Safeguarding Our Health and Our Environment

Acknowledgement to organizers, Niels Daulaire, President Global Health Council, the Co-chairs: Margaret Catley-Carlson, The Global Water Partnership, Thais Corral, Founder of REDEH, The network for Human Development bringing a women’s persepctivers to environmental issues in Brazil, and David Nabarro, Executive Director WHO for Sustainable Development and Health Environment and a special mentioning of this year’s award winners [to be included].

I am very honored to be with you tonight at a conference that year-in, year-out, convenes many of the world’s most incisive minds and committed hearts to discuss the leading health and development issues of our time. You have shown that commitment this week in examining the close relationship between health and the environment, with sustainable development, with the urban environment, and recognized the critical role of leadership at all levels: in our villages and cities, in our nations, and across our global community.

Many of us in this room tonight have witnessed personally the poor health of poor people around the world; have seen the filthy water they drink, the poisonous air they breathe; and so we do not need to ask ourselves again “What are the major health problems global challenges?” or ”What is the role of the environment in health and development?” or ”What are the links of health and the environment to poverty reduction and inequities?” We know the answers, as do poor people themselves.

The question that I want to ask instead tonight is not whether we have the technical knowledge to make a difference, but whether we arewilling to act now to vastly improve the health of poor people and safeguard our environment for future generations? All of us, whether we are policymakers, politicians, the financiers, the taxpayers, the social sector professionals, scientists, the representatives of development agencies, bilateral partners, PVOs and local communities, all of us have a role to play in fulfilling this historic task. As the world's largest membership alliance dedicated to improving health and saving lives throughout the world, it is little wonder that we are discussing such issues here at the Global Health Council. Its broad, diverse membership is a testament to its ability to convene a global coalition around healing the sick and protecting the well.

Let me pose the question then....are we willing to translate current knowledge into effective action for global health – are we willing to mobilize what it takes: leadership, strong health systems, targeted human and financial resources and a restructuring of how things are done to ensure that poor communities benefit?

Why am I so confident that we know what to do, and that we could make a major difference together in the status of global health? Clearly a conference like this that brings together so many best practices and lessons learned increases our confidence that we can make a significant difference if we work together across boundaries: the boundaries of people, gender, communities, nations, and across the boundaries of disciplines and sectors.

My own experience in the poverty-stricken townships of my native South Africa, countering the racism and ignorance of apartheid by working with other committed activists across boundaries of class, race and gender, has given me the confidence that great things can happen – I would like to bear witness to that here today. People often ask me how I could have survived under the conditions that I have been subjected to in my life. The short answer is that when you are faced with bone-numbing adversity, you have no choice but to survive. It is amazing what internal resources come to you under stressful circumstances¾resources you didn’t know you had until they were needed.

And so, it does not surprise me that here I am, the first African to hold the position as Managing Director of the World Bank, advocating with all my passion for accelerating progress towards the health, nutrition and population related Millennium Development Goals. Here I am in one of the richest cities in the world, where if any of us becomes ill, we will be treated by doctors with Cat scans and MRI’s. We will receive the latest drugs. If our doctors need to consult they can pick up a cell phone, press a few buttons and talk to anyone in the world. But as we all know as well, most of the world has no such access.

So, this is my job and mission. Let me focus on one of the Millennium Development se Goals to illustrate what has be done and what more could be achieved if we are willing to put the human and financial resources behind actions to achieve the child survival MDG.

The child survival revolution that started in the 1980s contributed to steady decreases in child mortality in some populations. Science, program implementation and evaluation have resulted in high impact interventions at low cost that can prevent two thirds of childhood deaths.

But the job is far from done. Still over 10 million children will die this year, almost all of them poor. Two thirds of these deaths could have been prevented if these effective child survival interventions had reached all children and mothers who need them.

Let me remind you of some of the astonishing facts in the year 2003: Of the 42 countries that account for 90% of child deaths worldwide, only five met the child summit target for child mortality bye the end of the last decade; immunization coverage has stalled at less than 70% in south Asia and has actually declined in sub-Saharan Africa from 60% in the early 1990s to 40% today. Global averages mask enormous differences in progress at regional and country levels. For example, in Angola and Niger, 25 in every 100 babies born will die before the age of fivewhile in Europe the comparable rate is fewer than one in every 100. A child born in the poorest fifth of Indonesia’s population is four times more likely to die before reaching five than one born in the wealthiest fifth.

Poor children are shouldering more than their fair share of this tragedy.The child survival revolution, for all its major accomplishments, has left us today with large child health inequalities. These include the exposure to environmental risks that disproportionally affect poor households. For example, a large proportion of the world’s rural poor still depend on charcoal and biomass for fuel – they are not likely to climb the energy ladder in the near future -- and children and their mothers who are the ones who are mainly exposed to the combined effect of poor ventilations and biomass fuel pay the price in illness and deaths. In addition to the household environment, differences in maternal education, health promoting behaviors, including hygiene, access and use of water, are key determinants that disproportionally affect poor families and influence child survival rates.

This brings me to a major point that I would like to stress tonight in the spirit of this conference: the need to explore the synergies and complementarities of actions across sectors: water, education, agriculture, roads and infrastructure and other sectors. We in the World Bank are very pleased to be part of some of the multi-sectoral and multi-disciplinary efforts to improve the health among poor communities, and to develop a healthier environment. For example, a multidisciplinary team are here at this conference from China , who we have had the privilege to work with in the support to community based interventions to reduce indoor air pollution among poor rural household in parts of China.

There are also partners here working on the private-public partnership to promote effective handwashing, which has been able to document that changes can be made in diarrhea prevalence among poor families through effective promotion of handwashing in Latin America and in other places. I believe that to accelerate progress towards the health, nutrition and population Millennium Development Goals, we need to strengthen our work cross sectors and disciplines – I am sure that some of those linkages are strengthened through the interactions during this conference.

We have recently become acutely aware of the intimate linkage between the environment and health outcomes; the breakdown of the water, sanitation and electricity infrastructure in Iraq and the anticipated effects on the health of a predominantly urban population, depending on a functioning environmental infrastructure for its health. We have also recently been reminded of the importance of having strong public health infrastructure and core functions in place, as witnessed by the effective, immediate, response to SARS in Vietnam, which managed to respond to SARS through combined clinical and public health approaches, limiting the outbreak in that country.

We are learning lessons from both failures and successes, strengthening the foundation for effective global actions in health. Last year, during our World Bank Annual Meetings of development and finance ministers, we wanted to demonstrate some progress in public health and communicable disease control, to show that we can indeed accelerate progress towards the HIV/AIDS, TB and malaria goals and increase our level of confidence in what works. One of the case studies that we presented to make our case strong were the Brazilian AIDS program, showing how political commitment, capacity and resources combined can achieve remarkable results. I am very pleased to note that this effort is being honored here tonight.

Finally, let me mention how pleased and privileged we are to work with so many of you who are here today: on the ground, and in global partnerships. Last year you honored the Rotarians for their role in polio eradication; we are pleased to be working with the Gates Foundation, the UN Foundation and Rotary on polio eradication – they are buying down the loans that client countries like Nigeria, Pakistan and India are taking to eliminate polio so that a global public goods like polio eradication can reach the last major pockets, leveraging funding from different sources. This is one example of financing innovations that we hope will break new grounds in how we might work together to mobilize the necessary resources for health. We are also pleased to be part of a current ongoing effort of a group of concerned scientists, policy makers and journalists – some of you are here tonight -- who are about to issue in The Lancet a call to action to leaders, governments and citizens to translate knowledge into action for child survival.

I am often asked if the MDGs can be achieved? Why work towards unachievable goals? My motto has always been: Give me the serenity to accept the things we can not change, courage to change the things we can change and the wisdom to know the difference. I believe that we can make a significant difference, even if it means full achievement of the goals in some countries only where good governance and the institutional and policy context have created readiness for accelerated progress; while in other countries, some of them in Sub Saharan Africa, progress will be to change the direction of the demoralizing trends in mortality rates or keeping trends from worsening in some places. I still believe though, that we should aim for progress towards the MDGs for all, and measure improvements in all population groups – and aim to close the equity gap in access to social services. Just closing the gap in child mortality levels between boys and girls in the Indian subcontinent alone would have a significant effect on the overall global aggregate child survival level.

This optimistic perspective, is based on a belief in: our willingness to translate current knowledge into effective action for maternal, child health and nutrition and for the combat of communicable diseases; fostering of strong leadership; building strong health systems and public health core functions; working multisectorally including the environmental determinants; and, the targeting of human and financial resources and restructuring how things are done to ensure that poor populations benefit.

Let me conclude by reading what I think is the perfect summary of our task here this week. It comes from the website of the Global Health Council, and I salute them for its directness and simplicity:

Each year, all around the world, tens of millions of human beings die needlessly, and hundreds of millions of lives are ravaged by ill health.

The world has the resources to greatly reduce this loss and suffering. When it comes to global health, there is no them, only us.

THANK YOU