WPRlRC53/SRl1
SUMMARY RECORD OF THE FIRST MEETING
Main Conference Hall and 2nd floor, Room A of the Kyoto International Conference Hall Monday, 16 September 2002 at 10.30 a.m. and 2 p.m.
CHAIRPERSON: Pehin Haji ABDUL AZIZ UMAR (Brunei Darussalam) later: Dr Hideo SHINOZAKI (Japan)
CONTENTS
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Opening ceremony ...................................................................................... . Opening of the session ................................................................................ . Address by the Retiring Chairperson .......................................................... . Election of new officers: Chairperson, Vice-Chairperson and Rapporteurs ............................................................ .. Adoption of the agenda ............................................................................... . Report of the Regional Director ................................................................... .. ANNEX I Speech by Dr Chikara Sakaguchi, Minister of Health, Labour and Welfare of Japan, at the opening ceremony ...... ...... ........ ......... ........................ ..... ....... Speech by Pehin Haji Abdul Aziz Umar, Retiring Chairperson, at the opening ceremony .... .......... ...... Speech by Dr Shigeru Omi, Regional Director, at the opening ceremony...... ............ .......... .......................... Speech by Mr Keiji Yamada, Kyoto Prefecture Governor, at the opening ceremony..................................... Speech by Mr Yori Kane Masumoto, Mayor of City of Kyoto, at the opening ceremony.........................
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2. 3.
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4. 5. 6.
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ANNEX 2 -
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ANNEX 3 -
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ANNEX 4 -
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ANNEX 5 -
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CONTENTS (continued) page
ANNEX6-
Speech by Dr Gro Harlem Brundtland, Director-General, at the opening ceremony Address by the Retiring Chairperson at the opening session ..... ..... ........ ... ...... ...... .......... ............ ....
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ANNEX 7 -
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I.
OPENING CEREMONY The opening ceremony was held at 10.30 a.m. at the Main Conference Hall of the
Kyoto International Conference Hall. The Minister of Health, Labour and Welfare, Japan, Dr Chikara SAKAGUCHI, welcomed the members of the Regional Committee and other guests to Kyoto and recalled that it was in Kyoto in October 2000 that the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific Region had certified the Region as poliomyelitis-free. The annual session of the Regional Committee meeting was an excellent opportunity for Member States to find solutions to common problems. Japan would continue to work in close collaboration with WHO, especially the Regional Office for the Western Pacific (Annex 1). The CHAIRPERSON of the Regional Committee, Pehin Haji ABDUL AZIZ UMAR (fifty-second session) thanked the Government of Japan for graciously hosting the Committee's fifty-third session. He was pleased to note the progress that had been achieved in improving the health and quality of life of the people of the Region and the renewed commitment to continuing the battle against tuberculosis and tobacco, and to preserving the gains that had been made in the campaign against poliomyelitis. He thanked the Member States and colleagues for their excellent support and cooperation during his year as chairperson (Annex 2). The REGIONAL DIRECTOR expressed his appreciation to the Government of Japan for hosting the fifty-third session of the Regional Committee, particularly the Ministry of Health, Labour and Welfare for the generous technical, financial and moral support given to WHO. He praised Japan's achievements in health, citing the passing of the health promotion law earlier in the year. He looked forward to hearing the Committee's views on important topics such as diet, physical activity and health, ethical issues and the newly created Global Fund to Fight AIDS, Tuberculosis and Malaria (Annex 3). Mr Keiji YAMADA, Governor of Kyoto Prefecture, welcomed participants to the fifty-
third session of the WHO Regional Committee for the Western Pacific on behalf of the citizens of Kyoto. He hoped that WHO would continue to assume its leadership role in global health and medical services (Annex 4).
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The Mayor of Kyoto City, Mr Yorikane MASUMOTO, welcomed the members of the Regional Committee. He hoped that constructive discussions to further improve the health of the Region would take place (Annex 5). The DIRECTOR-GENERAL thanked the Government of Japan and the Ministry of Health, as well as the City of Kyoto, for their warm hospitality and extended her greetings to all countries of the Region present at the meeting. She said that the world's poorest
communities were still not sharing in the benefits of globalization and that evidence clearly showed that investment in health had an important role to play in alleviating poverty. She assured Member States that WHO would work hard to support their efforts as they took the health agenda forward and that the full weight of the scientific and administrative strengths of the Organization would be available to them (Annex 6). After the completion of the opening ceremony, the participants reconvened at the 2 Floor, Room A of the Kyoto International Conference Hall. 2. OPENING OF THE SESSION: Item 1 of the Provisional Agenda The retiring Chairperson, Pehin Haji ABDUL AZIZ UMAR (Brunei Darussalam) declared open the fifty-third session of the Regional Committee for the Western Pacific. 3. ADDRESS BY THE RETIRING CHAIRPERSON: Item 2 of the Provisional Agenda The retiring Chairperson, Pehin Haji ABDUL AZIZ UMAR, made a statement to the Committee (Annex 7). 4. ELECTION OF NEW OFFICERS: CHAIRPERSON, VICE-CHAIRPERSON AND RAPPORTEURS Item 3 of the Provisional Agenda 4.1 Election of Chairperson Professor HUANG Jiefu (China) nominated Dr Hideo SHINOZAKI (Japan) as Chairperson; the nomination was seconded by Dr Baraniko MOOA (Kiribati). Decision: Dr Hideo SHINOZAKI (Japan) was elected unanimously. Dr SHINOZAKI took the chair. nd
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4.2
Election of Vice-Chairperson Dr Richard SMALL WOOD (Australia) nominated Dr Eliuel PRETRICK (Federated
States of Micronesia) as Vice-Chairperson; the nomination was seconded by Professor Pagvajav NYMADA WA (Mongolia). Decision:
Dr Eliuel PRETRICK (Federated States of Micronesia) was elected
unanimously. 4.3 Election of Rapporteurs Dr Viliarni Tau TANGI (Tonga) nominated Dr TEE Ah Sian (Malaysia) as Rapporteur for the English language; the nomination was seconded by Dr HONG Sun Huot (Cambodia). Mr Aukusitino MANUOHALALO (France) nominated Dr Nao BOUTTA (Lao
People's Democratic Republic) as Rapporteur for the French language; the nomination was seconded by Mrs LE THI THU HA (Viet Narn). Decision:
Dr TEE Ah Sian (Malaysia) and Dr Nao BOUTTA (Lao People's
Democratic Republic) were elected unanimously. S. ADOPTION OF THE AGENDA: Item 5 of the Provisional Agenda (Document WPRlRCS3/1 Rev. 1) The CHAIRPERSON moved the adoption of the Agenda Decision: In the absence of comments, the Agenda was adopted. 6. REPORT OF THE REGIONAL DIRECTOR: Item 7 of the Agenda (Document WPRlRCS3/2) The REGIONAL DIRECTOR, introducing the item, reminded the Regional Committee that it had been three and a half years since he had been appointed as WHO Regional Director for the Western Pacific. He said that, looking back over the past 12 months, it was fitting that he should review the progress that had been made in the Region since early 1999 and the challenges that lay ahead. Because of time constraints, he would mention only a few salient issues. At the Regional Committee's meeting in Macao in 1999, the Committee had endorsed his document WHO in the Western Pacific Region: a framework for action. As in previous
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years, the present report was structured around the themes and focuses described in that document. In the section on combating communicable diseases (chapters 1 to 5 of the report), Chapter 3 dealt with Stop TB and leprosy elimination. In Macao, the Regional Committee had declared that there was a "tuberculosis crisis" in the Region and had asked him to make Stop TB a Special Project of the Region as part of WHO's overall poverty reduction initiative. In response, WHO had immediately established a Technical Advisory Group, or TAG, for Stop TB, composed of internationally renowned experts on tuberculosis control and health systems. The TAG had drawn up a comprehensive and very ambitious strategy to reduce by 50% TB prevalence and deaths by 2010. Despite that challenging task, there were already signs of progress. The number of countries and areas in the Region implementing DOTS had grown from 21 in 1999 to 28 in 2000 and the population with access to DOTS had also increased, from 58% in 1998 to 67% in 2000. In the Philippines, for example, DOTS coverage of almost 100% had been achieved in a period of only five years. According to tuberculosis control experts, the Western Pacific Region was setting the pace in global tuberculosis control. The ambitious targets that had been set in the Region had been followed by global targets. The Inter-agency Coordination Committees that had been set up in the Region had been adopted in other regions as well. Thanks to the firm commitment and strong support of all Member States and partner agencies, it was expected that the Western Pacific would be the first region to reach the global target of detecting 70% of estimated cases through DOTS programmes and curing more than 85% of detected patients. When WHO looked at the unfinished task for tuberculosis, it could take encouragement from the huge progress that had been made in malaria control in the Western Pacific. Taking the nine endemic countries of the Region as a whole, reported malaria incidence had decreased by 56% and malaria mortality rates by 64% between 1992 and 2000. In particular, Viet Nam had reduced incidence by 71 % and mortality by 95% over that period, and Vanuatu had reduced incidence by 60% and reported mortality to zero in 2000. Although HlV/AIDS (Chapter 4) continued to pose a very serious threat to the Region, there had been some promising developments in prevention and control. The reduction in prevalence in Cambodia that WHO had reported last year was very important, not just for Cambodia but also for many other developing countries. Cambodia's intensive preventive
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measures, in particular the "100% condom use" campaign, had shown what could be done, even in the country with the highest HIV prevalence in Asia and limited resources. Also, the strong government commitment of Australia and New Zealand to tackle HIV/AIDS had enabled those countries to succeed in reducing HIV transmission. The REGIONAL DIRECTOR recalled that in that very hall two years previously, the Regional Certification Commission had certified the Western Pacific Region as polio-free. Furthermore, the Region as a whole had eliminated leprosy as a public health problem. Even at the country level, elimination had been achieved in all but two countries. In the battle against those two diseases, tremendous achievements had been made by an alliance among Member States, other partners and WHO. Turning to the building healthy communities and populations theme (chapters 6 to 10), he said that tobacco consumption was an international issue, and that cigarette smoking was being aggressively promoted by giant multinational corporations. Over the past three years, WHO had played a key role by supporting delegates from Member States in the Western Pacific Region to participate in the sessions of the Intergovernmental Negotiating Body that was drafting the proposed framework convention on tobacco control. Thus, policy-makers in the Region had a much stronger sense of ownership of the Convention. Comprehensive legislation was one of the key tools in tobacco control and it was very encouraging that progress in that regard had been made in Cook Islands, Malaysia, the Philippines, Tonga, the Republic of Korea and others. He pointed out the strong promotion of tobacco-free sport, particularly at the soccer World Cup, which had been held in the Region that year. WHO had approached FIFA to make those games tobacco-free and he congratulated the World Cup committees in the Republic of Korea and Japan for declaring the World Cup tobacco-free. Given the enormous influence that sport had on youth, that was something that the Region could be proud of. The Member States should build on that achievement and make all sport in the Region tobaccofree, particularly the Olympic Games in Beijing in 2008. Diabetes was another lifestyle-related threat to the health of people of the Region. Two years ago in Manila, the Committee had endorsed the Western Pacific Declaration on Diabetes and urged Member States and WHO to give high priority to prevention and control of noncommunicable diseases. Regional guidelines on the clinical management of diabetes had been developed, adapted to local situations and were now being widely used. WHO's cost analysis of diabetes treatment had brought home to Member States the staggering portion
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of health budgets that was consumed by diabetes care.
In one Pacific island country, for
example, 40% of the health budget was spent on offshore referrals, many of them for treatment of diabetes complications. Chapter 9 of the report described why WHO felt so strongly that integrated prevention and control programmes would not only reduce the burden of noncommunicable diseases, but would do so cost effectively, making maximum use of the limited resources available in Member States. Multisectoral interventions involving partners from the education, food and other sectors were already taking place at community level in many Member States. Many had established high-quality surveillance for noncommunicable diseases for the first time, enabling them to assess more accurately the noncommunicable disease burden; it also served as a tool for planning and management, especially in the Pacific. Turning to health sector development (chapters 11 to 14), he noted that an increasing number of people in the Western Pacific Region did not have access to basic health services. Even if services were available, many people could not afford them. In some countries, lowincome families had to spend as much as 20%-30% of their household income on health care, including drugs. In some cases, such out-of-pocket payments would drive people into poverty. WHO was strongly promoting pre-payment schemes as the best and most equitable solution to that problem. As noted in Chapter 11, over the past three years WHO had been working with Mongolia to implement universal health insurance, with the Philippines and Viet Nam to extend existing health insurance schemes to include the informal sector, and with the Lao People's Democratic Republic to introduce a pre-paid social health insurance scheme. In the Pacific, the Federated States of Micronesia, Fiji, Papua New Guinea and Samoa were all actively considering the introduction of social health insurance schemes. In the long term, pre-payment schemes would offer individuals more protection and make a major contribution to sustainable health system development. With so many new demands being placed on health systems, it was absolutely essential that the fmancing of health systems should be transparent and that the allocation of resources should be fair. Over the past three years, WHO had promoted the concept of national health accounts in the Region and many countries were now making considerable progress in implementing such national health accounts. He said that blood safety (Chapter 11) was another area where concrete achievements could be noted. In China, for example, the national blood transfusion service was being restructured and strengthened with support from WHO. Twenty thousand staff working for
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the blood transfusion service had enrolled in a training programme based on WHO distance learning materials for safe blood and blood products. China's great efforts were bearing fruit, as the percentage of voluntary nonremunerated blood donors was steadily climbing, from 25% in 1998 to 48% in 1999 and 54% in 2000. The report also recorded solid progress in such diverse areas as essential drugs, health legislation and traditional medicine. As he had said in Macao in 1999, strong and effective health systems should be the cornerstone of WHO's work. The progress that had been made over the past few years had brought WHO and Member States closer to putting such systems in place. Despite the achievements that had been made in all three of WHO's technical themes, the Region still faced many challenges: • • • • • high levels of some communicable diseases; steadily increasing levels of noncommunicable diseases; ageing popUlations; poor commitment to preventive measures; and health systems that were struggling to cope with the many demands placed on them. Cutting across all of those challenges were the budgetary constraints affecting both national health services and WHO. As WHO and Member States addressed those issues, they faced a number of fundamental, even philosophical, questions: • How would WHO and Member States continue to address issues related to poverty, inequity, gender and the needs of vulnerable groups? Those issues already
underpinned almost al\ areas of their work, yet they had to keep asking themselves: what more could be done? How could they further incorporate those concepts into their work? • What contribution should health make to sustainable development? The report of the Commission on Macroeconomics and Health had shown that investing in health made economic as well as moral sense. How could the health sector engage with other ministries, such as ministries of fmance? • How should they respond to the growing health risks that faced people of the Region? These included environmental, behavioural and social risks, which could
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be reduced, but would never entirely disappear, as they were a consequence of economic development and modernization. They had to be dealt with upstream, but unfortunately issues that yielded immediate rewards often took precedence. How could they overcome short-sightedness and encourage a more long-term perspective? • Lastly, what role should ethical considerations play? Should an effort be made to add an ethical dimension to existing programmes, or should work start afresh by establishing the ethical basis then building programmes on that moral foundation? There were no ea~y
answers. Although at one level public health was necessarily a
practical endeavour, it was also about values. If the values of the Organization and of Member States were the right ones, they would be able to make far more progress. Overall, the past three and a half years had been extremely productive, with many positive achievements across all areas of WHO's work. However, without the dedicated hard work and commitment of Member States, partner organizations, and nongovernmental organizations, WHO would not have come that far. Based on what had been accomplished together so far, it was clear that they could take on those challenges and make the Region healthier for everyone. Mr BaI1Illiko MOOA (Kiribati), congratulating the Regional Director on his report, noted that it included important, but less visible, health issues such as oral and mental health, which should be maintained in future reports. The report was complemented by statistical annexes, making it a reliable working and reference document. The annexes also provided a yardstick for each country in terms of both health development and the quality of health information and reporting. In collaboration with the recently appointed country liaison
officer, Kiribati should be able to improve its health information centre and provide fuller data for the next report. Dr SAKAGUCHI (Japan) praised the steady progress achieved in the control of tuberculosis, which made the Western Pacific the most advanced Region in terms of expansion of directly observed treatment, short-course (DOTS), and the strengthening of control of tobacco consumption and of diabetes. His Government accorded special
importance to control of lifestyle-related diseases, and had recently enacted legislation that provided the basis for preventing such diseases and promoting health. He agreed that the private sector has an important role in strengthening the health system. Delivery of health services in Japan was based on that principle, together with
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universal coverage under the public health insurance scheme, and his Government was willing to support the efforts of WHOIWPRO to improve the health financing system, as referred to by the Regional Director. In relation to the ethical questions raised by the Regional Director, his Government was paying particular attention to patient safety, but the whole area of public health ethics, including equity in bearing costs of public health services, was very important. WHO should continue to tackle such ethical issues. Dr SMALL WOOD (Australia), congratulating the Regional Director for his informative report, expressed his Government's strong support for development of the framework convention on tobacco control and related international action to control tobacco use. Recognizing the need to raise awareness of the convention and to promote appropriate action, Australia had developed a support package for the Region, that would continue until the convention was concluded in May 2003. It had also provided longstanding support for the Tobacco Free Initiative, which was making an essential contribution to reducing the growing burden of chronic disease. He also commended the high priority accorded to mental health in the form of the regional strategy. WHO's efforts would contribute both to reducing the burden of mental and neurological disorders and to preventing chronic disease. Sound evidence would be needed into order to sustain work and to find solutions to mental health problems in the Region. Special importance should to be given to monitoring and evaluating implementation of the strategy. Dr HONG (Cambodia), referring to the Director-General's remarks at the opening session on the links between health and security, expressed his concern about the deliberate use of smallpox virus. What was WHO's position on smallpox vaccination and the
stockpiling of smallpox vaccines? Cambodia had been particularly involved in development of the Global Strategy for Infant and Young Child Feeding, adopted at the Fifty-fifth World Health Assembly. It had just hosted an integrated national workshop on the subject - the first country to do so - which had brought together participants from various areas related to child health and from different organizations of the United Nations system. The Workshop was the first step in
implementing the Strategy and had contributed to formulating a plan for improving infant and young child feeding in line with the operational objectives set out in the Strategy.
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Mr CAPELLE (Marshall Islands) reported that increasing numbers of cases of chronic diseases, such as diabetes and hypertension, were being seen in his country, indicating that it was experiencing an epidemiological transition in which communicable and
noncommunicable diseases were prevalent concurrently. Aggressive campaigns had been implemented to address tuberculosis, sexually transmitted infections, leprosy, reproductive health and, more recently, alcohol and tobacco use, mental health, suicide, health care financing, human resources and information management. The sections headed 'Results and analysis' and 'Future' under each focus in the report would assist the Ministry of Health in his country in reviewing the programmes and services it provided to the community. Professor HUANG Jiefu (China) said that the Regional Office had made much progress in disease control, health sector reform and expansion of international partnerships, despite a changing international environment. Looking at the four annual reports that had been published since the Regional Director had taken office, he had noted substantial improvements in presentation. The current structure reflected the four themes and 17 focuses of the Regional Office. He suggested that subsequent reports should contain an executive summary in order to make the report more accessible to political leaders. The report reflected the proposals contained in the document WHO in the Western
Pacific Region: a framework for action that had been approved by Member States. Establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria had been of utmost importance, and, at the request of Member States, the Regional Office, in collaboration with the South-East Asia Regional Office, had organized a workshop on that topic in China. That had helped to ensure that the results of the first round of proposals from countries of the Region had been generally positive. Another workshop had been organized at the request of the Pacific island countries to prepare for the second round of applications. Entry into the World Trade Organization had been an important event in his country. At the request of the Ministry of Health of China, WHO had helped to organize a well-received workshop to discuss the implications ofthat event for the health sector. China needed to reform its system for managing blood products. A study tour had been organized by WHO, with a workshop for discussion of the experiences of other regions, such as Europe and the United States of America. The support provided by various United Nations agencies in the field of health in China was coordinated by a health theme group; as WHO was the lead agency in health, there was scope for it to playa greater role in needs assessment thus avoiding duplication with the work of other agencies.
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Professor LE NGOC TRONG (Viet Nam) also noted the continuing improvement in the quality of the report of the Regional Director, which now provided more detailed analysis of the issues facing the Region and WHO's response to those issues. The progress described in the report could also be seen in his country, for instance with respect to control of tuberculosis, blood safety and food safety. He thanked the Regional Director for his remarks concerning his country's achievements with respect to malaria. Dengue fever and dengue haemorrhagic fever were important public health problems in countries of the Region, and he hoped that WHO would devote more resources and technical support for their control. As the Regional Director had said, alleviation of poverty was a high priority in reducing the burden of disease. In his country, basic medical health services had been strengthened, particularly in the remote, mountainous areas, so that there was currently a medical doctor in 50% of the communes in Viet Nam. The Government had approved a national policy on injury and accident prevention, in order to address an increasingly important but preventable cause of morbidity, disability and death. WHO had provided technical support for national programmes on blood safety and on noncommunicable diseases, including mental health. A Government ordinance on food safety had been drawn up in collaboration with other ministries; continued support from WHO and other partners in that area would be essential. The Government of Viet Nam had approved a national policy on tobacco control in 2000, and a plan of action had been drawn up in June 2002, to be implemented by a board of directors consisting of ministers, heads of Government agencies and the chairmen of provincial people's committees. As part of the preparations for the 2003 South East Asian Games, the Ministry of Health was advocating that they be tobacco-free. He thanked WHO for its effective support to Viet Nam, despite fmancial constraints. The strengthened WHO Representative's office had been active in coordinating partner activities and in mobilizing additional resources for the health sector. Mrs PIERANTOZZI (Palau) expressed satisfaction with the improved format of the Regional Director's report, which indicated the hard work done by all Member States of the Region, with support from the Regional Office. She was encouraged by the accomplishments of China with respect to filariasis, those of Australia, Cambodia and New Zealand with respect to HIV/AIDS and those of Malaysia with respect to Healthy Cities. Her country would be able to learn from those experiences. The integration of hepatitis B vaccine into the immunization programme in China was encouraging. The description of such success stories
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in the report allowed all the countries of the Region to share in them. Her country acknowledged the help of many partners, including the United Nations Children's Fund, WHO, the Secretariat of the Pacific Community, Australia, Canada, Japan, New Zealand, the United States of America, and Taiwan (China). Such partners contributed to the successes described in the report. She thanked WHO for its support in the formation of the Pacific Basin Dental Association, which had received a grant from the United States of America for capacity building in the territories with which that country was associated. She asked whether WHO could investigate the preventive usefulness ofxylitol in oral health. Her delegation was encouraged by the progress that had been made in mental health in the Region, with the support of WHO. Although she agreed with the three goals of the regional strategy on mental health and the six approaches to achieving those goals, one important approach that appeared to have been omitted was human resources development. There was a clear need for counsellors and care givers in the prevention and treatment of mental illness and substance abuse. While thanking WHO for its support for tobacco control, she asked for information about the future of the Tobacco Free Initiative after the anticipated signing of the proposed framework convention on tobacco control in May 2003. She hoped that the activities in place would be continued, as adoption of the convention would represent only the beginning of another difficult period in tobacco control, especially in the Region. Dr KOI Kuok Ieng (Macao, China) said that the report showed the considerable progress made in the Region in the areas covered by the four themes set out in the document WHO in the Western Pacific Region: a framework for action, which had been endorsed at the
fiftieth session of the Regional Committee in Macao in 1999. WHO policies were certainly one of the most important inputs for the successes achieved in the health sector in Macao. He expressed appreciation for the prompt and effective guidance and support provided by the Regional Office to Macao during the 2001 epidemic of dengue haemorrhagic fever. Greater attention should be paid to the prevention and control of that disease. WHO support had also been provided for training in the areas of health information and health promotion. He suggested the establishment by the Regional Office of an electronic network to alert Member States to outbreaks of communicable diseases worldwide and, in particular, in the Region. Important policy documents should also be transmitted electronically to Member States.
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Dr DAYRIT (Philippines) remarked that the report clearly reflected WHO support to Member States in WHO priority programmes. Most of those programmes were well developed in the Philippines. For example, a nationwide measles elimination campaign was planned for 2003 or early 2004 and support from the Japanese Government for provision of vaccines was being sought. In relation to tuberculosis, he noted the potential role of the Global Fund in stabilizing drug supplies. The Regional Director's report also provided guidance on new areas, such as tobacco control. In the Philippines, the national debate on the framework convention for tobacco control was proving controversial. It was of particular interest to the Department of Health on the one hand, and the Departments of Agriculture, and Trade and Industry on the other; the latter expressing concern as to the effects on the national tobacco industry and tobacco farmers. The report provided useful comparative data on priority programmes that had not yet made sufficient headway in his country, for example, reproductive health. There was a particular need in the Philippines for an improvement in fertility awareness education. Efforts to enhance contraceptive use prevalence - a culturally and politically sensitive issue - were under way through local government, which had responsibility for family planning, with the involvement of community and church groups. In certain other critical areas mentioned in the report, such as mental health, the Philippines had made little progress: his Government looked forward to guidance from WHO to enable it to implement the regional strategy for mental health adopted by the Regional Committee at its previous session. Pehin HAJI ABU BAKAR APONG (Brunei Darussalam) welcomed the continued efforts of WHO to improve its work in Member States in the areas covered by the four themes of the Framework for action. He looked forward to the continued support of WHO in meeting the challenges of the link between poverty and disease, the increasing burden of noncommunicable diseases, and health system reform. Brunei Darussalam would continue to update its health legislation, and hoped for support from WHO in that area, if needed. The burden of responsibility for improving health lay not only with health services but also with other partners, who should be educated and empowered in health matters. Finally, he paid tribute to the retiring WHO Representative for Brunei Darussalam, Malaysia and Singapore for his valuable contribution to health work in Brunei Darussalam and to the success of the fifty-second session of the Regional Committee, held in that country.
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Mr VAEVAE PARE (Cook Islands) assured the Committee that his Government supported the work of WHO and looked forward to continued collaboration with the Organization. He drew attention to the burden of noncommunicable diseases in countries such as his own. Greater emphasis should be given to the control of diabetes, which had reached epidemic proportions in Cook Islands, with increased incidence of the serious cerebro- and cardiovascular sequelae of the disease. Despite many years of activities to educate the population in respect of healthy diets and physical exercise, consumption of meat and convenience foods was increasing, and levels of overweight, obesity and noncommunicable diseases continued to rise. While those efforts would continue, research was needed to fmd a cure for diabetes.
Mr MANUOHALALO (France) commended the Regional Director's report, which met the concerns expressed during discussions of previous reports. He drew attention to the useful information set out in the statistical annex, which would promote a better understanding of country situations. While public health problems related to lifestyles, including tobacco use, were a major preoccupation, the level of communicable diseases in the Region remained unacceptably high. The development of the proposed framework convention on tobacco control and other tools, including pertinent indicators for the evaluation and monitoring of health programmes, would enable Member States to improve the effectiveness of those programmes despite current economic constraints. Dr HOFSCHNEIDER (United States of America) said that, while the Region could be proud of achieving poliomyelitis-free status, surveillance for acute flaccid paralysis must be maintained. Surveillance activities should be integrated with those for other communicable diseases, and training in epidemiological fieldwork and laboratory testing should be enhanced. The United States would support such activities. Greater attention should be given to combating noncommunicable diseases, especially those related to unhealthy lifestyles. His Government had recognized overweight and obesity as major public health problems. In order to prevent such disorders, it was encouraging appropriate environmental changes, development of effective public-private partnerships and research on the design of effective interventions. It was essential to develop healthy habits early in life. He expressed support for efforts to improve mental health legislation and policies. Tobacco use among young people was a major focus of activities under the Tobacco Free Initiative. In relation to essential drugs, he pointed to the need for training to improve rational drug use and for increased access to drugs across the Region, in accordance with international agreements. He welcomed the implementation of improved science-based strategies for the control of communicable diseases, inter alia, mass drug administration for the elimination of lymphatic filariasis.
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Professor NYMADA WA (Mongolia), commending the report, said that during the past year his Parliament had, with WHO support, approved several important public health policy documents and amended health legislation. Although not mentioned in Chapter 14 of the report on emergency and humanitarian action, Mongolia had experienced severe winters over the past two years, which had had serious health consequences, including increased child and maternal mortality, and increased mental illness with a rise in the suicide rate. Mongolia had enjoyed good relations with WHO over the previous 40 years and looked forward to continued collaboration. At the invitation of the CHAIRPERSON, statements were made by representatives of the Sasakawa Memorial Health Foundation (also speaking on behalf of the Nippon Foundation), Rotary International District 2650, the International Federation of
Otorhinolaryngological Societies, the World Federation of Chiropractic, and the World Federation of Societies of Anaesthesiologists. The REGIONAL DIRECTOR thanked representatives for their encouragement and for the suggestions they had made on his Report. The representative of Cambodia had raised the matter of WHO policy on smallpox vaccination; WHO had established a policy on that topic, which had been made public in a press statement of2 October 2001. The Organization did not recommend mass vaccination against smallpox as a preventive measure. However, countries which deemed that certain sectors of their population were at risk, might consider vaCCinating them. WHO had no plans to stockpile vaccine, but would continue to monitor such stocks, to ensure that the vaccine would be available to all countries. He welcomed the suggestion from the representative of China that an executive summary be added to the report. There were a number of ways in which this might be achieved and he looked forward to discussing them further with the representative. The representative of China had also asked for WHO support in joint health situation analysis at country level. To a certain extent, that had been done already, in a joint United Nations effort entitled the "common country assessment". The work was in its early stages, but such support would be provided to the countries that sought it. He welcomed the proposal of the representative of Viet Nam that the South East Asian Games be tobacco-free once again. Regarding the question from Palau about oral health, especially whether WHO had a policy on xylitol, an artificial sweetener, the Regional Director said that the Organization recommended avoidance of excessive intake of sugar, especially among children, for the sake
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of dental health first and foremost. There was no policy so far on the specific sweetener mentioned. He agreed with the same representative that capacity building in mental health should be part of the mental health strategy; indeed, one of the six major strategies contained in the strategy that the Regional Committee had discussed two years previously was entitled "service provision, enhanced service delivery and evaluation at national and local level". One component of that strategy was the reorienting and training of personnel in mental health. The representative of Palau had asked what would happen when the proposed framework convention on tobacco control was adopted. The answer was that, even after adoption, there would still be a long way to go. The convention would have to be ratified by governments, and after that it would have to be implemented vigorously, against the resistance of vested interests. WHO would, therefore, never let up until the letter and the spirit of that convention were respected. The representative of Macao (China) had asked whether there was a regional network for surveillance based on the Internet. A Global Outbreak Verification Network had been set up by WHO Headquarters in consultation with the regions. So far it involved only collaborating centres and technical institutes; governments as such were not yet involved, but would be in the very near future. Replying to the representative of Cook Islands, who considered that WHO was paying insufficient attention to research into diabetes treatment, the Regional Director said that, since assuming office, he had focused primarily on prevention of the disease. Two years previously a strategy on noncommunicable diseases had been established, and the Regional Committee had endorsed the Western Pacific Declaration on Diabetes. Prevention had been the main focus in the recent past, since it had not been possible to do everything at once. Changes to the approach could of course be envisaged. He accepted that the winter disasters in Mongolia had not been mentioned in the report; the winter disasters in that country in 1999-2000 and 2000-2001 had been mentioned in the two previous reports, but he undertook to ensure that the disasters would be included in subsequent compilations of disasters in the Region. He thanked each of the nongovernmental organizations for their excellent interventions and collaboration. In particular, he thanked the Sasakawa Memorial Health Foundation and observed that, in spite of great progress, global elimination of leprosy had not yet been achieved. He expressed gratitude to Mr Sasakawa, ambassador of the Global Alliance for Leprosy, for his tireless efforts to eliminate that disease. He also praised Rotary 2650, which
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he said was one of the most active Rotary clubs in existence, for its work on the Expanded Programme on Immunization, polio eradication, and injection safety. The representatives of the organization had already visited Cambodia, China, the Lao Peoples' Democratic Republic, Mongolia, Vanuatu and Viet Nam, to work with national counterparts on immunization, provision of polio vaccine, and other activities. Comments from representatives had fallen into the following main categories: noncommunicable diseases (particularly diabetes), tobacco, mental health, and communicable diseases, especially dengue haemorrhagic fever. The Western Pacific Regional Office would do its utmost to further increase its efficiency, effectiveness and relevance to Member States in work on those topics.
The meeting rose at 5.40 p.m.
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SPEECHRY DRCHIKARASAKAGUCHI, MINISTER OF HEALTH, LABOUR AND WELFARE OF JAPAN, AT THE OPENING CEREMONY OF THE FIFTY-TIHRD SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
Welcome to Kyoto, Japan!
On behalf of the Govemment of Japan, I express the
warmest greetings from my heart to all of you who have come all the way from different parts of the Western Pacific Region and the rest of the world.
It is a great pleasure and honour for the Government of Japan to be able to host the fifty-third session of the World Health Organization Regional Committee for the Western Pacific. We recognize this as an important contribution to the vital role WHO is playing in the Region. During this session, there will be discussions among the Member States on the most important health issues facing the Western Pacific Region, such as diet, physical activity and health, which will be addressed in the ministerial round table, and the fight against HIV/ AIDS, tuberculosis, malaria and other parasitic diseases. Nowadays, people move across national borders to a degree unprecedented in human history. Consequently, health problems can no longer 'be confmed to only one country. In fact, they can, very rapidly, become problems of the Region and of the world. Collaboration between Member States has. thus; become essential to solving these problems. Today, key decision-makers for the health sector in our Region are gathering here in Kyoto to participate in this session of the Regional Committee. This is a golden opportunity to find solutions to the common problems that Member States share. Just as one health problem affects all nations, one excellent solution that has proven to be effective in one nation will benefit the entire Region. I sincerely hope that constructive and valuable discussions will take place in this meeting of the Regional Committee. As collaboration among the Member States of the Region advances, the role of the WHO Regional Office for the Western Pacific will inevitably become larger. Standing here refreshes my memory of the Kyoto Declaration, when, in October 2000, the Western Pacific Region was declared to be poliomyelitis-free. Having experienced medical services in a remote area as a medical doctor and the promotion of a new blood donation procedure through grassroots activities, I myself understand how many unsung heroes have sacrificed themselves for the universal provision of services. From this point of view, the declaration of the Region as poliomyelitis-free was a historic moment of victory in the public health arena for the WHO Office for the Western Pacific, headed by Dr Omi, and all other persons in the
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Annex 1 Member States who had contributed to it. Japan will continue to tackle health issues in our Region in close collaboration with WHO, especially its Regional Office for the Western Pacific. Health is more valuable than ever before in today's international society. Equity in health is the basis for friendship and peace. It is the most fundamental hope of human beings for the future. Public health personnel, including myself, bear a heavy responsibility for safeguarding and fostering such an indispensable value. We must show the Region and the world that the health sector plays a leading role in realizing the spirit of international collaboration and peace. Kyoto, the ancient capital of Japan, embodies the spirit of harmony that our people cherish above all. I sincerely hope that this beautiful city sets the stage for your unity and harmony. I would like to close my address by wishing you all a very successful and productive session. Thank you very much for your kind attention.
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ANNEX 2 SPEECH BY PEHIN HAJI ABDUL AZIZ UMAR, RETIRING CHAIRPERSON, AT THE OPENING CEREMONY OF THE FIFTY-THIRD SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
On behalf of the Regional Committee, I would like to thank our host, the Government
of Japan, for inviting us to the serene and beautiful City of Kyoto for the fifty-third session of the Regional Committee. We are deeply honoured to be your guests. We extend our heartfelt thanks for the warm welcome and the preparations that went into making this fifty-third session a memorable and productive one. At the fifty-second session of the Regional Committee in Brunei Darussalam, you, the distinguished Representatives, conferred upon me the honour of serving as Chairman of this august assembly. Time has passed so quickly. The job has been challenging. And it has been inspiring as well. It has given me the opportunity to better understand the work of the organization, and to be fully aware of the determination of both Member States and WHO to achieve our common goals. I look at this unified sense of purpose as a valuable feature of
this Region, despite the great diversity of the 37 countries and areas that make up this Region. Over the past year, our work has advanced, thanks to your support and cooperation. Once again, the Region has shown what can be done when we decide to work together in order to malce a difference. I speak for all of us who are gathered here today, when I say that I am anticipating a fruitful five days of deliberations in finding workable and sustainable solutions to the health challenges that our countries face. The Regional Committee is a collegial body, and in recent years that sense of collegiality has deepened. I see many new faces whom I would like to welcome, and I also see many familiar faces, friends, colleagues who have worked with us before and I am looking forward to the sense of camaraderie that has characterized the year that has passed. This has, and always will make working with the Regional Committee and experience that everyone learns from. One face we shall surely miss next year is that of Dr Brundtland. She will leave behind her an inspirational legacy of leadership and determination in public health. We wish to record our thanks to Dr Brundtland. The agenda for our meeting reflects the breadth and depth of what must be done to move ahead. I am certain we are all prepared to take on the many challenges that face us with vigour and with renewed commitment.
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It is not possible to be in Kyoto and not notice the heightened sense of aesthetics that pervades its buildings, temples, bridges, streets and gardens. We are truly delighted to be here, and are all looking forward to seeing the rest of the city and its many hidden treasures that are rich with history and tradition. Again, we thank our gracious host, the Government of Japan, for sharing this beautiful city with us, and for painstakingly preparing for this meeting which, I am certain, will live
long in our memories as one we truly enjoyed. Thank you.
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ANNEX 3 SPEECH BY DR SHIGERU OMI, REGIONAL DIRECTOR, AT THE OPENING CEREMONY OF THE FIFTY-THIRD SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC On behalf of the Western Pacific Region of the World Health Organization, I would like to express our sincere appreciation to the Government of Japan for hosting the fifty-third session of the WHO Regional Committee for the Western Pacific and to the honourable Dr Sakaguchi for his gracious welcome. We are delighted that Japan is hosting this session of the Regional Cornmittee here in Kyoto, one of the most culturally-rich cities in the world. On a personal note, I am very pleased to see so many old friends and familiar faces here in this conference hall. To you, and to those of you who may be attending a session of the Regional Committee for the first time, I would like to extend my warmest welcome. I would like to take this opportunity to thank the Government of Japan, and in particular the Ministry of Health, Labour and Welfare, for the generous technical, financial and even moral support that has been given to WHO over many years. I would also like to applaud Japan's many achievements in health. As everyone is aware, life expectancy in Japan is the longest in the world, which is due in part to the country's excellent social welfare and equitable health care systems. However, in spite of Japan's excellent health indicators, even this country is not spared from a relentless increase in lifestyle-related diseases. As is well known, many noncommunicable diseases can be prevented by simple measures, such as a healthy diet and regular exercise. However, creating policies and environments that will encourage people to make healthy choices is a complex and difficult process. In our host country, a health
promotion law was passed earlier this year and I would like to congratulate the honourable Minister for Health, Labour and Welfare, Dr Sakaguchi, and WHO Executive Board Member, Dr Shinozaki, for this excellent achievement. Later this week we shall have an opportunity to look at further options for encouraging healthy choices at the ministerial round table devoted to diet, physical activity and health. In addition to the round table, this week we have many important matters on our agenda, including the newly-created Global Fund to Fight AIDS, Tuberculosis and Malaria. There is also an agenda item on ethical issues. All of us in public health are faced by ethical dilemmas over such issues as the fair allocation of resources and the social and economic
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Annex 3 determinants of health. These are truly fundamental questions and I look forward very much to hearing the Committee's views on this important topic. It is a great honour for WHO to hold this session of the Regional Committee for the
Western Pacific here in Kyoto. Over the next five days we shall have to work hard and make some difficult decisions. However, we need to balance this serious work with the opportunity to enjoy, not only the delights of our host city, but also the collegial atmosphere that always characterizes meetings ofthe Regional Committee. Let me close by thanking the Government of Japan and the many people who have worked extremely hard to make this meeting possible and by welcoming once again representatives of Member States, members of partner agencies, NGOs and others to this fifty-third session of the WHO Regional Committee for the Western Pacific. Thank you very much indeed.
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SPEECH BY MR KEIJI YAMADA, KYOTO PREFECTURE GOVERNOR, AT THE OPENING CEREMONY OF THE FIFTY-THIRD SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
On the occasion of the fifty-third session of the WHO Regional Committee for the
Western Pacific, I would like to express my deeply felt congratulations on the opening of this session in Kyoto today and, on behalf of the 2.6 million citizens of Kyoto Prefecture, I would like to welcome the participants from various countries in the Western Pacific Region. WHO was established in 1948 with the aim of achieving the highest possible health level for all. With that lofty objective, WHO has taken a strong leadership in global health and medical services. With the great achievements of WHO, the organization is well known in Japan as a representative organization of the United Nations, like UNESCO and UNICEF. With the advancement of information technology and globalization, we have more and more exchanges of people and goods across the national borders. Likewise, in the area of health and medical services, specific local problems like diseases and hazardous foods will spread to become challenges on a global scale. It is in this sense that WHO's goals will increase more and more, and Member States will have to bear much heavier responsibilities. WHO has achieved great success in the eradication of smallpox and the declaration of the Western Pacific Region as poliomyelitis-free. I sincerely hope that WHO will continue to express its leadership. This session of the Regional Committee for the Western Pacific is to be held from 16 to 20 September, and will discuss the health and the medical services problems in the Western Pacific Region, including AIDS, tuberculosis and infectious diseases. Major policies will be decided. Tuberculosis is a major infectious disease in Japan and AIDS is increasing in its incidence, especially among the younger generation. I sincerely hope that this session will show the direction towards the solution of these problems. In March next year, we are going to hold the third water forum in Kyoto, Shiga and Osaka. The issues around water are closely related to public health and call for a global solution. Kyoto Prefecture Government is trying to make the utmost effort in preparing for a successful forum, and I would like to ask for your understanding and support for that forum as well.
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In conclusion, I would like to express my deepest appreciation to the Ministry of Health, Labour and Welfare, who have put a lot of effort into the opening of this session, and also to wish the very best to WHO Regional Committee for the Western Pacific and to all of you here. I would also like you to enjoy the autumn season of Kyoto as much as possible. With that I would like to close my opening remarks. Thank you very much.
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ANNEX 5
SPEECH BY MR YORl KANE MASUMOTO, MAYOR OF CITY OF KYOTO, AT THE OPENING CEREMONY OF THE FIFTY-THIRD SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC I would like to express my welcome to all of you on the occasion of the fifty-third session of the WHO Regional Committee for the Western Pacific. I would like to welcome you on behalf of the city of Kyoto. The Regional Committee for the Western Pacific has tried to spread the spirit of WHO. Health is a foundation for world peace and safety, and WHO is trying to achieve the highest possible health level for all. The WHO Regional Committee for the Western Pacific has played a very important role, for which I would like to express my deepest respect. This meeting is now being held in Kyoto, which is blessed with a long history and traditional culture. We are very honoured to hold this session here in Kyoto. On behalf of the 1.47 million Kyoto citizens, I would like to express my heartfelt welcome to all of you. I had the opportunity to attend the session for local government in South Africa at the United Nations World Summit for Sustainable Development. In addition to environmental problems, we were able to hear a very heated and enthusiastic discussion as to the current status and solution for the problem of providing safe potable water. Drinking water is very important for the improvement of public health. At this session of the Regional Committee for the Western Pacific I understand that you are going to discuss tuberculosis, AIDS, infectious diseases, diet and physical exercise and other health-promotion-related issues. I sincerely hope that constructive discussions will take place to further improve the public health of the Region. The declaration of the Western Pacific Region as poliomyelitis-free was adopted in Kyoto in October two years ago. In addition to the Western Pacific Region, I sincerely hope that poliomyelitis will be eradicated across the whole world. In Japan, we enacted a health promotion law last July to aggressively promote national health and disease prevention, and the campaign for "Healthy Japan 21". Kyoto City
Government has established the Kyoto Citizen Health Promotion Plan so that we can build a community where all Kyoto citizens can continue to enjoy both physical and mental health throughout their entire lives. I would like to collaborate with Governor Keiji Yamada of
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the health promotion of Kyoto Prefecture so that we can very actively promote policies for each one of Kyoto' s citizens. WHO Regional In conclusion, I would like to wish the fifty-third session of the best for WHO and the Committee for the Western Pacific great success and to wish the very Ministry of Health and Labour and Welfare.
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SPEECH BY DR GRO HARLEM BRUNDTLAND, DIRECTOR-GENERAL, AT THE OPENING CEREMONY OF THE FIFTY-THIRD SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Thank you for the opportunity to join today at this opening of the Regional Committee for the Western Pacific Region of WHO. I want to thank our hosts, the Government of Japan and the Ministry of Health, as well as the city of Kyoto, for their warm hospitality. And to extend my greetings to all countries present here from the Region. For the past few days the focus of many people in the world has been on the terrible events in the United States a year ago last week. I would like to join others in remembering the victims of that day. The talk has also been of the way forward. At the time we did not know how to understand fully what was happening. Since then our global interdependence has become even clearer. We have become conscious of the potential for disease and other threats to
health that could be used deliberately by terrorists. We have recognized more fully the links between health and human security. We have not done enough to tackle the poverty that affects 3 billion of our fellow humans. The world's poorest communities are not sharing the benefits of globalization. This was evident at the World Summit on Sustainable Development earlier this month. The evidence that investment in health has an important role to play in alleviating poverty is clearer than it ever was. Scaling up health actions can transfonn the lives of poor populations. We have many of the goals and measurable targets already agreed at the The rich countries need to take
Millennium Summit by all of the world's political leaders. responsibility for meeting their share of this investment.
Twenty-eight per cent of the world's population - over 1.7 billion people - lives in the Western Pacific Region. They live in countries which have some of the most developed economies in the world and in countries which have some of the least developed. In the human development index published by the United Nations Development Programme, there are nearly 140 countries in the world between the highest and the lowest in this Region. It is clear that we will not achieve our health goals globally if we do not succeed in all
the countries of this Region. The Region has a long history of mutual cooperation and of sharing experiences which can only help as we seek solutions.
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The issues on the health agenda for the Region are broad: Infant, child and maternal mortality and illness; Halting the spread of HIVI AIDS, malaria and tuberculosis and other diseases; Getting better and cheaper access to essential medicines; Controlling the tobacco epidemic and other risks to health, especially unhealthy diets and physical inactivity; Unhealthy environments, and especially achieving healthier environments for our children; How best to organize and pay for the health systems in the Region, including reviewing the role of public health systems. We will be working hard now'to build up our abilities to support you in your countries as you take the health agenda forward. I want to assure you that the full weight of the scientific and administrative strengths of the Organization - be they in Geneva, in Manila or in your country - is available to you. It is a great pleasure for me to return to Japan. success. Thank you. I wish this Regional Committee every
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89 ANNEX 7
ADDRESS BY THE RETIRING CHAIRPERSON AT THE OPENING SESSION OF THE FIFTY-THIRD SESSION OF THE WHO REGIONAL COMMITIEE I am truly pleased to be here with you in this beautiful and historic city of Kyoto for the fifty-third session of the Regional Committee. This early, I already can see that this is going to be one meeting we shall all remember. On behalf of Committee, I wish to thank our host, the Government of Japan for these excellent arrangements to make our stay here a memorable and rewarding experience. The Regional Committee bestowed on me last year the honour of chairing its fifty-second session. I must say that it was a great privilege indeed for me to have been given the opportunity to work with all of you in that capacity, and to be able to experience how this Region's proud tradition of mutual respect and cooperation was tested and proven again and again as we tackled a number of important issues that have impact on the health of people in the Region. Distinguished colleagues, it was a year like no other. We had very serious discussions on matters of common interest and went through a few difficult times when our views on certain issues differed primarily because of the diversity of our countries' social, economic and cultural situations. H,owever, the open and frank exchange of views enhanced our
deliberations and enabled us to come to some agreements on what each of us can do to make this Region move forward. Looking back over the past year, I am pleased to note the continued progress that we are making in our effort to improve our people's health and quality of life. The Committee
renewed its commitment to continuing the battle against tuberculosis and tobacco, and preserving the gains that had been made in the campaign against pOliomyelitis. We resolved to address the growing problems related to mental health and such issues as food safety; agreed on the direction and the framework upon which work in these areas can be pursued; and arrived at an agreement on further strengthening traditional medicine in countries of the Region. A review of the year's achievements as reflected in the Regional Director's report gives us reason to be satisfied. Member States did not let their guard down against communicable diseases such as malaria, tuberculosis, leprosy, and sexually transmitted infections, including HIY/AIDS. At the same time a renewed vigilance has emerged to curtail the growing
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problem of noncommunicable diseases, obesity and unhealthy lifestyles. However, you and I know only too well that new threats to health are unfolding even before we have completely addressed old ones. This only strengthens our resolve to work together in a unified response for us to be effective. In my address to you in the morning of II September last year, I said that health is a gift for all and an important component of human security. I said that it was for that reason that His Majesty's Government of Brunei Darussalam has made every effort to ensure that health is enjoyed by all through impro~ed access to information and good quality services. Little did I know then that those words somehow would frod their true meaning in the events that unfolded that day. At about this time last year, we the members of this Regional Committee, stood in disbelief, with the rest of human kind as a virulent wave of terrorism swept the world. After the initial shock, I am sure all of us spent some time reflecting on what this meant to our work. And I am almost sure that the events of September last year will always serve as a reminder to us that despite the progress of our work, so much more needs to be done to address the basic issues that divide the people of this planet; in equity, poverty, diversity. While we condemned and will always condemn violence as a means toward resolving problems, in the same breath, we hope that through our collaborative work, we would be able to bridge some of the gaps that have unleashed the rage, anger and hopelessness that fuel terrorism. We hope that in our own small way, as we work to improve the health of people in our Region, we too are able to contribute to the elusive quest for world peace. For without peace, we carmot achieve health, nor can we achieve peace without health. While things have changed after 11 September last year, situations within our own countries may still remain the same. Our experience this year should strengthen our resolve to make better health attainable for all as an end in itself, and as a means to peaceful coexistence. Our experience this year affirms our realization that we are truly an interdependent community of nations who must join hands to solve interdependent problems. I acknowledge and thank the Director-General, Dr Brundtland, for the great work she has done in leading this Organization forward. I congratulate the Regional Director, Dr Omi, for having provided the vision and the direction for the 37 countries and areas of the Region.
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Annex 7 It is not easy to come to a common ground in such a diverse Region. But, as he himself has often said. the secret is in working together to get the job done. Distinguished Representatives, shortly, we will be electing a new Chairperson and the other office bearers. I thank all of you for your excellent cooperation and for supporting me in the conduct of my duties. To the Vice-Chairperson, Her Excellency Sandra Pierantozzi, the rapporteurs, Dr Eti Enosa and Dr Jean-Paul Grangeon, and the secretariat, you have made my job lighter with your support. Thank you very much. As you know, I have also turned over the reins of the Ministry of Health of His Majesty's Government of Brunei Darussalam to my successor Minister Pehin Haji Abu Bakar Apong. So as I bid you goodbye as the outgoing chairperson, I also bid goodbye to this Regional Committee as I move on to fully devote my time to my duties as Minister of Education. It has indeed been a pleasure and privilege to work with you. I shall never forget the friendship, the cordiality and the spirit of camaraderie that have been apparent everywhere. I shall continue to work with you, my colleagues, in matters of health where the role of the Ministry of Education is critical. ~;..
All the help and the cooperation that you have given me had made my job lighter, last but not least if my performance was not up to your expectation, I should ask for your forgiveness. If I had met your expectation then I should not claim the merit in its entirety. People say that there is always a woman behind a man's success. And in this case, it has been clearly demonstrated. I was very fortunate to have a wonderful and dedicated woman to lean on. She gave me all the possible assistance needed, and consequently this made my job both bearable and enjoyable. And, ladies and gentlemen, this woman is of course Linda Milan. Thank you Linda for all the sincere help and advice that you have given me during my term as Chairperson of this Committee. Thank you all very much for the enriching experience and I wish you more success in all your future endeavours.