoTHB Ta6aKoKypeHH51.

MaR B Pecny6nuKe 6y,neT npoBe,neHa

TeaTpaJ1H30BaHHa51 nporpaMMa "CnopT npOTHB Ta6aKa", r,Ue 6y_uyr yqaCTBOBaTb 3HaMeHHTbie ll COBCeM MOJlO,Ubie cnopTCMeHbl.

MaR

2002

r. B Me)I(,UyHapo,UHhiH ,neHh 6oph6hr npoTHB Ta6aKoKypeHH51 MHHHCTepcTBO cosMeCTHO co BceM11pHOH opraHmaL(Heii 3,npaBooxpaHeHH51 (B03),

3,UpasooxpaHeHH51

Tenepa,UHOKOMnaHHeH H p51,UOM MOJlO,Ue)I(HbiX opraHI13aL(HH nnaH11pyeT npoBeCTH p51,U Meponp1151TI1H B MacrnTa6ax CTPaHhi, nocBRLL(eHHhiX 3TOMY ,UHIO. KaK 6biJ10 y)l(e CKa3aHO, peKJlaMHbie KaMnaHHH HCnOJ1h3YIOT B CBOHX L(eJ151X J10)1(Hbie L(eHHOCTH, pacnpocTpaHeHHbie B 06LL(eCTBe. I103TOMY 60J1blliYIO pOJlh B 6opb6e C Ta6aKOKypeHHeM HrpaiOT

3aKoHo,naTeJ111. Cepbe3HhiM ,UOCTI1)1(eHHeM Mhi CYHTaeM TOT <flaKT, YTO B Y36eKHCTaHe 3anpemeHhi: peKJlaMa Ta6aYHhiX 113,UeJ1HH no TeJleBH,UeHHIO ll pa,UHO C

7 YaCOB yrpa ,UO 22

YaCOB BeYepa;

6e3B03Me3,UHOe pacnpOCTPaHeHI1e o6pa3L(OB Ta6aYHbiX H3,UeJ1HH B L(eJ151X peKJlaMbl cpe,UH JlHL(, He ,UOCTI1flliHX COBeprneHHOJleTHero B03paCTa;

ASSNR/6 page 150 COOHCHpOBaHHe Meponpm!THH, npe)J,Ha3HaqeHHhiX npeHMyiUeCTBeHHO )J,JHI HeCOBeprueHHOJieTHHX, eCJIH npH 3TOM HCOOJih3yeTC51 Ha3BaHHe 111111 11306pa)KeHI1e Ta6aqHbiX H3)J,eJIHH; pacnpocTPaHeHI1e, B TOM qHcne npo)J,a)Ka, TOBapoB cpe)J,I1 HecoseprneHHOJieTH11X HCOOJih30BaHHeM Hai1MeHOBaHI151 H TOBapHoro 3HaKa Ta6aqHbiX H3)J,eJI11H; peKJiaMa Ta6aqHhiX H3)J,eJII1H B neqaTHhiX J13)J,aHI15IX, npe)J,Ha3HaqeHHhiX HeCOBeprueHHOJieTH11X; peKJiaMa Ta6aqHhiX 113)J,eJIHH Ha nepBbiX CTpaHHU.aX ra3eT, o6JIO)l(Kax )KypHaJIOB H )J,pyrHX nepHO)J,HqecKHX 113)J,aHHH. Ü6LUe113BeCTHO, qTO 3)J,Op0Bbe HaCeJieHI151 3aBHCHT He TOJihKO OT ypOBH51 )J,e51TeJibHOCTI1 opraHOB 3)J,paBOOXpaHeHH51, HO H OT MHOrHX COU.HaJihHhiX npo6JieM. TI03TOMy Mhl 06oe)J,I1H5IeM CBOH YCI1JIH51 C 00Jlh3YIOLU11MHC51 3aCJiy)KeHHOH penyTaU.HeH opraHI13aiJ.I15IMH, KOTOpbie Be)J,yT pa6ory cpe)J,H MOJIO)J,e)KH 11 OOHHMalOT CT05ILUI1e nepe)J, HHMI1 npo6JieMhl, - 3TO He TOJihKO rocy)J,apCTBeHHble yqpe)K)J,eHH51, HO 11 p5I)J, HenpaBHTeJibCTBeHHhiX, o6rueCTBeHHhiX opraHI13aU.I1H H <PoH)J,OB 11 (opraHI13aU.11H )KeHLUHH, <PoH)J,hl "MaXaJIJI51 , "KaMOJIOT", "CorOJIOM aBJIO)J, yqyH", "3KOCaH" H )J,pyrHe ). 3TO 003BOJI5IeT Ha)J,e51ThC51 Ha TO, qTo BCe COIJ.I1aJihHb!e HHCTI1TYThi o6mecTBa 6y)J,YT 3a)J,eHCTBOBaHbl B 6opb6e C Ta6aKOKypeHHeM. YBa)KaeMble )J,aMbl H rocno)J,a, ecJIH B He)J,aJieKOM 6y,lJ,yLUeM JIIO)J,H npH BCTpeqe He CTaHYT yroruaTh )J,pyr )J,pyra CHrapeTOH 11 HHKTO 3TOrO He 3aMeTHT, TO 3TO H 6y)J,eT 03HaqaTh, qTO Mhl He 3p51 opraHH3yeM 11 yqaCTByeM B TaKHX <PopyMaX, KaK HbiHelliHHH. Cnac116o 3a BHHMaHI1e. c )J,JI51

El PRESIDENTE: Con esto hemos llegado al final de la lista de oradores y de nuestro examen del punto

3 del

orden del dia. Una vez oidas las observaciones de los Ministros y jefes de delegaciones, sugiero que la Asamblea exprese su aprecio por el discurso de la Directora General acerca de la labor desempefiada por la Organizaci6n. Naturalmente, todos los discursos quedanin debidamente recogidos en las actas de la Asamblea La segunda sesi6n de la Comisi6n B se celebrara inmediatamente después de levantarse esta sesi6n plenaria. Se levanta la sesi6n.

The meeting rose at 11:45. La séance est levée à 11h45.

ASSNR/7 page 151

SEVENTH PLENARY MEETING Thursday, 16 May 2002, at 17:00 President: Dr J.F. LOPEZ BELTRÂN (El Salvador)

SEPTIEME SEANCE PLENIERE Jeudi 16 mai 2002, 17 heures Président: Dr J.F. LOPEZ BELTRÂN (El Salvador)

AWARDS DISTINCTIONS El PRESIDENTE: Se abre la sesi6n. A continuaci6n examinaremos el punto 7 del orden del dia, titulado Premios. Excelencias, distinguidos delegados, sefioras y sefiores: nos bernos reunido hoy aqui con ocasi6n de la entrega de los premios concedidos por la Fundaci6n Ihsan Dogramaci para la Salud de la Familia, el Premio Sasakawa para la Salud y la Fundaci6n de los Emiratos Arabes Unidos para la Salud. Es para mi un gran placer dar la bienvenida entre nosotros a los distinguidos ganadores de esos premios. También me satisface saludar al Sr. Yohei Sasakawa, representante de la Fundaci6n Conmemorativa Sasakawa para la Salud, y al Dr. Hamad Abdel Rahman AI-Madfaa, Ministro de Salud de los Emiratos Arabes Unidos, que representa al Fundador de la Fundaci6n de los Emiratos Arabes Unidos para la Salud. Presentation of the Ihsan Dogramaci Family Health Foundation Prize Remise du Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille Antes de que pasemos a la presentaci6n de la Fundaci6n Ihsan Dogramaci para la Salud de la Familia, quisiera sefialar a su atenci6n el documento ASSIINF.DOC./1, en el que aparecen las enmiendas de los Estatutos de la Fundaci6n. Este Premio se concede cada dos afios a una persona que baya prestado servicios en la esfera de la salud de la familia. Tengo el placer de anunciar que el Premio de la Fundaci6n Ihsan Dogramaci para la Salud de la Familia se ha concedido este afio a la Profesora Elizabeth Wollast, de Bélgica. La carrera de la Profesora Wollast se ha centrado en la salud de la familia y, en particular, en la salud de las mujeres y los nifios. La Profesora ha iniciado y llevado a cabo varios programas de control de la mortalidad materna en paises en desarrollo, como son Tunez, Burkina Faso y Marruecos. También ha preparado y realizado actividades de capacitaci6n en la esfera de la salud familiar y reproductiva en Bélgica, Tunez y Marruecos. Ha publicado gran numero de articulos, algunos de ellos en revistas cientificas intemacionales de gran prestigio. En reconocimiento de sus logros sobresalientes, tengo el placer de entregar a la Profesora Wollast la Medalla y el Premio de la Fundaci6n Ihsan Dogramaci para la Salud de la Familia.

A55NR/7 page 152

Ruego a la Profesora Wollast que se acerque al estrado. Amid applause, the President handed the Ihsan Dogramaci Family Health Foundation Prize to Professor Wollast. Le Président remet au Professeur Wollast le Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille. (Applaudissements)

El PRESIDENTE: A continuaci6n, invito a la Profesora Wollast a pronunciar unas palabras ante la Asamblea. Le Professeur WOLLAST : Monsieur le Président, Madame le Directeur général, Mesdames et Messieurs, quand, au début des années 70, l'OMS a porté la notion d'intégration sur les fonts baptismaux, l'idée, qui paraissait fort séduisante pour beaucoup, n'a pas été suivie d'applications aussi souvent qu'on l'eut espéré. Je veux parler ici, bien sûr, de l'intégration réelle, celle qui améliore sensiblement la couverture et débouche sur une prise en charge plus adéquate des mères et des enfants. C'est la Tunisie qui, en 1974, m'a permis de tenter une première expérience sur l'intégration. Ce pays avait alors une réelle volonté politique de développer les services de santé maternelle et infantile, y compris le planning familial, qui, à ce moment-là, décollait encore difficilement. Le modèle de services intégrés que nous avons conçu et expérimenté alors s'est révélé pleinement satisfaisant. Comparés à ceux des programmes verticaux qui persistaient simultanément durant les premières années, nos indicateurs de réussite avaient doublé, voire triplé, en deux ans, et les coûts étaient quatre fois moins élevés que ceux des programmes verticaux. Par conséquent, le modèle fut reproduit dans tout le pays et porte encore ses fruits à l'heure actuelle. Savez-vous qu'à l'époque, mis à part de rares pays comme la Tunisie, ce concept était si mal accueilli par les responsables nationaux- et même par une majorité d'organismes internationauxqu'il m'avait été difficile de faire accepter les premières publications scientifiques qui relataient les résultats encourageants de ces expériences. En parcourant depuis plus de 20 ans beaucoup de pays en développement, j'ai dû me rendre à l'évidence: nombre d'entre eux sont encore trop étroitement inféodés à des bailleurs de fonds, qui visent essentiellement des programmes verticaux, très segmentés. Il en résulte que ces pays trouvent rarement en eux les ressources nécessaires et suffisantes pour modifier leur politique et leur système de santé. Pourtant, nous savons que, dans la plupart des cas, les programmes verticaux ne sont pas porteurs de succès à moyen ou à long terme. Je regrette, pour ma part, que ces comportements soient encore si souvent ancrés dans l'esprit de responsables de programmes ou d'organisations de systèmes de santé, parce qu'ils sont porteurs de graves préjudices, en particulier pour la santé des femmes. Est-il imaginable que nous franchirons un grand pas dans notre lutte contre la mortalité maternelle, pourtant si préoccupante dans beaucoup de pays, si nous continuons à découper les femmes -virtuellement, je veux dire- en épisodes cloisonnés ou en problèmes séparés alors qu'ils sont étroitement imbriqués ? Aujourd'hui, les expériences que suggère le nouveau paradigme santé reproductive plaident largement en faveur d'une réorganisation de services maternels et infantiles en système de soins intégrés. Nous en sommes d'autant plus convaincus que le manque de succès de services maternels préventifs rencontré dans certains sites, comme les zones rurales du Maroc par exemple, nous a obligés à nous reposer des questions sur l'efficacité de ces services, pourtant plus ou moins intégrés. L'étude anthropologique qui fut alors entreprise montrait que si les services maternels n'associaient pas étroitement- et simultanément -les aspects curatifs aux activités préventives, ils risquaient d'être, pour longtemps encore, mal acceptés par les populations. Il est certain que, dans beaucoup de régions, les femmes des zones rurales sont peu affranchies pour consulter dans le domaine gynéco-obstétrical, en dehors de la maladie.

ASSNR/7 page 153 Il est pourtant vrai qu'aujourd'hui on parle beaucoup d'intégration, mais cette démarche procède plus souvent de la formulation d'un concept que de son application. Sans doute avez-vous rencontré, comme moi, des responsables qui ont « pensé » faire une révolution structurelle en changeant simplement et uniquement le nom des services pour les appeler des « services intégrés ». C'est dire en un mot comme en cent que, même dans ce domaine, qui paraît très accessible, il reste encore beaucoup de chemin à parcourir. Non qu'une restructuration de cette nature soit une révolution coûteuse - bien au contraire - mais elle nécessite des changements de comportement humain, ce qui n'est pas toujours, convenons-en, le plus facile à obtenir. Voilà pourquoi, Mesdames et Messieurs les membres du jury, je suis particulièrement heureuse de recevoir ce Prix, espérant que l'encouragement que vous m'avez donné stimulera d'autres initiatives de cette nature, initiatives auxquelles, s'il en était besoin, je ne manquerais pas d'apporter encore ma contribution. El PRESIDENTE: Gracias, Profesora Wollast. Presentation of the Sasakawa Health Prize Remise du Prix Sasakawa pour la Santé El PRESIDENTE: Distinguidos delegados, sefioras y sefiores: procederemos ahora a la entrega del Premio Sasakawa para la Salud. Este Premio se concede una vez al afio a aquellas personas o instituciones que hayan destacado por su labor innovadora en el desarrollo sanitario, y tiene por objeto alentar la continuaci6n de esa labor. Es para mi un placer anunciar que el Premio Sasakawa para la Salud correspondiente al afio 2002 se ha concedido al Programa Nacional de Atenci6n Odontol6gica Integral para Mujeres Trabajadoras de Escasos Recursos, de Chile. El Programa tiene como finalidad mejorar la situaci6n sanitaria de las mujeres que pertenecen a uno de los grupos mas desfavorecidos de la poblaci6n y ayudarlas a recobrar su autoestima. El Programa se propone no solo mejorar la salud dental de estas mujeres sino también incrementar sus oportunidades en el mercado de trabajo, permitiéndoles salir del circulo vicioso de pobreza y discriminaci6n en el que estân atrapadas. Las beneficiarias de este Programa son mujeres de bajos ingresos, de 18 a 45 afios de edad, cuyo nivel de instrucci6n no rebasa la ensefianza obligatoria y que han perdido el trabajo, estân subempleadas o tienen su primer empleo. Gracias a este Programa, 38 700 mujeres pudieron recibir un tratamiento odontol6gico completo entre 1995 y 2000. El monto del Premio se utilizarâ para apoyar la ampliaci6n de las actividades a 50 nuevas comunas, a fin de ofrecer atenci6n odontol6gica completa a unas 14 000 mujeres. A continuaci6n, ruego al sefior Sasakawa que dirija unas palabras a la Asamblea en nombre de la Fundaci6n Conmemorativa Sasakawa para la Salud. Cabe agregar que el Sr. Sasakawa es el embajador especial de la Alianza Mundial para la Eliminaci6n de la Lepra. Mr SASAKA WA (Sasakawa Memorial Health Foundation): Mr President of the Assembly, Madam Director-General, distinguished guests, ladies and gentlemen, it is a great honour and pleasure to be given this opportunity to speak before you today. I would like to begin by congratulating this year's recipient of the Sasakawa Health Prize. I wish to congratulate Mrs Sanchez not merely on receiving the award itself, but more importantly for the significant contribution she is making to promote the primary health care of disadvantaged groups in Chile. The efforts they are making to improve the dental health of underprivileged women will bring major benefits both to those women and to their families. l-congratulate them heartily.

A55NR/7 page 154

This year marks the 18th year of the Sasakawa Health Prize. Through the years, the prize has been conferred on individuals, institutions or organizations that have made notable advances in the health development of disadvantaged groups, especially in south-east Asia, Africa and South America. I stand before you today, however, not simply as the head of the Foundation that grants this prize. Rather, I speak to you today as an activist who is personally involved in the work which the Sasakawa Health Prize recognizes and commends. Projects in which 1 am personally involved include programmes to distribute essential drugs to those who are in critical need of them, a project to lend needed support to the victims of the nuclear disaster at Chemobyl in the former Soviet Union, and programmes to promote increased production of staple foods as the means to prevent malnutrition. Among the many areas of health on which I focus my activities, one to which I commit my Foundation's resources most substantially, is leprosy. Under our auspices, leprosy patients of limited financial means are given free access to drugs to treat their infliction. At the same time, I also spearhead initiatives to bring an end to the social discrimination, exclusion and stigma that remain attached to leprosy. Sadly, these social issues continue to compound the problems confronted by sufferers, and even former sufferers, of leprosy in most areas of the world. My persona! interest in the problems surrounding leprosy goes back 30 years. In those three decades, I have visited hundreds of hospitals, clinics and leprosy colonies in more that 20 countries. I have personally met with thousands of patients, or former patients, of the disease. I have listened to their stories; I have listened to their physical and emotional distress; and I have listened to their needs and wants. Most recently, last year I visited hospitals in India and Myanmar; this year, 1 met with families of leprosy patients in the Brazilian Amazon. Today, leprosy is a disease that can be treated. Multidrug therapy, which we are distributing at no cast to patients, is a highly effective drug. Regrettably, however, very few people are aware that leprosy is now treatable; and even among those who do know, many sufferers are afraid to seek out treatment because they fear the social stigma that their action will generate. In too many of our global societies, sufferers or former sufferers of leprosy continue to be excluded, to be discriminated against, even after they are physically cured of the disease. Social discrimination against leprosy is an issue that must be addressed by ali humanity, east, west, north, south. In my capacity as Special Ambassador for the Elimination of Leprosy, endorsed by the World Health Organization, it is my personal mission to focus first on treating the disease and second, on eradicating the social discrimination, exclusion and stigma towards leprosy that persist today. In last year's WHO health report, the Director-General wrote of the need to address the social discrimination and exclusion that accompany mental disorders. Her words surely struck a responsive chard in many people, as they did in me. Modem science has made it possible to treat many formerly untreatable diseases. I firmly believe that, as fellow human beings, we ali have a duty to augment the work that addresses those physical issues with an equally dedicated commitment to address the social issues I have spoken of. I will carry my efforts regarding leprosy forward. I hope that someday, like the misunderstood diseases themselves, the prejudiced views that attend them will be eliminated, forever. In closing, I wish once again, to congratulate the recipient of this year's Sasakawa Health Prize. On behalf of the Nippon Foundation, I applaud the achievements she is making in the area of primary health care to disadvantaged groups. On a personal basis, it gives me immense pleasure to recognize the progress they are making in an area in which I myself take such strong interest, as I have described. I eamestly look forward to your continuing progress in the coming years. Thank you for your kind attention. El PRESIDENTE: Gracias sefior Sasakawa por sus palabras. Ahora tenemos el privilegia de hacer entrega del Premio Sasakawa para la Salud a la sefiora Miriam Allende Sanchez, Directora del Programa Nacional de Atenci6n Odontol6gica Integral para Mujeres Trabajadoras de Escasos Recursos de Chile, a quien ruego que acuda al estrado. Amid applause, the President handed the Sasakawa Health Prize to Mrs Allende Sanchez. Le Président remet à Mme Allende Sanchez le Prix Sasakawa pour la Santé. (Applaudissements)

ASSNR/7 page 155 El PRESIDENTE: Ahora ruego a la sefiora Allende Sanchez que pronuncie unas palabras ante la Asamblea. La Sra. ALLENDE SÂNCHEZ: Distinguido sefior Presidente de esta 5Y Asamblea Mundial de la Salud, distinguida sefiora Directora General, distinguidos representantes de los Gobiemos de los Estados Miembros, estimados sefioras y sefiores: es un honor y un gran estimulo para mi participar en esta Asamblea y recibir el Premio Sasakawa para la Salud 2002, en representaci6n de mi pais y de los cientos de funcionarios del sistema publico de salud, que con su trabajo hicieron realidad el Programa Nacional de Atenci6n Odonto16gica para Mujeres Trabajadoras de Escasos Recursos y Jefas de Hogar. V en go del extremo austral de Latinoamérica, de Chile, pais que se extiende desde el desierto mas arido del mundo hasta la desolada y fria Antartida, desde las azules aguas del Océano Pacifico hasta la majestuosa Cordillera de los Andes. Nos encontramos actualmente en un proceso de consolidaci6n de la democracia, tras un largo periodo que signific6 un deterioro en las condiciones de vida y de salud para la poblaci6n chilena, particularmente de los mas pobres. Chile ha realizado grandes esfuerzos para lograr un crecimiento sostenido en la economia, alcanzando indicadores macroecon6micos que muestran una evoluci6n global muy favorable. Sin embargo, aun subsisten grupos de poblaci6n que se encuentran en situaci6n de inequidad. En el area de la salud publica se han realizado importantes cambios para mejorar la situaci6n de los chilenos, focalizando las acciones en los grupos mas postergados. En este sentido, la salud bucal es una de las areas en que se ha detectado un mayor dafio y particularmente son afectados los mas pobres. Un numero importante de mujeres jefas de hogar y trabajadoras temporeras vive en condiciones de pobreza. Constituyen uno de los grupos sociales con mayores obstaculos para mejorar su calidad de vida y la de sus familias. Su participaci6n en el mercado laboral se ve ademas afectada por la desmedrada situaci6n de su salud bucal. V en significativamente reducidas sus oportunidades de empleo, lo que no les permite romper el circulo de pobreza y discriminaci6n que las afecta. Frente a esta situaci6n, el Gobiemo, a través del Ministerio de Salud, Servicio Nacional de la Mujer, Ministerios de Educaci6n y del Trabajo, decidi6 dar una respuesta social, efectiva y coordinada a este grupo prioritario. Fue asi como se cre6 un Programa donde la atenci6n odontol6gica dio respuesta coherente al dafio y deterioro de la salud bucal de estas mujeres, que dificultaba su inserci6n laboral y les provocaba frustraciones, inseguridad y baja autoestima. Este Programa se encuentra en desarrollo desde hace siete afios. La poblaci6n objetivo corresponde a 370 000 mujeres, de entre 18 y 45 afios de edad, de escaso ni vel de escolaridad, que son jefas de hogar y se encuentran bajo la linea de pobreza. A la fecha, 62 000 mujeres han sido atendidas, incluyendo 14 000 que se rehabilitaran en el presente afio. El Programa dispone de un conjunto de indicadores técnicos que permiten evaluar y controlar sus resultados. Junto con los resultados cuantitativos, se evalua el grado de coordinaci6n existente entre las diferentes instancias y niveles que participan en su implementaci6n. El parametro de evaluaci6n y control que se considera mas relevante es la opinion y el grado de satisfacci6n de las propias beneficiarias respecto a la atenci6n recibida. Los principales resultados han sido el tratamiento odontol6gico de estas 62 000 mujeres, el alto grado de satisfacci6n de la poblaci6n femenina beneficiada, la eficiencia econ6mica (el costo promedio por mujer rehabilitada es de aproximadamente US$ 90) y muy especialmente la satisfacci6n de los profesionales participantes, por constatar que, con su trabajo, estan haciendo posible que un grupo importante de mujeres se encuentren en mejores condiciones para superar la pobreza. Reitero finalmente mis agradecimientos a la Organizaci6n Mundial de la Salud, a la Fundaci6n Sasakawa y a todos los equipos de salud chilenos que participan en su ejecuci6n, por su solidaridad y compromiso con estas mujeres. Con su aporte han hecho realidad el suefio de toda mujer: poder enfrentar el mundo con seguridad y confianza y sonreir al futuro, sin necesidad de ocultar su boca. Muchas gracias.

A55NR/7 page 156 El PRESIDENTE: Gracias sefiora Allende Sanchez por sus palabras. Presentation ofthe United Arab Emirates Health Foundation Prize Remise du Prix de la Fondation des Emirats arabes unis pqur la Santé El PRESIDENTE: Sefioras y sefiores, pasaremos a continuaci6n a la entrega del Premio de la Fundaci6n de los Emiratos Arabes Unidos para la Salud. El Premio se concede a personas o instituciones que hayan contribuido de forma destacada al desarrollo sanitario y este afio se otorga conjuntamente a Médecins sans Frontières y al Dr. Ibrahim Mohamed Yacoub, de Bahrein. Médecins sans Frontières es una conocida organizaci6n intemacional de ayuda humanitaria que presta asistencia médica de emergencia a poblaciones en peligro en mas de 80 paises. Su labor se centra principalmente en la atenci6n médica y sanitaria en casos de desastres naturales, como terremotos e inundaciones, y de conflicto. Lleva a cabo una amplia gama de actividades: programas de saneamiento y de nutrici6n en campamentos de refugiados; apoyo a la cirugia y el tratamiento de emergencia de los trastomos postraumaticos en las victimas de conflictos; programas de lucha contra determinadas enfermedades como la tuberculosis y el SIDA; programas sociales y de salud para nifios, y promoci6n de la salud. Médecins sans Frontières ya ha sido galardonada con numerosos premios intemacionales, de los cuales el mas prestigioso es el Premio Nobel de la Paz, que le fue concedido en 1999. El Dr. Ibrahim Mohamed Yacoub se considera el iniciador del sistema de atenci6n primaria en Bahrein. A principios de los afios sesenta, mucho antes de la Declaraci6n de Alma-Ata en 1978 y la adopci6n de la estrategia de atenci6n primaria de salud por la OMS, el Dr. Yacoub contribuy6 decisivamente al paso de la atenci6n sanitaria basada en el hospital, de la que se beneficiaba una minoria, a los centros de atenci6n primaria de salud, que proporcionaban atenci6n integral a toda la poblaci6n. Desde 1975 en adelante, particip6 activamente en la expansion de los servicios de atenci6n primaria de salud y en la aplicaci6n de la estrategia conocida como salud para todos en el afio 2000, adoptada por la OMS en 1978. Gracias a su dedicaci6n, Bahrein alcanz6 esa meta siete afios antes de lo previsto. Antes de entregar el premio a los distinguidos galardonados, ruego al Representante del Fundador del Premio de la Fundaci6n de los Emiratos Arabes Unidos para la Salud, el Dr. Hamad Abdel Rahman Al-Madfaa, que pronuncie unas palabras ante la Asamblea. Mr AL - MADFAA (United Arab Emirates):

A55NR/7 page 157

El PRESIDENTE: Tenemos a continuaci6n el privilegia de hacer entrega del Premio de la Fundaci6n de los Emiratos Arabes Unidos para la Salud a nuestros distinguidos galardonados. Ruego al Dr. Jean-Hervé Bradol, Presidente de Médecins sans Frontières (Francia), que acuda al estrado.

ASSNR/7 page 158 Amid applause, the President handed the United Arab Emirates Health Foundation Prize to Dr Bradol. Le Président remet au Dr Bradol le Prix de la Fondation des Emirats arabes unis pour la Santé. (Applaudissements)

Ahora invito al Dr. Bradol a pronunciar unas palabras ante la Asamblea. Le Dr BRADOL (représentant Médecins sans Frontières) : Monsieur le Président, Madame la Directrice générale, honorables invités, Mesdames et Messieurs, c'est avec émotion que je reçois le Prix de la Fondation des Emirats arabes unis pour la Santé au nom de l'ensemble des médecins sans frontières. Cette distinction, décernée par une des institutions les plus prestigieuses du monde arabe, nous touche particulièrement et nous adressons nos chaleureux remerciements aux Emirats arabes unis. Nous obtenons ce Prix pour notre action médicale. Je vais essayer de résumer- brièvement, rassurez-vous- la nature de l'aide que nous fournissons. Outre les secours médicaux d'urgence que nous apportons aux victimes de guerres, d'épidémies ou de catastrophes naturelles, nous intervenons également auprès des populations privées d'accès aux soins. Parmi les nombreux et complexes problèmes qui conduisent à un mauvais bilan de santé pour la majorité des habitants de cette planète, il en est un qui est particulièrement alarmant: c'est l'indisponibilité de médicaments efficaces pour les principales maladies infectieuses responsables chaque année de plusieurs millions de décès. Cette situation s'est installée progressivement au cours des trois dernières décennies. Elle est la résultante de plusieurs facteurs : émergence de résistances aux traitements les plus courants, abandon des programmes de recherche pour les maladies frappant les personnes à faible pouvoir d'achat, prix trop élevés des médicaments essentiels à la survie et application restrictive des dispositions légales régissant la propriété intellectuelle. Il est vrai que, ces deux dernières années, quelques lueurs d'espoir se sont allumées à l'horizon : l'Organisation mondiale de la Santé a donné l'exemple et s'est prononcée clairement en faveur de l'utilisation de molécules efficaces (notamment pour le traitement du paludisme et du SIDA), de grandes compagnies pharnmceutiques ont commencé à baisser les prix sous la pression de la concurrence des producteurs de génériques (l'avancée est significative en ce qui concerne les antirétroviraux utilisés dans le traitement du SIDA) et la dernière conférence de l'Organisation mondiale du Commerce, à Doha, en novembre 2001, a clairement affirmé la primauté de la santé publique sur les intérêts commerciaux. Beaucoup reste encore à obtenir, en particulier dans le domaine de la recherche, mais ne nions pas que les avancées sont réelles. De nouvelles opportunités sont donc théoriquement offertes aux cliniciens. Pourtant, et cela vous concerne directement en tant que responsables politiques de la santé, nous pouvons affirmer que nous nous heurtons, sur les terrains où nous pratiquons, à de nombreux blocages politiques et administratifs. Rassurez-vous, nous ne vivons pas dans l'illusion que changer les protocoles thérapeutiques à l'échelle d'un pays, voire d'un continent, puisse se faire du jour au lendemain. Nous savons que cela peut prendre des années et encore faut-il trouver les financements pour mettre en oeuvre ces nouvelles politiques. Mon message s'adresse aussi à celles et à ceux d'entre vous qui représentent les Etats les plus puissants de cette planète et, donc, susceptibles d'aider des pays aux ressources plus limitées à offrir des traitements de qualité à leurs malades. L'aide internationale doit cesser de financer des protocoles thérapeutiques inefficaces et de se retourner ainsi contre les intérêts de ses bénéficiaires. C'est encore trop souvent le cas, notamment dans les programmes de lutte contre le paludisme. Les ressources financières existent et elles doivent être rendues disponibles. La recherche de nouveaux outils adaptés aux besoins des malades doit devenir une priorité et bénéficier également de cette nécessaire augmentation des moyens financiers. Aux responsables politiques de la santé des pays dont les ressources financières sont réduites, j'aimerais dire que ces limites ne peuvent en aucun cas justifier de ne pas commencer localement, là où la possibilité existe d'utiliser des traitements de qualité. Trop souvent, l'impératif de respect des protocoles nationaux joue contre toute possibilité d'innovation. Nous devons rapidement faire taire, par l'exemplarité d'actions nouvelles, les voix qui se sont élevées tant dans le monde industriel pharmaceutique que dans celui des bailleurs de fonds internationaux pour dire que le niveau

ASSNR/7 page 159 d'éducation de nos malades et la qualification des professionnels de santé sont trop faibles pour permettre l'utilisation de ces nouveaux médicaments. Ne nous y trompons pas, derrière les arguments techniques et financiers mis en avant pour refuser des traitements efficaces à ces malades se cache le plus cynique mépris à l'encontre des plus pauvres. C'est ce mépris qui fonde la situation d'apartheid sanitaire qui caractérise l'état de santé du monde dans lequel nous vivons. C'est dans ce mur de mépris que nous devons ouvrir des brèches par des actions, certes d'une ampleur limitée au début, mais qui indiquent le chemin à suivre pour permettre demain la survie de millions d'êtres humains. El PRESIDENTE: Gracias, doctor Bradol, por sus palabras. Ahora ruego al Dr. Yacoub que tenga la bondad de acudir al estrado.

Amid applause, the President handed the United Arab Emirates Health Foundation Prize to DrYacoub. Le Président remet au Dr Yacoub le Prix de la Fondation des Emirats arabes unis pour la Santé. (Applaudissements) A continuaci6n, invito al doctor Yacoub a pronunciar unas palabras ante la Asamblea. DrYACOUB: Mr President, Madam Director-General, your excellencies, ladies and gentlemen, it gives me great pleasure to be here today on the occasion of receiving the United Arab Emirates Foundation Prize for 2002. 1 am both proud and humbled by such an honour. 1 thank the selection committee for the ir confidence and appreciation of my work. 1 also wish to thank the Government of the United Arab Emirates for establishing this prize and for continuing to support health services worldwide. lt has been over 40 years since 1 began my career as a medical doctor and, as time passes, 1 am convinced that it is not my work alone nor the efforts of any individual that placed my country, the Kingdom of Bahrain, as a bright star in relation to global health services. lt is the collaboration of every physician, nurse, technician and lay person in my community, working to achieve better health for ali. lt is an honour to be added to those who have striven to improve the quality of life and health for ali. Thank you. El PRESIDENTE: Gracias por sus palabras, doctor Yacoub. Con esto bernos puesto fin al punto 7 del orden del dia y a la sesi6n plenaria oficial de la Asamblea de la Salud. La proxima sesi6n plenaria se celebrara el viemes 17 de mayo a las 9.00 boras. Se levanta la sesi6n.

The meeting rose at 18:00. La séance est levée à 18h00.

A55NR/8 page 160

EIGHTH PLENARY MEETING Friday, 17 May 2002, at 9:05 President: Mrs J. PHUMAPHI (Botswana)

HUITIEME SEANCE PLENIERE Vendredi 17 mai 2002, 9h05 Président: Mme J. PHUMAPHI (Botswana)

SECOND REPORT OF THE COMMITTEE ON CREDENTIALS 1 DEUXIEME RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS 1

The PRESIDENT: The Assembly is called to order. The Assembly has to consider the second report of the Committee on Credentials which held its second meeting yesterday, Thursday, 16 May. The report is contained in document A55/46 which you have ali received. Delegates will note that it was the Bureau of the Committee on Credentials that examined the credentials of the Member States named in the report. Since the establishment of the report, formai credentials have been received from Nicaragua that had previously submitted provisional credentials. lt has not been feasible to reconvene the Bureau of the Committee on Credentials to examine the formai credentials of Nicaragua but, in accordance with previous practice, 1 have examined these credentials and have found them to be in keeping with the Assembly's Rules of Procedures. 1 would, therefore, recommend to the Assembly that Nicaragua be accepted as having formai credentials. Does the Assembly agree with this procedure? 1 see no objection. Does the Assembly agree to approve the report along with addition of the credentials that 1 have examined? There are no comments. The report is therefore approved.

ANNOUNCEMENT COMMUNICATION

The PRESIDENT: When the General Committee met on Wednesday, 15 May, it drew up the list for the annual election of Members entitled to designate a person to serve on the Executive Board and it considered the programme ofwork for the remainder of the Assembly, giving me the authority to consult with the

1 1

See reports ofcommittees in document WHASS/2002/REC/3. Voir les rapports des commissions dans le document WHASS/2002/REC/3.

ASSNR/8 page 161 chairpersons of the main committees to review the progress of the ir work and revise the ir programme accordingly, ifnecessary. In view of the authority given to me by the General Committee, and following consultation with the chairpersons of the main Committees, and since Committee B is progressing rapidly with its work, it has been agreed to transfer items 13.1 0, Infant and young child nutrition, 13.11, Di et, physical activity and health and 13.12, Ageing and health from Committee A to Committee B. After consideration of the progress of work in the main committees, the General Committee recommended that this plenary should meet this morning at 9:00 to consider item 6, Executive Board: election and item 9, Reports of the main committees. In accordance with the programme of work drawn up by the General Committee, Committee A and Committee B will meet immediately after the plenary adjourns. At 13:00, two technical briefings will be held: one on Civil society perspectives on health: the people's Charter for Health, in room 16 and another one on Twenty-five years of essential drugs: achievements and challenges, in room 12. This afternoon, Committee A and Committee B will meet again at 14:30 and continue until20:30. On Saturday, 18 May, at 9:00, both Committees A and B will hold their last meeting to finalize their resolutions and reports, followed by the ninth plenary, which will consider their last reports. The closure of the Assembly will take place immediately thereafter.

EXECUTIVE BOARD: ELECTION CONSEIL EXECUTIF: ELECTION

The PRESIDENT: We can now consider item 6 Executive Board: election. I draw your attention to the list of 10 Members contained in document A55/44 drawn up by the General Committee in accordance with Rule 102 of the Rules of Procedure. In the General Committee's opinion these 10 Members would provide, ifelected, a balanced distribution ofthe Board as a whole. These members are, in the French alphabetical order: China, Gabon, Gambia, Ghana, Guinea, Kuwait, Maldives, Russian Federation, Spain and United States of America. Is the Assembly prepared, in accordance with Rule 80 of the Rules of Procedure, to elect these 10 Members as proposed by the General Committee? 1 see no objection. 1 therefore declare the 10 Members elected. This election will be duly recorded in the records of the Assembly. May 1 take this opportunity to invite Members to pay regard to the provisions of Article 24 of the Constitution wh en appointing a person to serve on the Executive Board. We can now proceed to agenda item 9, Reports of the main committees.

FIRST REPORT OF COMMITTEE B 1 PREMIER RAPPORT DE LA COMMISSION B 1

The PRESIDENT: Let us now consider the first report of Committee B. This is contained in document A55/43. Please disregard the word "draft" as the committee approved the report without amendments. The report contains one resolution which is entitled "Health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine". Is the Assembly willing to adopt this resolution? 1 1

See reports ofcommittees in document WHASS/2002/REC/3. Voir les rapports des commissions dans le document WHASS/2002/REC/3.

A55NR/8 page 162

Mr LEVY (Israel): Thank you, Madam President. 1 would like to state for the record that Israel voted against the resolution contained in document A55/43. Thank you. Mr THOMPSON (United States of America): Thank you, Madam President. My delegation would also like the record to reflect that this resolution was adopted in Committee B by a roll-cali vote and that the United States voted against it. Thankyou. The PRESIDENT: This will be so recorded. Is the Assembly willing to adopt the resolution? The resolution is adopted and the first report of Committee B is therefore approved.

SECOND REPORT OF COMMITTEE B 1 DEUXIEME RAPPORT DE LA COMMISSION B 1

The PRESIDENT: We shall now consider the second report of Committee B. This is contained in A55/45. The report contains seven resolutions and one decision. The first resolution is entitled "Financial report on the accounts of WHO for 2000-2001, report of the Extemal Auditor, and comments thereon made on behalf of the Executive Board; report of the Internai Auditor". Is the Assembly willing to adopt this resolution? 1 see no objection, the resolution is adopted. The second resolution is entitled "Members in arrears to an extent which would justify invoking Article 7 of the Constitution". Is the Assembly willing to adopt this resolution? 1 see no objection, the resolution is adopted. The third resolution is entitled "Arrears in payment of contributions: Azerbaijan". Is the Assembly willing to adopt this resolution? 1 see no objection, the resolution is adopted. The fourth resolution is entitled "Arrears in payment of contributions: the Dominican Republic". Is the Assembly willing to adopt this resolution? 1 see no objection, the resolution is adopted. The fifth resolution is entitled "Miscellaneous income". Is the Assembly willing to adopt this resolution? 1 see no objection, the resolution is adopted. The sixth resolution is entitled "Real Estate Fund". Is the Assembly willing to adopt this resolution? 1 see no objection, the resolution is adopted. The seventh resolution is entitled "Revolving Sales Fund". Is the Assembly willing to adopt this resolution? I see no objection, the resolution is adopted. Und er agenda item 15.6 the Committee agreed on a decision entitled "Scale of assessments for 2004-2005". Does the Assembly agree with this decision? I see no objection, it is so decided and the second Report of Committee B is therefore approved. This completes our work for today. Immediately on adjoumment of this meeting, Committees A and B will resume their work. The next plenary will be held tomorrow, Saturday, 18 May. The meeting is adjoumed. The meeting rose at 9:20. La séance est levée à 9h20. 1 1

See reports of committees in document WHASS/2002/REC/3. Voir les rapports des commissions dans le document WHASS/2002/REC/3.

A55NR/9 page 163

NINTH PLENARY MEETING Saturday, 18 May 2002, at 14:20 President: Dr J.F. LOPEZ BELTMN (El Salvador)

NEUVIEME SEANCE PLENIERE Samedi 18 mai 2002, 14h20 Président: Dr J.F. LOPEZ BELTMN (El Salvador)

REPORTS OF THE MAIN COMMITTEES 1 RAPPORTS DES COMMISSIONS PRINCIPALES 1

El PRESIDENTE: Ûltima sesi6n plenaria de esta Asamblea. Se han recibido las credenciales de Azerbaiyân, que previamente habia presentado credenciales provisionales. Dado que no ha sido posible que la Mesa de la Comisi6n de Credenciales las examine, de acuerdo con prâcticas anteriores las he examinado yo mismo y las he encontrado en buena y debida forma. Por consiguiente, recomiendo a la Asamblea que se acepten las credenciales oficiales de Azerbaiyân. {,Esta la Asamblea de acuerdo? Como no veo objeci6n, se aceptan las credenciales ofieiales que ha presentado Azerbaiyân. El siguiente punto, el numero 9, se refiere a los informes de las comisiones principales. Continuaremos ahora con la aprobaci6n de los informes de las comisiones principales. Comenzaremos con el primer informe de la Comisi6n A, documenta A55/47. El informe contiene una resoluci6n titulada «Salud mental, respuesta al llamamiento a favor de la acci6n». {_,Desea la Asamblea adoptar esta resoluci6n en su forma enmendada? Al no haber objeciones, la Asamblea adopta la resoluci6n y por consiguiente aprueba el primer informe de la Comisi6n A. A continuaci6n nos ocuparemos del segundo informe de la Comisi6n A, contenido en el documenta A55/49. Sirvanse prescindir de la palabra proyecto habida cuenta de que la Comisi6n adopt6 el informe sin enmiendas. El informe contiene seis resoluciones. La primera de elias se titula «Salud y desarrollo sostenible». l,Desea la Asamblea adoptar esta resoluci6n en su forma enmendada? Dado que no hay objeciones, se adopta la resoluci6n. La segunda resoluci6n se titula «Contribuci6n de la OMS al seguimiento del periodo extraordinario de sesiones de la Asamblea General de Naciones Unidas sobre VIH/SIDA». l,Desea la Asamblea adoptar esta resoluci6n en su forma enmendada? Al no haber objeciones, se adopta la resoluci6n. La tercera resoluci6n se titula «Protecci6n de las misiones médicas durante los conflictos armados». l,Desea la Asamblea adoptar esta resoluci6n en su forma enmendada? Al no haber objeciones, se adopta la resoluci6n.

1 1

See reports of committees in document WHASS/2002/REC/3. Voir les rapports des commissions dans le document WHASS/2002/REC/3.

ASSNR/9 page 164

La cuarta resolucion se titula «Garantfa de la accesibilidad de los medicamentos esenciales». l,Desea la Asamblea adoptar esta resolucion? Al no haber objeciones, se adopta la resolucion. La quinta resolucion se titula «Erradicacion de la viruela: destruccion de las reservas de virus variolico». l,Desea la Asamblea adoptar esta resolucion? Al no haber objeciones, se adopta la resolucion. La sexta resolucion se titula «Respuesta mundial de salud publica a la aparicion natural, la liberacion accidentai o el uso deliberado de agentes biologicos y qufmicos o de material radionuclear que afecten a la salud». l,Desea la Asamblea adoptar esta resolucion en su forma enmendada? Al no haber objeciones, se adopta la resolucion. Por consiguiente, se aprueba el segundo informe de la Comision A. Examinaremos a continuacion el tercer informe de la Comision A. El informe estaria a su disposicion. Contendra tres resoluciones. La primera resolucion se titula «Prevencion y control de la fiebre dengue y la fiebre hemorragica dengue». Concedo la palabra a la Secretaria. Mr AITKEN (Senior Policy Adviser): Thank you Mr President. This resolution was adopted in the Committee with one change to the preambular paragraph and a number of changes to the operative paragraphs which will appear in the Committee's report. El PRESIDENTE: l,Desea la Asamblea adoptar esta resolucion en su forma enmendada? Al no haber objeciones, se adopta la resolucion. La segunda resolucion se titula «Calidad de la atencion: seguridad del paciente». De nuevo conceda la palabra a la Secretaria. Mr AITKEN (Senior Policy Adviser): Thank you, Mr President. This resolution was adopted in the Committee with no change to the information contained in Conference Paper No.6. El PRESIDENTE: l,Desea la Asamblea adoptar esta resolucion? Al no haber objeciones, se adopta la resolucion. La tercera resolucion se titula «Contribucion de la OMS al logro de los objetivos de desarrollo de la Declaracion del Milenio de las Naciones Unidas». Concedo nuevamente la palabra a la Secretaria. Mr AITKEN (Senior Policy Adviser): Thank you, Mr President. This resolution was adopted in the Committee as in Conference Paper No.7 with one change to footnote No. 4 and with a change to operative paragraph 1.6 in the Spanish language. El PRESIDENTE: l,Desea la Asamblea adoptar esta resolucion en su forma enmendada? Pakistan tiene la palabra. Ms BALOCH (Pakistan): Mr President, 1 thank you very mu ch for bringing this matter be fore us. We have one observation on the draft resolution and that is regarding paragraph 2 on page 3 in the English version. There are three paragraphs under paragraph 2. It is our understanding that they are stand-alone

A55NR/9 page 165 paragraphs, so we would request th at numbering be changed so that each of the individual paragraphs is considered as a separate paragraph and not as a subset of one or the other. Secondly, Mr. President, in the same resolution, paragraph 3, subparagraph 2, it is our understanding that in the thü:d line at the end, where we have the word "such", it should read as "these recommendations" - it is the recommendations of the Commission that we are referring to, so if that could be clarified we would be grateful. Thank you Mr President. El PRESIDENTE: Gracias a la delegada del Pakistan, aceptamos su propuesta de que en el parrafo 3(2) en lugar de such figure these recommendations. No habiendo mas observaciones, se adopta la resolucion y, por consiguiente, se aprueba el tercer informe de la Comision A. Examinaremos a continuacion el tercer informe de la Comision B que figura en el documenta ASS/48 y que contiene tres resoluciones y una decision. La primera resolucion se titula «Sueldos de los titulares de puestos sin clasificar y del Director General». l,Desea la Asamblea adoptar esta resolucion? Al no haber objeciones, se adopta la resolucion. La segunda resolucion se titula «Modificaciones del Estatuto del Persona!». l,Desea la Asamblea adoptar esta resolucion? Al no haber objeciones, se adopta la resolucion. La tercera resolucion se titula «Reembolso de los gastos de viaje a los miembros del Consejo Ejecutivo». l,Desea la Asamblea adoptar esta resolucion? Al no haber objeciones, se adopta la resolucion. En relacion con el punto 16.3 del orden del dia, la Comision acordo una decision titulada «Nombramiento de representantes en el Comité de la Caja de Pensiones del persona! de la OMS». l,Esta de acuerdo la Asamblea con esta decision? Al no haber objeciones, asi queda decidido y por consiguiente se aprueba el tercer informe de la Comision B. Examinaremos ahora el cuarto informe de la Comision B, que es el documenta ASS/50. Les ruego que no tengan en cuenta la palabra «proyecto», pues la Comision adopto el informe sin enmienda alguna. El informe contiene una resolucion que se titula «Régimen alimentario, actividad fisica y salud». l,Desea la Asamblea adoptar esta resolucion en su forma enmendada? Al no haber objeciones, se adopta la resolucion y por consiguiente se aprueba el cuarto informe de la Comision B. Examinaremos ahora el quinto informe de la Comision B, que contiene dos resoluciones: la primera dice «Necesidad de ampliar la representacion de los paises en desarrollo en la Secretaria y en los cuadros y comités de expertos». Concedo la palabra a la Secretaria. Mr AITKEN (Senior Policy Adviser): Thank you Mr President. This resolution was adopted in the Committee, as contained in Conference Paper No.2 Rev.l, with one change and one correction which 1 have been asked to read by both Pakistan and Australia. The change is that the reference in the resolution to the words "countries in transition" is removed everywhere it appears. The correction 1 have been asked to read by Pakistan and Australia is the paragraph 6, where the words "through a publicly available document including on the Internet" will be omitted. This was an error made when we reproduced the resolution ovemight. El PRESIDENTE: Al no haber objeciones, se adopta la resolucion. La segunda resolucion tiene como titulo «Nutricion dellactante y del nifio pequefio». De nuevo conceda la palabra a la Secretaria. Mr AITKEN (Senior Policy Adviser): Thank you, Mr President. This resolution was adopted in the Committee, based on the text in the Conference Paper before the Committee.

A55NR/9 page 166 El PRESIDENTE: Gracias, sefior Secretario. z,Desea la Asamblea adoptar esta resolucion en su forma enmendada? Colombia tiene la palabra. El Dr. RIVEROS DUENAS (Colombia): Es simplemente para aclarar que el documento original es en lengua inglesa y no pudimos ver la ultima traduccion revisada; la que tenemos en circulacion tiene algunos errores de traduccion. Creo que la Asamblea puede aceptar la version original y posteriormente se preparara la traduccion correcta. El PRESIDENTE: El delegado de Colombia presenta la mocion de que se considere la presentacion en idioma inglés y de que la traduccion al espafiol se haga luego. z,Desea la Asamblea adoptar esta resolucion en su forma enmendada? Al no haber objeciones, se adopta la resolucion y por consiguiente se aprueba el quinto informe de la Comision B. Se me ha comunicado que, debido a limitaciones de tiempo, lamentablemente la Comision B no ha podido examinar tres de los puntos que se le habian transferido de la Comision A. Por consiguiente, he convenido en que los puntos 13.17 «Campana Panafricana de Erradicacion de la Mosca Tsetsé y de la Tripanosomiasis», 13.18 «Control de la neurocisticercosis» y 13.19 «Funcion de los arreglos contractuales en la mejora del desempefio de los sistemas de salud» se incorporen en el orden del dia de la 56a Asamblea Mundial de la Salud.

SELECTION OF THE COUNTRY OR REGION IN WHICH THE FIFTY-SIXTH WORLD HEALTH ASSEMBLY WILL BE HELD CHOIX DU PAYS OU DE LA REGION OU SE TIENDRA LA CINQUANTE-SIXIEME ASSEMBLEE MONDIALE DE LA SANTE

El PRESIDENTE: A continuacion procederemos a la eleccion del pais o la region en que ha de reunirse la 56a Asamblea Mundial de la Salud. Deseo sefialar a la atencion de la Asamblea que, de conformidad con lo dispuesto en el articulo 14 de la Constitucion, la Asamblea de la Salud, en cada sesion anual, designara el pais o region en el cual se celebrara la siguiente sesion anual, el Consejo Ejecutivo fijara posteriormente ellugar. Asimismo, me permito recordarles que la 38a Asamblea Mundial de la Salud llego a la conclusion de que en interés de todos los Estados Miembros conviene mantener la practica de celebrar la Asamblea de la Salud en la sede de la Organizacion. Asi pues, entiendo que la Asamblea decide que la 56a Asamblea Mundial de la Salud se celebre en Suiza. Al no haber objeciones, asi queda decidido. A continuacion, honorables delegados, levantaré la sesion durante algunos minutos. Les ruego que permanezcan en sus asientos. Nuestro siguiente punto es «Clausura de la Asamblea»

The meeting rose at 14:40. La séance est levée à 14h40.

ASSNR/10 page 167

TENTH PLENARY MEETING Saturday, 18 May 2002, at 14:40 President: Dr J.F. LOPEZ BELTRÂN (El Salvador)

DIXIEME SEANCE PLENIERE Samedi 18 mai 2002, 14h40 Président: Dr J.F. LOPEZ BELTRÂN (El Salvador)

CLOSURE OF THE SESSION CLOTURE DE LA SESSION El PRESIDENTE: Antes que nada, me gustarfa dar las gracias al Dr. Manuel Dayrit, Secretario de Salud de Filipinas, al Sr. Thami El Khyari, Ministro de Salud de Marruecos, al Dr. Julio Frenk, Secretario de Salud de México, y al Dr. C. P. Thakur, Ministro de Salud y Protecci6n de la Familia de la India, por presidir las cuatro mesas redondas, y también a todos los que han participado en esta experiencia sumamente interesante y estimulante. Es muy satisfactorio observar que las mesas redondas, incluidas por primera vez en el orden del dia de la Asamblea hace tres afios, siguen constituyendo una valiosa oportunidad para intercambiar puntos de vista y experiencias que resultan sumamente enriquecedoras para todos. Estamos tomando la oportunidad también para agradecer al Dr. James Kiely, Presidente de la Comisi6n A, su apoyo en la presidencia de la Comisi6n A. Igualmente deseo hacer extensiva esta felicitaci6n a la Profesora Awa Marie Coll Seck por los servicios prestados como Presidenta de la Comisi6n B. Ahora que las Comisiones principales han terminado su labor, incluido el examen de los informes del Consejo Ejecutivo, estamos en condiciones de tomar nota formalmente de esos informes. A raiz de las observaciones formuladas, entiendo que la Asamblea desea encomiar al Consejo por la labor realizada y expresar su aprecio por la dedicaci6n con que el Consejo ha llevado a cabo las tareas que se le habian encomendado. Al no haber observaciones, asi queda decidido. Y ahora vamos a tener el gusto de escuchar las palabras de la Directora General. Doctora Brundtland, le ruego que haga uso de la palabra. The DIRECTOR-GENERAL: Mr President, distinguished delegates, this has been both a challenging and intense World Health Assembly. It has been a week of tremendous progress for global health. What has emerged from this Assembly is a deepening consensus about the interventions, policies and strategies needed to fight the main diseases of our world and reduce the risks to health. There have been constructive and helpfut propositions on how to progress with the work on HIV/AIDS, on taking the Global Fund to Fight AIDS, TB and Malaria forward. We have a promising and powerful resolution linking the Millennium Development Goals and the report of the Commission on Macroeconomies and Health.

A55NR/10 page 168 In his passionate speech to the World Health Assembly, Professor Jeffrey Sachs described for us what the stakes are. We have the potential to save millions of lives each year and to lay the foundation for societies that can work their way out of poverty. I would like to thank all delegations and especially you, Mr President, and the Vice-presidents and Chairmen of the committees and round tables. May I also thank all my colleagues on the staff of WHO and our interpreters. Ali have worked very hard to help achieve the important steps for health taken by this Assembly. Thank you very much. El PRESIDENTE: Gracias, doctora Brundtland. A continuaci6n, excelencias, sefiores mtmstros, distinguidos delegados, sefiora Directora General, sefioras y sefiores, en primer lugar deseo agradecerles personalmente y en nombre de mi pais, El Salvador, la confianza que han depositado en mi al elegirme Presidente de esta Asamblea Mundial de la Salud. Nuestras deliberaciones han concluido y creo que, una vez mas, bernos podido abordar el gran numero de cuestiones incluidas en nuestro orden del dia con un resultado que por mi parte no pensaba que podriamos lograr en tan poco tiempo. Deseo expresar también mis agradecimientos y felicitaciones a los sefiores V icepresidentes. Este afio nuestra tarea no ha sido facil. El mundo ha cambiado muchisimo desde que nos reunimos el afio pasado en esta misma sala, y al enorme numero de problemas que ya debiamos afrontar se ha afiadido la amenaza de la inseguridad en sus multiples formas. En nuestra bUsqueda de recursos para sacar a millones de personas de la enfermedad de la pobreza extrema tenemos que competir ahora con esta nueva amenaza para la salud humana, lo cual reduce nuestro acceso a unos recursos que ya eran insuficientes. Sin embargo, estoy convencido de que, si los ministros de salud permanecemos unidos, como siempre lo bernos hecho para lograr nuestro objetivo comun de luchar contra las enfermedades, podremos superar este obstaculo con que tropezamos en nuestra noble tarea de trabajar a favor de la salud de nuestros pueblos por conducto de una entidad tan sobresaliente y digna de admiraci6n y orgullosamente nuestra como es la Organizaci6n Mundial de la Salud. En el informe que nos presenta nuestra Directora General, la Dra. Brundtland, se sefialan los progresos realizados durante el ultimo afio. Creo que podemos estar orgullosos de estos enormes avances logrados desde nuestra ultima reunion: ahora podemos estar seguros de que se esta luchando seriamente contra el flagelo de las enfermedades. Por nombrar unas pocas: bernos avanzado considerablemente en la lucha contra el consumo de tabaco y la carga de morbilidad que esto supone, como indica la celebraci6n de diversas reuniones encaminadas a la elaboraci6n del Convenio Marco para el Control del Tabaco. También bernos progresado en la lucha contra el VIH/SIDA, la tuberculosis, el paludismo y el dengue. Nuestra Organizaci6n ha prestado un apoyo técnico y administrativo muy sustancial para la creaci6n del Fondo Mundial que, cuando nos reunimos el afio pasado, solo era una idea y que ahora no es mas un suefio sino una realidad. En sus intervenciones, ustedes se han referido a la necesidad de adoptar un nuevo enfoque con respecto a los riesgos para la salud. Las mesas redondas que hemos celebrado este afio no podian ser mas oportunas. Permitaseme que baga referencia a otro asunto que bernos abordado en el curso de esta semana. Necesitamos saber si nuestras politicas sanitarias seran eficaces, si se aplicaran de manera eficiente y si se permitira lograr que las responsabilidades financieras se distribuyan de manera mas equitativa entre todos. Hemos celebrado muchos debates sobre los medios de encontrar pruebas fehacientes a este respecto. Todo médico sabe que la mejor manera de establecer un diagn6stico diferencial completo es escuchar otras opiniones. Estoy convencido de que el actual debate abierto sobre los medios mas id6neos de aumentar la eficacia de nuestras politicas y sistemas de salud redundara en beneficio de todos. Asimismo, tenemos la dicha de celebrar este afio el centenario de la Organizaci6n Panamericana de la Salud, un acontecimiento de primera magnitud en la historia de la salud publica intemacional y en particular de las Américas. Este afio hemos tenido el honor de escuchar los mensajes de dos eminentes oradores invitados, la Sra. Carol Bellamy, Directora Ejecutiva de UNICEF, y el Profesor Jeffrey Sachs, autoridad intemacional en economia del desarrollo. La Sra. Bellamy destac6 la necesidad de que centremos nuestra atenci6n en las necesidades sanitarias de los nifios y las madres.

ASSNR/10 page 169 El Profesor Sachs nos dijo cuanto nos costaria sacar a millones de personas de la enfermedad de la pobreza; en sus palabras, « 10 céntimos por cada 10 do lares» que done el mun do rico, sera suficiente para llevar adelante estos planes. Confio en que ese llamamiento no caera en oidos sordos. Para resumir, doctora Brundtland, actualmente la salud ocupa un puesto cada vez mas alto entre las prioridades del programa intemacional de desarrollo, pero si queremos sacar a millones de pobres de la pobreza absoluta y lograr que disfruten de la salud que necesitan y merecen, bernos de redoblar nuestros esfuerzos para reforzar esta tendencia. La OMS ha demostrado que sin salud no existe desarrollo. Todos sabemos que sin salud no puede haber paz ni estabilidad, otras dos condiciones fundamentales para el desarrollo. Confio en que emprendamos un nuevo afio de trabajo estimulante y dinamico. Les agradezco la seriedad con que han abordado la labor de esta semana y les deseo que tengan un retomo feliz a sus paises de origen después de un periodo de actividad tan intenso. Muchas gracias y que Dios nos bendiga a todos. Asi pues, en este momento declaro oficialmente clausurada la ssa Asamblea Mundial de la Salud.

The session closed at 14:50. La session est close à 14h50.

A55NR page 171

COMPOSITION DE L'ASSEMBLEE DE LA SANTE MEMBERSHIP OF THE HEALTH ASSEMBLY LISTE DES DELEGUES ET AUTRES PARTICIPANTS LIST OF DELEGATES AND OTHER PARTICIPANTS DELEGATIONS DES ETATS MEMBRES DELEGATIONS OF MEMBER STATES AFGHANISTAN- AFGHANISTAN Chef de délégation - Chief delegate Dr S. Sediq Ministre de la Santé publique Mr G. Sekobe Cluster Manager, Non-Personal Health Services, Department of Health Dr R.E. Mhlanga Cluster Manager, Maternai, Child and Women's Health, Department ofHealth Dr N. Simelela Cluster Manager, HIV/AIDS, Department of Health Dr H.Z. Zokufa Cluster Manager, Pharmaceutical Services, Department of Health Dr T.M. Balfour Head, International Health Liaison, Department of Health Mrs C.C. Kotzenberg Director, Chronic Diseases and Disabilities, Department of Health Mr C.S. Moloto Member of the Executive Council for Health, Northern Province MrG.S. Nene Ambassador, Permanent Representative, Gene va Ms D. Mafubelu Counsellor (Health), Permanent Mission, Geneva Mr L.S. Mngadi Media Liaison Officer to the Minister of Health Mrs P. Lambert Legal Adviser to the Minister of Health

Délégué(s)- Delegate(s) Dr F. Feroz Vice-Ministre de la Santé publique Dr S. Kazemi Ambassadeur, Représentant permanent, Genève

Suppléant(s)- Alternate(s) M. A. Lakhal Secrétaire, Mission permanente, Genève

AFRIQUE DU SUD- SOUTH AFRICA Chef de délégation - Chief delegate Dr M.E. Tshabalala-Msimang Minister of Health

Délégué(s)- Delegate(s) Dr A. Ntsaluba Director-General, Department of Health

Suppléant(s)- Alternate(s) Mrs M.K. Matsau Deputy Director-General, Strategie Health Programme, Department of Health

Conseiller(s)- Adviser(s) Mr R.V. Mabope Special Adviser to the Minister of Health

A55NR page 172

MsN. Khoza Personal Assistant to the Minister of Health OrE. Buch Professor ofHealth Policy and Management, School of Health Systems and Public Health, University of Pretoria

Suppléant(s) -.Alternate(s) Dr M.E.K. Kellou Directeur de la Prévention, Ministère de la Santé et de la Population Professeur N. Zidouni Directeur général, Institut national de Santé publique, Ministère de la Santé et de la Population

ALBANIE- ALBANIA Chef de délégation - Chief delegate

Conseiller(s)- Adviser(s) Professor M. Xhani Minister of Health M. K. Ramoul Conseiller, Mission permanente, Genève M. N.-E. Benfreha Conseiller, Mission permanente, Genève

Délégué(s)- Delegate(s) Mr V. Thanati Ambassador, Permanent Representative, Geneva Professor N. Kac ani University Hospital Centre .

ALLEMAGNE-GERMANY Chef de délégation - Chief delegate Mrs U. Schmidt Federal Minister ofHealth (Chef de délégation du 13 au 14 mai 2002) (Chief delegate from 13 to 14 May 2002)

Suppléant(s)- Alternate(s) Mrs M. Schneider Second Secretary, Permanent Mission, Geneva

Délégué(s)- Delegate(s) ALGERIE- ALGERIA Chef de délégation - Chief delegate M. M.-S. Dembri Ambassadeur, Représentant permanent, Genève Mr W. Lewalter Ambassador, Permanent Representative, Geneva Mr H. VoigtHinder Ministerialdirigent, Federal Ministry of Health (Chef de délégation du 15 au 18 mai 2002) (Chiefdelegate from 15 to 18 May 2002)

Chef adjoint de la délégation - Deputy chief delegate M. A. Kara Mostepha Secrétaire général, Ministère de la Santé et de la Population

Suppléant(s)- Alternate(s) Mr K. Metscher Deputy Permanent Representative, Geneva MrP. Rothen First Counsellor, Permanent Mission, Geneva Dr H. Peitsch Deputy Head of Division GF 03, Division UN Specialised Agencies, Federal Foreign Office

Délégué(s)- Delegate(s) M. M.L. Chergui Directeur d'Etudes chargé des Relations internationales, Ministère de la Santé et de la Population

ASSNR

page 173

MrM. Debrus Head of Division, Multilateral Cooperation in the Field of Health, Federal Ministry ofHealth MrK. Botzet Counsellor, Permanent Mission, Geneva Mrs M. Wesseler Counsellor, Permanent Mission, Geneva Dr C. Luetkens Head of Division, Hesse's Ministry for Energy, Environment, Youth, Family Affairs and Health, Wiesbaden Mrs H. Reemann Federal Centre for Health Education, Cologne Dr R. Korte Head of Division Health, Education, Emergency, Aid, German Agency for Technical Cooperation (GTZ), Eschborn Mrs Langbein Persona! Secretary to the Federal Minister of Health Mrs M. Niemeyer Attaché, Permanent Mission, Geneva Mrs S. Stamme Attaché, Permanent Mission, Geneva Mrs W. Lohmann Attaché, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Mrs M. Coli-Armangué Head, Unit ofEpidemiology, Ministry of Health and Social Welfare MrX. Trota Third Secretary, Permanent Mission, Geneva

ANGOLA- ANGOLA Chef de délégation - Chief delegate Dr A.J. Hamukwaya Ministre de la Santé

Délégué(s)- Delegate(s) M. J.F. Martins Ambassadeur, Représentant permanent, Genève Mme A. Fernandes de Carvalho Directrice nationale de la Santé publique

Suppléant(s)- Alternate(s) M. A.R.M. Neto Directeur, Cabinet d'Echange international Mme E. Pedro Gaspar Assesseur du Ministre de la Santé Mme 1. Neves Coordinatrice de l'Assistance maternelle et infantile Mme S.P. da Silva Conseiller, Mission permanente, Genève M. J.M. N'Dongala Attaché de Presse, Mission permanente, Genève M. A. Sales Deuxième Secrétaire, Ministère des Relations extérieures M. A.Q. Chipilica Chef, Secrétariat du Ministre de la Santé M. J. Tiago Secrétaire, Administration nationale pour l'Enseignement et l'Administration

ANDORRE- ANDORRA Chef de délégation - Chief delegate Mrs M. Codina Minister ofHealth and Social Welfare

Délégué(s)- Delegate(s) Mrs M. Camps-Gallart Secretary of State on Health, Ministry of Health and Social Welfare Mr F. Bonet Ambassador, Permanent Representative, Geneva

A55NR page 174

ANTIGUA-ET-BARBUDA- ANTIGUA ANDBARBUDA Délégué(s)- Delegate(s)

Sr. H. Solari Embajador, Representante Permanente, Ginebra

Suppléant(s)- Alternate(s) Mr S.R. Aymer Special Adviser to the Minister of Health and Social Improvement Dr. C. Vizzotti Subsecretario de Relaciones Sanitarias e Investigaci6n de Salud, Ministerio de Salud Dr. R. Torres Superintendente de Servicios de Salud, Ministerio de Salud Sra. N. Nascimbene de Dumont Representante Permanente Suplente, Ginebra Sra. A. de Hoz Ministro, Misi6n Permanente, Ginebra Sr. M. Valle Fonrouge Consejero, Misi6n Permanente, Ginebra Sr. E. Varela Consejero, Misi6n Permanente, Ginebra Sra. A. Repetti Segundo Secretario, Misi6n Permanente, Ginebra

ARABIE SAOUDITE- SAUDI ARABIA Chef de délégation - Chief delegate Professor O. Shobokshi Minister of Health

Délégué(s)- Delegate(s) Dr R.M. Khalil Adviser to the Minister of Health Dr M.N. Al-Howasi

Suppléant(s)- Alternate(s) Dr Y.Y. AI-Mazrou Assistant Deputy Minister for Preventive Medicine Dr I.A. Al-Showaier

Conseiller(s)- Adviser(s) Mr H.M. AI-Fakhri Mr M.I. Al Agail First Secretary, Permanent Mission, Geneva Mr A.H. Zawawi Pharmacist Dr. F. Vallone Representante de la "Red Mundial de Grupos pro Alimentaci6n Infantil" Sr. R. Leguia Sr. A. Periago Asesor, Misi6n Permanente, Ginebra Srta. C. Periago Asesor, Misi6n Permanente, Ginebra

ARGENTINE- ARGENTINA Chef de délégation - Chief delegate Dr. G. Gonzalez Garcia Ministro de Salud

ARMENIE- ARMENIA Chef de délégation - Chief delegate Mr A. Mkrtchian Minister of Health

Délégué(s)- Delegate(s) Dra. M. Oviedo Senadora Nacional

ASSNR page 175

Chef adjoint de la délégation - Deputy chief delegate Mr Z. Mnatsakanian Permanent Representative, Geneva

AUTRICHE- AUSTRIA Chef de délégation - Chief delegate Professor R. Waneck Secretary of State for Health (Chef de délégation du 13 au 14 mai 2002) (Chief delegate from 13 to 14 May 2002)

Délégué(s)- Delegate(s) Mr T. Samvelian First Secretary, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Dr H. Hrabcik Director-General of Public Health, Federal Ministry for Social Security and Generations Dr F. Pietsch Deputy Director-General of Public Health, Federal Ministry for Social Security and Generations (Chef de délégation du 15 au 18 mai 2002) (Chief delegate from 15 to 18 May 2002)

AUSTRALIE- AUSTRALIA Chef de délégation - Chief delegate Professor R. Smallwood Chief Medical Officer, Department of Health and Aged Care

Délégué(s)- Delegate(s) MrM. Smith Ambassador, Permanent Representative, Geneva Mr T. Kingdon Assistant Secretary, Policy and International Branch, Department of Health and Aged Care

Suppléant(s)- Alternate(s) Dr E. Atzler Deputy Permanent Representative, Geneva Dr V. Gregorich-Schega Head, International Health Relations, Federal Ministry for Social Security and Generations Ms E. Strohmayer Deputy Head, International Health Relations, Federal Ministry for Social Security and Generations Dr J.-P. Klein Deputy Head, Infectious Diseases and Blood Safety, Federal Ministry for Social Security and Generations MrR. Bayer International Health Relations, Federal Ministry for Social Security and Generations

Suppléant(s)- Alternate(s) MrG. Sam Assistant Secretary, Communicable Diseases and Health Protection Branch, Department of Health and Aged Care Mr P. Callan Counsellor (AusAID), Permanent Mission, Geneva Mr B. Eckhardt Director, International Organisations Section, Department of Health and Aged Care Mr L. Brodrick First Secretary, Permanent Mission, Geneva Ms L. D'Cruz Administrative Assistant (AusAID), Permanent Mission, Geneva

AZERBAIDJAN- AZERBAIJAN Chef de délégation -Chief delegate Mr M. Najafov Chargé d'affaires a.i., Permanent Mission, Geneva

ASSNR

page 176

Délégué(s)- Delegate(s) Mr 1. Asadov Third Secretary, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Dr T. Ali Ambassador, Permanent Representative, Geneva

BAHAMAS- BAHAMAS Suppléant(s)- Alternate(s) Chef de délégation - Chief delegate Dr Dahl-Regis ChiefMedical Officer, Ministry ofHealth Professor A.B.M. Ahsan Ullah Director-General of Health Services

Conseiller(s)- Adviser(s) Délégué(s)- Delegate(s) Mrs H. Gray Director of Planning, Public Hospital Authority Mr K.I. Hossain Counsellor, Permanent Mission, Geneva Ms R. Fatima Counsellor, Permanent Mission, Geneva Mrs M. Begum Director (in-Charge), Directorate ofNursing Services MrT. Rahman Third Secretary, Permanent Mission, Geneva

BAHREIN- BAHRAIN Chef de délégation - Chief delegate Dr F.R. Al-Mousawi Minister of Health

Délégué(s)- Delegate(s) BARBADE-BARBADOS Mr S.M. Al-Fehani Ambassador, Permanent Representative, Geneva Mr I.E. Akbari Head, International and Public Relations

Chef de délégation - Chief delegate Mr J. Walcott Minister of Health

Délégué(s)- Delegate(s) Suppléant(s)- Alternate(s) Dr F.S. Al-Kawari Family Physician-in-Charge, Regional Health Centre Mr R.A. Dhaif Director, Office of the Minister ofHealth Mr E. Griffith Ambassador, Permanent Representative, Geneva Miss S. Rudder Deputy Permanent Representative, Geneva

Suppléant(s)- Alternate(s) BANGLADESH-BANGLADESH Chef de délégation - Chief delegate Dr K.M. Hossain Minister ofHealth and Family Welfare Mr L. Weekes Permanent Secretary, Ministry ofHealth Dr B. Miller Chief Medical Officer, Ministry of Health Mrs E. Gabriel ChiefNursing Officer, Ministry ofHealth

A55NR page 177

MsN. Clarke Counsellor, Permanent Mission, Geneva Ms H. Jones First Secretary, Permanent Mission, Geneva

M. J. Dams Adjoint au Directeur de l'Administration des Soins de Santé, Communauté flamande Mme J. Delvaux Adjointe au Directeur, Ministère de la Communauté flamande, Administration politique étrangère, Cellule Organisations multilatérales M. B. Cools Conseiller au Cabinet de Mme le Ministre de la Protection de la Consommation, de la Santé publique et de l'Environnement M. M. Ginter Attaché principal de la Carrière extérieure, Communauté française Wallonie-Bruxelles, Genève M. T. Lahaye Conseiller adjoint, Commission communautaire française de la Région de Bruxelles-Capitale Dr J. Larue Ile Direction générale de la Coopération internationale, Ministère des Affaires étrangères Mme P. Megal Conseiller adjoint, Ministère de la Santé publique Mme L. Meulenbergs Conseiller, Ministère de la Santé publique M. G. Rayée Conseiller, Mission permanente, Genève M. T. Salomonson Attaché, Mission permanente, Genève Mme J. Zikmundova Conseiller, Mission permanente, Genève

BELARUS-BELARUS Chef de délégation - Chief delegate M. V. Malevich Représentant permanent adjoint, Genève

Délégué(s)- Delegate(s) M. E. Yushkevich Conseiller, Mission permanente, Genève

BELGIQUE- BELGIUM Chef de délégation - Chief delegate Mme M. Aelvoet Ministre de la Protection de la Consommation, de la Santé publique et de l'Environnement

Chef adjoint de la délégation- Deputy chief delegate M. J.-M. Noirfalisse Ambassadeur, Représentant permanent, Genève

Délégué(s)- Delegate(s) M. P. Nayer Délégué, Communauté française WallonieBruxelles, Genève

Suppléant(s)- Alternate(s) Dr G. Thiers Directeur, Institut de la Santé publique-Louis Pasteur M. A. Berwaerts Directeur général, Ministère de la Santé publique Mme C. Cacouault Assistante, Communauté française WallonieBruxelles, Genève

Conseiller(s)- Adviser(s) Professeur F. Baro Directeur, Centre collaborateur de l'OMS Santé et Facteurs psychosociaux et biologiques

ASSNR page 178

Professeur Thilly Ecole de Santé publique, Université libre de Bruxelles Professeur E. Wollast Ecole de Santé publique, Université libre de Bruxelles Professeur A. Meheus Université d'Anvers Mme M. Loubriat Ecole de Santé publique, Université libre de Bruxelles

M. B.E. Accrombessi Deuxième Secrétaire, Mission permanente, Genève

BHOUTAN -BHUTAN Chef de délégation - Chief delegate Mr L.S. Ngedup Minister for Health and Education

Délégué(s)- Delegate(s) MrB. Kesang Ambassador, Permanent Representative, Geneva Dr G. Tshering Director, Health Department

BELIZE- BELIZE Chef de délégation - Chief delegate Ms A. Hunt First Secretary, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Ms P. Choden First Secretary, Permanent Mission, Geneva Mr S. Tenzin Second Secretary, Permanent Mission, Geneva MrC. Tenzin Second Secretary, Permanent Mission, Geneva Mr S. Tobgay Second Secretary, Permanent Mission, Geneva Ms Payden Head, Public Health Engineering Section, Department of Health

Délégué(s)- Delegate(s) Ms G. Haselmann

BENIN- BENIN Chef de délégation - Chief delegate Dr Y.C. Kandissounon Seignon Ministre de la Santé publique

Délégué(s)- Delegate(s) M. S. Amehou Chargé d'affaires, Mission permanente, Genève Dr P. Dossou-Togbe Secrétaire général, Ministère de la Santé publique

BOLIVIE- BOLIVIA Chef de délégation - Chief delegate Dr. E. Paz Argandofia Ministro de Salud

Suppléant(s)- Alternate(s) DrD.Yevide Directrice nationale de la Protection sanitaire, Ministère de la Santé publique M.J.Foundohou Directeur, Inspection et Vérification interne, Ministère de la Santé publique

Délégué(s)- Delegate(s) Sr. R. Alba Balderrama Embajador, Representante Permanente, Ginebra Dr. F. Antezana Aranibar Asesor Especial del Sefior Ministro de Salud

ASSNR page 179

Suppléant(s)- Alternate(s) Sr. P. Gumucio Dagron Ministro Consejero, Misi6n Permanente, Ginebra BOSNIE-HERZEGOVINE- BOSNIA AND HERZEGOVINA Chef de délégation - Chief delegate Mr M. Balaban Minister of Health, Republic of Srpska, Bosnia and Herzegovina Délégué(s)- Delegate(s) Mr M. Latinovic Deputy Minister of Health, Republic of Srpska, Bosnia and Herzegovina Mr A. Smajkic Director, Public Health Institute, Bosnia and Herzegovina Suppléant(s)- Alternate(s)

Dr P.N. Mazonde Director of Health, Ministry of Health Suppléant(s)- Alternate(s) DrT. Moeti Deputy Director of Health Services, Ministry ofHealth Mrs K. Mompati Principal Health Officer (Nutrition), Ministry ofHealth Mr G. Pitso Second Secretary, Permanent Mission, Geneva MrMogotsi Third Secretary, Permanent Mission, Geneva BRESIL- BRAZIL Chef de délégation - Chief delegate Mr O. Azevedo Mercadante Vice-Minister ofHealth Délégué(s)- Delegate(s)

Mr M. Vukasinovic Ambassador, Permanent Representative, Geneva Ms R. Bahtijarevic Adviser, Public Health lnstitute, Bosnia and Herzegovina Mrs D. Andelic First Secretary, Permanent Mission, Geneva Mr Z. Pavie Ministry of Health, Republic of Srpska BOTSWANA- BOTSWANA Chef de délégation - Chief delegate Ms J. Phumaphi Minister of Health Délégué(s)- Delegate(s) Mr M. Chakalisa Permanent Secretary, Ministry ofHealth

Mr L.F. de Seixas Corrêa Ambassador, Permanent Representative, Geneva Mrs C.A. do Valle Pereira Deputy Permanent Representative, Geneva Suppléant(s)- Alternate(s) Professor J. Y unes Professor of Public Health, University of Sào Paulo Mr F.S. Duque Estrada Meyer Minister Counsellor, Permanent Mission, Geneva Mr R.B. Costa Filho Deputy National Coordinator for Sexually Transmitted Diseases/AlOS, Ministry of Health Mr J. Barbosa da Silva Jr. Director, National Centre ofEpidemiology, Ministry of He al th

ASSNR

page 180 Mr J.A. Zepeda Bermudez Director, National School of Public Health, Ministry of Health Mr R. Monteleone Neto Director, Department of Sensitive Materials, Ministry of Science and Technology Ms D. Costa Coitinho Coordinator for Feeding and Nutrition, Ministry of Health Mr F.A. da Silva First Secretary, Permanent Mission, Geneva Mr J .A. Dourado Quintaes First Secretary, Permanent Mission, Geneva Mr F. Costi Santarosa Second Secretary, Permanent Mission, Geneva Ms M. Mülser Parada Head, International Affairs Division, Ministry ofHealth Mr P.G. Meireles External Cooperation Sector, National Coordination for Sexually Transmitted Diseases/AIDS, Ministry of Health Mr P. Duarte Cardoso Third Secretary, Permanent Mission, Geneva Mr F .P. Cannabrava Second Secretary, Permanent Mission, Geneva Mr C. Duarte Secretary for Health Policies, Ministry of Health

Délégué(s)- Delegate(s) Dr M.S. Abdullah Specialist Oncologist, Ministry ofHealth

Suppléant(s)- Alternate(s) Dr H.R. Hj Md Said Senior Medical Officer (Epidemiologist), Ministry of Health Mr M. Haji Idris Acting Assistant Director (Administration and Finance), Ministry ofHealth Mr N. Haji Johari Acting Assistant Director (International Affairs ), Ministry of Health Ms R. Kamaludin Second Secretary, Permanent Mission, Geneva

BULGARIE- BULGARIA Chef de délégation - Chief delegate Professor B. Finkov Minister of Health

Chef adjoint de la délégation - Deputy chief delegate Mr D. Tzantchev Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Dr S. Kulaksasow Director, International Cooperation and European Integration, Ministry of Health

BRUNEI DARUSSALAM- BRUNEI DARUSSALAM Chef de délégation - Chief delegate Mr P.A. Aziz Acting Minister of Health

Suppléant(s)- Alternate(s) Mr V. Dontchev Head, Department of International Humanitarian Organizations, Ministry of Foreign Affairs Ms T. Y ovcheva Head of Cabinet ofthe Minister ofHealth Ms B. Djoneva Attaché, Permanent Mission, Geneva

Chef adjoint de la délégation - Deputy chief delegate Mr M.H.M. Jaafar Ambassador, Permanent Representative, Gene va

ASSNR page 181

BURKINA FASO- BURKINA FASO Chef de délégation - Chief delegate

Chef adjoint de la délégation- Deputy chief delegate

M. P.J.E. Tapsoba Ministre de la Santé Délégué(s)- Delegate(s)

Dr Mam Bun Heng Secretary of State for Health Délégué(s)- Delegate(s)

Dr B.K.M. Sombie Conseiller technique du Ministre de la Santé Dr S.D. Zombre Directeur général de la Santé publique Suppléant(s)- Alternate(s)

Dr Mean Chhivun Deputy Director-General for Health Suppléant(s)- Alternate(s)

Dr Sok Touch Director, Department of Communicable Diseases Control Ms Keat Phuong Director, Department ofHuman Resource Development Dr Lo Veasna Kiry Deputy Director, Department of Planning CAMEROUN-CAMEROON

Dr G. Conombo Kafando Directrice de la Santé de la Famille Dr J.A. Tiendrebeogo Secrétaire permanent, Conseil national de Lutte contre le SIDA et les Infections sexuellement transmissibles BURUNDI- BURUNDI

Chef de délégation - Chief delegate Chef de délégation - Chief delegate

DrJ. Kamana Ministre de la Santé publique Délégué(s)- Delegate(s)

M. U. OlanguenaAwono Ministre de la Santé publique Délégué(s)- Delegate(s)

M. A. Nahayo Ambassadeur, Représentant permanent, Genève Dr J.-P. Nyarushasti Directeur général a.i., Ministère de la Santé publique Suppléant(s)- Alternate(s)

M. E.A. Ahana Attaché à la Présidence de la République M. C.C. Tantah Chargé d'affaires a.i., Mission permanente, Genève Suppléant(s)- Alternate(s)

Mme J. Bihotori Premier Conseiller, Mission permanente, Genève CAMBODGE- CAMBODIA Chef de délégation - Chief delegate

Dr B. Yaou Inspecteur général, Ministère de la Santé publique Dr C. Bomba Nkolo Chef, Division de la Coopération, Ministère de la Santé publique Dr E.R. Owona Conseiller technique No. 1, Ministère de la Santé publique

Dr Hong Sun Huot Senior Minister and Minister of Health

A55NR page 1&2

Dr M.L. Baye Conseiller technique No. 2, Ministère de la Santé publique DrJ.R. Ndo Directeur de la Pharmacie et du Médicament, Ministère de la Santé publique Dr B. Kollo Directeur de la Santé communautaire, Ministère de la Santé publique Professeur K. Shiro Secrétaire permanent, Comité national de Lutte contre le SIDA

Conseiller(s)- Adviser(s) MrG. Mar Minister of Health, Province of Alberta Ms S. Ewart-Johnson Deputy Minister ofHealth and Wellness, Province of Alberta DrR. Massé Sous-ministre adjoint à la Santé publique, Province de Québec Dr H. Haddad President, Canadian Medical Association Mrs J. Hutt Senior Programme Manager, Multilateral Branch, Canadian International Development Agency Ms S. Black AIDS Specialist and Interim Senior HIV1 Senior Health Adviser, Policy Branch, Canadian International Development Agency MrC. MacKay Counsellor, Permanent Mission, Geneva Ms M. O'Shea Senior Policy Adviser, United Nations and Commonwealth Affairs Division, Department ofF oreign Affairs and International Trade Ms A. Kapellas Second Secretary, Permanent Mission, Geneva Ms H. Geller Assistant to the Minister of Health Ms F. Mohamed Assistant to the Minister of Health

CANADA- CANADA Chef de délégation - Chief delegate Ms A. McLellan Minister of Health

Délégné(s)- Delegate(s) Mr C. Westdal Ambassador, Alternate Permanent Representative, Geneva Mr I. Green Deputy Minister, Health Canada

Suppléant(s)- Alternate(s) Mr E. Aiston Director-General, International Affairs Directorate, Health Canada Mr I. F erguson Deputy Permanent Representative, Geneva Dr J. Larivière Senior Medical Adviser, International Affairs Directorate, Health Canada Mr D. MacPhee Counsellor, Permanent Mission, Geneva MrM. Methot Director, International Health Division, International Affairs Directorate, Health Canada

CAP-VERT- CAPE VERDE Chef de délégation - Chief delegate M. D.L.R. Dantas dos Reis Ministre de la Santé

ASSNR page 183

Délégué(s)- Delegate(s) M. A.P. Alves Lopes Chargé d'affaires a.i., Mission permanente, Genève Dr E. Santos Directrice, Hôpital "Baptista de Sousa"

Suppléant(s)- Alternate(s) Dr Ren Dequan Deputy Director-General, State Drug Administration Mr Liu Jun Director-General, Shanghai Municipal Health Bureau Dr M. Chan Director, Department of Health, Hong Kong Special Administrative Region Mr Chui Sai On Director, Department of Social Culture, Macao Special Administrative Region Dr Qi Xiaoqiu Director-General, Department of Disease Control, Ministry of Health Dr Shen Zhixiang Director-General, Department of International Cooperation, State Administration of Traditional Chinese Medicine Dr Leung Pak Lin Deputy Director, Department ofHealth, Hong Kong Special Administrative Region Mr Koi Kuok Ieng Director, Department of Health, Macao Special Administrative Region Mr He Jinguo Director, Health Division, Department of Social Security, Ministry of Finance Mr Ren Yisheng Director, Division V, Department of International Organizations and Conferences, Ministry of Foreign Affairs Mr Ding Zhizhuang First Secretary, Department of Hong Kong, Macao and Taiwan Affairs, Ministry of Foreign Affairs Mr Diao Mingsheng Counsellor, Permanent Mission, Geneva

CHILI- CHILE Chef de délégation - Chief delegate Sr. J.E. Vega Embajador, Representante Permanente, Ginebra

Délégué(s)- Delegate(s) Sr. F. Ernst Primer Secretario, Misi6n Permanente, Ginebra Dra. R. Child Jefa, Oficina de Cooperaci6n y Asuntos Internacionales, Ministerio de Salud

Suppléant(s)- Alternate(s) Dr. F. Mufioz Jefe, Division Rectoria y Regulaci6n Sanitaria, Ministerio de Salud Dra. M. Allende Asesora Odontol6gica de Atenci6n Primaria, Ministerio de Salud

CHINE- CHINA Chef de délégation - Chief delegate Dr Zhang Wenkang Minister of Health

Délégué(s)- Delegate(s) Mr Sha Zukang Ambassador, Permanent Representative, Geneva Mr Liu Pei long Director-General, International Cooperation Department, Ministry of Health

ASSNR page 184

Dr Qin Huaijin Secretary, Department of General Administration, Ministry of Health Dr Qi Qingdong Director, Division of Multilateral Relations, Department of International Cooperation, Ministry of Health Ms Wang Yuxun Director, Division of Planning and Priee, Department of Planning and Finance, Ministry ofHealth Dr Zhang Deying Director, Division of Child Health, Department of Primary Health Care and Maternai and Child Care, Ministry of Health Dr Zhang Zongjiu Director, Division of Medical Service Management, Department of Medical Administration, Ministry of Health Dr Zhang Li Deputy Director, Division of Chronic and Non-Communicable Diseases, Department of Disease Control, Ministry of Health

Mr Tan Jian Counsellor, Permanent Mission, Geneva Mr Zhou Jian Counsellor, Permanent Mission, Geneva Mrs Liang Bizhen First Secretary, Permanent Mission, Geneva Mrs Han Li First Secretary, Permanent Mission, Geneva MrLongZhou Second Secretary, Permanent Mission, Geneva Mrs Lan Mei Second Secretary, Permanent Mission, Geneva

CHYPRE- CYPRUS Chef de délégation - Chief delegate Mr F. Savvides Minister of Health

Délégué(s)- Delegate(s) Mr A. Vikis Ambassador, Permanent Representative, Geneva Mrs C. Komodiki Chief Health Officer, Ministry of Health

Conseiller(s)- Adviser(s) Dr Lei Chin Ion Director, S.J. Anuario Hospital, Macao Special Administrative Region Ms Zhong Yi Consultant, Director Office, Department of Social Culture, Macao Special Administrative Region Mr Lo Chee Ping Special Assistant to Director, Department of Social Culture, Macao Special Administrative Region Mr Liu Guangyuan Assistant Consultant, Division of Multilateral Relations, Department of International Cooperation, Ministry of Health Mr Shen Y ongxiang Counsellor, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Ms F.-G. Lanitou-Williams Deputy Permanent Representative, Geneva Ms E. Mina Second Secretary, Permanent Mission, Geneva

Conseiller(s)- Adviser(s) Mr A. Vasiliou President, Pancyprian Medical Association Mrs A. Tapakoudi President, Cyprus Nurses Association

ASSNR page 185

COLOMBIE- COLOMBIA Chef de délégation - Chief delegate Dr. G.E. Riveros Duefias Ministro de Salud

Délégué(s)- Delegate(s) M. R.J. Menga Ambassadeur, Représentant permanent, Genève Dr D. Bodzongo Directeur général de la Santé

Chef adjoint de la délégation- Deputy chief delegate Sr. C. Reyes Rodriguez Embajador, Representante Permanente, Ginebra

Suppléant(s)- Alternate(s) M. P.H. Kengouyat Conseiller Juridique Dr A. Enzanza Conseiller, Ministère de la Santé et de la Solidarité M. J. Biabaroh-Iboro Ministre conseiller, Mission permanente, Genève Mme D. Bikouta Premier Conseiller, Mission permanente, Genève Mme V .A. Ossie Ministère de la Santé M. J.F. Boyabe Ministère de la Santé

Délégué(s)- Delegate(s) Dr. J. Boshell Samper Director General, Instituto Nacional de Salud

Suppléant(s)- Alternate(s) Sra. F .E. Benavides Cotes Ministro Plenipotenciario, Misi6n Permanente, Ginebra

COMORES- COMOROS Chef de délégation - Chief delegate M. M. Michami Ministre de la Santé publique, des Affaires sociales et de la Condition féminine

COSTA RICA- COSTA RICA Délégué(s)- Delegate(s) Chef de délégation - Chief delegate Dr A. Msa Mliva Directeur général de la Santé publique, Ministère de la Santé publique, des Affaires sociales et de la Condition féminine M. A. Chaibou Bedja Conseiller technique chargé de la Coopération Dr. E. L6pez Cârdenas V iceministro de Salud

Délégué(s)- Delegate(s) Sra. N. Ruiz de Angulo Embajadora, Representante Permanente, Ginebra Sra. C. Claramunt Garro Representante Permanente Suplente, Ginebra

CONGO- CONGO Chef de délégation - Chief delegate M. L.A. Opimbat Ministre de la Santé, de la Solidarité et de l'Action humanitaire

Suppléant(s)- Alternate(s) Sr. A. Solano Ortiz Ministro Consejero, Misi6n Permanente, Ginebra

A55NR page 186

Sr. S. Corella Ministro Consejero, Misi6n Permanente, Ginebra

Conseiller(s)- Adviser(s) Mme J.T. Saracino Conseiller spécial du Président de la République pour les Questions de Santé M. L. Sanou Conseiller technique auprès du Conseiller spécial du Président de la République

COTE D'IVOIRE- COTE D'IVOIRE Chef de délégation - Chief delegate Professeur R. Abouo-N'Dori Ministre de la Santé publique

CROATIE- CROATIA Chef adjoint de la délégation - Deputy chief delegate M. C. Beke Dassys Ambassadeur, Représentant permanent, Genève

Chef de délégation - Chief delegate Dr A. Vlahusié Minister of Health

Délégué(s)- Delegate(s) M. A. Kouadio Komoe Conseiller spécial du Ministre de la Santé publique

Chef adjoint de la délégation - Deputy chief delegate Ms S. Cek Ambassador, Permanent Representative, Geneva

Suppléant(s)- Alternate(s) Professeur F. Aoussi Eba Conseiller technique du Ministre de la Santé publique, Chargé des Programmes de Luttre contre le VIHISIDA et autres Pathologies infectieuses et parasitaires Professeur J. Andoh Directeur général des Prestations Dr C.N. Adjobi Directeur, Coordonnateur du Programme national de Santé infantile Dr C. Anderson Koua Directeur, Coordonnateur du Programme élargi de Vaccination Dr C. Kounandi Directeur, Inspection de la Médecine du Travail, Ministère du Travail, de la Fonction publique et de la Réforme administrative Mme R. Assi Gbonon Directeur de la Pharmacie et du Médicament M. J.K. Weya Premier Conseiller, Mission permanente, Genève

Conseiller(s)- Adviser(s) Dr D. Skoko-Poljak Senior Adviser, Ministry of Health Mr C. Grbesa Third Secretary, Permanent Mission, Geneva

CUBA-CUBA Chef de délégation - Chief delegate Sr. E. Comendeiro Viceministro de Salud Publica

Chef adjoint de la délégation - Deputy chief delegate Sr. J.I. Mora Godoy Embajador, Representante Permanente, Ginebra

Délégué(s)- Delegate(s) Dr. A. Gonzalez Femandez Director, Relaciones Intemacionales, Ministerio de Salud Publica

ASSNR page 187

Suppléant(s)- Alternate(s) Dr. C. Ord6fiez Director, Policlfnico "Plaza", Ministerio de Salud Publica Sra. B. Feliu Escalona Jefa Nacional de Enfermeras, Ministerio de Salud Publica Sra. A. Rodriguez Camejo Segundo Secretario, Misi6n Permanente, Ginebra Sr. A. Castillo Santana Tercer Secretario, Misi6n Permanente, Ginebra

Mme M. Kristensen Consultant, Administration de la Santé publique

Conseiller(s)- Adviser(s) M. K. Geil Secrétaire particulier du Ministre de l'Intérieur et de la Santé Dr S. Poulsen Ministère de l'Intérieur et de la Santé

DJIBOUTI- DJIBOUTI Chef de délégation - Chief delegate Dr M.A. Kamil Ministre de la Santé

DANEMARK-DENMARK Chef de délégation - Chief delegate

Délégué(s)- Delegate(s) M. L.L. Rasmussen Ministre de l'Intérieur et de la Santé Dr S.B. Tourab Secrétaire général, Ministère de la Santé

Délégué(s)- Delegate(s) DOMINIQUE- DOMINICA M. 1. Valsborg Secrétaire général, Ministère de l'Intérieur et de la Santé Dr J.K. G0trik Directeur général de la Santé publique

Chef de délégation - Chief delegate Mr H. Sabaroche Minister for Health and Social Security

Délégué(s)- Delegate(s) Suppléant(s)- Alternate(s) M. H.R. Iversen Ambassadeur, Représentant permanent, Genève M. M. J0rgensen Directeur, Ministère de l'Intérieur et de la Santé Mme L. Garval Chef de Section, Ministère des Affaires étrangères M. S. Thomsen Chef de Section, Ministère de l'Intérieur et de la Santé M. M.B. Jensen Secrétaire d'Ambassade, Mission permanente, Genève Dr R. Radix Chief Medical Officer, Ministry for Health and Social Security Dr J .E. Green Assistant Secretary-General, CARICOM Secretariat

Suppléant(s)- Alternate(s) Dr J. St. Catherine Programme Manager, Health Sector Development, CARICOM Secretariat

EGYPTE- EGYPT Chef de délégation - Chief delegate Dr M.A.A. Tag-El-Din Minister of Health and Population

ASSNR page 188

Délégué(s)- Delegate(s) MrsN. Gabr Ambassador, Permanent Representative, Geneva Dr M.N. El-Tayeb Professor ofRheumatology and Rehabilitation, Faculty of Medicine, Heliopolis University

EMIRATS ARABES UNIS- UNITED ARAB EMIRATES Chef de délégation - Chief delegate Dr H.A.R. Al-Madfaa Minister of Health

Délégué(s)- Delegate(s) Mr H.A. Al-Alkeem Under-Secretary, Ministry ofHealth Mr S. Al Aboodi Ambassador, Permanent Representative, Geneva

Suppléant(s)- Alternate(s) Dr H.A.A. Zaher Director, Technical Support Office, Ministry of Health and Population Dr I.A.M. Hamed Ministry of Health and Population Mr H. Selim Labib Counsellor, Permanent Mission, Geneva Mr K. Abdel Hamid Counsellor, Permanent Mission, Geneva Mr M. Mounir Loutfy Third Secretary, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Dr M. Fikri Assistant Under-Secretary for Preventive Medicine, Ministry of Health Mr N.K. Al-Bdour Assistant Under-Secretary for External Relations and International Health Mr A.R.Y. Abdullah Managing Director, International Gulf Pharmaceutical Company Mr S.A. Al-Naeemi Director-General, International Gulf Pharmaceutical Company Drug Store Dr Z. Khaz'al Preventive Medicine Expert, Ministry of Health Dr A. Al-Kattami Specialist, Seifben Ghabbash Hospital Mr A.H.S. Al-Hamoud Head, Section of External Affairs

EL SALVADOR-EL SALVADOR Chef de délégation - Chief delegate Dr. J.F. L6pez Beltnin Ministro de Salud Publica y Asistencia Social

Délégué(s)- Delegate(s) Sr. E.M. Ramos Falla Director, Instituto Salvadorefio del Seguro Social Sr. V.M. Lagos Pizzati Embajador, Representante Permanente, Ginebra

Suppléant(s)- Alternate(s) Sr. M.E. Castro Grande Ministro Consejero, Misi6n Permanente, Ginebra

EQUATEUR-ECUADOR Chef de délégation - Chief delegate Dr. P. Jamriska Ministro de Salud Publica

ASSNR page 189

Délégué(s)- Delegate(s) Dr. C. Cepeda Subsecretario de Salud Sr. R. Paredes Representante Permanente Suplente, Ginebra

Suppléant(s)- Alternate(s) Sr. M. Pérez del Arco Asesor, Secretaria General de Asuntos Exteriores, Ministerio de Asuntos Exteriores Sr. A. Ric6n Palenciano Director, Gabinete de la Sefiora Ministra de Sanidad y Consumo Sr. O. Quintana Trias Subdirector General de Relaciones Intemacionales, Ministerio de Sanidad y Con sumo Sr. J .L. Consamau Guardiola Consejero, Misi6n Permanente, Ginebra Sra. 1. de la Mata Barranco Subdirectora General de Programas Sanitarios, Sociosanitarios, Acreditaci6n Calidad y Prestaciones, Ministerio de Sanidad y Consumo Sr. A. Rodriguez Alvarez Subdirector General de Asistencia y Prestaci6n Farmacéutica, Ministerio de Sanidad y Consumo Sra. J. Gonzâlez Alonso Subdirectora General de Promoci6n de la Salud y Epidemiologia, Ministerio de Sanidad yConsumo Sr. F. Parras Vâsquez Secretario, Plan Nacional sobre el SIDA, Ministerio de Sanidad y Consumo Sra. C. Grau Oliver Subdirectora General de Epidemiologia y Centros Nacionales de Salud Publica, Ministerio de Sanidad y Consumo Sr. J.M. Martinez Ruiz Director de Comunicaci6n, Ministerio de Sanidad y Consumo Dr. J. Lozano Olivares Consejero de Direcci6n, Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo

Suppléant(s)- Alternate(s) Sr. J. Valencia Ministro, Misi6n Permanente, Ginebra Sr. A. Cabrera Primer Secretario, Misi6n Permanente, Ginebra

ERYTHREE- ERITREA Chef de délégation - Chief delegate Mr S.S. Meky Minister of Health

Délégué(s)- Delegate(s) Ms A. Gebresellassie Head, Information, Education and Communication Unit, Ministry of Health Mr W.-Y. Berekit Eritrean Council, Geneva

ESPAGNE- SPAIN Chef de délégation - Chief delegate Sra. C. Villalobos Talero Ministra de Sanidad y Consumo

Chef adjoint de la délégation - Deputy chief delegate Sr. R. Moreno Palanques Secretario General de Gestion y Cooperaci6n Sanitaria, Ministerio de Sanidad y Consumo

Délégué(s)- Delegate(s) Sr. J. Pérez-Villanueva y Tovar Embajador, Representante Permanente, Ginebra

ASSNR page 190

Dra. O. Tello Anchuela Directora, Centro Nacional de Epidemiologia, Ministerio de Sanidad y Consumo Dra. M.L. Garcia Tufion Jefa de Servicio, Subdirecci6n General de Relaciones Internacionales, Ministerio de Sanidad y Consumo Sra. E. Rodriguez Machado Jefa de Servicio, Subdirecci6n General de Relaciones Internacionales, Ministerio de Sanidad y Consumo

Suppléant(s)- Alternate(s) Dr J. Chow Deputy Assistant Secretary for International Health and Science, Bureau of Oceans, International Environmental and Scientific Affairs, Department of State Dr W.R. Steiger Special Assistant to the Secretary for International Affairs, Department of Health and Human Services

Conseiller(s)- Adviser(s) ESTONIE- ESTONIA Chef de délégation - Chief delegate Mr C. Kull Ambassador, Permanent Representative, Geneva Dr K. Bernard Special Adviser for National Security, Intelligence and Defense, Department of Health and Human Services Ms A. Blackwood Director for Health Programs, Bureau of International Organization Affairs, Department ofState Ms L. Conlin Assistant Secretary for Trade Development, Department of Commerce Dr D. Fleming Acting Director, Centers for Disease Control and Prevention, Department of Health and Human Services Dr J. Heiby Senior Technical Adviser, US Agency for International Development Mr D.E. Hohman Health Attaché, Permanent Mission, Geneva Mr D. Keating Office of the US Trade Representative, Permanent Mission, Geneva Ms L. Oliphant Executive Director, President's Council on Physical Fitness, Department of Health and Human Services MrT.M. Peay Legal Adviser, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Mr H. Danilov Secretary-General, Ministry of Social Affairs Ms K. Saluvere Deputy Secretary-General, Ministry of Social Affairs

Suppléant(s)- Alternate(s) Ms M. Kokajev First Secretary, Permanent Mission, Geneva

ETATS-UNIS D' AMERIQUE- UNITED STATES OF AMERICA Chef de délégation - Chief delegate Mr T.G. Thompson Secretary of Health and Human Services

Chef adjoint de la délégation - Deputy chief delegate Mr K.E. Moley Ambassador, Permanent Representative, Geneva

A55NR page 191

Ms C. Sim Political Counsellor, Permanent Mission, Geneva Mr S. Simonson Deputy General Counsel, Office of General Counsel, Department of Health and Human Services Dr E.E. Slater Assistant Secretary for Health, Department of Health and Human Services Mr C. Stonecipher First Secretary, Permanent Mission, Geneva Ms M.L. Valdez Associate Director for Multilateral Affairs, Office of Global Health Affairs, Department of Health and Human Services MrB. Wood Chief of Staff, Immediate Office of the Secretary, Department ofHealth and Human Services Dr S. Ferenc Senior Science Adviser, Grocery Manufacturers of America Dr F. Kaufman President-Elect, American Diabetes Association Dr Z.P. Zachariah Director of Cardiology, Holy Cross Hospital, Fort Lauderdale

Suppléant(s)- Alternate(s) Mr S. Taffesse Expert Adviser, Ministry of Health Mr S. Mengesha Counsellor, Permanent Mission, Geneva MrO. Owar First Secretary, Permanent Mission, Geneva

EX-REPUBLIQUE YOUGOSLAVE DE. MACEDOINE- THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA Chef de délégation - Chief delegate Dr O. Orovcanec Minister of Health

Délégué(s)- Delegate(s) Ms D. Zafirovska Chargé d'affaires, Permanent Mission, Geneva Dr A. Cibisev State Secretary, Ministry ofHealth

Suppléant(s)- Alternate(s) Ms S. Cicevalieva Head, Department for European Integration and International Cooperation, Ministry of Health Dr B. J osifovski Head, Department for Primary and Preventive Health Care, Ministry of Health MrN. Xaferi Second Secretary, Permanent Mission, Geneva Mr G. Atanasov Third Secretary, Permanent Mission, Geneva

ETHIOPIE- ETHIOPIA Chef de délégation - Chief delegate Dr Kebede T. Minister of Health

Délégué(s)- Delegate(s) MrF. Yimer Ambassador, Permanent Representative, Geneva DrGirmaA. Head, Planning Division, Ministry of Health

FEDERATION DE RUSSIE- RUSSIAN FEDERATION Chef de délégation - Chief delegate Professor Y .L. Shevchenko Minister of Health

A55NR page 192

Chef adjoint de la délégation - Deputy chief delegate Mr L.A. Skotnikov Ambassador, Permanent Representative, Geneva Délégué(s)- Delegate(s) Dr S.M. Furgal Chief, International Relations Department, Ministry of Health Suppléant(s)- Alternate(s) Mr A.V. Pirogov Deputy Permanent Representative, Geneva Conseiller(s)- Adviser(s)

Mr S.V. Bychkov Attaché, Permanent Mission, Geneva FIDJI-FIJI Chef de délégation - Chief delegate Mr P.K. Nacuva Minister ofHealth Délégué(s)- Delegate(s) Mr L. Rokovada Permanent Secretary for Health Dr T. Tuiketei Assistant Director, Primary and Preventive Health Services, Ministry of Health FINLANDE- FINLAND

Mr A.M. Taranov Director, Federal Medical Insurance Fund Dr A.V. Pavlov Deputy Chief, Department of International Cooperation, Ministry of Health Mr V .K. Rjazancev Head, Department of Cooperation with CIS, WHO and other International Organizations, Department of International Cooperation, Ministry of Health Mr V .M. Zimjanin Chief Adviser, International Organizations Department, Ministry of Foreign Affairs Mr A.A. Pankin Senior Counsellor, Permanent Mission, Geneva Mr N.N. Fetisov Counsellor, Permanent Mission, Geneva Mr P.G. Chernikov Counsellor, Permanent Mission, Geneva Mr N.N. Sikachev Counsellor, Permanent Mission, Geneva Mr A.V. Markov Second Secretary, Permanent Mission, Geneva

Chef de délégation - Chief delegate MrM. Lehto Permanent Secretary, Ministry of Social Affairs and Health Délégué(s)- Delegate(s) Mr P. Huhtaniemi Ambassador, Permanent Representative, Geneva Mr J. Eskola Director-General, Department for Family and Social Affairs, Ministry of Social Affairs and Health Suppléant(s)- Alternate(s) Ms M. Blanco Sequeiros Deputy Director-General, Health Department, Ministry of Social Affairs and Health Ms L. Ollila Ministerial Adviser, International Affairs Unit, Ministry of Social Affairs and Health MrT. Melkas Director, Health Department, Ministry of Social Affairs and Health

ASSNR page 193

Ms R. Resch Director, Unit for United Nations Affairs, Ministry for Foreign Affairs Ms A. Vuorinen Minister Counsellor, Permanent Mission, Geneva Ms T. Mikkola Senior Adviser, Health Department, Ministry of Social Affairs and Health Mr P. Jarvinen Ministerial Adviser, Legal Affairs, Health Department, Ministry of Social Affairs and Health

MrP. Lôv Member of Parliament Ms R. Vahasalo Member of Parliament Ms S. Korhonen Permanent Mission, Geneva

FRANCE-FRANCE Chef de délégation - Chief delegate M. B. Kessedjian Ambassadeur, Représentant permanent, Genève

Conseiller(s)- Adviser(s) Ms G. Blumenthal Health and Population Adviser, Unit for Sectoral Policy, Ministry for Foreign Affairs Ms V. Heikkinen Counsellor (Development Cooperation), Unit for United Nations Development Issues, Ministry for Foreign Affairs Ms K. Haikiô Counsellor, Permanent Mission, Geneva Mr A. Uutela Chief ofLaboratory, National Public Health Institute Ms L. Valjento Counsellor, Unit for United Nations Affairs, Ministry for Foreign Affairs Ms A. Milén Special Adviser, European Union Northern Dimension, National Research and Development Centre for Welfare OrO. Ela National Research and Development Centre for Welfare Ms E. Mlikiplili Member of Parliament Mr T. Ihamaki Member of Parliament

Chef adjoint de la délégation- Deputy chief delegate Professeur L. Abenhaim Directeur général de la Santé, Ministère de l'Emploi et de la Solidarité

Délégué(s)- Delegate(s) M.F. Saint-Paul Représentant permanent adjoint, Genève

Suppléant(s)- Alternate(s) M. J. Maire Délégué aux Affaires européennes et internationales, Ministère de l'Emploi et de la Solidarité M. J.-B. Brunet Directeur général de la Santé, Ministère de l'Emploi et de la Solidarité MmeF.Auer Conseiller, Mission permanente, Genève Mme C. Feuillet Conseiller des Affaires étrangères, Direction des Nations Unies et des Organisations internationales, Ministère des Affaires étrangères M. P. Chevit Directeur, Ecole nationale de la Santé publique

ASSNR page 194

Mme M.-C. Coent Délégation aux Affaires européennes et internationales, Ministère de l'Emploi et de la Solidarité Mme A. Pinteaux Délégation aux Affaires européennes et internationales, Ministère de l'Emploi et de la Solidarité Mme A. Castera Mission permanente, Genève M. P. Dedryver Mission permanente, Genève Mme 1. Jahan Ahmed Mission permanente, Genève

M. E.A. Lengota Attaché de Cabinet du Ministre de la Santé publique

GAMBIE- GAMBIA Chef de délégation - Chief delegate Dr Y. Kassama Secretary of State for Health and Social Welfare

Délégué(s)- Delegate(s) Mr A.M. Njie Permanent Secretary, Department of State for Health and Social Welfare Dr O. Sam Director of Medical Services

GABON- GABON Chef de délégation - Chief delegate M. F. Boukoubi Ministre de la Santé publique

GEORGIE- GEORGIA Chef de délégation - Chief delegate Dr A. Gamkrelidze Minister of Labour, Health and Social Affairs

Chef adjoint de la délégation - Deputy chief delegate Mme Y. Biké Ambassadeur, Représentant permanent, Genève

Délégué(s)- Delegate(s) Mr A. Kavadze Ambassador, Permanent Representative, Geneva Dr M. Gudushauri First Deputy Minister of Labour, Health and Social Affairs

Délégué(s)- Delegate(s) Professeur P.A. Kombila Koumba Directeur général de la Santé

Suppléant(s)- Alternate(s) Dr G. Malonga Mouele Directeur, Plan national de Lutte contre le SIDA et les Maladies sexuellement transmissibles Dr M. Toung Mve Responsable, Programme Tuberculose Mme M. Angone Abena Conseiller, Mission permanente, Genève Mme M. Epoulou Modiya Chef, Centre de Nutrition, Ministère de la Santé publique

Suppléant(s)- Alternate(s) Mr K. Edilashvili First Secretary, Permanent Mission, Geneva

GHANA- GHANA Chef de délégation - Chief delegate Dr K. Afriyie Minister of Health

ASSNR page 195

Chef adjoint de la délégation - Deputy chief delegate Mr F. Poku Ambassador, Permanent Representative, Geneva

GRENADE- GRENADA Délégué(s)- Delegate(s) Dr C.M. Modeste-Curwen Minister of Health and the Environment

Délégué(s)- Delegate(s) Professor A.B. Akosah Director-General, Ghana Health Service

GUATEMALA- GUATEMALA Chef de délégation - Chief delegate Dr. M.R. Bolafios Duarte Ministro de Salud Publica y Asistencia Social

Suppléant(s)- Alternate(s) DrK.Ahmed Chief Medical Officer, Ministry ofHealth Mrs S. Abdul-Salaam Director, Ministry of Health Mrs A. A. Twum-Amoah Counsellor, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Sr. A. Arenales Forno Embajador, Representante Permanente, Ginebra Dr. 1. Lemus Bojorquez Director, Sistema Integral de Atenci6n en Salud, Ministerio de Salud Publica y Asistencia Social

GRECE- GREECE Chef de délégation - Chief delegate Mr H. Nasiokas Deputy Minister ofHealth and Welfare

Suppléant(s)- Alternate(s) Sr. H.I. Espinoza Ministro Consejero, Misi6n Permanente, Ginebra Srta. S. Hochstetter Primer Secretario, Misi6n Permanente, Ginebra

Délégué(s)- Delegate(s) Mr T. Kriekoukis Ambassador, Permanent Representative, Geneva Dr M. Violaki-Paraskeva Honorary Director-General, Ministry of Health and Welfare

GUINEE- GUINEA Chef de délégation - Chief delegate Professeur M. S. Diallo Ministre de la Santé publique

Suppléant(s)- Alternate(s) Mr T. Sapounas Director, Public Health Division, Ministry of Health and Welfare Dr A. Milios Counsellor, Permanent Mission, Geneva Mrs M. Liodaki Ministry ofHealth and Welfare

Délégué(s)- Delegate(s) Dr M. Barry Directeur national de la Santé publique

Suppléant(s)- Alternate(s) Dr J .L. Austin Conseiller à la Coopération, Ministère de la Santé publique

A55NR page 196

M. B.M. Camara Chargé d'affaires a.i., Genève

GUINEE-BISSAU- GUINEA-BISSAU Chef de délégation - Chief delegate Dr A.S. Embalo Ministre de la Santé publique

Dr F. Lemoine Assistant Directeur, Direction de la Planification et de la Coopération externe, Ministère de la Santé publique et de la Population Dr J. Deas Coordonnateur des Infections sexuellement transmissibles et du SIDA, Ministère de la Santé publique et de la Population M. E.L. Joseph Ministre conseiller, Mission permanente, Genève

Délégué(s)- Delegate(s) Dr J. Sa Nogueira Direction générale de la Santé publique M. R.A. Ferreira Cacheu Conseiller du Ministre de la Santé publique pour la Politique de Santé et la Coopération

HONDURAS-HONDURAS Chef de délégation - Chief delegate Sra. G. Bu Figueroa Consejero, Misi6n Permanente, Ginebra

GUYANA- GUYANA Délégué(s)- Delegate(s)

Délégué(s)- Delegate(s) Dr L. Ramsammy Minister of Health Sr. C. L6pez Escobar Consejero, Misi6n Permanente, Ginebra Sra. K. Cis Rosales Segundo Secretario, Misi6n Permanente, Ginebra

HAITI- HAITI Chef de délégation - Chief delegate Dr H.-C. Voltaire Ministre de la Santé publique et de la Population

HONGRIE- HUNGARY Chef de délégation - Chief delegate

Délégué(s)- Delegate(s) Dr C. Surena Directeur de Cabinet du Ministre de la Santé publique et de la Population M. J. Hilaire Chargé d'affaires, Mission permanente, Genève DrG. Pulay State Secretary, Ministry ofHealth

Délégué(s)- Delegate(s) Dr H. Pava Deputy State Secretary, Ministry ofHealth Mr A. Szab6 Ambassador, Permanent Representative, Geneva

Suppléant(s)- Alternate(s) Dr H. Derenoncourt Cabinet du Ministre de la Santé publique et de la Population

Suppléant(s)- Alternate(s) Mrs K. Novak Head of Department, Ministry of Health

A55NR page 197

Dr A. Radnai Head of Department, National Public Health and Medical Officer's Service Dr A. Nyikos Second Secretary, Permanent Mission, Geneva Dr E. Mosolits Assistant

ILES SALOMON- SOLOMON ISLANDS Chef de délégation - Chief delegate Ms A. Taneko Minister for Health and Medical Services

Chef adjoint de la délégation - Deputy chief delegate Dr G. Muanimu Permanent Secretary, Ministry of Health and Medical Services

ILES COOK- COOK ISLANDS Chef de délégation - Chief delegate Mr V. Vaevae-Pare Minister of Health

Délégué(s)- Delegate(s) Dr G. Malefoasi Under-Secretary, Health Care, Ministry of Health and Medical Services

Délégué(s)- Delegate(s) MrT. Araiti Secretary of Health Dr J. Williams Ad viser, Ministry of Health

INDE-INDIA Chef de délégation - Chief delegate Dr C.P. Thakur Minister ofHealth and Family Welfare

Suppléant(s)- Alternate(s) Dr R. Daniel Health Manager

Délégué(s)- Delegate(s) Mr S.K. Naik Secretary, Department ofHealth, Ministry of Health and Family Welfare Mrs M. Sinha Secretary, Department oflndian System of Medicine and Homeopathy, Ministry ofHealth and Family Welfare

ILES MARSHALL- MARSHALL ISLANDS Chef de délégation - Chief delegate Mr A.T. Jacklick Minister of Health and Environment

Chef adjoint de la délégation - Deputy chief delegate Mr D.F. Capelle Secretary of Health, Ministry of Health and Environment

Suppléant(s)- Alternate(s) Dr S.P. Agarwal Director-General of Health Services, Ministry ofHealth and Family Welfare MrH.S. Puri Ambassador, Permanent Representative, Geneva Mr S. Sabharwal Deputy Permanent Representative, Geneva Mr S. Ranjan Private Secretary to the Minister of Health and Family Welfare

Délégué(s)- Delegate(s) Mr J.J.T. Santos National Health Planner, Ministry ofHealth and Environment

A55NR page 198

MrK. Tuhin First Secretary, Permanent Mission, Geneva Mr A. Srivastava Third Secretary, Permanent Mission, Geneva Mr A.K. Jha Deputy Secretary, Ministry ofHealth and Family Welfare Dr S.K. Sharma Govemment of lndia Service MrB. Mukund Govemment of lndia Service Dr H.R. Nagendra Govemment of India Service Dr D. Triguna Govemment of ln dia Service Mrs G. Pauranik Govemment of lndia Service

Dr S. Achmad Deputy Director-General for Communicable Disease Control and Environmental Health, Department of Health Mrs L.S. Slamet Deputy ofTherapeutic Product Control, The National Agency ofDrug and Food Control, Ministry of Health DrR. Masrun Head of Provincial Health District of East Kalimantan, Ministry of Health Dr S. Soeparan Head of Planning Bureau, Ministry ofHealth Mrs W. Parmono Head of Assistant, Provincial Health District of the Special Territory of the Capital City of Jakarta, Ministry ofHealth DrH. Yusa Director, Persahabatan General Hospital Ms A.Y.S. Hamid Head, Indonesian National Nurses Association Mrs N. Bahaudin Chief, Division of International Cooperation, Bureau of Planning, Ministry of Health Mr 1. Wiranataatmadja Minister Counsellor, Permanent Mission, Geneva Mr A.P. Sarwono First Secretary, Permanent Mission, Geneva Mr S. Satradiredja First Secretary, Permanent Mission, Geneva Mr B. Nugroho Second Secretary, Permanent Mission, Geneva

INDONESIE- INDONESIA Chef de délégation- Chief delegate Dr A. Sujudi Minister of Health

Chef adjoint de la délégation - Deputy chief delegate Mr N. Wisnumurti Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) MrSampumo Head, The National Agency ofDrug and Food Control, Ministry of Health

Suppléant(s)- Alternate(s) Mr D. Kasri Deputy Permanent Representative, Geneva Professor A. Azwar Director-General of Community Health, Ministry of Health

IRAN (REPUBLIQUE ISLAMIQUE D')IRAN (ISLAMIC REPUBLIC OF) Chef de délégation - Chief delegate Dr M. Pezeshkian Minister ofHealth, Treatment and Medical Education

ASSNR page 199

Délégué(s)- Delegate(s) Dr M.R. Alborzi Ambassador, Permanent Representative, Geneva

Dr S.N. Salim Ministère de la Santé

Suppléant(s)- Alternate(s) Dr K.O. Habib Ministère de la Santé Dr A.H. Ismail Directeur, Centre de Recherche et d'Immunologie, Ministère de la Santé M. S.A.O. Hussain Conseiller, Mission permanente, Genève M. G .F. Askar Premier Secrétaire, Mission permanente, Genève

Suppléant(s)- Alternate(s) Dr N. Pirmoazen Member of Parliament, Health Commission Dr M.E. Akbari Deputy Minister of Health, Treatment and Medical Education Mr A.A. Mojtahed Shabestari Deputy Permanent Representative, Geneva Dr B. Sadrizadeh Adviser to the Minister of Health, Treatment and Medical Education Dr M.S. Farahani Director-General for Public and International Affairs, Ministry of Health, Treatment and Medical Education Mr A. Bonakdar Deputy Director for Specialized Agencies, Ministry of Foreign Affairs Mr P. Seadat First Secretary, Permanent Mission, Geneva Mr M.N. Verzani Ministry of Health, Treatment and Medical Education Mr R. Pourmand-Tehrani First Secretary, Permanent Mission, Geneva

IRLANDE- IRELAND Chef de délégation - Chief delegate Ms M. Whelan Ambassador, Permanent Representative, Geneva

Chef adjoint de la délégation - Deputy chief delegate Dr J. Kiely Chief Medical Officer, Department ofHealth and Children

Délégué(s)- Delegate(s) MrC. Keenan Department of Health and Children

Suppléant(s)- Alternate(s) Ms M. Aylward Department of Health and Children Ms M. O'Connor Department of Health and Children Mr D. McCarthy Department of Health and Children Ms S. Sexton Department of Health and Children

IRAQ-IRAQ Chef de délégation - Chief delegate Dr O.M. Mubarak Ministre de la Santé

Délégué(s)- Delegate(s) M. S.K. AI-Nima Ambassadeur, Représentant permanent, Genève

A55NR page 200

Mr E. MacAodha Deputy Permanent Representative, Geneva MrB. Ardiff Attaché, Permanent Mission, Geneva

Ms V. Ing6lfsd6ttir Chief Nurse, Directorate of Public Health Ms 1. Davidsd6ttir First Secretary, Permanent Mission, Geneva

ISLANDE- ICELAND Chef de délégation - Chief delegate Mr J. Kristjansson Minister of Health and Social Security (Chef de délégation le 15 mai 2002) (Chief delegate on 15 May 2002)

ISRAEL- ISRAEL Chef de délégation - Chief delegate MrY. Levy Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Chef adjoint de la délégation - Deputy chief delegate Mr D.A. Gunnarsson Permanent Secretary, Ministry ofHealth and Social Security (Chef de délégation 13 au 14 et 16 au 18 mai 2002) (Chief delegate 13 to 14 and 16 to 18 May 2002) MrY. Amikam Deputy Director-General for Information and International Relations, Ministry of Health DrY. Sever Director, Department of International Relations, Ministry of Health

Suppléant(s)- Alternate(s) Mr E. Ben-Tura Deputy Director, International Organizations Department, Ministry of Foreign Affairs MrH. Waxman Counsellor, Permanent Mission, Geneva Dr A. Leventhal Director, Public Health Services, Ministry of Health Professor R. Rahamimov Chief Scientist, Ministry of Health Ms S. A vraham Herlin Adviser, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Mr S.H. Johannesson Ambassador, Permanent Representative, Geneva

Suppléant(s)- Alternate(s) Ms R. Haraldsd6ttir Deputy Permanent Secretary, Ministry of Health and Social Security DrH. Briem State Epidemiologist, Ministry ofHealth and Social Security Mr 1. Einarsson Director, Ministry of Health and Social Security Mr S. Magnusson Director, Ministry of Health and Social Security Mr H.M. Arthursson Director of Information, Ministry of Health and Social Security

ITALIE- ITALY Chef de délégation - Chief delegate M. G. Sirchia Ministre de la Santé

ASSNR page 201

Délégué(s)- Delegate(s) M. A. Negrotto Cambiaso Ambassadeur, Représentant permanent, Genève Professeur V. Silano Directeur de la Protection de la Santé humaine, de la Santé publique vétérinaire et des Rapports internationaux, Ministère de la Santé

Suppléant(s)- Alternate(s) Mr M.S.H. El Shili Counsellor of the Foreign Liaison and International Cooperation Dr M. Legnain Head, National Committee for Children, Bengazi Office Mr M. Abuseif Minister Plenipotentiary, Permanent Mission, Geneva Ms Z. Sahli Counsellor, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Mme A. Cinque Chef du Secrétariat technique, Conseiller pour les Relations externes, Ministère de la Santé Mme M. Di Gennaro Directeur général du Système de l'Information et de la Statistique, Ministère de la Santé Mme N. Quintavalle Premier Conseiller, Mission permanente, Genève M.F. Cicogna Bureau des Rapports internationaux, Ministère de la Santé M. G. Majori Directeur, Laboratoire de Parasitologie, Institut supérieur de la Santé Mme L. Tagliaferri Mission permanente, Genève

JAMAIQUE- JAMAICA Chef de délégation - Chief delegate MrR. Smith Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Mrs G. Allen-Young Permanent Secretary, Ministry ofHealth Dr D. Duncan-Goffe Director, Health Services, Planning and Integration, Ministry of Health

Suppléant(s)- Alternate(s) Ms T. Campbell ChiefNursing Officer Ms S. Betton First Secretary, Permanent Mission, Geneva

JAMAHIRIYA ARABE LffiYENNELIBYAN ARAB JAMAHIRIY A Chef de délégation - Chief delegate Mr A.E. Eltaif Deputy Prime Minister of Service Affairs, General People's Committee for Health and Social Security

JAPON- JAP AN Chef de délégation - Chief delegate Mr K. Haraguchi Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Dr S.S. Owainat General Manager, Health Service Administration

Délégué(s)- Delegate(s) MrJ. Kondo Vice-Minister ofHealth, Labour and Welfare

ASSNR page 202

Suppléant(s)- Alternate(s) Dr H. Imada Assistant Minister for Technical Affairs, Minister' s Secretariat, Ministry of Health, Labour and Welfare Mr M. Watanabe Counsellor, Permanent Mission, Geneva MrO. Tasaka Director, International Affairs Planning Office, International Affairs Division, Minister' s Secretariat, Ministry of Health, Labour and Welfare Dr K. Okamoto Director, International Cooperation Office, International Affairs Division, Minister's Secretariat, Ministry of Health, Labour and Welfare Mr A. Beppu Counsellor, Permanent Mission, Geneva Dr H. Chimura Director, Division of Po licy Based Medical Services Planning, Administration Department, National Cancer Center

Dr K. Tsujii Section Chief, International Affairs Division, Minister' s Secretariat, Ministry of Health, Labour and Welfare Ms M. Harada Section Chief, International Affairs Division, Minister' s Secretariat, Ministry of Health, Labour and Welfare Dr K. Amamoto Medical Officer, Maternai and Child Health Division, Equal Employment, Children and Families Bureau, Ministry of Health, Labour and Welfare Mr J. Kataoka Medical Officer, Management Guidance Division, Department ofNational Hospitals, Health Service Bureau, Ministry of Health, Labour and Welfare Dr K. Fujisaki Managing Director, Medical Cooperation Department, Japan International Cooperation Agency

JORDANIE- JORDAN Chef de délégation - Chief delegate

Conseiller(s)- Adviser(s) Mr J. Yamamoto Deputy Director, International Affairs Division, Minister' s Secretariat, Ministry of Health, Labour and Welfare Dr M. Sakoi Deputy Director, International Affairs Division, Minister' s Secretariat, Ministry of Health, Labour and Welfare Dr M. Kaminota Deputy Director, Tuberculosis and Infectious Diseases Control Division, Health Service Bureau, Ministry of Health, Labour and Welfare MrS.Hemmi First Secretary, Permanent Mission, Geneva MrK. Tomita First Secretary, Permanent Mission, Geneva Dr F. El Nasser Minister of Health and Health Care

Délégué(s)- Delegate(s) Mr S.A. Madi Ambassador, Permanent Representative, Geneva Dr S. Al Kharabseh Director-General, Primary Health Care Department, Ministry of Health

Suppléant(s)- Alternate(s) MrM. Qassem Head, International Health Department, Ministry of Health Mr W. Obeidat Second Secretary, Permanent Mission, Geneva

ASSNR page 203

KAZAKHSTAN- KAZAKHSTAN Chef de délégation - Chief delegate Mr Z. Doskaliev Minister of Health

Mr E.K. Rintaugu Counsellor, Permanent Mission, Geneva Mr M.A.O. Oyugi Counsellor, Permanent Mission, Geneva Miss T. Irina First Secretary, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Mr N. Danenov · Ambassador, Permanent Representative, Geneva Professor M. Kulzhanov Rector, School of Public Health

KIRIBATI- KIRIBATI Chef de délégation - Chief delegate MrB.R.Mooa Minister of Health

Suppléant(s)- Alternate(s) Mr A. Akhmetov Minister Counsellor, Permanent Mission, Geneva MrM. Tukeev Head, International Cooperation Division, Ministry of Health Ms D. Kairgeldina First Secretary, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Dr T.B. Kienene Permanent Secretary for Health

KOWEIT- KUWAIT Chef de délégation - Chief delegate Dr M.A. Al-Jarallah Minister of Health

Délégué(s)- Delegate(s) KENYA- KENYA Chef de délégation - Chief delegate Professor S.K. Ongeri Minister of Public Health Mr D.A.R. Razzooqi Ambassador, Permanent Representative, Geneva Dr A.Y. Al-Saif Assistant Under-Secretary for Public Health Affairs, Ministry of Health

Délégué(s)- Delegate(s) Mrs A.C. Mohamed Ambassador, Permanent Representative, Geneva Dr H.A. Mohamed Head, Preventive and Promotive Services, Ministry of Health

Suppléant(s)- Alternate(s) Dr Y.A. Al-Nesef Assistant Under-Secretary for Medical Support Services, Ministry of Health Mr N. Al-Bader Second Secretary, Permanent Mission, Geneva Dr K.A. Al-Saqabi Director, Planning and Follow-up Department, Ministry of Health Dr S.F. Al-Dearah Vice-Director, Primary Health Care Department, Ministry of Health

Suppléant(s)- Alternate(s) MrW.K. Boit Director, Kenya Medical Training College Dr K.C. Chesang Provincial Medical Officer, Ministry of Health

ASSNR

page 204 Dr F .K. Al-Khalifah Deputy Director, Al-Jahra' Hospital Mr W.Y.F. Al-Wuqayyan Director, Office of the Minister of Health Mrs S. AlSharrah ChiefNursing Officer, Ministry ofHealth Mr Y. Al-Sharrah Assistant Secretary-General, Arabization Centre for Medical Science Ms D. Podvinska Third Secretary, Permanent Mission, Geneva

LIBAN- LEBANON Chef de délégation - Chief delegate DrW.Ammar Directeur général, Ministère de la Santé publique

Délégué(s)- Delegate(s) Dr A. J oukhadar Conseiller personnel du Ministre de la Santé publique Mr H. Hoteit Chef de Bureau de l'Equipement, Ministère de la Santé publique

LESOTHO- LESOTHO Chef de délégation - Chief delegate Dr P. Se katie Minister of Health

Délégué(s)- Delegate(s) LIBERIA- LIBERIA Mrs M. Rasethuntsa Deputy Principal Secretary, Ministry ofHealth and Social Welfare Dr T. Ramatlapeng Director-General of Health Services, Ministry ofHealth and Social Welfare

Chef de délégation - Chief delegate Dr P.S. Coleman Minister ofHealth and Social Welfare

Délégué(s)- Delegate(s) Dr N.S. Bartee ChiefMedical Officer Ms M. Lankar Officer-in-Charge, Saclepea Clinic, Nimba County

Suppléant(s)- Alternate(s) Mrs M. Tiheli ChiefNursing Officer, Ministry ofHealth and Social Welfare Dr M. Moteetee Executive Director, Ministry ofHealth and Social Welfare

LITUANIE- LITHUANIA Chef de délégation - Chief delegate

LETTONIE- LATVIA Chef de délégation - Chief delegate Mr V. Jaksons Ad viser to the Minister of Welfare Mr K.R. Dobrovolskis Minister ofHealth

Chef adjoint de la délégation - Deputy chief delegate Professor V. Grabauskas Rector, Kaunas University of Medicine

Délégué(s)- Delegate(s) Mr J. Karklins Ambassador, Permanent Representative, Geneva

ASSNR page 205

Délégué(s)- Delegate(s) Mr A. Rimkunas Ambassador, Permanent Representative, Geneva

Suppléant(s)- Alternate(s) M. E. Tata Deuxième Secrétaire, Mission permanente, Genève

Conseiller(s)- Adviser(s) Mr E. Petrikas Minister Counsellor, Permanent Mission, Geneva

MALAISIE- MALAYSIA Chef de délégation - Chief delegate Mr S. Sothinathan Parliamentary Secretary, Ministry ofHealth

LUXEMBOURG-LUXEMBOURG Chef de délégation - Chief delegate Mme M. Pranchère-Tomassini Ambassadeur, Représentant permanent, Genève ·

Chef adjoint de la délégation - Deputy chief delegate Dr A. Mohamad Taha Director-General of Health, Ministry of Health

Délégué(s)- Delegate(s) Chef adjoint de la délégation - Deputy chief delegate Dr D. Hansen-Koenig Directeur de la Santé Dr A.S. Tee Deputy Director-General of Health, Ministry ofHealth

Suppléant(s)- Alternate(s) Délégué(s)- Delegate(s) Mme A. Schleder-Leuck Conseiller de Direction, Ministère de la Santé Dr M. Ismail Deputy Director-General of Health (Research and Technical Support), Ministry ofHealth DrH. Rajmah Ambassador, Permanent Representative, Geneva Dr H.K. Jalal Director of Health, Department of Health Malacca, Ministry of Health DrY. Sarah Director of Health, Department of Health Pahang, Ministry of Health Mr R.Z. Zainol Deputy Permanent Representative, Geneva Mr R.Z.S. Raja Reza Second Secretary, Permanent Mission, Geneva Ms F. Nuli Second Secretary, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) M. M. Godefroid Premier Secrétaire, Mission permanente, Genève

MADAGASCAR- MADAGASCAR Chef de délégation - Chief delegate Professeur H. Ratsimbazafimahefa Ministre de la Santé

Délégué(s)- Delegate(s) M. M. Zafera Ambassadeur, Représentant permanent, Genève Mme Y. Pasea Conseiller, Mission permanente, Genève

A55NR page 206

MALAWI- MALAWI Chef de délégation - Chief delegate MrY. Mwawa Minister of Health and Population

Suppléant(s)- Alternate(s) Dr T. Sidibe Directeur, Centre de Recherche, d'Etude et de Documentation pour la Survie de l'Enfant Dr D.K. Minta Coordinateur, Programme national de Lutte contre le SIDA

Chef adjoint de la délégation - Deputy chief delegate Dr R.B. Pendame Secretary for Health and Population

MALTE-MALTA Chef de délégation - Chief delegate

Délégué(s)- Delegate(s) Dr A.M. Phoya Director of Health Planning Services Dr L. Deguara Minister of Health

MALDIVES- MALDIVES Chef de délégation - Chief delegate Mr A. Abdullah Minister of Health

Chef adjoint de la délégation - Deputy chief delegate Mr M. Bartolo Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Délégué(s)- Delegate(s) Dr A.A. Yoosuf Director-General of Health Services, Ministry ofHealth Mr 1. Shaheem Assistant Director-General, Department of Public Health Dr R. Busuttil Director-General of Health

Suppléant(s)- Alternate(s) DrT. Firman Senior Medical Officer Dr L. Licari Consultant in Environmental Health Ms A. Mifsud First Secretary, Permanent Mission, Geneva

MALI-MALI Chef de délégation - Chief delegate Mme F. Traoré N afo Ministre de la Santé

Conseiller(s)- Adviser(s) Mr S. Gambin Ministry of Health

Délégué(s)- Delegate(s) DrM.A. Kane Conseiller technique, Ministère de la Santé Dr S. Samake Directeur national de la Santé

MAROC- MOROCCO Chef de délégation - Chief delegate M. T. El Khyari Ministre de la Santé

A55NR page 207

Délégué(s)- Delegate(s) M. O. Hilale Ambassadeur, Représentant permanent, Genève DrF. Hamadi Secrétaire général, Ministère de la Santé

Suppléant(s)- Alternate(s) Mr L.C. Nuckchady Adviser, Permanent Mission, Geneva

MAURITANIE- MAURITANIA Chef de délégation - Chief delegate Mr D.A. Hamet Ministre de la Santé et des Affaires sociales

Suppléant(s)- Alternate(s) Dr M. El'Ismaili Lalaoui Inspecteur général, Ministère de la Santé Dr M. Laaziri Directeur de la Planification et des Ressources financières, Ministère de la Santé Dr J. Mahjour Directeur de l'Epidémiologie et de la Lutte contre les Maladies, Ministère de la Santé DrN. Bezad Conseiller technique, Cabinet du Ministre de la Santé MmeN. Kamri Enseignante, Institut de Formation aux Carrières de Santé Mme S. Bouassa Conseiller, Mission permanente, Genève

Délégué(s)- Delegate(s) M. M.S. Ould Mohamed Lemine Ambassadeur, Représentant permanent, Genève Dr M.I. Ould Mohamed VaU Directeur de la Protection sanitaire, Ministère de la Santé et des Affaires sociales

Suppléant(s)- Alternate(s) Dr M.T. Mint Ahmedou Directrice de la Pharmacie et des Laboratoires, Ministère de la Santé et des Affaires sociales M. H. Ould Hemeth Premier Conseiller, Mission permanente, Genève M. S.O. Aïdara Premier Conseiller, Mission permanente, Genève

MAURICE- MAURITIUS Chef de délégation - Chief delegate

MEXIQUE- MEXICO Mr A.K. Jugnauth Minister of Health and Quality of Life

Chef de délégation - Chief delegate Dr. J. Frenk Secretario de Salud

Chef adjoint de la délégation - Deputy chief delegate Mrs R. V eerapen Permanent Secretary, Ministry of Health and Quality of Life

Délégué(s)- Delegate(s) Sr. G. Albin Embajador, Representante Permanente, Ginebra Dr. G. Ortiz Secretario de Salud del Estado de México, Director, Instituto de Salud del Estado de México

Délégué(s)- Delegate(s) Dr R.S. Sungkur Chief Medical Officer, Ministry of Health and Quality of Li fe

A55NR page 208

Suppléant(s)- Alternate(s) Dr. J. Sepulveda Director General, Instituto Nacional de Salud Publica, Secretaria de Salud Sr. P. Macedo Representante Permanente Suplente, Ginebra Sr. V. Arriaga Director General de Cooperaci6n y Difusi6n en Adicciones y Salud Mental, Secretaria de Salud Dr. P. Kuri Director de Epidemiologia, Secretaria de Salud Sr. E. Jaramillo Director General de Cooperaci6n International, Secretaria de Salud Sra. M. Posada Directora de Organismos Internacionales, Secretaria de Relaciones Exteriores Sra. H. Davila Directora de Asuntos Regionales y Bilaterales Americanos, Secretaria de Salud Sra. S. Rovirosa Ministro, Misi6n Permanente, Ginebra Sra. L. Sosa Marquez Segundo Secretario, Misi6n Permanente, Ginebra Sra. J. Jimenez Representante de la Secretaria de Salud ante la Comisi6n Interinstitucional de Enfermeria

Sr. M.W. Orozco Diputado del Partido Acci6n Nacional Sr. N.S. Escobedo Diputado del Partido Acci6n Nacional Sra. M. Nufiez de Monreal Diputada del Partido de la Revoluci6n Democratica

MICRONESIE (ETATS FEDERES DE)MICRONESIA (FEDERATED STATES OF) Délégué(s)- Delegate(s) Dr E.K. Pretrick Secretary, Department ofHealth, Education and Social Affairs

MONACO- MONACO Chef de délégation - Chief delegate Dr A. Negre Directeur de 1' Action sanitaire et sociale

Délégué(s)- Delegate(s) Mlle A. Médecin Mission permanente, Genève

MONGOLIE- MONGOLIA Chef de délégation - Chief delegate Professor P. Nymadawa Minister of Health

Délégué(s)- Delegate(s) Conseiller(s)- Adviser(s) Sr. J.S. Velasquez Diputado del Partido Revolucionario Institucional Sr. F. Granja Diputado del Partido Revolucionario Institucional Sr. E.A. Leines Diputado del Partido Revolucionario Institucional Mr K. Bekhbat Ambassador, Permanent Representative, Geneva Dr V. Surenchimeg Head, International Cooperation Department, Ministry of Health

Suppléant(s)- Alternate(s) Mr V. Enkhbold Third Secretary, Permanent Mission, Geneva

A55NR page 209

MOZAMBIQUE- MOZAMBIQUE Chef de délégation - Chief delegate Mr F. Ferreira Songane Minister of Health

Suppléant(s)- Alternate(s) Dr Kyi Soe Director-General, Department of Health Planning Mr Tin Maung Aye Deputy Permanent Representative, Geneva DrYe Myint Director ofDisease Control, Department of Health MrTun Ohn Counsellor, Permanent Mission, Geneva Mrs Aye Aye Mu Counsellor, Permanent Mission, Geneva Mr Moe Kyaw Aung First Secretary, Permanent Mission,Geneva Mrs Ei Ei Tin First Secretary, Permanent Mission, Geneva MrYe Htut First Secretary, Permanent Mission, Geneva Dr Tin Min Deputy Director of Medical Care, Department ofHealth Dr Pe Thet Htoon Director, International Health Division, Ministry of Health

Délégué(s)- Delegate(s) Dr H.A.P. Cossa Director for Planning and Cooperation, Ministry of Health Mr A.C. Zandamela Ambassador, Permanent Representative, Geneva

Suppléant(s)- Alternate(s) Dr A. Barreto Deputy Director of Health, Ministry of Health Dr F .J. Brito Provincial Director ofHealth MrM. Carlos Third Secretary, Permanent Mission, Geneva Mrs M.L. Pale Third Secretary, Permanent Mission, Geneva

MYANMAR- MYANMAR Chef de délégation - Chief delegate MrKet Sein Minister for Health

NAMIBIE- NAMffiiA Chef de délégation - Chief delegate Dr L. Amathila Minister of Health and Social Services

Chef adjoint de la délégation- Deputy chief delegate MrMya Than Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Dr K. Shangula Permanent Secretary, Ministry ofHealth and Social Services Ms M. Nghatanga Director, Primary Health Care, Ministry of Health and Social Services

Délégué(s)- Delegate(s) Professor Maung Maung Wint Director-General, Department of Medical Sciences

A55NR page 210

Suppléant(s)- Alternate(s) Mr M. Goraseb Deputy Director, Primary Health Care Disease Control, Ministry of Health and Social Services Ms M. Pendukeni Senior Health Programme Officer, Ministry of Health and Social Services

Délégué(s)- Delegate(s) Sra. C. Sanchez Reyes Ministro Consejero, Misi6n Permanente, Ginebra

Suppléant(s)- Alternate(s) Sr. N. Cruz Torufio Primer Secretario, Misi6n Permanente, Ginebra

NEP AL- NEP AL NIGER- NIGER Chef de délégation - Chief delegate Chef de délégation - Chief delegate Mr S.S. Bhandari Minister of Health Mme H.O. Abdoulwahid Secrétaire d'Etat aux Endémies, Ministère de la Santé publique et de la Lutte contre les Endémies

Délégué(s)- Delegate(s) Ms C. Yadav Deputy Speaker, Ho use of Representatives Dr S.R. Simkhada Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Dr A. Alarou Directeur général de la Santé publique, Ministère de la Santé publique et de la Lutte contre les Endémies Dr A.l. Souley Directrice de la Santé de la Reproduction, Ministère de la Santé publique et de la Lutte contre les Endémies

Suppléant(s)- Alternate(s) DrR. Thapa Senior Public Health Policy Adviser, Ministry ofHealth Dr B.D. Chataut Chief Specialist, Po licy, Planning and International Cooperation Division, Ministry ofHealth Mr N.B. Shrestha Minister Counsellor, Permanent Mission, Gene va

NIGERIA- NIGERIA Chef de délégation - Chief delegate Professor A.B.C. Nwosu Minister of Health

Délégué(s)- Delegate(s) Mr A.S. Suleiman Permanent Secretary, Federal Ministry of Health Mr P.I. Ayewoh Ambassador, Permanent Representative, Geneva

NICARAGUA- NICARAGUA Chef de délégation - Chief delegate Dr. L. Mejia Solis Embajador, Representante Permanente, Ginebra

Suppléant(s)- Alternate(s) Mr B.O. Owoseni Permanent Mission, Geneva

A55NR page 211

Dr S. Suie Director, Planning, Research and Statistics Dr A.O. Asagba Director, Public Health Department Dr M. S. Amaechi Director, Population Activities, Federal Ministry of Health Dr A. Nasidi Dr M. Anibueze Deputy Director, Public Health Department, Federal Ministry ofHealth Dr M.I.G. Leck DrT. Fakeye MrH. Okoli Dr I.G. Banigo Director, Federal Ministry ofHealth Mrs T.I. Koleosho Nursing Administrator, National Primary Health Care Development Agency Dr D. Awosika Director, Federal Ministry ofHealth Professor A. Sofowora Expert in Traditional Medicine, University of Ibadan, Ibadan Mr J.C. Ejinaka Permanent Mission, Geneva Mr C. lgboka Special Assistant to the Minister of Health

Ms H.C. Sundrehagen Director-General, Ministry of Health

Suppléant(s)- Alternate(s) Dr O.T. Christiansen Counsellor, Permanent Mission, Geneva Dr L. Hanssen Director-General, Norwegian Board ofHealth Ms K. Bremer Director-General, Norwegian Medicines Agency Dr G.-E. A. Bjemeboe Division Director, Norwegian Directorate of Health and Social Welfare Dr P. Wium Senior Adviser, Norwegian Directorate of Health and Social Welfare Ms B. Blaker Adviser, Ministry ofHealth Ms E. Reine Adviser, Ministry ofHealth Ms T. Kongsvik Senior Adviser, Ministry of Foreign Affairs Mr L. Lien Health Adviser, Norwegian Agency for Development Cooperation

Conseiller(s)- Adviser(s) Ms 1. Feet Director, Norwegian Nurses Association

NORVEGE- NORWAY Chef de délégation - Chief delegate Ms K. Ravnanger State Secretary

NOUVELLE-ZELANDE- NEW ZEALAND Chef de délégation - Chief delegate Ms A. King Minister of Health

Délégué(s)- Delegate(s) Mr S.B. Johansen Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Mr T. Caughley Ambassador, Permanent Representative, Geneva

ASSNR page 212

Dr K. Poutasi Director-General ofHealth, Ministry ofHealth

Suppléant(s)- Alternate(s) Mr M.K. Al-Parsi Director-General of Health Affairs- South Sharkia Region, Ministry ofHealth Dr S.T. Al-Awaidi Director, Diseases Control Department, Ministry of Health Mr 1. Al-Khanjari First Secretary, Permanent Mission, Geneva Mr A. Al-Qassimi First Secretary, Permanent Mission, Geneva Mr Z. Al-Saadi First Secretary, Permanent Mission, Geneva Ms A. Al Hanairy First Secretary, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Dr C. Tukuitonga Director of Public Health, Ministry ofHealth MrM. Holman Senior Policy Analyst, Ministry ofHealth Ms J. Macmillan Counsellor (Political), Permanent Mission, Geneva Mr J. Harvey Press Secretary, Office of the Minister of Health MrR. Lind Ministry of Health Ms D. Geels Counsellor (Political), Permanent Mission, Geneva Ms T. Mackevics UN Policy Support Officer, Permanent Mission, Geneva Ms J. Caughley Adviser to the Minister of Health MrT. Nash Executive Assistant, Permanent Mission, Geneva

OUGANDA-UGANDA Chef de délégation - Chief delegate Mr J. Muhwezi Minister of Health

Délégué(s)- Delegate(s) Mr R. Muhinda Permanent Secretary, Ministry ofHealth Professor F. Omaswa Director-General of Health Services

OMAN-OMAN Chef de délégation - Chief delegate Dr A.M. Moosa Minister of Health

Suppléant(s)- Alternate(s) Ms J.E. Masinde Acting Commissioner ofNursing Services Dr D.K.W. Lwamafa Commissioner, National Disease Control MrN. Irumba Chargé d'affaires, Deputy Permanent Representative, Geneva Dr A. Gakwandi Deputy Permanent Representative, Geneva Mr N. Ndoboli First Secretary, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Mr M.O.A. Aideed Ambassador, Permanent Representative, Geneva Dr A.J.M. Suleiman Director-General of Health Affairs, Ministry of Health

A55NR page 213

Mr A.D. Manana First Secretary, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Dr C.T. Otto Director, Bureau of Public Health, Ministry of Health Mrs L.F. Mari ur Special Assistant to the Vice-President on Health Matters

OUZBEKISTAN- UZBEKISTAN Chef de délégation - Chief delegate Professor D.A. Asadov First Deputy Minister ofHealth

Conseiller(s)- Adviser(s) MrM. Dilber Director, Paediatrics Research Institute Mr A. Sidikov Head, Department of International Relations, Ministry of Health

PANAMA- PANAMA Chef de délégation - Chief delegate Dr. F. Gracia Ministro de Salud

Délégué(s)- Delegate(s) Sr. A. Béliz . Embajador, Representante Permanente, Ginebra Sr. R. de Saint Malo Director Nacional de Asuntos Intemacionales

PAKISTAN -PAKISTAN Chef de délégation - Chief delegate MrM.Aslam Director-General (Health), Ministry of Heal th

Chef adjoint de la délégation- Deputy chief delegate Mr A. Basit Counsellor, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Srta. A. Arosemena Representante Permanente Suplente, Ginebra

Délégué(s)- Delegate(s) Mr 1. Hussain Counsellor, Permanent Mission, Geneva

PAPOUASIE-NOUVELLE-GUINEEPAPUA NEW GUINEA Chef de délégation - Chief delegate Mr A.T. Tomscoll Minister of Health

Suppléant(s)- Alternate(s) Ms M.Z. Baloch Second Secretary, Permanent Mission, Geneva MrF.I. Khan Second Secretary, Permanent Mission, Geneva Mr S. Ahmad

Délégué(s)- Delegate(s) DrN. Mann Secretary for Health, Department of Health MrT. Nori Executive Officer of the Minister of Health

PALAOS-PALAU Chef de délégation - Chief delegate Mrs S.S. Pierantozzi Vice-President and Minister ofHealth

PARAGUAY-PARAGUAY Chef de délégation - Chief delegate Dr. M. Chiola Ministro de Salud Publica y Bienestar Social

ASSNR page 214

Délégué(s)- Delegate(s) Sr. L.M. Ramirez Boettner Embajador, Representante Permanente, Ginebra Dr. R. Dullak Pefia Director General de Planificaci6n y Evaluaci6n, Ministerio de Salud Publica y Bienestar Social Suppléant(s)- Alternate(s) Sr. F. Barreiro Primer Secretario, Misi6n Permanente, Ginebra PAYS-BAS- NETHERLANDS Chef de délégation - Chief delegate Dr E. Borst-Eilers Minister of Health, Welfare .and Sport Délégué(s)- Delegate(s) Dr H.J. Heinemann Ambassador, Permanent Representative, Geneva Dr G.M. van Etten Director, International Affairs, Ministry of Health, Welfare and Sport Suppléant(s)- Alternate(s) Mr B.C.A.F. van der Heijden Deputy Permanent Representative, Geneva Ms M.A.C.M. Middelhoff First Secretary, Permanent Mission, Geneva Ms R. Buijs Senior Adviser, Department of Social Development, Ministry ofF oreign Affairs Ms E.A.C. van Ginneken Policy Adviser, United Nations and International Financial Institutions Department, Ministry of Foreign Affairs Dr L.J. van der Heiden Senior Adviser, International Affairs, Ministry ofHealth, Welfare and Sport

Conseiller(s)- Adviser(s) Mr H.R.V. Lancée Department of Communications, Ministry of Health, Welfare and Sport PEROU-PERU Chef de délégation - Chief delegate Dr. F. Carbone Campoverde Ministro de Salud Délégué(s)- Delegate(s) Sr. J. Voto-Bernales Embajador, Representante Permanente, Ginebra Sr. J.L. Salinas Montes Representante Permanente Suplente, Ginebra Suppléant(s)- Alternate(s) Dr. L.A. Suarez Ogrio Director General, Oficina de Epidemiologia, Ministerio de Salud Dra. R. Hidalgo J ara Directora General, Oficina de Salud de las Personas, Ministerio de Salud Srta. E. Beraun Escudero Segunda Secretaria, Misi6n Permanente, Ginebra Conseiller(s)- Adviser(s) Dr. M.A. Bustamante Garcia Secretario Ejecutivo, Organismo Andino de Salud - Convenio Hip6lito Unanue PHILIPPINES -PHILIPPINES Chef de délégation - Chief delegate Dr M.M. Dayrit Secretary of Health

A55NR page 215

Chef adjoint de la délégation - Deputy chief delegate Mr S.T. Ramel Ambassador, Permanent Representative, Geneva

Dr M. Manicki Director, Department for European Integration and International Cooperation, Ministry of Health Mrs B. Bitner Counsellor to the Minister of Health, Department for European Integration and International Cooperation, Ministry of Health Mr A. Sados Second Secretary, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Mr D.Y. Lepatan Deputy Permanent Representative, Geneva

Suppléant(s)- Alternate(s) PORTUGAL-PORTUGAL Mrs M.T.C. Lepatan Minister, Permanent Mission, Geneva Ms R.V.S. Paulino Director III and Officer-in-Charge, Bureau of International Health Cooperation, Department ofHealth

Chef de délégation - Chief delegate M. L.F. de Correia Pereira Ministre de la Santé

Délégué(s)- Delegate(s) M. A. de Mendonça e Moura Ambassadeur, Représentant permanent, Genève Professeur J. Pereira Miguel Directeur général de la Santé

Conseiller(s)- Adviser(s) Dr E.S. Dayrit Consultant in Management Sciences for Health Ms E. Maaghop Attaché, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) POLOGNE-POLAND Chef de délégation - Chief delegate Professor M. Lapinski Minister of Health M.F. George Sous-directeur de la Santé Professeur F. V entura Commission nationale de Lutte contre le SIDA

Délégué(s)- Delegate(s) Mr K. Jakubowski Ambassador, Permanent Representative, Geneva DrA. Nauman U nder-Secretary of State, Ministry of Health

Conseiller(s)- Adviser(s) M. A.J. Mocho Adjoint du Ministre de la Santé M. P. Bârcia Conseiller, Mission permanente, Genève

QATAR-QATAR Suppléant(s)- Alternate(s) Chef de délégation - Chief delegate Professor J. Szczerban Chairman, Scientific Advisory Council of the Minister of Health Dr H.A.H. Al-Binali Minister of Public Health

ASSNR page 216

Délégué(s)- Delegate(s) Dr K. Al-Jaber Assistant Under-Secretary for Technical Affairs Mr H.M. AI-Hatmi Manager, Office of the Minister of Public Health

M. M. Gonde Assistant du Directeur de l'Etablissement des Soins, Ministère de la Santé publique et de la Population

REPUBLIQUE DE COREE- REPUBLIC OFKOREA Chef de délégation - Chief delegate MrT.-B. Lee Minister of Health and Welfare

Suppléant(s)- Alternate(s) Mr A.H.A. Al-Abdallah Head, Public and International Relations

Chef adjoint de la délégation - Deputy chief delegate Mr E.-Y. Chung Ambassador, Permanent Representative, Geneva

REPUBLIQUE ARABE SYRIENNESYRIAN ARAB REPUBLIC Chef de délégation - Chief delegate Professor M.l. Al-Chatti Minister of Health

Délégué(s)- Delegate(s) DrD.-K. Oh Director-General, Bureau ofHealth Promotion, Ministry of Health and Welfare

Délégué(s)- Delegate(s) Dr T. Salloum Ambassador, Permanent Representative, Geneva Dr H. al Haj Hussein Director of International Relations

Suppléant(s)- Alternate(s) MrC.-S. Kim Secretary to the President for Health and W elfare, Presidential Secretariat Mr C.-J. Moon Counsellor, Permanent Mission, Geneva Mr K.-1. Hu First Secretary, Permanent Mission, Geneva Ms S.-H. Kim Deputy Director, Human Rights and Social Affairs Division, Ministry ofF oreign Affairs and Trade Mr H.-J. Choi Director, International Cooperation Division, Ministry of Health and W el fare Mr J.-W. Kwon Director, Medical Policy Division, Ministry of Health and Welfare

Suppléant(s)- Alternate(s) Mr S. Sarra Minister Counsellor, Permanent Mission, Geneva

REPUBLIQUE CENTRAFRICAINECENTRAL AFRICAN REPUBLIC Chef de délégation - Chief delegate M. J. Kalite Ministre de la Santé publique et de la Population

Délégué(s)- Delegate(s) Dr N.G. Dimanche Directeur général de la Santé publique et de la Population

ASSNR page 217

Ms H.-R. Chai Deputy Director, International Cooperation Division, Ministry ofHealth and Welfare MrK.-N. Kim Secretary to the Minister of Health and Welfare

Délégué(s)- Delegate(s) Dr B. Boupha Director, National Institute of Public Health

REPUBLIQUE DE MOLDOVAREPUBLIC OF MOLDOVA Chef de délégation - Chief delegate Dr A. Gherman Minister of Health

Conseiller(s)- Adviser(s) DrC.-Y. Kim Professor, College of Medicine, Seoul National University DrE.-S. Kim Professor, College ofNursing, Y onsei University

Délégué(s)- Delegate(s) Mr A. Calmâc Deputy Permanent Representative, Geneva Dr S. Domente Head, Foreign Relations Division, Ministry of Health

REPUBLIQUE DEMOCRATIQUE DU CONGO- DEMOCRATie REPUBLIC OF THE CONGO Chef de délégation - Chief delegate Professor N.L.M. Mamba Ministre de la Santé

Suppléant(s)- Alternate(s) MrV. Maxim Third Secretary, Permanent Mission, Geneva

Délégué(s)- Delegate(s) Professeur M.M. Mampunza Directeur du Cabinet du Ministre de la Santé Dr Singa Nyota Conseillère médicale du Ministre de la Santé

REPUBLIQUE DOMINICAINEDOMINICAN REPUBLIC Chef de délégation - Chief delegate Sr. F.A. Cuello Camilo Embajador, Representante Permanente, Ginebra

Suppléant(s)- Alternate(s) Délégué(s)- Delegate(s) M. Tchelo Mazombo Conseiller chargé du Partenariat du Ministre de la Santé M. S. Mutomb Mujing Deuxième Conseiller, Mission permanente, Genève Dra. M. Bello de Kemper Consejero, Mision Permanente, Ginebra

REPUBLIQUE POPULAIRE DEMOCRATIQUE DECOREE DEMOCRATie PEOPLE'S REPUBLIC OFKOREA Chef de délégation - Chief delegate Mr Ri Tcheul Ambassador, Permanent Representative, Geneva

REPUBLIQUE DEMOCRATIQUE POPULAIRE LAO- LAO PEOPLE'S DEMOCRATie REPUBLIC Chef de délégation - Chief delegate Dr D. Vongsack Vice-Minister ofHealth

ASSNR page 218

Délégué(s)- Delegate(s) Mr Han Dae Song Director of Division, Department of International Organizations, Ministry of Foreign Affairs Dr Kim Won Ho Policy Adviser, Ministry of Foreign Affairs

Chef adjoint de la délégation- Deputy chief delegate Dr M. Makame Minister of Health, Zanzibar

Délégué(s)- Delegate(s) Ms M.J. Mwafisi Permanent Secretary, Ministry ofHealth

Suppléant(s)- Alternate(s) Suppléant(s)- Alternate(s) Mr Jang Chun Sik Counsellor, Permanent Mission, Geneva Dr G.L. Upunda Chief Medical Officer, Ministry of Health Dr T.F. Thani Director, Medical Services, Zanzibar Dr A.A. Mzige Director, Preventive Services, Ministry of Health Ms J.A. Safe ChiefNursing Officer, Ministry of Health DrR.A. Swai Programme Manager, National AIDS Control Programme, Ministry of Health Dr S. Egwaga Programme Manager, National Tuberculosis and Leprosy Programme, Ministry of Health Dr A.M. Mwita Programme Manager, National Malaria Control Programme, Ministry of Health Mr E.W.M. Manumbu Director of Planning and Policy, Ministry of Health Mrs H.H.M. Missano Director, Nutrition, Education and Training, Tanzania Food and Nutrition Centre, Ministry ofHealth

REPUBLIQUE TCHEQUE- CZECH REPUBLIC Chef de délégation - Chief delegate Dr M. Vit Deputy Minister of Health

Délégué(s)- Delegate(s) Mr A. Slaby Ambassador, Permanent Representative, Geneva Mrs B. Jankaskova Head of Division, Department of International Relations, Ministry of Health

Suppléant(s)- Alternate(s) Mr 1. Pintér Counsellor, Permanent Mission, Geneva Mrs E. Svimberska Department of International Relations, Ministry of Health Mr J. Schwippel Department of International Organizations, Ministry ofF oreign Affairs

REPUBLIQUE-UNIE DE TANZANIE UNITED REPUBLIC OF TANZANIA Chef de délégation - Chief delegate Dr A.M. Abdallah Minister of Health

ROUMANIE- ROMANIA Chef de délégation - Chief delegate Mrs D. Bartos Minister of Health and Family

ASSNR page 219

Délégué(s)- Delegate(s) Mrs A. Filip Ambassador, Permanent Representative, Geneva DrA.Rafila Director-General, Ministry of Health and Family

Mr S. Fuller Ambassador, Permanent Representative, Geneva Mrs S. Mullally ChiefNursing Officer Dr .J. Lob-Levyt Department for International Development Ms H. Nellthorp First Secretary, Permanent Mission, Geneva Dr W. Thome Senior Medical Adviser Mr T. Kingham Department of Health Mr J. Worley Department for International Development

Suppléant(s)- Alternate(s) Dr R. Constantiniu Director, Ministry of Health and Family Dr A. Roncea Deputy Director, Ministry of Health and Family Dr D. Farcasanu Deputy Director, Ministry of Health and Family DrL. Micu Counsellor, Ministry of Health and Family Mrs D. Iordache First Secretary, Permanent Mission, Geneva

Conseiller(s)- Adviser(s) MrN. Boyd Department of Health Mrs S. McCrory Legal Adviser, Permanent Mission, Geneva Mrs A. Brown Department of Health Mr J. Bradley Second Secretary, Permanent Mission, Geneva MrL. Levy Department of Health Ms R. Dickson Department of Health Dr A. Robb Department for International Development Ms E. Back Department for International Development Ms S. Cotton Attaché, Permanent Mission, Geneva Mr M. Hamilton Assistant Private Secretary to the Minister of State for Health

ROYAUME-UNI DE GRANDEBRETAGNE ET D'IRLANDE DU NORDUNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND Chef de délégation - Chief delegate Mr J. Hutton Minister of State for Health (Chef de délégation le 13 mai 2002) (Chief delegate on 13 May 2002)

Chef adjoint de la délégation - Deputy chief delegate Sir Liam Donaldson Chief Medical Officer (Chef de délégation du 14 au 18 Mai 2002) (Chief delegate from 14 to 18 May 2002)

Suppléant(s)- Alternate(s) Dr P. Troop Deputy Chief Medical Officer

A55NR page 220

Suppléant(s)- Alternate(s) RWANDA-RWANDA Chef de délégation - Chief delegate Dr M. Mugabo Secretary-General, Ministry of Health Mme G. Bertozzi Coordonnateur, Département de la Santé et de la Sécurité sociale

Délégué(s)- Delegate(s) Dr C. Mukunde Paediatrician, Kibuye Children' s Hospital Dr B. Uhagaze Medical Director, Byumba Health Centre

SAINT-VINCENT-ET-GRENADINES SAINT VINCENT AND THE GRENADINES Délégué(s)- Delegate(s) Ms N. Dabinovic Maritime Commissioner

SAMOA- SAMOA Suppléant(s)- Alternate(s) Chef de délégation - Chief delegate Dr T. Karen gera Ministry of Health Mr M. Siafausa Vui Minister of Health

SAINTE-LUCIE- SAINT LUCIA Délégué(s)- Delegate(s) Délégué(s)- Delegate(s) Mr D.E. Greaves Minister for Health, Human Services and Family Affairs DrE. Enosa Director-General of Health

SAO TOME-ET-PRINCIPE- SAO TOME AND PRINCIPE Chef de délégation - Chief delegate Dr E.M.A. Agostinho das Neves Ministre de la Santé

SAINT-KITTS-ET-NEVIS- SAINT KITTS AND NEVIS Délégué(s)- Delegate(s) Dr E.A. Martin Minister of Health and Environment

Délégué(s)- Delegate(s) Dr C. Augusto da Cruz Directeur, Centre hospitalier de Sao Tome Dr A. Soares Marques de Lima Conseiller du Ministre de la Santé

SAINT-MARIN- SAN MARINO Chef de délégation - Chief delegate Dr S. Canducci Ministre de la Santé et de la Sécurité sociale

SENEGAL- SENEGAL Délégué(s)- Delegate(s) Chef de délégation - Chief delegate Mme F. Bigi Ambassadeur, Représentant permanent, Genève Mme H. Zeiler Conseiller, Mission permanente, Genève Professeur A.M. Coll Seck Ministre de la Santé et de la Prévention

ASSNR page 221

Délégué(s)- Delegate(s) Mme A.C. Diallo Ambassadeur, Représentant permanent, Genève Professeur S.B. Badiane Conseiller technique, Cabinet du Ministre de la Santé et de la Prévention

Délégué(s)- Delegate(s) Mr E.E. Luy Consul General, Geneva

SINGAPOUR- SINGAPORE Chef de délégation - Chief delegate Mr Vanu Gopala Menon Ambassador, Permanent Representative, Geneva

Suppléant(s)- Alternate(s) Dr M. Loume Directeur de la Santé, Ministère de la Santé et de la Prévention Dr C. Fall Directeur de la Prévention, Ministère de la Santé et de la Prévention Mme K. Fall Chef de Cabinet du Ministre de la Santé et de la Prévention M. M. Diouf Conseiller en Communication, Ministère de la Santé et de la Prévention M. A. Basse Premier Secrétaire, Mission permanente, Genève

Chef adjoint de la délégation - Deputy chief delegate Dr Suok Kai Chew Director, Epidemiology and Disease Control Division, Ministry ofHealth

Délégué(s)- Delegate(s) Ms M. Liang Deputy Permanent Representative, Geneva

Suppléant(s)- Alternate(s) MrK. Lim First Secretary, Permanent Mission, Geneva Ms Y en Cheng Ong First Secretary, Permanent Mission, Geneva Dr P.Y.M. Chang Medical Officer, Professional Standards and Development Division, Ministry of Health

SEYCHELLES-SEYCHELLES Chef de délégation - Chief delegate Mrs M. Macgaw Principal Secretary, Ministry ofHealth

SLOVAQUIE- SLOVAKIA Chef de délégation - Chief delegate MrR. Kovac Minister of Health

Délégué(s)- Delegate(s) Dr C. Shamlaye Special Adviser, Ministry of Health

SIERRA LEONE- SIERRA LEONE Chef de délégation - Chief delegate Dr C.W. Kamara Director of Planning and Information, Ministry of Health and Sanitation

Chef adjoint de la délégation- Deputy chief delegate Mr K. Petôcz Ambassador, Permanent Representative, Geneva

ASSNR page 222

Délégué(s)- Delegate(s) Mr S. Hlavacka Director-General for Health Care Strategy, Ministry of Health

SOMALIE- SOMALIA Chef de délégation - Chief delegate Dr M. Nurani Bakar Minister of Health

Suppléant(s)- Alternate(s) Délégué(s)- Delegate(s) Mrl. Rovny Chief Hygienist Mrs J. Hurmi Director, Foreign Relations Department, Ministry of Health Mrs J. Bartosiewiczova Counsellor, Permanent Mission, Geneva Mrs N. Septakova Ministry ofForeign Affairs Mrs Z. Cervena Foreign Relations Department, Ministry of Health Mr M. O. Dubad Chargé d'affaires a.i., Permanent Mission, Geneva Mr A.A. Isse Counsellor, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Mr A.K. Mohamaoud Ministry of Health

SOUDAN- SUDAN Chef de délégation - Chief delegate Dr A.B. Osman Minister of Health

SLOVENIE- SLOVENIA Chef de délégation - Chief delegate

Délégué(s)- Delegate(s) DrD. Keber Minister of Health Dr A.S. Ahmed Under-Secretary, Ministry of Health Mr O.M.A. Siddig Deputy Permanent Representative, Geneva

Délégué(s)- Delegate(s) Mr A. Gosnar Ambassador, Permanent Representative, Geneva Dr J. Maucec-Zakotnik State Secretary, Ministry ofHealth

Suppléant(s)- Alternate(s) Dr 1. El Dio Mohamed Abdalla Ministry of Health Mr C.L. Jada Second Secretary, Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Dr V .K. Petrie Counsellor to the Minister of Health Mr A. Zidar Second Secretary, Permanent Mission, Geneva

SRI LANKA- SRI LANKA Chef de délégation - Chief delegate Mr P. Dayaratne Minister ofHealth, Nutrition and Welfare

ASSNR page 223

Délégué(s)- Delegate(s) Mr P. Kariyawasam Ambassador, Permanent Representative, Geneva Dr K.C.S. Dalpatadu Deputy Director-General of Planning, Ministry ofHealth, Nutrition and Welfare Suppléant(s)- Alternate(s) Dr A. Mendis Deputy Director-General of Laboratory Service, Ministry ofHealth, Nutrition and Welfare Conseiller(s)- Adviser(s) Dr P. Abeykoon Health Advisory Council, Ministry of Health, Nutrition and Welfare Ms H. Arunathilake Second Secretary, Permanent Mission, Geneva Mr S. Gunaratna Second Secretary, Permanent Mission, Geneva Mrs D. Dayaratne Persona! Assistant to the Minister ofHealth, Nutrition and Welfare SUEDE- SWEDEN Chef de délégation - Chief delegate Mr L. Engqvist Minister for Health and Social Affairs Chef adjoint de la délégation- Deputy chief delegate Ms K. Wigzell Director-General, National Board of Health and Welfare Délégué(s)- Delegate(s) Mr J. Molander Ambassador, Permanent Representative, Geneva

Suppléant(s)- Alternate(s) Mr M. Sjôberg State Secretary, Ministry of Health and Social Affairs Ms 1. Nilsson Carlsson Director, Ministry ofHealth and Social Affairs Ms A.-C. Filipsson Director, Special Expert, Ministry of Health and Social Affairs Mr 1. Sundquist Counsellor, Ministry for Foreign Affairs Ms K. Rangnitt First Secretary, Permanent Mission, Geneva Dr A. Molin Senior Programme Officer, Swedish International Development Authority Ms B. Schmidt Administrative Director, National Board of Health and Welfare Professor R. Norrby Director-General, Swedish Institute for lnfectious Disease Control Mr B. Pettersson Deputy Director-General, National Institute of Public Health Conseiller(s)- Adviser(s) Dr A. Milton Secretary-General, Swedish Medical Association SUISSE- SWITZERLAND Chef de délégation - Chief delegate Mme R. Dreifuss Chef du Département fédéral de 1'Intérieur Chef adjoint de la délégation - Deputy chief delegate Professeur T. Zeltner Directeur de l'Office fédéral de la Santé publique

A55NR page 224

Délégué(s)- Delegate(s) M. C. Faessler Représentant permanent adjoint, Genève

M. A. von Kessel Service Affaires internationales, Office fédéral de la Santé publique M. C. Risch Conseiller du Chef du Département fédéral de 1'Intérieur

Suppléant(s)- Alternate(s) Mme M. Berger Mission permanente, Genève Mme S. Zobrist Chef, Service Affaires internationales, Office fédéral de la Santé publique MmeR.Adam Section ONU, Département féderal des Affaires étrangères M. D. Mausezahl Service de Politique du Développement social, Département fédéral des Affaires étrangères M. D. Kraus Affaires internationales, Institut fédéral de la Propriété intellectuelle M. R. Vonovier Premier Secrétaire, Mission permanente, Genève Mme B. Schulte Biotechnologie et Politique des Produits thérapeutiques, Office fédéral de la Santé publique M. J. Martin Affaires multilatérales, Direction du Développement et de la Coopération, Département fédéral des Affaires étrangères M. F. del Ponte Affaires multilatérales, Direction du Développement et de la Coopération, Département fédéral des Affaires étrangères M. M. Keller Mesures non tarifaires, Département de l'Economie, Secrétariat d'Etat à l'Economie Mme D. Sordat Services Affaires internationales, Office fédéral de la Santé publique

SWAZILAND- SWAZILAND Chef de délégation - Chief delegate Mr T.M. Mlangeni Acting Minister for Health and Social Welfare

Délégué(s)- Delegate(s) Dr J. Kunene Acting Director of Health Services Mrs G. Magagula Public Health Nursing Sister

Suppléant(s)- Alternate(s) Mr D. Shongwe Health Planner

TADJIKISTAN- TAJIKISTAN Délégué(s)- Delegate(s) Mr A. Akhmedov Minister of Health

TCHAD-CHAD Chef de délégation - Chief delegate M. N.Y. Beassoumal Ministre de la Santé publique

Délégué(s)- Delegate(s) Dr M.E. Mbaiong Directeur général adjoint du Ministère de la Santé publique M. N. Abdelkerim Directeur adjoint des Activités sanitaires

A55NR page 225

Suppléant(s)- Alternate(s) DrH. Outman Responsable national de l'Appui psychomédico-social, Programme national de Lutte contre le SIDA et les Maladies sexuellement transmissibles

Dr Supamit Chunsuttiwat Senior Medical Officer in Preventive Medicine, Department of Communicable Disease Control, Ministry of Public Health Dr Viroj Tangcharoensathien Senior Health Policy and Plan Analyst, Bureau of Health Po licy and Planning, Ministry of Public Health Dr Borwom Ngamsiriudom Director, Bureau ofHealth Promotion, Department ofHealth, Ministry ofPublic Health Dr Sopida Chavanichkul Deputy Director, Bureau of International Health, Ministry of Public Health Dr Jiruth Sriratanaban Assistant Director, Chulalongkom Hospital Mrs Krisana Chandraprabha Deputy Permanent Representative, Geneva Mr Apirat Sugondhabhirom First Secretary, Permanent Mission, Geneva Mr Nikomdej Balankura First Secretary, Permanent Mission, Geneva Professor Tassana Boontong President, Thailand Nursing Council Mr Pensri Rabieb President, The Nurses Association ofThailand Ms Waranya Teokul Office ofNational Economie and Social Development Board Professor Chumrurtai Kamchanachitra Institute for Population and Social Research, Mahidol University Ms Pompit Silkavute Director, Technical Department, Food and Drug Administration, Ministry of Public Health Dr Kanitta Bundhamcharoen Policy and Plan Analyst, Bureau ofHealth Po licy and Planning, Ministry of Public Health

THAILANDE- THAILAND Chef de délégation - Chief delegate Mrs Sudarat Keyuraphan Minister of Public Health

Chef adjoint de la délégation - Deputy chief delegate Mr Virasakdi Futrakul Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Dr Winai Wiriyakitjar Permanent Secretary, Ministry of Public Health

Suppléant(s)- Alternate(s) Dr Supachai Kunaratanapruk Deputy Permanent Secretary, Ministry of Public Health Dr Suwit Wibulpolprasert Deputy Permanent Secretary, Ministry of Public Health Professor Pakdee Pothisiri Director-General, Department of Health, Ministry of Public Health Dr T. Thavichachart Managing Director, The Govemment Pharmaceutical Organization, Ministry of Public Health Dr Amnuay Gajeena Senior Medical Officer in Policy and Plan Office of the Permanent Secretary, Ministry of Public Health

A55NR page 226

Ms Orisa Sursattayawong Foreign Relations Officer, Bureau of International Health, Ministry of Public Health Ms K. Chinda Technical Health Officer, Information and Public Relations Office, Ministry of Public Health

Ms M.A. Richards Chargé d'affaires a.i., Permanent Mission, Geneva

Suppléant(s)- Alternate(s) Ms L. Boodhoo First Secretary, Permanent Mission, Geneva Ms S.-A. Clarke-Hinds First Secretary, Permanent Mission, Geneva

Conseiller(s)- Adviser(s) Dr Arun Pausawasdi Adviser to the Minister of Public Health Dr Samlee Plianbangchang Adviser to the Minister of Public Health Dr Pruttichai Damrongrat Spokesman, Ministry of Public Health Mr Udomdej Ratanasathien Secretary to the Minister of Public Health

TUNISIE - TUNISIA Chef de délégation - Chief delegate M. H. M'barek Ministre de la Santé publique

Délégué(s)- Delegate(s) M. H. Ben Salem Ambassadeur, Représentant permanent, Genève Dr H. Abdessalem Directeur général, Unité de la Coopération technique, Ministère de la Santé publique

TOGO-TOGO Chef de délégation - Chief delegate Professeur K.C. Agha Ministre de la Santé publique

Suppléant(s)- Alternate(s) Délégué(s)- Delegate(s) Dr E. Batchassi Directeur général de la Santé publique Mme S.l. Ammar Conseiller des Affaires étrangères, Mission permanente, Genève Mlle S. Cheikh Mission permanente, Genève M. N. Belkhir Mission permanente, Genève

TONGA-TONGA Délégué(s)- Delegate(s) Dr V.T. Tangi Minister of Health

TURQUIE- TURKEY TRINITE-ET-TOBAGO- TRINIDAD AND TOBAGO Chef de délégation - Chief delegate MrC. Imbert Minister of Health

Chef de délégation - Chief delegate MrM. Sungar Ambassador, Permanent Representative, Geneva

Délégué(s)- Delegate(s) Délégué(s)- Delegate(s) Mr H. O'Brien Permanent Secretary, Ministry of Health DrN. Ünal Member of Parliament

ASSNR page 227

Dr V. Ulusoy Deputy Under-Secretary, Ministry of Health

Mr G. Tante kin Expert, Undersecretariat for State Planning Organization

Suppléant(s)- Alternate(s) TUVALU- TUVALU Dr 1. Toprak Director-General of Primary Health Care, Ministry of Health DrR. Kose Director-General of Mother, Chi id Health and Family Planning, Ministry ofHealth Professor O. Canbolat Director-General of Pharmaceuticals, Ministry ofHealth Dr H. Ôztoprak Counsellor, Ministry ofHealth

Chef de délégation - Chief delegate Dr A.K. Seluka Minister of Health

Délégué(s)- Delegate(s) Mrs M. Nelesone Permanent Secretary for Health Dr T. Nelesone Acting Director of Health

Suppléant(s)- Alternate(s) MrK. Ôzden Head, Department of Externat Relations, Ministry of Health MrU. Dogan Deputy Permanent Representative, Geneva Mrs S. Akman Counsellor, Permanent Mission, Geneva Mrs A. Sinirlioglu Counsellor, Permanent Mission, Geneva Mr Z. Gazioglu Counsellor, Permanent Mission, Geneva Mr S. Tezel Aydin Deputy Head, Department of Externat Relations, Ministry of Health Mrs A. Soylu Second Secretary, Permanent Mission, Geneva Mr L. Eler Second Secretary, Permanent Mission, Geneva Dr F.N. Aksakal General Directorate of Primary Health Care, Ministry of Health Mr M. Varlik Expert, Undersecretariat for State Planning Organization MrH. Holona Persona! Assistant to the Minister of Health

UKRAINE- UKRAINE Chef de délégation - Chief delegate Professor V .F. Moskalenko Minister of Health

Délégué(s)- Delegate(s) Mr M.V. Skuratovskyi Permanent Representative, Geneva Professor N.H. Hojda Deputy State Secretary, Ministry ofHealth

Suppléant(s)- Alternate(s) Mrs Z.V. Tsenilova Head, International Relations Department, Ministry of Health Mrs S.M. Homanovska Second Secretary, Permanent Mission, Geneva

A55NR page 228

URUGUAY- URUGUAY Chef de délégation - Chief delegate Dra. O. L6pez Directora General de Salud, Ministerio de Salud Publica

Sr. W. Santana Primer Secretario, Misi6n Permanente, Ginebra

VIETNAM-VIETNAM Chef de délégation - Chief delegate Professor Pham Manh Hung Vice-Minister ofHealth

Délégué(s)- Delegate(s) Sr. C. Pérez del Castillo Embajador, Representante Permanente, Ginebra Sra. C. Muxi Asesora, Ministerio de Salud Publica

Délégué(s)- Delegate(s) Mr Nguyen Quy Binh Ambassador, Permanent Representative, Ge neva Dr Duong Huy Lieu Director, Planning Department, Ministry of Health

Suppléant(s)- Alternate(s) Sra. R. Franco Consejera, Misi6n Permanente, Ginebra Sra. A. de Bellis Segunda Secretaria, Misi6n Permanente, Ginebra

Suppléant(s)- Alternate(s) Mrs Le Thi Thu Ha Deputy Director, International Cooperation Department, Ministry of Health MrVuHuyTan Counsellor, Permanent Mission, Geneva

VANUATU- VANUATU Délégué(s)- Delegate(s) Mr J. W abaiat Director-General, Ministry of Health

YEMEN- YEMEN Chef de délégation - Chief delegate

VENEZUELA-VENEZUELA Chef de délégation - Chief delegate Dra. M.L. Urbaneja Durant Ministra de Salud y Desarrollo Social Dr A.N. Al-Munibari Minister of Public Health and Population

Chef adjoint de la délégation - Deputy chief delegate Dr Y. Al-Babili Deputy Minister of Public Health and Population

Délégué(s)- Delegate(s) Sr. V. Rodriguez Cedefio Representante Permanente Suplente, Ginebra Dr. F. Armada Director de Salud Ambiental y Control Sanitario, Ministerio de Salud y Desarrollo Social

Délégué(s)- Delegate(s) Dr F. bio Ghanem Ambassador, Permanent Representative, Geneva

Suppléant(s)- Alternate(s) Sra. M. Hernândez Consejero, Misi6n Permanente, Ginebra

Suppléant(s)- Alternate(s) Mr Z.M. Hajar Chargé d'affaires, Permanent Mission, Geneva

ASSNR page 229

Mr K.A. AI-Sakkaf Counsellor to the Minister of Public Health and Population for the Bilateral Relations Affairs Dr M. AI-Shahary Director-General, Technical Cooperation Dr A.A. Abdullah Coordinator, Arab Associateship Programme on the Medical Specialities Mr Y. Al-Shahary Third Secretary, Permanent Mission, Geneva

ZAMBIE- ZAMBIA Chef de délégation - Chief delegate Dr B. Chituwo Minister of Health

Délégué(s)- Delegate(s) Dr G. Silwamba Permanent Secretary, Ministry ofHealth MrB. Bowa Ambassador, Permanent Representative, Geneva

YOUGOSLAVIE- YUGOSLAVIA Suppléant(s)- Alternate(s) Chef de délégation - Chief delegate Dr Z. Micovic Minister for Health of the Republic of Montenegro Mr D. Chimfwembe Director of Planning and Development, Ministry of Health MrsD.Mwewa ChiefNursing Officer Mrs C. Chibolcka Ministry of Health Miss A. Kazhingu Second Secretary, Permanent Mission, Geneva

Chef adjoint de la délégation - Deputy chief delegate Mr M. Knezevic Assistant Federal Secretary for Labour, Health and Social Care

Délégué(s)- Delegate(s) ZIMBABWE- ZIMBABWE Mr M. Scepanovic Ambassador, Permanent Representative, Ge neva

Chef de délégation - Chief delegate Dr P.O. Parirenyatwa Deputy Minister of Health and Child Welfare

Suppléant(s)- Alternate(s) Dr Z. Maricic Assistant Minister for Health and Protection of the Environment of the Republic of Serbia Dr D. Lausevic Assistant Minister for Health of the Republic of Montenegro Mr A. Radovanovic Counsellor, Permanent Mission, Geneva Mrs S. Boskovic-Prodanovic Attaché, Permanent Mission, Geneva

Chef adjoint de la délégation - Deputy chief delegate OrE. Xaba Permanent Secretary for Health and Child Welfare

Délégué(s)- Delegate(s) Mrs B. Mutetwa Chargé d'affaires a.i., Permanent Mission, Geneva

A55NR page 230

Suppléant(s)- Alternate(s) Mrs M. Sibanda Finance Director, Ministry ofHealth and Child Welfare Ms G. Mahlangu Dr O. Mugurungi Mrs R. Madzima Mr B. Mugarisanwa Counsellor, Permanent Mission, Geneva MrT. Zigora Chief Executive Officer, Parirenyatwa Group of Hospitals Mr S.C. Mhango Minister Counsellor, Permanent Mission, Geneva Dr S.T. Mukanduri Minister Counsellor, Permanent Mission, Geneva

Dr E. Rocco Expert Dr S. Tabolli Expert

OBSERVATEURS OBSERVERS ORDRE DE MALTE- ORDER OF MALTA M. P.-Y. Simonin Ambassadeur, Observateur permanent, Genève Mme M.-T. Pictet-Althann Observateur permanent adjoint, Genève M. M. de Skowronski Observateur permanent adjoint, Genève Mme R. Saraceno Premier Secrétaire, Mission permanente, Genève

OBSERVATEURS D'UN ETAT NON MEMBRE OBSERVERS FOR A NON-MEMBER STATE SAINT-SIEGE- HOLY SEE Mgr J. Lozano Barragan Président du Conseil pontifical pour la Pastorale des Services de la Santé Mgr D. Martin Nonce Apostolique, Observateur permanent, Genève Mgr E. Pefia Parra Conseiller, Mission permanente, Genève Mgr J .-M.M. Mpendawatu Expert Dr A. Landi Expert Dr G. Rizzardini Expert

COMITE INTERNATIONAL DE LA CROIX-ROUGE INTERNATIONAL COMMITTEE OF THE RED CROSS Dr P. Perrin Médecin Chef, Division de l'Assistance, Unité Santé OrE. Bumier Division de l'Assistance, Unité Santé M. O. Coutau Conseiller diplomatique, Division des Organisations internationales

FEDERATION INTERNATIONALE DES SOCIETES DE LA CROIX-ROUGE ET DU CROISSANT-ROUGE INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES Mrl. Osman Director, Monitoring and Evaluation Division . Mr A. Bermejo Head, Health and Care Department

A55NR page 231

Mr T. Heinasmaki Senior Officer for Health, Health and Care Department MrG. Gizaw Senior Officer for Communicable Diseases, Health and Care Department Mr F. Font Sierra Senior Officer for Maternai and Child Health, Health and Care Department Ms G.Y. Fong Lo Senior Officer for First Aid, Health and Care Department MrC. Lamb Head, Humanitarian Advocacy Department Mr V. Drakulic Senior Officer, Humanitarian Advocacy Department Mr N. Farrell Public Health Adviser for ARCHI, Africa Department Mr T. Svenning Senior Officer, Relationship Management Department Mr S. Davey Director, Advocacy and Communications Division Ms J. Muller External Affairs Officer, Relationship Management Department OBSERVATEURS INVITES CONFORMEMENT A LA RESOLUTION WHA27.37 OBSERVERS INVITED IN ACCORDANCE WITH RESOLUTION WHA27.37 PALESTINE- PALESTINE Dr 1. Tarawiyeh Director-General, Ministry of Health MrN. Ramlawi Ambassador, Permanent Observer, Geneva

Dr M. Al-Sharif Under-Secretary Mr M. Abu Ramadan Director-General, International Cooperation Department Mr R. Al-Husseini MrR. Khouri Adviser of the Minister of Health for International Organizations Mr T. Al-Adjouri Counsellor, Deputy Permanent Observer, Geneva REPRESENTANTS DE L'ORGANISATION DES NATIONS UNIES ET DES INSTITUTIONS APPARENTEES REPRESENTATIVES OF THE UNITED NATIONS AND RELATED ORGANIZATIONS ORGANISATION DES NATIONS UNIES- UNITED NATIONS Ms L. 0 ldring Human Rights Officer, Office of the High Commissioner for Human Rights FONDS DES NATIONS UNIES POUR L'ENFANCE- UNITED NATIONS CHILDREN'S FUND Ms C. Bellamy Executive Director Mr S. Woodhouse Regional Director, UNICEF Office, Geneva Dr Y. Bergevin Chief, Health Section Mr A. W. El Abassi Senior Officer Liaison with WHO, Geneva Mr C. Tinstman Senior Adviser, Poliomyelitis Eradication

ASSNR page 232

Ms M. Bavicchi-Lerner Planning Officer, Planning and Programme Section, UNICEF Office, Geneva Ms J. Polsky Planning Officer, Planning and Programme Section, UNICEF Office, Geneva

FONDS DES NATIONS UNIES POUR LA POPULATION UNITED NATIONS POPULATION FUND Mr A.L. MacDonald Director, UNFPA European Liaison Office, Geneva Mr E. Palstra Senior Externat Relations Officer, UNFP A European Liaison Office, Geneva Ms A. Angarita Technical Officer, UNFPA European Liaison Office, Geneva Ms E. Mayrhofer Professional Officer, UNFPA European Liaison Office, Geneva Dr A. Buzurukov Professional Officer, UNFPA European Liaison Office, Geneva Ms A. Tournon Professional Officer, UNFP A European Liaison Office, Geneva DrN. Dodd Deputy Director, Technical Support Division Dr W. Doedens Technical Officer, UNFPA European Liaison Office, Geneva

CONFERENCE DES NATIONS UNIES SUR LE COMMERCE ET LE DEVELOPPEMENT UNITED NATIONS CONFERENCE ON TRADE AND DEVELOPMENT MrC. Gore Senior Economie Affairs Officer, Office of the Special Coordinator for Least Developed, Landlocked and Island Developing Countries MrD. Diaz Economie Affairs Officer, Division on International Trade in Goods and Services, and Commodities

PROGRAMME DES NATIONS UNIES POUR LE DEVELOPPEMENT UNITED NATIONS DEVELOPMENT PROGRAMME MrE. Bonev Senior Adviser, UNDP European Office, Geneva Mr S. Oertel Programme Officer, UNDP European Office, Geneva

PROGRAMME DES NATIONS UNIES POUR L'ENVIRONNEMENTUNITED NATIONS ENVIRONMENT PROGRAMME Mr J.B. Willis Director, UNEP Chemicals, Geneva Mr S. Milad UNEP Chemicals, Geneva Ms A. Sunden-Bylehn UNEP Chemicals, Geneva Mr H. Fadaei UNEP Chemicals, Geneva

OFFICE DE SECOURS ET DE TRAVAUX DES NATIONS UNIES POUR LES REFUGIES DE PALESTINE DANS LE PROCHE-ORIENT UNITED NATIONS RELIEF AND WORKS AGENCY FOR PALESTINE REFUGEES IN THE NEAR EAST Mr P. Hansen Commissioner-General DrF. Mousa Director of Health Mr R. Aquarone Chief, UNRWA Liaison Office, Geneva

A55NR page 233

Ms R. Tylka Administrative Assistant, UNR W A Liaison Office, Geneva

Ms H. Tracey MrR. Noble MrP. Ghys Ms J. Oison MrC. Michon Mr S. Niyonzima Mr R.S. Ntounga Mr G. Sikipa Ms S. Lillestoel Ms K. Griffith Mr J. Tyszko

HAUT COMMISSARIAT DES NATIONS UNIES POUR LES REFUGIES OFFICE OF THE UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES Mr S. Malé Senior Health Adviser, Health and Community Development Sector Ms K. Burns Senior Public Health Officer, Health and Community Development Sector Ms T. Assebe Reproductive Health Officer, Health and Community Development Sector Dr P. Spiegel Consultant, Health and Community Development Sector

ORGANE INTERNATIONAL DE CONTROLE DES STUPEFIANTS INTERNATIONAL NARCOTICS CONTROL BOARD Professor H. Ghodse President Mr P. Pachta Chief, Narcotics Control and Estimates Unit

ONUSIDA- UNAIDS Dr P. Piot Executive Director Dr K. Cravero Ms M. Fahlen MrM. Sidibe Mr J. Sherry Ms M.O. Emond Ms M. Grunitzky-Bekele Mr L. Loures Mr W. Sittitrai Ms R. Chahil-Graf Mr E. Haarman Ms J. Girard Mr J. Fleet Ms S. Smith Programme on HIV1AIDS and the World of Work Dr S. Niu InFocus Programme on Safety and Health at Work and the Environment Mr A. Bonilla Garcia Policy and Research Coordinator, Social Protection Sector

INSTITUTIONS SPECIALISEES SPECIALIZED AGENCIES ORGANISATION INTERNATIONALE DU TRAVAIL INTERNATIONAL LABOUR ORGANIZATION

ASSNR page 234

Ms C. Mulenga Programme on HIV1 AIDS and the W orld of Work Ms G .J. Ullrich Sectoral Activities Department Ms P. Gabriel InFocus Programme on Skills, Knowledge and Employability Ms C. Mulanga Programme on HIV1 AIDS and the W orld of Work Mr C. Perrin Bureau for Extemal Relations and Partnerships Mr G. Ruyssen Bureau for Extemal Relations and Partnerships ORGANISATION DES NATIONS UNIES POUR L'ALIMENTATION ET L'AGRICULTURE FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS Mr T.N. Masuku Director, F AO Liaison Office with the United Nations, Geneva ORGANISATION DES NATIONS UNIES POUR L'EDUCATION, LA SCIENCE ET LA CULTURE UNITED NATIONS EDUCATIONAL, SCIENTIFIC AND CULTURAL ORGANIZATION M. G. Malempré Directeur, Bureau de Liaison, Genève BANQUE MONDIALE- WORLD BANK Mr C. Lovelace Director, Health, Nutrition and Population

UNION INTERNATIONALE DES TELECOMMUNICATIONS INTERNATIONAL TELECOMMUNICATION UNION M. M. Paratian Chef du Protocole et chargé des Relations avec les Organisations internationales ORGANISATION METEOROLOGIQUE MONDIALE WORLD METEOROLOGICAL ORGANIZATION M. C. Wang Bureau des Relations extérieures ORGANISATION MONDIALE DE LA PROPRIETE INTELLECTUELLE WORLDINTELLECTUALPROPERTY ORGANIZATION Mlle K. Lee Conseiller, Bureau du Conseiller spécial du Directeur général ORGANISATION DES NATIONS UNIES POUR LE DEVELOPPEMENT INDUSTRIEL UNITED NATIONS INDUSTRIAL DEVELOPMENT ORGANIZATION Mr A. Di Liscia Assistant Director-General and Director, UNIDO Liaison Office, Geneva AGENCE INTERNATIONALE DE L'ENERGIE ATOMIQUE INTERNATIONAL ATOMIC ENERGY AGENCY Mr S. Groth Director, Division of Human Health, Department ofNuclear Sciences and Applications Ms J. Knesl IAEA Office, Geneva

A55NR page 235

ORGANISATION MONDIALE DU COMMERCE WORLD TRADE ORGANIZATION Mrs G. Stanton Senior Counsellor, Agriculture and Commodities Division Mrs J. Watal Counsellor, Intellectual Property Division

Mr 1.0. Mensa-Bonsu Minister Counsellor, Geneva Professor K. Ndombo Dr L.O. Masimba

SECRETARIAT DU COMMONWEALTH COMMONWEALTH SECRETARIAT Mrs J. Parris Chief Programme Officer, Health Department, Human Resource Development Division Dr S.P. Akpabio

REPRESENTANTS D'AUTRES ORGANISATIONS INTERGOUVERNEMENTALES REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZATIONS LIGUE DES ETATS ARABES- LEAGUE OF ARAB STATES M. S. Alfarargi Ambassadeur, Observateur permanent, Genève Dr H.A. Hammouda Directeur, Département de la Santé et de 1'Environnement M. M.L. Mouaki Benani Conseiller, Délégation permanente, Genève M. O. El Hajje Délégation permanente, Genève M. S. Aeid Délégation permanente, Genève

Dr K.T. Joiner Dr S.V. Shongwe Mr Z.J. Ngwenya Ms M. Shomari

COMMISSION EUROPEENNE EUROPEAN COMMISSION MrC. Trojan Ambassador, Permanent Delegation, Geneva MrB. Merkel Head of Unit, Directorate General for Health and Consumer Protection, European Commission, Luxembourg Ms M.-A. Coninsx Minister Counsellor, Permanent Delegation, Geneva Mr A. Lanaras Directorate General for Health and Consumer Protection, European Commission, Luxembourg MrG. Thinus Directorate General for Health and Consumer Protection, European Commission, Luxembourg MrN. Fahy Directorate General for Health and Consumer Protection, European Commission, Luxembourg

OFFICE INTERNATIONAL DES EPIZOOTIES OFFICE INTERNATIONAL DES EPIZOOTIES Dr P. Economides Member of the Administrative Commission, Secretary-General ofthe Regional Commission for the Middle East Countries

UNION AFRICAINEAFRICAN UNION Ms S.A. Kalinde Permanent Observer, Geneva

A55NR page 236

MrC. Dufour Permanent Delegation, Geneva

CONSEIL DES MINISTRES DE LA SANTE, CONSEIL DE COOPERATION DES ETATS ARABES DU GOLFE HEALTH MINISTERS' COUNCIL FOR GULF COOPERATION CO UN CIL STATES Dr A.M. Shobokshi Minister of Health of Saudi Arabi a Dr T.A. Khoja Executive Director Mr R.I. Al-Mousa Dr H.A. Gadalla Medical Consultant

ORGANISATION DE LA CONFERENCE ISLAMIQUE ORGANIZATION OF THE ISLAMIC CONFERENCE Mr A.T. Hane Ambassador, Permanent Observer, Geneva Mr J. Olia Deputy Permanent Observer, Geneva

COMITE PERMANENT INTER-ETATS DE LUTTE CONTRE LA SECHERESSE DANS LE SAHEL PERMANENTINTERSTATE COMMITTEE FOR DROUGHT CONTROLINTHESAHEL M. B. Traoré Programme majeur Population et Développement

ORGANISATION INTERNATIONALE DE PROTECTION CIVILE INTERNATIONAL CIVIL DEFENCE ORGANIZATION Mr V. Viacheslav

REPRESENTANTS DES ORGANISATIONS NON GOUVERNEMENTALES EN RELATIONS OFFICIELLES AVEC L'OMS REPRESENTATIVES OF NONGOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO Alliance internationale des Femmes International Alliance of Women Ms G. Haupter Ms M. Pal Ms M.A. Kildare

ORGANISATION INTERNATIONALE POUR LES MIGRATIONS INTERNATIONAL ORGANIZATION FOR MIGRATION Dr J. Stuc key Migration Health Services Dr A. Eltom Migration and Health Programme Development Officer, Migration Health Services Ms M. Haour-Knipe HIV1 AIDS Coordinator, Migration Health Services Ms J. Weekers Medical Administrator Dr G. Grujovic Medical Screening Systems Specialist, Migration Health Services

Association du Commonwealth pour les Handicaps mentaux et les Incapacités liées au développement Commonwealth Association for Mental Handicap and Developmental Disabilities Dr V .R. Pandurangi Dr G. Supramaniam Mr A. V. Pandurangi

ASSNR page 237

Dr N .K. Venkataramana Dr S. Venkataramana Mr P.K. Menon Ms G. Anasuya Bai Mr A.N.N. Samrat

Association internationale des Techniciennes et Techniciens diplômés en Electro-Radiologie médicale International Society of Radiographers and Radiological Technologists Dr A. Yule

Association internationale de Conseil en Allaitement International Lactation Consultant Association Ms M. Lehmann-Buri Ms J. Thomann

Association internationale des Techniciens Biologistes International Association of Biologists Technicians Mme N. Marchal

Association internationale pour la Prévention et le Dépistage du Cancer International Society for Preventive Oncology Dr H.E. Nieburgs Dr L. Santi

Association internationale de Logopédie et Phoniatrie International Association of Logopedics and Phoniatries Dr A. Muller

Association internationale de Pédiatrie International Pediatrie Association Dr J.G. Schaller

Association internationale pour la Santé de la Mère et du Nouveau-Né International Association for Maternai and Neonatal Health Professor H. Bossart Mrs G .M. Santschi

Association internationale des Femmes Médecins Medical Women's International Association Dr C. Bretscher-Dutoit Dr S. Capek

Association italienne Amis de Raoul Follereau ltalian Association of Friends of Raoul Follereau DrE. Venza

Association internationale des Médecins pour la Prévention de la Guerre nucléaire International Physicians for the Prevention ofNuclear War Dr A. Behar Dr M. Femex

Professor A. Landolfi Dr S. Deepak

Association médicale du Commonwealth Commonwealth Medical Association Dr J. Richards Ms M. Haslegrave Dr J. Havard Professor K. Stuart

A55NR page 238

Association médicale mondiale World Medical Association DrD. Human

Professor D. Sanders MrM. Rowson Ms M. Reeves

DrR. Smoak Dr Q. Chowdhury Dr E. Accorsi Dr K. Balasubramaniam Ms E. Viaud DrU. Kumar Ms C. Eychenne Dr P. John Mr R. Dennett Mr J. Fernandes

Association mondiale de Psychiatrie World Psychiatrie Association Dr S. Flache

Mr C. Schuftan Ms S. Shannon Dr M. Shiva Dr S. Deepak Ms N. Basu

Association mondiale des Sociétés de Pathologie et Biologie médicale World Association of Societies of Pathology and Laboratory Medicine Dr P. Merten

Dr P.V. Unnikrishnan

Association pharmaceutique du Commonwealth Commonwealth Pharmaceutical Association Mr J. Bell

Ms S. Sivaraman Ms C. Fischer Ms B. Leach

Professor T. Moffat Ms V. Rose

CMC -L'Action des Eglises pour la Santé CMC- Churches' Action for Health Dr P. Nickson OrE. Ombaka

Ms A.H. Nouman

Collège international des Chirurgiens International College of Surgeons Professor Chun-Jean Lee

Dr G.B. Buckle Mr M. Downham Dr J. Pehle Dr M. Kurian Dr Z. Chowdhury Ms M.S. Masaiganah Ms E. Verheul

Comité inter-africain sur les Pratiques traditionnelles ayant effet sur la Santé des Femmes et des Enfants Inter-African Committee on Traditional Practices affecting the Health of Women and Children Mrs B. Ras Work

A55NR page 239

Mrs M. Greuter Mrs R. Bonner

Conseil international des Femmes International Council ofWomen Mrs P. Herzog

Mrs J. Koch

Comité international catholique des Infirmières et Assistantes médico-sociales International Catholic Committee of Nurses and Medico-social Assistants Miss J. Bartley

Conseil international des Infirmières International Council of Nurses Dr Yu-Mei Chao Dr J.A. Oulton Dr M. Kingma

Confédération internationale des SagesFemmes International Confederation of Midwives Mrs P. ten Hoope-Bender

Dr T. Ghebrehiwet Ms P. Hugues Mrs L. Carrier-Walker

Mrs R. Brauen Mrs L. Gorrell Ms J. Bonnet Ms R. Perry

Confédération mondiale de Physiothérapie World Confederation for Physical Therapy Ms S. Mercer Moore Ms B.J. Myers

Mrs F. Meret Mrs C. Bosson Dr B. Malone Ms A. Tsang Mrs M. Bertholet Pradervand

Conseil de l'Industrie pour le Développement lndustry Council for Development DrD. Jonas Dr S. Jongeneel

Conseil international pour la Lutte contre les Troubles dus à une Carence en Iode International Council for Control oflodine Deficiency Disorders DrH. Burgi

Conseil des Organisations internationales des Sciences médicales Council for International Organizations of Medical Sciences Professor J.E. IdanpiUin-Heikkila

Conseil mondial de la Santé Global Health Council Dr N. Daulaire

Dr J. Gallagher Ms S. Hall Mr S.S. Fluss Ms S. Crowley Dr J. V enulet Mr S. Hossain Dr Abdussalam Dr C.S. Wiysonge

A55NR page 240

Dr T.M. Hussain Mr T. Bombelles Ms B.L. Rasmussen Mr E. Mugisha Ms S. Shannon Mr H. McConnell

Dr P. Carlevaro Mr J. Cooke Mr A. Aumonier Mr S. Darragh Mr S. Brinchmann Professor R. Krebs Mr M. Grayson Ms N .V. Smith

Fédération dentaire internationale FDI World Dental Federation Dr A. Ratnanesen Dr J. T. Barnard

Fédération internationale de Coopération des Centres de Recherche sur les Systèmes et Services de Santé Federation for International Cooperation of Health Services and Systems Research Centers Dr Bui Dang Ha Doan

Fédération internationale des Associations d'Etudiants en Médecine International Federation of Medical Students Associations Mr J. Kammeyer Mr G. Spiteri Mr J.M. Munoz Mr C. Dospinescu

DrD. Lévy Mr F. Striel

Fédération internationale de Gynécologie et d'Obstétrique International Federation of Gynecology and Obstetrics DrR. Kulier

MrN. Borojevic Mr M. Odermarski Ms H. Bencevic

Fédération internationale de l'Industrie du Médicament International Federation ofPharmaceutical Manufacturers Associations DrH.E. Baie Dr E. Noehrenberg DrD. Webber MrM. Murata

Fédération internationale des Collèges de Chirurgie International Federation of Surgical Colleges Professor S.W.A. Gunn

Fédération internationale des Industries des Aliments diététiques International Special Dietary Foods Industries Dr A. Bronner

Dr O. Morin Mr M. de Skowronski Ms P. Goldschmid Mr A. Micardi

ASSNR page 241

Ms J. Keith Mr D. Spiegel Mr D. Hawkins

Fédération internationale pour la Planification familiale International Planned Parenthood Federation Ms C. Hoffman

Ms K. Bolognese Ms H. Mouchly Weiss MrK. deJong Mr A. Maier Mr L. Delgado Mr Thien Luong Van My MsG. Koffy Mr N. Christian sen Ms C. Drotz-Jonasson Ms S. Jacobs

Fédération mondiale de Chiropratique World Federation of Chiropractie Dr P .F. Carey Dr R. Baird Mr D. Chapman-Smith Dr M. Alattar Dr G. Auerbach Dr M. Aymon Dr S. Borges Dr A. Oztürk Dr B. Sauser Dr M. Tétrault

Fédération internationale pharmaceutique International Pharmaceutical Federation Dr P. Kiel gast

DrY. Weiss MrT. Hoek Mr C.R. Hitchings Professor H. Junginger Mr J. Parrot Mr P.-D. Lee Chao Mr A. Fontana Ms D. Gal Ms S. Siiskonen Ms S. Faria Mrs C. Lesser

Fédération mondiale des Associations de la Santé publique World Federation of Public Health Associations Dr T. Abelin Dr M. Akhter Dr 1. Alshowaier Dr S. Banoob Mr F. Bassoukissa Ms J. Bell Davenport Dr M. Denkovski Mr G. Ghazzawi Dr J. Glasser

A55NR page 242

MsJ. Gunby Mr A. Hawkes Dr Wang Hexiang Ms M. Hilson Dr A. Jones Dr E. Kanyesigye

Dr Kan Xuegui Dr P. Kuri Morales Ms S. Wilbum

Fédération mondiale des Sociétés de Neurochirurgie World Federation ofNeurosurgical Societies Professor A. Basso

Dr C. Korcczak Dr A. Leventhal Ms A. Long MrH. Lowson Dr C. Montoya Dr A. Mzige Dr T. Nakahara Professor S. Serrano Dr J.C. Nassanga Dr P. Orris Dr D.Z. Paget DrG. Rayner Mr G. Reschauer MrC. Rosene Dr Lu Rushan DrR.O. Swai Dr Sok Touch Dr J.B. Tomaro Dr G. Tellnes Ms S. Bandali Mr A. Uutela Dr K. van der V elden Ms R. Villars Dr V. V an Casteren

Fédération mondiale du Coeur World Heart Federation Professor A. Bayes de Luna Ms D. Grizeau-Clemens

Fédération mondiale du Thermalisme et du Climatisme World Federation ofHydrotherapy and Climatotherapy

Fédération mondiale pour la Santé mentale World Federation for Mental Health Ms P. Lahti Dr S. Flache

Fédération mondiale pour l'Enseignement de la Médecine World Federation for Medical Education MrH. Karle

Fondation Aga Khan -Aga Khan Foundation

Forum Mondial pour la Recherche en Santé Global Forum for Health Research (GFHR) Mr L.J. Currat Mr A. de Francisco

ASSNR

page 243

Ms S. Jupp Mr T. Nchinda Ms A. Pawlowska Mr J. W arriner

Ms K. Baillie

International Society of Doctors for the Environment International Society of Doctors for the Environment Dr G. Silberschmidt

MrR. Widdus MsK.Holm Ms A. Armstrong Ms S. Botta Ms P. Atiase Ms O. Wetterwald Ms G. Laviolle

Ligue internationale des Sociétés dermatologiques International League of Dermatological Societies Professor J.-H. Saurat

Ligue internationale La Leche La Leche League International

Hel pAge International- HelpAge International Mr T. Petersen

Ms H. Kuonen-Goetz Ms B. Reiser

Inclusion International- Inclusion International Ms U. Michel

Industrie mondiale de l'Automédication responsable World Self-Medication lndustry Dr J .A. Reinstein Ms M. Friend

Medicus Mundi Internationalis (Organisation internationale de Coopération pour la Santé) Medicus Mundi Internationalis (International Organization for Cooperation in Health Care) Mr M.A. Argal DrY. Sossou DrD. Forkan MrG. Eskens Dr A. Foracchia Mr B. Pastors Professor Z. Pawlowski

Infact - Infact Ms K. Mulvey

Institut international des Sciences de la Vie International Life Sciences Institute Dr E. Kennedy

MrT. Puis

International Association for the Study of Obesity International Association for the Study of Obesity MrN. Rigby

DrN. Rehlis Dr S. Rypkema Professor H. Van Balen

A55NR page 244

DrE. Widmer Ms F. Wijckmans

Ms L. Kimbo MrN. Qué Mr P. Mugambizi DrG. Buckle MrR. Chana

Organisation internationale de Normalisation International Organization for Standardization Mr T .J. Hancox

Dr P.C. John

Organisation internationale des Unions de Consommateurs (Organisation internationale des Consommateurs) International Organisation of Consumers Unions (Consumers International) Ms A. Allain

Dr J. Fernando Dr K. Balasubramaniam MrK. Sagoo Ms H. Lutescia

Ms B. Barry Ms C. Vacca Ms B. Bationo Dr W. Bannenberg Ms 1. Fernandez Ms E. 'tHoen Dr A. Gupta MrD. Berman Ms M. Lehners Ms P. Boulet Dr L. Lhotska Ms L. Westin Ms A. Linnecar Mr J. Albinson Ms E. Petitat-Cote Ms N. Cebotarenco Ms P. Rundall Mr J. Love Dr P. Sherestra Dr F. Vallone Ms E. Sterken Dr C.C. Canila Dr A. Segall Ms C. Bruneton Mr A. Cassels Ms H. Chastanier Mr J. Reinhard MrT. Luppe Ms J. Richter Dr A.T.M.Z. Chowdhury Ms C. Fischer Mr A.Q. Chowdhury Dr K. Moody Mr O. Msaki Ms B. Leach

A55NR page 245

Organisation islamique pour les Sciences médicales Islamic Organization for Medical Sciences

Féderation mondiale des Sociétés d'Acupuncture The World Federation of AcupunctureMoxibustion Societies

Dr Y. Al-Sharrah Dr G. Gunia Organisation mondiale contre la Cécité International Agency for the Prevention of Blindness

Dr R. Telle Dr A. Liguori

Mr M. Whitlam Professor F. Bangrazi Petti Organisation mondiale des Médecins de Famille World Organization ofFamily Doctors

Mr A. Kausland Union internationale contre les Infections transmises sexuellement International Union against Sexually Transmitted Infections

Dr 1. Hellemann OXFAM- OXFAM

Ms P. Saunders Société internationale de Prothèse et Orthèse International Society for Prosthetics and Orthotics

Dr G.M. Antal Union internationale des Architectes International Union of Architects

Mr H.-E. Gatermann Vision mondiale internationale World Vision International

Dr J. Steen Jensen Dr B. McHugh

DrE.Ram Soroptimist International - Soroptimist International

DrH. Mahler MsG. Khanna Dr M. van Hoyweghen Dr R. Narayan Dr T. Narayan Ms M. Zuniga

Ms I.S. Nordback The Network: Community Partnerships for Health through Innovative Education, Service, and Research The Network: Community Partnerships for Health through Innovative Education, Service, and Research

Dr P. Kekki

Mt A. Wibley The Save the Children Fund (UK) The Save the Children Fund (Royaume-Uni)

Dr J. Richter MsN. Upham Dr P. Zinkin DrN. Billo

Ms R. Keith Ms A. Heaton MrM. Bailey

ASSNR page 246

Dr B. Picoul Mr W.A.O. Opula Ms I.C. Basto de Azevedo Ms L. Martin Dr Schumacher Ms A. Lindsay Mrs R. Bloem MrD. Brown Mr H. Ruttimann Ms S. Parvin DrL.P. Banu Mr A. Chetley Dr A. Moukolo

Mr W .P. Luedemann Ms K.M. Hennings Mr J. Al binson Ms L. Westin Ms N. Cebotarenco Mr S. Habibi MrT. Davies Mrs D. Davies Ms D. Bride! OrO. Broun Ms 1. Grum OrO. Logie

REPRESENTANTS DU CONSEIL EXECUTIF Madame M. Abel M. J.A. Chowdhury Dr K. Karam Madame K. Wigzell

REPRESENTATIVES OF THE EXECUTIVE BOARD MrsM. Abel Mr J.A. Chowdhury DrK.Karam Ms K. Wigzell

A55NR page 247

INDEX OF NAMES This index contains the names of speakers reported in the present volume.

INDEX DES NOMS DES ORATEURS Cet index contient les noms des orateurs dont les interventions figurent dans le présent volume.

ABDULLAH, A. (Maldives), 69 ABEL, M. (Vanuatu) (Chairman ofthe Executive Board/Président du Conseil exécutif), 24 ABOUO-N'DOURI, R. (Côte d'Ivoire), 85 AFRIYIE, K. (Ghana), 88 AGOSTINHO DAS NEVES, E.M.A. (Sao Tome and Principe/Sao Tomé-et-Principe), 130 AITKEN, D. (Senior Policy Adviser/Conseiller principal en politique), 164, 165 ALLENDE SANCHEZ, M. (Sasakawa Health Prize/Prix Sasakawa pour la Santé), 155 AMATHILA, L. (Namibia/Namibie), 71 ARMADA, F. (Venezuela), 136 ASADOV, D.A. (Uzbekistan/Ouzbékistan), 148 ASLAM, A.M. (Pakistan), 20, 92 AZEVEDO MERCADANTE, O. (Brazil/Brésil), 80 AZIZ, P .A. (Brunei Darussalam/Brunéi Darussalam), 113

BERMEJO, A. (International Federation of Red Cross and Red Crescent Societies/Fédération internationale des Sociétés de la Croix-Rouge et du CroissantRouge), 143 BHANDARI, S.S. (Nepal/Népal), VicePresident of the Fifty-fifth World Health AssemblyNice-Président de la Cinquante-Cinquième Assemblée mondiale de la Santé, 66 BOUPHA, B. (Lao People's Democratie Republic/République démocratique populaire lao), 119 BRADOL, J.-H. (United Arab Emirates Health Foundation Prize/Prix de la Fondation des Emirats arabes unis pour la Santé), 158

BALOCH, M.Z. (Pakistan), 164 BARTOS, D. (Romania!Roumanie), 59 BEASSOUMAL, N.Y. (Chad/Tchad), 121 BELLAMY, C. (Executive Director, United Nations Children's Fund/Directeur général/Fonds des Nations Unies pour l'Enfance), 31

CARBONE CAMPOVERDE, F. (Peru/Pérou), 83 CHATTI, M.I. AL- (Syrian Arab Republic/République arabe syrienne), 60 COLEMAN, P.S. (Liberia/Libéria), 129 COLL SECK, A.M. (SenegaVSénégal), Chairman of Committee B/Président de la Commission B, 115

DAY ARATNE, P. (Sri Lanka), 50 DAYRIT, M.M. (Philippines), 117 DEGUARA, L. (Malta/Malte), 76 DIRECTOR-GENERAL/DIRECTEUR GENERAL, 25, 62, 167 DOSKALIEV, Z. (Kazakhstan), 103

ASSNR page 248 ELTAIF, A.E. (Libyan Arab Jamahiriya/Jamahiriya arabe libyenne), 146 ENGQVIST, L. (Sweden/Suède), 57 MADFAA, H.A.R. AL- (United Arab Emirates Health Foundation/Fondation des Emirats arabes unis pour la Santé), 156 MAUCEC-ZAKOTNIK, J. (Slovenia/Slovénie), 100 M'BAREK, H. (Tunisia/Tunisie), 73 MCLELLAN, A. (Canada), 46 MICOVIC, Z. (Yugoslavia/Yougoslavie), 90 MODESTE-CURWEN, C.M. ( Grenada/Grenade), 17 MOOA, B.R. (Kiribati), Vice-President of the Fifty-fifth World Health AssemblyNicePrésident de la Cinquante-Cinquième Assemblée mondiale de la Santé, 104 MOSKALENKO, V.F. (Ukraine), VicePresident ofthe Fifty-fifth World Health AssemblyNice-Président de la Cinquante-Cinquième Assemblée mondiale de la Santé), 127 MUBARAK, O.M. (Iraq), 94 MUHWEZI, J. (Uganda/Ouganda), 126 MUNIBARI, A.N. AL- (Yemen!Yémèn), 120 MuNOZ, F. (Chile/Chili), 132 MWA W A, Y. (Malawi), 16

FEROZ, F. (Afghanistan), 123 FRENK, J. (Mexico/Mexique), 37 GAMKRELIDZE, A. (Georgia/Géorgie), 95 GONZALEZ GARCIA, G. (Argentina!Argentine), 55

HAMUKWAYA, A.J. (Angola), 139 HILAIRE, J. (Haïti/Haïti), 142 HONG Sun Huot (Cambodia/Cambodge), President of the Fifty-fourth World Health Assembly/Président de la Cinquante-Quatrième Assemblée mondiale de la Santé, 1, 5 HOSSAIN, K.M. (Bangladesh), 102

JAMRISKA, P. (Ecuador/Equateur), 78

KAMIL, M.A. (Djibouti), 124 KASSAMA, Y. (Gambia!Gambie), 141 KET SEIN (Myanmar), 122 KEYURAPHAN, S. (Thailand!Thaïlande), 55 KHYARI, T. EL (Morocco/Maroc), 65 KING, A. (New Zealand!Nouvelle-Zélande), 51 KONDO, J. (Japan/Japon), 43 KRISTJANSSON, J. (Iceland/Islande), 92

NASSER, F. EL (Jordan/Jordanie), 82 NAUMAN, A. (Poland!Pologne), 89 NGEDUP, L.S. (Bhutan!Bhoutan), 87 NURANI BAKAR, M. (Somalia!Somalie ), 134 NYMADAWA, P. (Mongolia/Mongolie), 38

LEE, T.-B. (Republic ofKorea/République de Corée), 54 LEMUS BOJORQUEZ, 1. (Guatemala), 135 LEVY, Y. (Israel/Israël), 79, 162 LOPEZ, O. (Uruguay), 131 LOPEZ BELTRAN, J.F. (El Salvador), President of the Fifty-fifth World Health Assembly/Président de la CinquanteCinquième Assemblée mondiale de la Santé, 12, 63, 168 LOPEZ CARDENAS, E. (Costa Rica), 68 LOZANO BARRAGAN, J. (Holy See/SaintSiège), 144

OLANGUENA A WONO, U. (Cameroon/Cameroun), 44 ONGERI, S.K. (Kenya), 139 ORDZHONIKIDZE, S. (Under-SecretaryGeneral of the United Nations, DirectorGeneral ofthe United Nations Office at Geneva, Representative of the SecretaryGeneral of the United Nations/Secrétaire général adjoint de l'Organisation des Nations Unies/Directeur général de l'Office des Nations Unies à Genève/Représentant du Secrétaire général de l'Organisation des Nations Unies), 2 OSMAN, A.B. (Sudan/Soudan), 137

ASSNR page 249 PEZESHKIAN, M. (Iran, Islamic Republic of/Iran, République islamique d'), 99 PHUMAPHI, J. (Botswana), Vice-President of the Fifty-fifth World Health AssemblyNice-Président de la Cinquante-Cinquième Assemblée mondiale de la Santé, 111 SUNGAR, M. (Turkey/Turquie), 91

TAG-EL-DIN, M.A. (Egypt/Egypte), 39 THAKUR, C.P. (lndia/Inde), 98 THOMPSON, T.G. (United States of America/Etats-Unis d'Amérique), 41, 162 UNGER, P.-F. (Representative of the Conseil d'Etat of the Republic and Canton of Geneva/Représentant du Conseil d'Etat de la République et Canton de Genève), 4

RI TCHEUL (Democratie People's Republic of Korea/République populaire démocratique de Corée), 147 RIVEROS DUENAS, G.E. (Colombia/Colombie), 61, 116, 166

SACHS, J. (Center for International Development, Harvard University, Chair of the Commission on Macroeconomies and Health/Centre pour le Développement international de 1'Université Harvard, Président de la Commission Macroéconomie et Santé), 108 SARABOCHE, H. (Dominica/Dominique), 75 SASAKA WA, Y. (Sasakawa Health Prize F oundation/F ondation commémorative Sasakawa pour la Santé), 153 SHARIF, M. AL- (Palestine), 96 SHEVCHENKO, Y.L. (Russian Federation/Fédération de Russie), 42 SHOBOKSHI, O. (Saudi Arabia/Arabie saoudite), 53 SMALLWOOD, R. (Australia/Australie), 112 SOTHINATHAN, S. (Malaysia/Malaisie), 84 SUJUDI, A. (Indonesia/Indonésie), 64

VILLALOBOS TALERO, C. (Spain/Espagne), 46, 62 VIT, M. (Czech Republic/République tchèque), 72 VLAHUSié, A. (Croatia/Croatie), 145

WOLLAST, E. (Ihsan Dogramaci Family Health Foundation Prize/Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille), 152

Y ACOUB, LM. (United Arab Emirates Health Foundation Prize/Prix de la Fondation des Emirats arabes unis pour la Santé), 159

ZHANG Wenkang (China/Chine), 18, 58

A55NR page 250

INDEX OF COUNTRIES AND ORGANIZATIONS This index lists the countries, organizations and bodies represented by the speakers whose names appear in the index on the preceding pages.

AFGHANISTAN, 123 ANGOLA,l39 ARGENTINA, 55, AUSTRALIA, 112

GAMBIA, 141 GEORGIA, 95 GHANA, 88 GRENADA, 17 GUATEMALA, 135

BANGLADESH, 102 BHUTAN, 87 BOTSWANA, 111 BRAZIL, 80 BRUNEI DARUSSALAM,, 113

HAITI, 142 HOLY SEE, 144

CAMBODIA, 1, 5 CAMEROON, 44 CANADA,46 CARICOM, 75 CENTRAL AMERICAN STATES AND DOMINICAN REPUBLIC, 68 CHAD, 121 . CHILE, 132 CHINA, 18, 58 COLOMBIA, 61, 116, 166 CONSEIL D'ETAT OF THE REPUBLIC AND CANTON OF GENEY A, 4 COSTA RICA, 68 COTE D'IVOIRE, 85 CROATIA, 145 CZECH REPUBLIC, 72

ICELAND, 92 INDIA, 98 INDONESIA, 64 INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES, 143 IRAN, ISLAMIC REPUBLIC OF, 99 IRAQ, 94 ISRAEL, 79, 162

JAPAN,43 JORDAN, 82

KAZAKHSTAN, 103 KENYA, 139 KIRIBATI, 104

DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, 147 DJIBOUTI, 124 DOMINICA, 75

LAO PEOPLE'S DEMOCRATIC REPUBLIC, 119 LIBERIA, 129 LIBYAN ARAB JAMAHIRIYA, 146

ECUADOR, 78 EGYPT, 39 EL SALVADOR, 12, 63, 168 EUROPEAN UNION, 46

MALAWI, 16 MALAYSIA, 84 MALDIVES, 69 MALTA, 76 MEDECINS SANS FRONTIERES (FRANCE}, 158

A55NR page 251 MEXICO, 37 MONGOLIA, 38 MOROCCO, 65 MY ANMAR, 122 SMALL ISLAND STATES OF THE WESTERN PACIFIC, 104 SOMALIA, 134 SOUTHERN AFRICAN DEVELOPMENT COMMUNITY, 71 SPAIN, 62 SRI LANKA, 50 SUDAN,l37 SWEDEN,57 SYRIAN ARAB REPUBLIC, 60

NAMIBIA, 71 NEPAL, 66 NEW ZEALAND, 51

PAKISTAN, 20, 92, 164 PALESTINE, 96 PERU, 83 PHILIPPINES, 11 7 POLAND, 89 PROGRAMA NACIONAL DE ATTENCION ODONTOLOGICA INTEGRAL PARA MUJERES TRABAJADORES DE ESCASOS RECURSOS, 155

THAILAND, 55 TUNISIA, 73 TURKEY, 91

REPUBLIC OF KOREA, 54 ROMANIA, 59 RUSSIAN FEDERA TlON, 42

UGANDA, 126 UKRAINE, 127 UNICEF, 31 UNITED ARAB EMIRATES HEALTH FOUNDATION, 156 UNITED NA TIONS, 2 UNITED STATES OF AMERICA, 41, 162 URUGUAY,l31 UZBEKISTAN, 148

SAO TOME AND PRINCIPE, 130 SASAKAW A HEALTH PRIZE FOUNDATION, 153 SAUDI ARABIA, 53 SENEGAL, 115 SLOVENIA, 100

VANUATU,24 VENEZUELA, 136

YEMEN, 120 YUGOSLAVIA, 90

A55NR page 252

INDEX DES PAYS ET ORGANISATIONS Cet index contient les noms des pays, organisations et organismes divers représentés par les orateurs dont les noms figurent dans l'index précédent.

AFGHANISTAN, 123 ANGOLA,139 ARABIE SAOUDITE, 53 ARGENTINE, 55 AUSTRALIE, 112

BANGLADESH, 102 BHOUTAN, 87 BOTSWANA, Ill BRESIL, 80 , BRUNEI DARUSSALAM, 113

FEDERATION DE RUSSIE, 42 FEDERATION INTERNATIONALE DES SOCIETES DE LA CROIX-ROUGE ET DU CROISSANT-ROUGE, 143 FONDATION COMMEMORATIVE SASAKAW A POUR LA SANTE, 153 FONDATION DES EMIRATS ARABES UNIS POUR LA SANTE, 156

CAMBODGE, 1, 5 CAMEROUN, 44 CANADA,46 CARICOM, 75 CHILI, 132 CHINE, 18, 58 COLOMBIE, 61, 116, 166 COMMUNAUTE DE DEVELOPPEMENT DE L'AFRIQUE AUSTRALE, 71 CONSEIL D'ETAT DE LA REPUBLIQUE ET CANTON DE GENEVE, 4 COSTA RICA, 68 COTE D'IVOIRE, 85 CROATIE, 145

GAMBIE, 141 GEORGIE, 95 GHANA, 88 GRENADE, 17 GUATEMALA, 135

HAITI, 142

INDE, 98 INDONESIE, 64 IRAN, REPUBLIQUE ISLAMIQUE D', 99 IRAQ, 94 ISLANDE, 92 ISRAEL, 79, 162

DJIBOUTI, 124 DOMINIQUE, 75

JAMAHIRIYA ARABE LIBYENNE, 146 JAPON, 43 JORDANIE, 82

EGYPTE, 39 EL SALVADOR, 12, 63, 168 EQUATEUR, 78 ESPAGNE, 62 ETATS D' AMERIQUE CENTRALE ET REPUBLIQUE DOMINICAINE, 68 ETATS-UNIS D'AMERIQUE, 41, 162

KAZAKHSTAN, 103 KENYA, 139 KIRIBATI, 104

LIBERIA, 129

A55NR page 253

MALAISIE, 84 MALAWI, 16 MALDIVES, 69 MALTE, 76 MAROC,65 MEDECINS SANS FRONTIERES (FRANCE), 158 MEXIQUE, 37 MONGOLIE, 38 MY ANMAR, 122

REPUBLIQUE DEMOCRATIQUE POPULAIRE LAO, 199 REPUBLIQUE POPULAIRE DEMOCRATIQUE DECOREE, 147 REPUBLIQUE TCHEQUE, 72 ROUMANIE, 59

NAMIBIE, 71 NEPAL, 66 NOUVELLE-ZELANDE, 51

SAINT-SIEGE, 144 SAO TOME-ET-PRINCIPE, 130 SENEGAL, 115 SLOVENIE, 100 SOMALIE, 134 SOUDAN,137 SRI LANKA, 50 SUEDE, 57

ORGANISATION DES NATIONS UNIES, 2 OUGANDA, 126 OUZBEKISTAN, 148

TCHAD, 121 THAILANDE, 55 TUNISIE, 73 TURQUIE, 91

PAKISTAN, 20, 92, 164 PALESTINE, 96 PEROU, 83 PETITS ETATS INSULAIRES DU PACIFIQUE OCCIDENTAL, 104 PHILIPPINES, 117 POLOGNE, 89 PROGRAMA NACIONAL DE ATENCION ODONTOLOGICA INTEGRAL PARA MUJERES TRABAJADORES DE ESCASOS RECURSOS, 155

UKRAINE, 127 UNICEF, 31 UNION EUROPEENNE, 46 URUGUAY, 131

VANUATU,24 VENEZUELA, 136

REPUBLIQUE ARABE SYRIENNE, 60 REPUBLIQUE DECOREE, 54

YEMEN, 120 YOUGOSLAVIE, 90

Key facts

Organisation World Health Organization (WHO)

Document type Governing Bodies documents

Adoption date December 31, 2002

Source World Health Organization