WPRlRC58/SRl2 SUMMARY RECORD OF THE SECOND MEETING (T AMNA Hall B, 5th floor, International Convention Center, Jeju, Republic of Korea Tuesday, 11 September 2007 at 09:00) CHAIRPERSON: Dr Chang Jin MOON (Republic of Korea) CONTENTS
page 1. 2.
Address by the incoming Chairperson .................................................................. . Report of the Regional Director (continued) ......................................................... . Address by a keynote speaker ............................................................................... . Programme budget 2006-2007: budget performance (interim report) .................. . Annex 1 Address by the incoming Chairperson .... .... ......... ..... ......... ....... ... ...... ..... Annex 2 Address by Professor Alistair Woodward .... .... ...... .... ............. ...... ...... ...
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I.
ADDRESS BY THE INCOMING CHAIRPERSON: Item 4 of the Agenda The CHAIRPERSON addressed the Committee (Annex 1).
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REPORT OF THE REGIONAL DIRECTOR: Item 8 of the Agenda (Document WPRlRC58/2) (continued) The REGIONAL DIRECTOR thanked representatives for their comments on his report. Regarding the remarks made by the representatives of Solomon Islands and Fiji, he agreed
that small island countries would need more support from WHO since their needs could be overlooked by global governing bodies. During the me:eting of Ministers of Health for the Pacific Island Counties in Vanuatu in March 2007, he had been mandated to convey the wish of the ministers to continue holding that biennial meeting beyond his term of office. He undertook to convey that wish to the new Regional Director immediately after the dection in 2008. He thanked the Government of Japan for its support to the People at the Centre of Care initiative and in many other areas, including tuberculosis control, and expressed his appreciation for Japan's hosting of an international symposium on people-centred care in November 2007. The representative of Fiji had remarked on the impact of climate change. Although the budget allocation for dealing with that issue was limited, the Regional Director stressed the importance of advocacy and sharing of information, particularly on the health impact of climate change, and encouraged health ministers to reach out to other sectors. There was a need for all sectors to be more proactive in their advocacy. He acknowledged the collaboration that had included the tripartite meeting between China, Japan and the Republic of Korea and all Member States ill the Region would benefit. Risk assessment had been among the subjects discussed. The representative of China bad raised three concerns: noncommunicable diseases and food safety. communicable diseases,
He noted that the budgetary allocation for
noncommunicable diseases had been increased in the next biennium to provide more support to countries, including China. Food safety was another important concern for many countries. The high-level forum on food safety that was being organized in Beijing, China, in November 2007 would be supported by WHO. Funds would be mobilized to support a staff member in food safety in China and the Regional Office.
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The representative of Viet Nam had also raised the issue of food safety.
WHO would
cooperate with the Asian Development Bank and the Canadian International Development Agency to obtain more support and cooperation in that area. Concurring with the comments of the representative of the United States of America, he confirmed that focus would be placed on WHO's core competencies and, with reference to the serious public health concerns raised in Viet Nam by road trafflc accidents, said that WHO would bolster the support already being provided by the Bloomberg Family Foundation. He thanked Viet Nam for its commitment to the sharing of avian influenza virus samples. He also expressed gratitude to the nongovernmental organizations that had made statements on their cooperation with the work of the Regional Office. He looked forward to the continuation of close dialogue with those organizations. Turning to the two questions raised by the representative from Tonga, he said that he was open to suggestions concerning the format of future reports. His own preference, however, would be to retain the current format based on themes and focuses. First, it would be impractical, given the organizational structure of the Regional Office, to use the 13 cross-cutting strategic objectives set out in the proposed Programme Budget 2008-2009. Second, preparation of the report in its current
format engendered a sense of responsibility and accountability among Regional Office staff. As for his remaining term of office, his work would continue to be guided by the policies of the Regional Committee and the global governing body. He intended, however, to build further on the seeds now being planted in the areas of noncommunicable diseases and health system development, with the aim of achieving benefits for the Region comparable to those reaped over the past eight years in the area of communicable diseases. He also intended to focus on advocacy for global warming and on promotion of the people-centred approach to health care, in addition to the continuing fight against noncommunicable diseases and HN/AIDS. In short, with the help of colleagues and Member States, his efforts in pursuit of successful achievements for the Region would remain tireless to the end. 3. ADDRESS BY A KEYNOTE SPEAKER: Item 7 of the Agenda Professor Alistair Woodward, Head of School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand, addressed the Committee (Annex 2). Mr HODGSON (New Zealand), having outlined his previous experience in the New Zealand Government with respect to climate change, emphasized that the issue was a difficult one. Although his country was the only one in the Southern Hemisphere to have set binding targets for meeting its
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obligations under the Kyoto Protocol, it would not be able to reach them. Small, individual efforts were a good start, but they would not be enough; collective action was the only solution to the global problem of climate change. Governments should take into account all costs and benefits, including social and health costs, in making decisions. It was difficult to put a monetary value on human lives, but that distasteful task had been undertaken by his Government to improve decision-making. He reiterated that small steps to reduce climate change we:re straightforward, such as the suggestion by the Regional Director to allow staff members to wear c:asual clothing to work to reduce the need for air-conditioning, thus reducing the carbon footprint, and it was important that such steps be taken. Mrs ARTHUR (France) welcomed the discussion on climate change. She said that her country supported the creation of a United Nations agency for environmental issues and considered that health should be a component of all environmental programmes. As mentioned by Professor Woodward, France had been one of the first victims of the effects of global industrialization and had now formulated its own plan to reduce emissions of greenhouse gases. The mandate for the Ministry for the Environment, for instance, now also covered transport. Mr SOALAOI (Solomon Islands) also welcomed the inclusion of climate change on the agenda of the current meeting. The Region's experience with SARS had shown the importance of working together to address global threats. That experience had also shown that action must be taken immediately, before it was too late. He said that health was a development issue and vice versa. At the same time as nations wished to improve the environment for their children, they also wished to develop; nevertheless, a better future might have to be pursued regardless of economic development. The low-lying Pacific island countries and areas would be the first victims of climate change. They could not help themselves, and they urgently required the cooperation of their larger neighbours and of industrialized countries outside the Region. Mr IT ALELI (Tuvalu) said that his country would be the first victim of sea-level rise, which had now clearly been shown to be a man-made disaster. It was not the problem of one country but a global concern that must be addressed globally. Climate change would have negative consequences both economically and on health in island nations in the :Pacific and the Caribbean. He looked forward to further discussions on climate change at future meetings. Mr MANINRAKA (Kiribati), concurring with previous speakers on the timeliness of the discussions on climate change, stressed the urgency of the situation in the Region. If industrialized countries found it difficult to help small-island States, however, he asked how the problem was to be addressed. Adaptation was not a solution for countries that would be submerged by rising sea levels. He asked that industrialized countries act before it was too late.
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Dr GAFA (Niue) said that so-called natural disasters such as Cyclone Heta, which had caused catastrophic damage in 2003-2004, were partly the result of climate change. She agreed with the comments made by the representatives of Solomon Islands and Tuvalu that the larger countries in the Region should be more aware of the situation and the impact of climate change on the smaller island countries and areas, which included huge costs and extensive damage to health systems. She thanked WHO for assistance in procuring equipment following Cyclone Heta. It was important to have good leadership, research and infonnation on climate change, and health and environment ministries needed to work together closely to be able to have an impact. One issue that had been overlooked was waste management; on Niue that included asbestos contamination and fuel leakage. It was important to look at how waste was treated to ensure that there was clean air and water--elements essential to human life and health. Her country's focus on climate change did not currently extend to its impact on health, and she was pleased the topic was being discussed because that impact needed to be examined. Niue had low rates of malaria, no lymphatic filariasis, no tuberculosis and no HIV/AIDS; however, those were all issues that needed to be kept on the radar for the future. She appreciated the dual message of the bicycle in the presentation, and suggested that, as well as being good for the environment, it was also a way of increasing the fitness of populations and combating the growing problem of obesity. Ms LANGIDRIK (Marshall Islands) echoed her Pacific island neighbours' concerns and thanked the Director-General for placing climate change on the WHO agenda. The Marshall Islands were the lowest of the coral islands in the Pacific Ocean and her Government was extremely concerned about the effects of climate change. Some effects, in the fonn of droughts, were already being felt, and the impact on water availability was notable, with water being limited and people having to travel long distances to obtain essential supplies. She reiterated the request of the low-lying coral islands in the Pacific for help. Her country had also expressed its concerns in other forums, and it was important for everyone to make their voices heard so that climate change--a global phenomenon-would achieve global acknowledgement as an issue that needed to be tackled. Mrs GIDLOW (Samoa) aligned her country with the small island nations, especially in the Pacific, noting that climate change was an impOltant global issue. Human activity was responsible for climate change and human activity was therefore responsible for making a change for the better. She therefore asked the developed countries for help, as the smaller countries would be the first to feel the impact of climate change.
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She asked what the lifespan of small island nations in the Pacific would be, given that the negative aspects far outweighed the positive. The health consequences were clear; if there were no islands, however, health protection would no longer be relevant. She hoped it was not too late to act; the issue had been discussed at the regional and global levels, but there had been no action. She suggested that, as climate change would be on the agenda of the next session of the Regional Committee, that representatives from the South Pacific Regional Environment Programme be invited to attend, as they would have a more informed understanding of the impact on small Pacific islands. Mr TUIA (Tokelau) applauded the fact that climat'~
change was on the agenda; the issue was
an important one and was of great concern for small island countries. They had already experienced hardship as a result of a series of cyclones and had worked to overcome damage and disaster many times, and needed more information on how to prepare for future calamities. He was pleased to have the opportunity to speak out about the suffering of the small island nations and that their concerns were starting to be considered. Dr LAM (Hong Kong, China) said it was obvious that something had to be done urgently to mitigate the effects of climate change, although the health sector had limited influence in the area of environmental issues. Climate change should be placed on the global agenda, and WHO should take the lead in building the capacity of Member States and devising protocols and a timeframe for work towards mitigating its effects. Dr DALALOY (Lao People's Democratic Republ:ic) reported that he had recently attended the First Ministerial Regional Forum on Environment and Health, held in Bangkok, Thailand, where it had been emphasized that climate change had been caused by man and was not a natural phenomenon. He congratulated the Director-General for placing the topic on the agenda as it was an important and complex issue that needed to be tackled on a global scale. He was pleased to have the opportunity to express his support for the small island countries, noting that the smallest, poorest and most vulnerable would be the first to be affected and the hardest hit. The CHAIRPERSON invited Professor Woodward and the Regional Director to respond. Professor WOODWARD noted an asymmetry in cause and effect: those most responsible for climate change would not be affected first or worst. It made sense to focus on practical actions such as
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dengue control, water supply, civil defence and waste disposal. It would indeed be difficult not to lose sight of the big picture. The REGIONAL DIRECTOR said that the Regional Offices for the Western Pacific and South-East had invited, not only the Ministry of Health, but also the Ministry of the Environment and Her Royal Highness Princess Chulabhorn of Thailand to attend the First Ministerial Regional Forum on Environment and Health, although the WHO contribution had been minimal. The Regional Director had therefore invited Professor Woodward to address the Regional Committee, leading to the discussion on climate change, which Member States clearly took very seriously. He therefore proposed that, by the next Regional Committee, and in conjunction with WHO Headquarters, a global and regional strategy would be drafted, to cover the issues of capacity-building and cost. He would work with the United Nations Environment Programme and with the South Pacific Regional Environment Programme, so that the voice of the Pacific would be heard loud and clear. The DIRECTOR-GENERAL thanked Professor Woodward for highlighting the problem of climate change, and for the responses of representatives, which showed WHO the way forward. She would work with the Western Pacific and other regions. Work on the subject had begun much earlier, but it had not had the attention it deserved. The good news was that, at the Asia-Pacific Economic Cooperation (APEC) Summit, world leaders, including the Prime Minister of China and the President of United States of America, had agreed to work on climate change. After APEC and other discussions, over 100 Heads of State intended to speak on climate change in New York on 24 September. There was hope therefore that something would be done. As the representative of Hong Kong (China) had observed, ministries of health often had a small voice, but now environment ministries and cabinets could be drawn into the matter. 4. PROGRAMME BUDGET 2006-2007: BUDGET PERFORMANCE (INTERIM REPORT): Item 9 of the Agenda (Documents WPRlRC58/3, WPRlRC58/3 Corr. 1 and WPRlRC58/3 Corr.2) The DIRECTOR, PROGRAMME MANAGEMENT, introducing Agenda item 9, noted that the regular budget approved by the World Health Assembly in 2005 had amounted to US$ 76 505 000, a 6.2% increase from the 2004-2005 approved programme budget of US$ 72 036 000. However, the Director-General had established the initial working allocation at 97.6% due to projected delayed payment of assessed contributions. In addition, the Director-General had decided to reduce the regular budget provisions of all regions under Appropriation Section 3 (determinants of health) to ensure adequate funding for the fITst session of the Conference of the Parties for the WHO Framework Convention on Tobacco Control. The resulting reduction for the
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Regional Office for the Western Pacific was US$ 358 000. However, in April 2007, the DirectorGeneral had returned an unused balance of US$ 54 000. 31 May 2007 was US$ 74 365 000. The interim report was intended to keep the Regional Committee informed of developments since its endorsement of the original budget proposals in 2004. Regarding the details of financial implementation, Annex I showed the changes in the overall amount of the original budget since its presentation to the Regional Committee in September 2004 up to 31 May 2007. Annex 2 showed the detailed revised working allocations and the status of interim financial implementation for all 36 areas of work. The obligations incurred as at 31 May 2007, for the regular budget, showed a total of US$ 60 958 604, or 82% of the revised working allocation. Implementation of activities supported by the regular budget was being intensified to ensure that the remaining funds would be fully obligated by the end of the year. Extrabudgetary funds implemented amounted to US$ 76 883 169. Columns 5 and 6 showed the total implementation of all funds and implementation by all areas of work as a percentage of all funds implemented. Annex 3 showed information on programme outcomes for intercountry and country activities by expected results for the 35 areas of work. The final report on the budget performance would be presented to the Regional Committee at its fifty-ninth session in 2008. Final implementation would be discussed then, though questions at this stage were welcomed. Mrs ARTHUR (France) expressed appreciation of the level of detail in the report, and the way it had satisfied the requests from France for results-based budgeting. However, she drew attention to the matter of gender equity in access to health care; neglected in the current biennium, it seemed to be hardly financed for the 2008-2009 biennium. She therefore asked how the Regional Office intended to remedy that situation. The report should have presented a brief summary of the results of the many meetings that had taken place in the Region. In general, she regretted that the strategic technical documents of WHO were not systematically translated into the official languages of the Region. Dr HUR (Republic of Korea) commended the report but regretted that its focus was only on achievements. The budgets for essential health interventions, malaria and tuberculosis, had been 90%-100% implemented, while for reproductive health, only 12.47% of the total budget of US$ 3 million had been put to use, and only 44% of the regular budget had been implemented. He The revised working allocation as of
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urged the Secretariat to increase efforts in that area. There was still much room for achievement of expected results. Only 45% of the budget for gender equality, women and health had been implemented, with little reported in terms of achievements that were still outstanding. He suggested that a more flexible approach to budget implementation would help the Secretariat when division by areas of work resulted in sums that were too small. Dr SUGIURA (Japan) expressed satisfaction at the high level of implementation of the 2006-2007 programme budget. Annex 3 of the interim report demonstrated the broad scope and geographical extent of WHO's work in the Region. The budgeting had proved well balanced and timely, and new priorities, such as the emergence of avian influenza, had been swiftly integrated. Mr HODGSON (New Zealand) welcomed the continued improvement in the transparency of reporting but called for the provision in future reports of more detailed numerical data, in particular on outcomes, and information on any constraints on implementation. However, the current report did not indicate whether programmes were or were not on track, or the reasons for the delays in disbursement in some areas. It would be useful to know where and why problems were arising in order for Member States and the Secretariat to learn lessons and enhance future performance. PEHIN DATO SUYOI OSMAN (Brunei Darussalam) said that the report reflected the account taken of priority areas in the budget allocations, which had enhanced health in the Region. He expressed appreciation for the WHO technical and consultant support provided to his country during the 2006-2007 biennium in the areas of surveillance, prevention and management of noncommunicable diseases, and health information systems, which had accelerated progress in priority programmes. Turning to the proposed programme budget for 2008-2009, he welcomed the proposals relating to strategic objective 3 and strategic objective 4. Brunei Darussalam's noncommunicable disease programme would include a study of the prevalence of diabetes mellitus and noncommunicable disease risk factors, and would focus on obesity prevention through the improvement of nutrition for infants and young children. Mrs GIDLOW (Samoa) commended the Secretariat on the report and acknowledged the support provided to Member States, in particular in the areas of communicable diseases, the spread of which was exacerbated by the increasing movement of people between countries, and health promotion, which was vital for slowing the rise in noncommunicable diseases. Samoa appreciated WHO's flexibility in meeting country needs and requested consideration of the provision oflong-term
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technical support, as appropriate,
In
strategic areas where capacity-building was essential, for
example, for the implementation of surveillance and reporting to meet the requirements of the International Health Regulations (2005). Ms HALTON (Australia) joined previous speakers in welcoming the increased transparency of reporting, which represented a major step forward. Having chaired the Programme Budget and Administration Committee of the WHO Executive Board, she was well aware of the calls for increased transparency over the years. WHO had undertaken and was continuing reforms to its budgeting procedures, and it was gratifYing to note the progress made. WHO had also shown increasing willingness to explain constraints. For example, at the Committee's last meeting, the Regional Director for Africa had provided a useful presentation on the difficulties he had faced in disbursing allocated funds for programme activities and in meeting the requests made by the Regional Committee for Africa. However, in the Western Pacific, further improvements were needed to clarifY reporting on performance, with the provision of more numerical and explanatory information, so that Member States could gain a better understanding of where funds had been allocated and spent, and of the progress made in each area. A covering document containing substantive information as narrative text might be a useful adjunct to future reports containing expanded numerical data. Dr QI (China) commended the Secretariat on the high rate of implementation of the 2006-2007 programme budget and endorsed the comme:nts made by the previous speaker. He asked whether any problems were anticipated for the remaind'~r
of the biennium and suggested that future
interim reports should include an analysis of the likely progress of implementation to the end of the budget period. The DIRECTOR, PROGRAMME MANAGEMENT thanked representatives for their useful comments, which would be taken into account in developing future reports. It was always difficult to know how best to present the large volumes of infomlation and numerical data available, and the Secretariat was always willing to respond to the Regional Committee's suggestions. The current report's focus on indicators presented in narrative form, as requested previously by the Regional Committee, perhaps obscured the concrete progress made in each area. Reporting of performance was a challenge across the Organization and had been the subject of considerable discussion at the global level. WHO Headquarters had championed the adoption of a "traffic light system" to show progress or lack of progress in particular programme areas, with substantive explanation provided for areas signalled with a red or amber light. The 2007-2008 biennium would see the adoption of the new global management system, which relied on more sophisticated software and included more refined indicators and baselines. The system should facilitate reporting and provide more in-depth analysis.
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The low implementation rate reported up to 31 May 2007 in some areas, such as reproductive health and gender equity, women and health, was partly the result of staffing changes at the Regional Office. However, programme activities were continuing in those areas, and it was anticipated that the allocations would be fully obligated by the end of the budget period. The meeting rose at 11 :55.
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SUMMARY RECORD OF THE SECOND MEETING
107 ANNEX 1
ADDRESS BY THE INCOMING CHAIRPERSON
I am deeply honoured to have been elected Chairperson of the fifty-eighth session of the Regional Committee. I would like to thank you, my colleagues, for your trust and confidence. The official government welcome was extended yesterday by Dr Byun Jaejin, the Minister of Health and Welfare of the Republic of Korea. But it is my personal privilege and delight to welcome all of you once more to the Republic of Korea, especially to your host province, Jeju. On behalf of my country, let me thank WHO and the Member States for another opportunity to host a session of the WHO Regional Committee for the Western Pacific, which we hosted in 1965, in 1981 and in 1996. We also welcome the opportunity to showcase this beautiful country and its contribution to our health efforts in the Region. Aside from having hosted the regional committee meeting four times, Korea had the honour of having two of its distinguished citizens serve WHO at the highest levels: a Director General of WHO. Dr Jong-wook Lee, and a Regional Director, Dr Sang-Tae Han. I am proud to say that Korea has transformed from a recipient country into a donor country. As a result, WHO and other development partners have gradually changed their roles within the country, moving chiefly to liaison and resource mobilization. Now the Korean Government is working hard to reciprocate the support it has received from the international community, including WHO, by addressing the needs of the developing world whenever it can. Recently, Korea, China and Japan decided in a Tripartite Health Minister's Meeting to commit 1 million US dollars in total to support developing countries' preparedness and response against a health care crisis. Taking this opportunity, I would like to express my gratitude to China and Japan for their support and cooperation. The Korean Foundation for International Healthcare, also known as Dr Lee Jong-wook Memorial Fund, is another testimony to the Korean Government's interest in increasing its contribution to international health development. The Fund, established in 2003 following Dr. Lee's election as Director-General, has been utilized to provide aid for developing countries and North Korea. As you might know, the Korean Government will soon have a historic opportunity, I hope, to ultimately contribute to improved health and quality of life in North Korea. President Moo-hyun Roh of the Republic of Korea is scheduled to visit Pyongyang, the capital city of North Korea in early October this year for a summit meeting with North Korean leader Mr Jeong-il Kim. This summit meeting is very significant in that it will take inter-Korean relations to a new height, promote peace and prosperity on the Korean peninsula, and pave the way for a reunification between South and
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North. In the field of health care, the Korean Govenunent will continue working hard to make every community on the Korean peninsula healthy by, for example, carrying out diverse joint programs based on mutual trust to improve North Korea's health care system.
It is with some nostalgia that I tell you now that when Korea offered to host this meeting, we were looking for the opportunity to welcome a fellow Korean, Director-General J W Lee, Korea's greatest contribution to international health. But I am pleased to note that the WHO Regional
Committee for the Western Pacific is meeting for the first time with the presence of Dr Margaret Chan, our new Director-General. As we all know, Dr Chan is also from this Region and has been a respected member of the WHO family in the Western Pacific. Under her brilliant
leadership, we have gone through the transition to a new system speedily and smoothly. Now, we must, and we can, continue with our important work more vigorously than ever. The comprehensive agenda before us gives us good reason to be hopeful and to push forward with renewed commitment. We shall have a keynote speaker on a topic of global significance and urgency. I believe that the impact of climate change on people's health and lives is far, far reaching than we can now comprehend. We could reach a point of no return if we do not act now. My country is very keen on pushing the agenda for responsible environmental governance and contributing in concrete ways towards securing a sustainable environment for future generations. The change from areas of work to strategic objectives as reflected in the Proposed Mediumterm Strategic Plan of the Western Pacific Region for the period 2008-2013 provides a new roadmap in the way WHO works within the Organization, and with Member States and partners. I look forward to our discussion on this subject. We all know that the Region must indeed pick up the pace to be on track to achieve the Millennium Development Goals. I note with some concern that noncommunicable and chronic
diseases, now a major health problem in Korea, and wmlch have crossed economic borders to pose an economic threat to middle- and low-income countries, is not included in the MDGs. I note with satisfaction that we are making headway in addressing HN/AIDS and tuberculosis, as well as in implementing the WHOIUNICEF Regional Child Survival Strategy which covers maternal and child health, including immunization. Yes, the Region has about a third of the global MDR-TB (Multi Drug Resistance Tuberculosis) burden, but we must also take pride in being the first and so far only Region to achieve the 2005 global TB control targets.
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Annex I I believe that access to essential drugs and health technologies is crucial to achieving MDG targets for health and to curbing threats from emerging diseases that can reach pandemic proportions. Thus, we should pay close attention to how innovation and intellectual property issues impact access. We must resolve not only to support relevant resolutions but also to implement follow-through actions that such resolutions call for. Now, speaking of health systems, the reality is that many of our fragile health systems, especially in resource-constrained countries, are waging an enormous battle to provide health care for all, to reach every person in need who is sick and uncared for. I am reminded of a most telling truth about humanity penned by John Donne: ... Any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee. Today, the ring of truth in these words is brought closer to home by the pounding pace of globalization and the emergence of more complex health challenges. Disease no longer respects social and geographical barriers or boundaries, and we perish or survive together. There are many barriers to health care delivery and all our health programmes and initiatives must identify and break them down. I do not think we can overemphasize the fact that international and intersectoral collaboration is crucial, if we are to provide the best care possible at the point of need for the close to two billion people who live in our Region. Yes, we need to rethink and reorient health care and health systems. I agree that the future health agenda is about humanizing health care, about harmonizing science and humanity to serve the health needs and aspirations of all health constituencies. Within the health sector, we need a fundamental shift in our guiding values and principles so that improving people's health and responding to their needs becomes the core of all of health care. This work ethic should underpin everything that we do as shapers of health care. Its presence or absence spells the difference between success and failure in attaining health for all-health in its fullest sense. Korea has contributed to the formulation of the draft policy framework on people-centred health care, having been involved in the stakeholder consultation process at country level. We
welcomed and appreciated the opportunity to critically examine our own health care system, and I am therefore keenly interested in the deliberations on two important agenda items, health systems strengthening and putting people at the centre of health care. I would also think that gender mainstreaming and achieving greater equity, two expressed goals in Korea's Health Care Development Plan for the 21st Century, are among the more important considerations under these topics.
lID Annex I
REGIONAL COMMITIEE: FIFTY -EIGHTH SESSION
Judging from the Regional Director's report, we have accomplished much in improving health in the Region. But there is much more to be done. While the work ahead may be daunting, I believe that with the culture of caring and sharing that Dr Omi cultivated since his inauguration, we are up to the challenge and we can get the job done together. Our long held principle of solidarity in diversity will continue to guide us in making hard decisions and taking bold actions for health for all in the Region. Let us make this meeting a venue to sharpen our focus, expand our knowledge and perspective, forge closer partnerships and friendships. Let us speak out with one voice and act in concert for the health and well being of all the people in this Region. With your active participation and with the Secretariat's able support, this meeting can really begin to make a difference that we expect to get translated into our work both at regional and national levels. Your stay with us might be short, but the Korean people will do their best to make it pleasurable and for it to be remembered with fondness long after-maybe, long enough to make you come back for another visit, or for another meeting. Once again, I bid you all a warm welcome, wishing you a week-long window of opportunity for working and sharing and learning together.
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111 ANNEX 2
ADDRESS BY PROFESSOR ALISTAIR WOODWARD, HEAD OF SCHOOL OF POPULAnON HEALTH, FACUL TY OF MEDICAL AND HEALTH SCIENCES, UNIVERSITY OF AUCKLAND
I am conscious that the Director-General in her opening speech yesterday has already introduced this topic. She drew a compelling picture of the health problems due to climate change and the reasons why our sector should be centrally involved in mitigation and adaptation. My aim is to build on her comments. This talk has three parts. I will start with a quick summary of the science of climate change, as I see it, and then outline some ways in which climate change is already and will in the future affect our Region. I shall finish by suggesting some actions that the health sector can take. The most comprehensive and up-to-date reference is undoubtedly the Fourth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC). This was an enormous undertaking, involving over 2500 scientists, with four drafts scrutinized by tens of thousands of reviewers. I have drawn out the four findings of the report that are most relevant to this meeting. Most important, in my view, is the conclusion that climate change is not a risk in the distant future but has already started. In that respect, the tone and wording of the four IPCC reports changed between 1990 and 2007. In IPCC terms, 'very likely' means more than 90% probability: there is very little doubt, the Fourth Assessment Report tells us, that human activities are changing the world's climate. Another significant conclusion of the reports published earlier this year is that impacts of riSing temperatures and changed rainfall on physical and ecological systems are now evident. On every continent and in the oceans, there are now fmgerprints of climate change. Warming of the northern parts of the Atlantic, for example, has caused two-thirds of marine fishes to shift latitude or depth or both over the past 25 years. Closer to the venue of this meeting, in Jiangsu Province, China, the winter freezing zone has moved northwards, and climate-limited species like the water snail that transmits schistosomiasis have also shifted northwards, putting perhaps an extra 20 million people at risk for the disease. The third major finding of the Fourth Assessment Report is that there have been impacts on humans as well. Those with few resources are certainly at greatest risk, but recent events have shown that even the richest societies are vulnerable to rapid climate change. One of the most striking illustrations is the European heat wave of 2003. In France, extreme heat in August of that year led to approximately 25 000 deaths over and above what would have been expected. There have been
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similar, if less dramatic, events in the Western Pacific Region. In the summer of 1998, for example, a heat wave in Shanghai increased mortality in the city by more than threefold. Finally, the Report included an assessment of the future effects of climate change. It concluded that there will be some positive outcomes (for example, parts of the world will become too hot and dry for sustained transmission of malaria), but, overwhelmingly, the balance of health effects is on the negative side. The largest effect, globally, is projected to result from food stress and undernutrition. There will be some winners and some losers, but, overall, climate change is expected to have a negative effect on food production. For example, in northern Asia, rising temperature, falling humidity and increased concentrations of low-lying ozone, in combination, may reduce grain production by up to one-fourth. What does this mean for the Western Pacific? On the whole, future threats will be no different in kind from those faced in the Region already. What will be different, I suggest, is the severity and range of climate-related problems. I have chosen two examples; the first is dengue. The emergence of dengue is not explained by climate change, but changes in temperature and rainfall in the future will make it very much more difficult to control the disease . Vector and pathogen are both sensitive to ambient conditions: where these are favourable, the forc~:
of infection with dengue is increased. This
will apply where the disease is already established, and there will also be pressure at the boundaries. Empirical modelling suggests that the climate that is likely to exist in 2085 will put an extra 1 billion people at risk for dengue worldwide. The second example is water. Projections are that the seasonal and spatial distribution of rainfall will shift, rainfall intensity will increase and evaporation will increase owing to rising temperatures. Altogether, this means that the percentage of the world's land area in drought will increase perhaps 10-fold by the end of the century. Particularly vulnerable will be the low-lying island States of the Pacific: when the effects of sea-level rise and increased storm activity are added to changes in rainfall, water resources on the islands are likely to be seriously compromised. There will pe st;:ripus effects as well in densely populated mid-continental areas. For instance, flows in tbe Red River are projected to decline by up to 20% by 2100. The world's climate is changing so rapidly that adaptation, fmding better ways of reducing the impact of environmental perturbation, must be a priority. How successful this will be depends not only on how much resources a country has but also how it is allocated. According to the IPCC, "economic development is an important component of adaptation, but on its own will not insulate countries from disease and injury due to climate change."
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A relevant example from outside the Western Pacific is that of Cuba, which is placed in the middle of the hurricane belt in the Caribbean. It is a poor country, with a gross domestic product of somewhat less than US$ 4000 per person. Yet, it has systems for disaster preparedness that appear to work very well, with low casualty rates. Why is this? An analysis of the Cuban experience by Oxfam suggested two explanations. First, 'tangible assets' have been applied to the problem. Cuba has a well-organized civil defence apparatus, early warning systems, rescue teams, stockpiles of food and water and a building code that is enforced and that limits storm damage. But, Oxfam concluded, there are also important 'intangibles' to be considered. These include making anticipation and prevention priorities rather than reaction and treatment, political commitment to equity in health outcomes, community mobilization and education and improvement of those in the population at greatest risk. Cuba rates highly on a number of other public health indicators, such as child survival, and the explanation is probably similar. Thus, thinking about the best way to respond to climate change might not be too different from how we should be thinking about the best way to deliver public health. My fmal point about the implications of climate change for this Region is that we should pay attention not only to the impact on health of climate change but also the impacts on health of responding to climate change. The average global temperature has risen by about 0.6°C. A rise of 2 C over the pre-industrial average is considered by many as the edge of tolerably risky climate change. It appears to me that we are most unlikely to prevent warming of this extent. To achieve a better-thaneven chance of avoiding warming of 3°C, countries like New Zealand will have to cut their greenhouse gas emissions by about 80% before 2050. This will require considerable reorganization, which will inevitably have consequences for health, perhaps positive (so-called 'co-benefits'), perhaps negative (what I have called 'collateral damage'). In planning how to reach emissions targets, all countries will be faced with a curve of the cost-benefit function of carbon dioxide reduction that shows some easy gains, where reducing emissions saves money immediately; however, as efficiency improves, the cost per tonne of carbon dioxide will rise sharply. Far-reaching decisions on infrastructure and energy consumption will be taken on the basis of such curves. My point is that calculations should not be blind to social impact and especially to health outcomes. Put another way, we should strive to maximize the win-win choices (where there are health co-benefits) and minimize the wine-lose options (where there are emission savings but collateral damage to health). I shall take transport as an example. This sector is a major contributor to emissions. Indeed, in New Zealand and many other countries, transport is the fastest growing source of greenhouse emissions. It also has a significant effect on public health. Globally, about 1.2 million deaths each
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year are due to road traffic injuries and 800 000 deaths due to urban air pollution. One should not overlook the roughly 1.9 million deaths ascribed to physical inactivity. The challenge as I see it is to link decisions on transport policy to these and other health outcomes. To do that, it is the responsibility of this sector to provide more precise and relevant information on the health consequences of strategies such as: a move to more active transport, carbon charges in various forms and the introduction ofbiofuels. What actions can we take? The environmental health issues that galvanized public health in the nineteenth century were local, not global, and that is an important distinction. But the underlying problem-the overwhelming effects of human activity in the forms of mechanization and consumption of natural resources-was the same. I suggest we might learn some lessons from the public health pioneers who faced the first industrial environmental crisis. Information, especially information on risks to health and the consequences of interventions, accidental or intended, drove the sanitary revolution 150 years ago. Research must provide the same impetus to our collective response to modern global environmental change. A well-organized public health movement hastened the clean-up of cities in Europe in the 1800s. Climate change requires a response on regional and global scales, but, once again, collective action is more likely than piecemeal initiatives to make a difference. I see that organizations like WPRO can playa very important role in this regard, and I shall describe what might be placed on the climate change agenda. First, however, I shall say something about leadership. The primary causes of the problem are outside the direct control of the health sector. It was the same in the rapidly industrializing countries of northern Europe in the nineteenth century. Health can, however, take a lead in raising awareness of the problem, framing thinking and talking about solutions. There are plenty of precedents. Edward Chadwick, for example, a hero in the British public health tradition, moved the debate about housing from a discourse about economic productivity and moral behaviour to one about disease rates and life expectancy. Closer to our time, Bernard Lown and Evgueni Chazov, founding co-chairs of International Physicians for the Prevention of Nuclear War, provided inspired leadership in reframing
thinking about the future us!' of nuclear weapons. The late David Lange, a former prime minister of New Zealand, said, "IPPNW made medical reality prot of political reality." In the same spirit, I believe that the health system can, and must, be at the forefront of climate change. As the DirectorGeneral said in her opening address, "Just as we fought so long to secure a high profile for health on the development agenda, we must now fight to place health issues at the centre of the climate change agenda."
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What might a plan of action look like? I would fIrst like to acknowledge the work of WHO that is already under way. This includes the WPRO thematic working group on climate change, ozone depletion and ecosystem change; country-based projects under way in this Region on adaptation; and a WHO strategy for protecting health from changing climate, which is being prepared. Below are some suggestions for further work. Most of the climate change assessments to date have been national. I suggest that these be complemented by regional assessments, to take account of the complexities and interconnections of climate impacts. Examples include food yields and the modulating impacts of trade and agricultural policies; water flows in shared rivers; and the health and well-being of displaced populations. Epidemiologists and health planners could also benefIt from the new generation of climate models, which generate, near-term, high-resolution climate data. The work undertaken by WPRO in China and Fiji on local adaptations to present-day climate threats is a great start. Other topics worth exploring might include water management in low-lying Pacific islands (taking up such issues as solar distillation and groundwater recharge); communitybased disaster preparedness (a recent study estimated that such interventions could cost no more than 2% of the post-flood relief that would otherwise be required); and interventions to reduce the social and medical impacts of drought in rural settlements. I have already mentioned the importance of developing methods of analysis to assist decisionmaking on mitigation of climate change. There is an important agenda at the edges of health: building bridges into other government departments, such as agriculture, energy and tourism, and using these links to develop policies that are environmentally sustainable and health-promoting at the same time. Lastly, taking the lead means modelling the changes we believe are needed. As organizations, health departments can set examples by shrinking their environmental footprint. I am pleased to say that out Ministry of Health in New Zealand has made a commitment to do so. As individuals, of course, we can lead the way in what Ian Roberts, an English epidemiologist, has called 'speaking carbon'. In conclusion, there is doubt that this is the largest, most far-reaching and most complex
environmental issue of them all. I have chosen, however, to end on an optimistic note, reflected in my choice of a picture of a group of cyclists. I chose the bicycle because it is surely a machine of the future - a remarkable effIcient way for people to get around under their own power. But the picture also has another message: Cyclists in a bunch move much more rapidly than when riding on their
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REGIONAL COMMITTEE: FIF1'Y-'E'IfflrttFs'Es~t&N
Annex 2 : ·1, " I"
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