Speech of Dr Shin Young-soo, WHO Regional Director for the Western Pacific at the Second Regional Forum of WHO Collaborating Centres in the Western Pacific
28 November 2016, Manila, Philippines - Distinguished participants;
Ladies and gentlemen:
I am pleased to welcome you to the Second Regional Forum of WHO Collaborating Centres in the Western Pacific.
The record attendance is a testament to your commitment to the strong technical collaboration between WHO and Member States.
Many of you are old friends. Welcome back! Please join me in welcoming new participants to the extended WHO family.
As Regional Director, I would like to start our programme by sharing key regional health developments since our first forum in 2014. Our collective efforts have led to significant gains in health and development in the Region.
People are living longer than ever.
Countries are moving up in income brackets. All of our Member States have progressed to middle- or high-income status.
This progress, however, has created new challenges.
As people live longer, countries face increases in noncommunicable disease and other challenges of ageing populations.
Increases in income have led to reductions in donor support – even though countries may not be ready to pick up the slack in funding. This can threaten some of the Region's most celebrated health gains.
While the World Health Assembly focuses on global health issues, the six regions of WHO have separate governing bodies to discuss health matters unique to each region.
In the Western Pacific Region, our 37 countries and areas meet every October as the Regional Committee.
I am in my second term as the elected head the WHO Secretariat in the Region. I report to the Regional Committee on the work of WHO in the Region every year.
The Regional Committee also reviews and approves the allocation of budget for each country.
The Regional Committee also discusses important health issues in the Region, setting priorities for WHO's work and endorsing action plans through resolutions.
The sixty-sixth session of Regional Committee was held in October 2015 in Guam in the United States of America. Five resolutions were adopted to address health issues challenging Member States.
They specify tasks to be addressed by WHO in collaboration with our extended implementing arms – WHO collaborating centres.
I would now like to introduce these items one by one.
First is viral hepatitis – which is really a disease of Asia.
This disease kills more than 1500 people a day in the Western Pacific Region – more than HIV, tuberculosis and malaria combined.
The Region contains about a quarter of the world's population yet bears 40% of the global mortality burden from viral hepatitis.
The Regional Committee has adopted resolutions on viral hepatitis in the past:
In 2005, the Regional Committee established the interim milestone of less than 2% prevalence of hepatitis among 5-year-olds by 2012; and
In 2013, the Regional Committee went even further setting 2017 as the deadline to achieve the goal of less than 1% prevalence among 5-year-olds. The goal was achieved Region-wide in 2016 – a year and a half ahead of the deadline!
In addition to prevention, we turned our efforts to the tens of millions of people across the WHO Region living with chronic hepatitis infection and the risk of cirrhosis and liver cancer.
In 2015 the Regional Committee endorsed the Regional Action Plan for Viral Hepatitis in the Western Pacific for 2016 to 2020.
Since new drugs are available, this action plan allows us to go beyond immunization. We are now working to control hepatitis B and cure hepatitis C.
The action plan focuses on improving access to treatment for people living with hepatitis and supporting countries to negotiate to reduce the prices of life-saving drugs.
All health gains can be sustained only when people have access to the quality health services they need without undue financial hardship.
Unfortunately, in the Western Pacific Region, not all our health systems are performing as well as we hope.
In some countries, people continue to pay high out-of-pocket costs for health services.
In other countries, there are safety and quality issues, and resources are limited. People cannot access the range of quality services they need.
The Regional Committee endorsed the Regional Action Framework on Universal Health Coverage to guide health system strengthening.
At the core of this framework is that a well performing health system must have quality, efficiency, equity, accountability, resilience and sustainability.
This means that we have to address health system development at several levels.
First, governments must lead with vision, and exercise policy levers effectively and accountably.
Second, health services must focus on people rather than diseases to ensure equitable access to quality services.
Third, communities must be engaged and empowered to take control of their health. They must have sufficient health literacy to seek the right care, and they should be involved in decisions on health service planning and delivery.
To achieve this, countries are developing UHC road maps, as part of their national health policy, strategy and plan development.
In a few weeks time, we will convene the first technical advisory group on UHC to review progress in implementing the regional action framework.
The international community is firmly committed to ending the tuberculosis epidemic by 2030.
The Regional Framework for Action on Implementation of the End TB Strategy 2016–2020 builds on this commitment to ensure that the most vulnerable groups are reached.
The strategy focuses on social and financial protections for patients and families to deal with the catastrophic costs and discrimination associated with TB.
The strategy also recognizes the serious threat of drug-resistant TB. It calls for rapid adoption of the latest innovations such as new diagnostics and drugs.
Even though we know injuries and violence are preventable, they cause more than one million deaths in our Region each year.
The Regional Action Plan for Violence and Injury Prevention in the Western Pacific for 2016 to 2020 aims to strengthen leadership, coordination and actions through the life-course on this issue.
This area requires the health sector to work effectively with police and justice, education, labour, finance, transport and planning.
In our Region, more than half of the people live in cities. Our Region is home to nine megacities with populations of more than 10 million people.
Living in urban areas may offer residents an “urban advantage.” However, health challenges brought about by rapid and unplanned urbanization impact all Member States.
Poor housing conditions, congestion and lack of access to safe water and sanitation create risks for communicable diseases to spread.
Outdoor and indoor air pollution is the largest single environmental health risk.
Since the Ottawa Charter for Health Promotion of 1986, WHO’s work to improve health in cities has been a priority – Healthy Cities and Healthy Islands.
A recent review found that Healthy Cities and Healthy Islands approach has been effective in mobilizing political and cross-sectoral support for urban health.
But the review also found that our approach should be proactive rather than reactive. We can also take a broader approach to address other urban health risks and reduce inequities.
The Regional Framework for Urban Health in the Western Pacific for 2016 to 2020 shifts the focus from "healthy cities" to "healthy and resilient cities“. The framework takes a proactive approach to urban health. The goal is to improve health, and promote equity and sustainable urban development.
In 2016, the Regional Committee met here in the Conference Hall of our Regional Office. They again adopted five resolutions on key health issues.
The Constitution of WHO clearly sets out the Organization’s mandate on health and environment. From 1947 to the 1980s, WHO’s key environmental health programme was water supply and sanitation.
In the wake of the horrifying Bhopal chemical and Chernobyl nuclear disasters, there was a renewed global focus on the environment in the 1980s. Environmental health became a priority.
Worsening environmental conditions and emerging environmental threats to health are alarming.
One quarter of death and illness in the Region is linked to the environment, with a disproportionate impact on vulnerable groups such as young children and the poor.
More than 80% of people in cities are regularly exposed to air pollution.
Rising sea levels threaten the viability of Pacific island countries and areas.
The good news is the unprecedented opportunity created by the 2030 Agenda for Sustainable Development to accelerate action on health and the environment.
The Western Pacific Regional Framework for Action on Health and Environment on a Changing Planet can support the strengthening of health and environment sectors to achieve the Sustainable Development Goals.
The framework focuses on strategic approaches for intersectoral action, health impact assessment, participatory governance, life-course approaches to health and the environment, evidence-informed policies and practices, and transboundary action.
We have also made great strides in fighting malaria.
Since 2000, we have reduced malaria deaths by 90% in the Region’s 10 endemic countries. Based on this success, the international community is now working to end the malaria epidemic by 2030.
However, countries in the Greater Mekong Subregion face an additional challenge in drug-resistant malaria. This is a potential threat to global health security.
Taking action on this will be critically important for future malaria control activities.
The Regional Action Framework for Malaria Control and Elimination in the Western Pacific 2016 to 2020 recognizes this.
The framework focuses on strengthening surveillance and ensuring universal access to malaria-related services. It will also contribute to accelerating elimination of malaria, including drug-resistant forms, and it will address bottlenecks to strengthening operational research.
The WHO Director-General, Dr Margaret Chan, called our Region “the world capital of dengue”.
While the case fatality rate has been cut in half, the truth is the Region’s annual number of reported dengue cases has more than doubled from approximately 200 000 in 2008 to more than 450 000 cases in 2015.
Our understanding of the disease is incomplete and the tools we have to address dengue are limited. We need a new approach.
The new Western Pacific Regional Action Plan for Dengue Prevention and Control shifts its approach from containment to mitigation to minimize social disruption and death.
The action plan aims at early adaption of new tools but also it encourages best use of available interventions and further emphasizes clinical management and risk communication.
The United Nations General Assembly endorsed the Sustainable Development Goals or SDGs in 2015. These goals were developed through a Member State-driven process and Member States are the key drivers in taking this agenda forward.
At the regional level, we developed the Regional Action Agenda on Achieving the SDGs in the Western Pacific to support Member States.
The contents of the SDGs and of our regional action agenda will be a key area of discussion in the coming two days.
Finally, I want to talk about our updated Asia Pacific Strategy for Emerging Diseases or APSED.
Based on the lessons learnt from SARS, the international community revised the International Health Regulations in 2005. APSED was developed as a regional tool for Member States to achieve the core capacities required under the revised International Health Regulations. Since then, the strategy has been evaluated and revised every five years.
The new strategy, APSED III, incorporated the results of evaluation and lessons learnt from Ebola -- which resulted in the establishment of a new WHO programme on health emergencies.
APSED III promotes new directions such as multi-source information for evidence-based risk assessment. It also introduces new elements such as an integrated management system and Emergency Operation Centres.
While it maintains emphasis on the core system, APSED III places the core system in the context of the broader health system and further links with the SDGs.
These strategies will guide our work in these priority areas in the coming years.
In addition to these important areas, I would like to review briefly key health events in our Region over the past two years.
Learning from the Ebola outbreak in 2014 in West Africa, WHO has launched a new health emergency programme globally. This new programme changes the way WHO does business. It creates one direct line of authority, one workforce, one set of rules and processes and one budget for all of WHO’s work on health emergencies.
Our experience in Ebola also revealed gaps in Member States’ core capacities under the International Health Regulations. In response, the Joint External Evaluation or JEE has become an important tool to monitor and evaluate IHR capacities and identify areas to enhance preparedness.
Our Region has faced several disease outbreaks over the past two years:
The outbreak of Middle East respiratory syndrome in the Republic of Korea showed us that vulnerability is universal. One single MERS imported case in 2015 resulted in hospital-to-hospital transmission. This led to the largest MERS outbreak outside the Middle East, with 186 confirmed cases and, among them, 38 deaths.
In the Lao People’s Democratic Republic an outbreak of circulating vaccine-derived poliovirus type 1 was quickly contained and we hope that early next year we will confirm that the Region’s polio-free status was maintained.
As you know, the Zika virus disease outbreak was declared a Public Health Emergency of International Concern in February 2016. Some of our Pacific island countries and areas have faced this disease for many years. In fact, 19 countries and areas in our Region have reported locally-acquired Zika cases since 2007. This means we are the second most affected Region after the Americas.
Countries in our Region remain highly prone to disasters.
In the Pacific, Tropical Cyclone Winston, was the most powerful storm on record to make landfall in the Southern Hemisphere. It swept through Fiji in early 2016.
Together with the Fiji Ministry of Health and Medical Services and UNICEF, WHO coordinated the Health and Nutrition Clusters of the disaster response.
Intense weather patterns are likely to increase. The first three months of 2016 were the hottest ever on record.
The international community has committed to the Paris Agreement on climate change and it is rapidly being ratified.
In our Region, we convened Ministers of Health and the Environment, as part of the Regional Forum on Health and Environment in Southeast and East Asian countries. They called for action on antimicrobial resistance, transboundary haze and air pollution, transnational waste shipments, and marine pollution and destruction of coral reefs.
In the Pacific, our work has been guided by the Healthy Islands vision since 1995. This vision has provided a holistic framework to address the social determinants of health in Pacific island countries in areas.
In 2015, Pacific health ministers reviewed the 20 years progress on Healthy Islands and renewed their commitment to this vision.
The vision is that Healthy Islands are places where:
children are nurtured in body and mind;
environments invite learning and leisure;
people work and age with dignity;
ecological balance is a source of pride; and
the ocean which sustains us is protected
Each year on April 7, we celebrate the birthday of the World Health Organization. This is an opportunity to raise awareness of an important health issue.
In 2015 we focused on food safety and how to make food safe from farm to plate.
In 2016 the theme was diabetes. Global prevalence is increasing. It is estimated that 131 million people in our Region have diabetes.
A few days ago experts from across the world gathered in Shanghai for the Ninth Global Conference on Health Promotion. The International Mayor’s Forum was convened as part of the Conference.
Mayors and local leaders play a key role in the SDG era. Through the Shanghai Consensus on Healthy Cities, more than 100 mayors committed to make their cities inclusive, resilient and healthy.
Even more recently – last Thursday and Friday – the Forum of Asia Pacific Parliamentarians for Global Health met for the second time. They also considered their leading role in work towards the Sustainable Development Goals and committed to support this important agenda.
Two years ago we made history by convening the Region’s WHO collaborating centres for the first time.
This was a first for our Region and for WHO globally.
Our goal at the First Forum, was to reaffirm our partnership and identify new and strategic ways of working together.
It was a great opportunity for us to build stronger foundations for effective collaboration.
Through the first forum we confirmed that you are part of the extended WHO family.
This is why we wanted to share with you more detail on key events and issues in the past two years.
The SDGs are a notable development. These goals will have an immense impact upon WHO’s ways of working and on global health as a whole.
I hope you will have productive discussions over the next two days. I look forward to strengthening our already robust collaboration and partnership. Thank you.