World Health Summit 2019 - Universal Health Coverage
Table of Contents
- We'd like to welcome you to this what we believe is a really important and...
- Thought in the movement that should be more of a cross-cutting issue because we...
- And regional system they still need to be supplemented with global preparedness...
- We have diseases of plenty the diseases of want are in the poor countries and...
- Think that's one area we must invest in and we must that can needs to be built...
- That you may have had about the public sector about multinational companies...
00:00
we'd like to welcome you to this what we
believe is a really important and
critical session on universal health
coverage and we can see that many of you
are interested in this many of us
believe that universal health coverage
is a core of the sustainable development
goals is one of those goals that really
also define so much else that we want to
achieve with the SDGs the
00:31
director-general of the World Health
Organization often says it's truly at
the core of the SDGs it's about people's
health and well-being and of course it
covers a wide range of health services
but also prevention health promotion
palliative care we've been at a really
critical historical moment and this is
01:01
what I hope we'll also be able to
discuss is that at the United Nations at
this year's UN General Assembly a
high-level political declaration on
universal health coverage was adopted
and that is the background of our
discussion here today with this really
distinguished panel I'll just give you a
short rundown of who is here with us and
then the way we'll proceed is we've
01:33
agreed on a set of questions where we'll
do some rounds with this panel rather
than have three consecutive keynotes
we've sort of broken them up a little
bit and that I hope will also be of
interest to you so first of all we have
with us dr. Carissa Etienne she is the
director of the pan-american Health
Organization welcome Carissa we have
with us dr. Guyton G guitar he who is
02:05
the global CEO and director general of
amra Health Africa group
I'm happy to say together with me the
co-chair of UHC 2030 and you'll hear
more about that I have to my left dr.
Harold Musa who is with Novartis here in
Germany the head of Novartis social
business to my right we have dr.
Frederick Christianson from the
Coalition for epidemic preparedness
innovations many of you will know it as
02:37
say P and he's the deputy CEO there and
then we have a special guest of honor
here and we're incredibly happy and
proud that she is with us dr. Margaret
Chan the former director of the World
Health Organization and then we have dr.
Denis Noah who is the head of the global
solutions summit that focuses on the
03:09
sustainable development goals and how we
we can best achieve them so we have
people who are really deeply involved
with universal health coverage we are
people who are involved with other
sectors and with political action who
see universal health coverage as
important we have colleagues from the
private sector who are contributing we
consciously wanted to see where is this
interface between universal health
03:40
coverage and health security because
again dr. Tedra says it's two sides of
the same coin we don't want to juxtapose
them we have the opportunity of a longer
historical perspective also from dr.
Chang this move towards universal health
coverage did start also under her
leadership at at the World Health
Organization and so and we have special
04:12
aspects that dr. Geetha he get in GGG as
I call him will bring particularly
related to the community health
dimension
and I hope also the women's health
dimension that we've spoken about so
much so Carissa I'd like to ask you
first could you give the audience here a
very short rundown of what was achieved
in New York from the perspective of
w-h-o from the perspective of the Pan
American Health Organization was this
04:46
really this historical breakthrough that
many people speak about Thank You Ilona
and good morning it was monumental I
many of you are probably too young to
know this but in 2009 I was assistant
director-general for health systems and
services dr. chan was DG we had to fight
to say that you need strong health
systems to achieve many of the vertical
05:17
disease programs that were underway it
was a fight we had primary health care
as one of our priorities nobody very few
people were ready to listen to primary
health care we had to stop using the
term primary health care and then we
went on under dr. Chan's leadership to
develop the World Health Report 20 2010
on universal health coverage and then
05:50
gradually it began to gain momentum
gradually we were then able to
reintroduce the whole concept of primary
health care PHC as a term had
disappeared from the whu-oh literature
so yes this was monumental historic I
think it places health at the very
center of the sustainable development
agenda it elevates universal health
coverage to the highest political level
06:22
and and that is also very important it
was a global call to action and it
reaffirmed that health is a human right
it means universal and universal means
universal it's
speaks to all people having those right
all people's having access to health
services and coverage but also to the
social determinants of health
I think it raised also the fundamental
06:52
importance of equity social justice and
solidarity and social protection so that
too was extremely important to reaffirm
this and it spoke about the elimination
of stigma and discrimination the whole
need to focus on the poor and the people
who live in conditions of vulnerability
as one of the priorities very important
for me are very important for the world
very important for the achievement of
universal health is the fact that
07:24
primary health care was cited as the
main approach to transform and to
strengthen health systems and it clearly
stated that health is a responsibility
of the state it is a political choice
and for that we need strong transparent
governance and stewardship a stewardship
that allows full participation of all of
the citizenry governance that is a whole
07:56
of society approach but also engages
civil society engages the private sector
but allows for the voices of so many who
have not been been hitherto heard it
calls for the participation and the
development of mechanisms to ensure that
full participation and I think it gave
us a clear path for action certainly the
whole question of meaningful
participation the implementation of
high-impact policies to protect people's
08:27
health and they are addressing the
social economic environmental
determinants of health through a multi
sectoral approach some of you will
remember that we began speaking of the
multi sectoral approach as early as 1978
yes I was alive when I was a health
professional then and for many years
we've had great difficulty
and implementing a true multi-sectoral
approach and it reinforces this as one
of the clear paths for action and we
09:00
need to work to prioritize health
promotion and prevention I think that
took him out very strong strongly and to
strengthen the first level of care
including technology and the access to
technology and human resources as well
it also on that part I didn't agree with
it also called for increase in public
expenditure in health to by 1 percent of
GDP I'm afraid that's not going to get
us to universal health I beg to differ
09:29
and I think also importantly the need to
strengthen national health authorities
and national health leadership and to
include the essential Public Health
functions I think in some windows with
some of the important areas for me thank
you very much and I'd like to draw your
attention to this publication there are
copies outside health a political choice
where you get many of the statements
also from heads of state and government
10:00
on the importance of universal health
coverage and from many of the actors
that Karissa referred to of course there
were some elements that not all of us
were very happy and that were missing I
refer to sexual and reproductive health
and rights and some of you might know
that there was a long very very
difficult political negotiation and
there was fear at one stage that because
10:31
of this agenda and because of the
migration agenda the high-level
political declaration might actually
fail one must say that the
co-facilitators of the process did an
extraordinary job to actually finally
get a consensus to get a version of the
high-level political declaration that
still fulfilled the historic elements
that Karissa said and that but that
11:03
allowed a discussion
in the high-level meeting about the
differences that do exist in relation to
that issue I'd like to turn to getting G
particularly in terms of your role as
the co-chair of UHC 2030 UHC 2030 is
exactly the kind of platform of the many
actors as charissa said and in order to
11:32
help move the discussions for the
high-level meeting forward USC 2030
developed six asks and maybe key change
EU can reflect on those six asks on ask
number seven that came afterwards but
also what of the asks was reflected in
the high-level declaration and where do
you think work still needs to be done
charissa already said you know that 1%
is perhaps not enough and I think there
12:05
are some other elements that you might
want to highlight thank you Thank You
Lana I think first is to celebrate that
we ended up with a declaration and I
would like to ask everyone here to stand
and clap to ourselves that we actually
achieved a declaration less elaborate
the small gains in global health
we achieved a declaration and that was
really major because as Ilona has
highlighted a few weeks before we were
12:36
talking to each other and wondering are
we going to have a declaration or notes
and we were really worried we started
working on a plan B but you know what
you see yeah you're watching us yes
so at least we did not have to affect
the plan B we actually had a declaration
that declaration at some point Ilona
told me this is a Christmas tree you
know we have you know many things in
between 83 paragraphs but at the end of
the day we had the declaration and many
of the things that we wanted captured
13:07
were actually captured so that was you
know that's something we must celebrate
because even as we say there are things
that we didn't achieve this is a journey
it was the first time that we're having
a high-level
political declaration on universal
coverage ever now the multi-stakeholder
platform that is UHT 2030 which is made
up of civil society private sector
academia government's had been working
behind the scenes for three or four
months before the high-level meeting and
13:37
they the work was largely around
collecting views of different
stakeholders to feed into the process to
assist the co-facilitators Thailand and
Georgia and the president of the General
Assembly to develop the declaration that
wasn't going to be negotiated by members
so in the process we did come up with
what were calling the 6 asks plus what
was pushed for by the you know by the
women the gender equality women in
global health on the 7th ask which we
14:09
thought in the movement that should be
more of a cross-cutting issue because we
felt that the issue of women and girls
rights and gender equality was actually
the center of gravity of universal
health coverage so we didn't see that as
a separate ask it was actually going to
be they asked across all their ratios
and we had six of those and the first
one was going to be political leadership
beyond health looking at UHC at a social
contract between governments and their
people that was the first ask the second
ask was around that no one should have
14:41
be left behind and therefore the debates
that were they around migrants was
actually quite painful for us to see
that actually we felt that some parts of
the global citizenry should actually be
left behind
so the leaving no one behind was the
second ask of the movement the third ask
of the movement was that because of the
complexity of the health system
especially the debate which has been
with us for a very long time around
private sector plays public sector that
and all these things and the centrality
of equity in UHC we felt that government
15:14
needed to legislate and regulate so that
there's a framework within which
everyone operates towards equity for
investor health coverage then we said
that quality needs to be at the center
so upholding quality of care was was
important and we noted that quality in
this case was not necessarily excellent
it was optimal quality for the best
outcome based on where the individuals
were and then we talked around the issue
of investing more I'm investing better
that's actually investing in health for
15:45
UHC was not purely about more just about
more money it is also about how the
money was spent and we'll talk about
this when we come to talking about
achievement of UHC in low middle income
countries and then we looked at finally
moving together moving together looking
at all sectors together not one
government non-state actors everyone
together to achieve UHC when you look at
the declaration actually a lot of these
issues were actually reflected because
beyond the six those six asks we then
16:15
develop targets as well that should get
you by 2023 and if you look across I was
counting the paragraphs actually and I
think about 37 paragraphs
reflected the six asks and their targets
as well so it was a major major
achievement so maybe just to mention one
or two number one is that we did achieve
to get the commitment for another
high-level meeting for UHC which is a
2023 which also kind of coincides with
16:46
the targets that we had put you know
within the the 6s the other thing is
that we have the commitments who have
reports at the 75th and 76 General
Assembly on this declaration I think
Carissa talked about the financing many
of the civil society organizations prior
to the declaration we are pushing for
five percent of GDP
many countries that are struggling at to
three percent so whu-oh and you know and
the declaration ended up with one
17:16
percent additional so we also I agree
with you that actually we need more to
move more toward the five percent I
think one percent is not enough but we
also agreed that we are going to add 1
billion more people on to coverage by
2023 which is also within basics asks so
those major progress and there are many
things that were mentioned and also the
cognition of the UHC 2030 platform
within the declaration was a major win
because it means that more
stakeholder engagement is a recognized
approach to some of these global
17:47
declarations yes thank you very much
coach ng that I think is very helpful
and I'd encourage everyone to go on the
USC 2030 website and look carefully at
those six asks we see our role as
continuing to promote them and for me
personally one of the most important
statements is in the six asks is that
health is a social contract and that
really it is an expression of solidarity
within society societies organized that
18:20
solidarity in different ways but
definitely and we see that in many of
the social movements and even uprisings
over the last years in many parts of the
world that the lack of such a social
contract for health is actually leading
to political instability and therefore
that role of having a society that is
willing to support its weakest and most
18:51
vulnerable members is very important
when you H C is discussed of course
public finance plays a very important
role the fiscal space plays a very
important role but as we know as a
platform from USC 2030 the private
sector also plays an important role and
in some countries such as India the
major part of primary care and health
care is actually provided through the
19:22
private sector many countries with
social contracts have private providers
within the context of the social
contract so I'd like to ask dr. Nusa
what your view from the private sector
perspective has been on this declaration
on this achievement how have you
contributed we had close collaboration
with the West for example so from the
view of your company and let's say the
private sector in a larger view how do
you see this movement for UHC Thank You
19:54
Luna and thank you
for for mentioning India will come to
India in a short moment when the
question comes what is the role of the
private sector
I usually wonder I wonder whether there
is the role the the private sector I
guess needs to define individually a
role there is no such thing as the
perfect health system there is no such
thing as the private sector's role each
each individual needs to define what it
20:26
can do best what what that means for my
company is that it is important to
address societal matters with business
models so that that making business is
not necessarily non combine able with
doing social good and environmentally
good as well so what Novartis has done
11 years ago in India is to start a
20:58
community program a community program
called healthy families societal work
like education on health on sanitation
and hygiene was independently combined
with a usual commercial approach
promoting essential medicines adjacent
to those communities
this model has proven to be around for
11 years now it is financially
sustainable so it's adding to the core
21:28
what a pharmaceutical company usually
wants to do and it is generating
societal returns and contributing to not
only universities control but indeed
universal health coverage and this is
this is something which is important on
our journey the social business journey
that my team is representing within
Novartis to also reflect and reflect on
the narrative reflect and be more self
22:00
aware of our role as a private sector
organization which indeed needs to focus
on health rather than on diseases
which needs to look at the patient at
its core that's easy said I know but
what I mean is that is that at the
community level
there usually is is not a tertiary care
hospital right so decentralization of
care and promoting this with business
22:33
models is important because people
present with a fever they don't present
knowing that they have malaria they
present with with a fever and may also
have hypertension and gestational
diabetes at the same time so
strengthening primary healthcare as a
key pillar of universal health coverage
is what we try to build business models
around and have successfully done so in
India and also in Vietnam and
increasingly also also in Africa and
23:05
with that many disease areas can be
addressed and with that also a health
security topic can be addressed not only
to prevent developed countries from from
spreading the diseases or hemorrhagic
fevers but also by strengthening the
community the community is getting less
vulnerable to undue influence from from
people who don't mean good who just want
to want to make sure that they can get
23:38
further further followers like
terrorists organizations for example so
we are increasingly aware of the role we
can play and we have to play and link
this and bridge that and I guess we come
to that in the in the sequel of the
discussion how the usual traditional
thinking of a private sector
organization developing individual
medicines for individual diseases can be
nicely combined with a more
community-based approach thank you very
much and of course I'm very happy about
24:09
your comment we had a big discussion of
that also in USC 2030 there is no such
thing as the private sector it's
becoming more and more diverse in
relation to health new types of company
entering the health sphere particularly
in relation to digital health etc so one
needs to have a much wider view I'm
going to just stop for half a minutes to
allow all those people standing there to
find a seat so let's have a bit of
24:39
unrest and please help your colleagues
by moving a bit and letting them come in
there's lots of seats front here
okay that's better now everyone can sit
comfortably I'd like to turn to dr.
Kristensen you of course are involved in
the whole number of ways with epidemic
preparedness and dr. news already sort
of alluded to that and I'd like to come
back to this point you know how do we
bring two agendas that are usually seen
25:26
as very very separate together how is
that from your personal view from the CP
view how can the kind of work on
emergency preparedness be a basis for
UHC and the other way around in a way
what's that dynamics yeah thank you
alone on thank you for inviting us to
this this panel I think I'd like to pick
up on two points that have been made
already which sort of support my view
25:56
that these two agendas really do feed
off each other and support each other of
course they are slightly different but
at the same time there are particularly
two points that I'd like to make in
terms of them being you know have to be
based on fundamentally the same thing
and one is the primary healthcare point
of view that also health security has to
start locally and and that's close to my
heart as a an earlier general
practitioner I think you know having a
well-functioning
26:28
healthcare system begins with a primary
health care system and you have to build
on that functioning day to day health
care system both for universal health
coverage as well as for being able to
address you know major health security
issues so you can't really have
universal health coverage without also
having health security and the other way
around I think the other main point is
26:59
that both agendas really built on a
whole-of-government whole of society
approach you you need to engage very
widely
everything from country leadership but
also then and maybe particularly for
health security having you know good
coordination and alignment between both
the local national regional and global
partners last month the global
27:30
preparedness monitoring board report
came out and you know from a seppie
point of view we were of course happy
that they focused on the the threat of a
a major pandemic so if there's a new
highly lethal airborne pathogen that
starts spreading either from natural
causes or or no natural causes they you
know we've heard these numbers but it is
really mind-boggling that you know it
could kill 80 million people in a matter
28:00
of months and really wipe out 5% of the
economy and so they pointed to the fact
that we are making good progress in in
trying to prepare for this but there is
still a lot to be done and the world is
not really prepared for that kind of
scenario and of course if there is a
scenario like that that would really hit
you universal health coverage and and
the the ability to have a real
functioning health system at the same
28:31
time they pointed to a number of
recommendations and I just like to
highlight two of them one was you know
the invite for other international
funding mechanisms to expand their scope
and also include health emergency
preparedness so both they were called on
both the Global Fund for AIDS
Tuberculosis malaria and for Garvey to
take these considerations into account
because I think if you have a good local
29:03
and regional system they still need to
be supplemented with global preparedness
as well and they also pointed to the
fact that we need to develop frameworks
for non inference of infectious diseases
how to share sample and information
sharing for those kinds of diseases in
as well and give countries trust that if
they do share samples and data they will
get access to those results in as a
29:36
consequence the other recommendation was
to ensure adequate investment in
developing vaccines therapeutics and
Serge manufacturing capacity again you
know fundamental for health security of
course but also very important for
universal health coverage and in all of
this you know sep is just a small but
important part of the bigger system of
being well-prepared from glad that you
know we've been able to get established
and and get some progress and being
30:09
pointed to in this report as well as I
saw the report from the g20 health
ministers declaration that also support
you know we're very encouraged by the
developments from Garvey from double-a
show another thank you very much and
thank you also for drawing attention to
the fact that not only did we have the
declaration from the high-level meeting
at the UN General Assembly but there was
a good sort of alignment of the stars in
30:40
that year that both the g7 and the g20
took up issues that were highly relevant
and particularly the g20 with a strong
focus on universal health coverage and
the g7 with a very strong focus also on
women's issues and equity issues so
again one must say that particularly
Japan who hosted the g20 this year and
if any Japanese colleagues are here are
very very big thank you Japan organized
31:14
I would say a very concerted strategy to
have UHC on many high-level political
agendas and also creating in New York a
group of friends of UHC that brought
representatives from the different
countries together that brought UHC not
only to the health ministers meeting
but also organized in the context of the
g20 the very first joint meeting of
31:44
health and finance ministers
particularly because of the challenge of
financing UHC and also then aside from
you know the health ministers meeting
that was just last week and we'd
recommend that resolution as well but
brought the USD agenda to the
deliberations of the heads of state so I
think one can also see in terms of
health diplomacy
what a difference a concerted political
32:17
strategy a health diplomacy strategy can
make and we'll have more discussions on
that also tomorrow at one of the closing
panels I'd like to turn to Margaret Chan
and say Margaret when you hear all this
much of that movement started under your
leadership and dr. Ted Rose has
frequently said how the kind of things
he is doing he is able to build on what
you have started how do you feel when
32:49
you hear this and what are things that
you said I'm glad we're there but we
need to continue to push that and share
your thoughts with us first Ilona thank
you very much I like to thank the world
have summit for the invitation and it's
good to be back and see so many old
friends and new friends you as a rather
33:20
loaded question I'd like to make three
points for those of you you know about
it's no secret that I retire from the
Big Show in 2017 right two years down
the road what have I been doing nothing
I kept my promise also true I kept my
promise to my family that I will do
nothing for six months only for six
months and then I started gradually to
33:50
think about life after with
and what does that mean I've been away
from my family for 14 years living in
Geneva alone so I owe it to my family so
family comes first now for those of you
who are near retirement already in
retirement you may disagree with me but
that is some wonderful feeling family
now but 2019 is a very important year
for me and this is the year that I begin
34:21
gradually to Esin to global health again
I attended three important meetings in
2019
there is one in january/february in
Thailand Bangkok PMAC and then the one
that I was asked to organize by the
current chair of the poll our forum who
is no stranger to all of you mr. ban
ki-moon he's a chair of our global
34:53
health of a forum for Asia and you know
how passionate he is about SDG and he
said to me say that Margaret I don't
think I can get rid of you neither can
you get rid of me we need to work
together so because you know the the SDG
2030 is such a huge agenda and among the
17 goals well there I say that's a bit
of my view goal number three is most
35:26
important and three point neck is most
important well you may say I'm arrogant
but that's our experience so I mean now
I'm attending the World Health Summit
so all these three very important Global
Health Forum that I begin to use them to
ease in because I need to live up to the
promises I make to all the members days
of the big show when they gave me the
35:57
honor of DG emeritus I raised one
question with all my member states I
said do you mean I need to continue to
work
in global health but without pay and
they all agree so here I am keeping my
promises now the second point I also
would like to raise his I agree with
everything that Carissa said it was a
fight but when it is a tough job given
36:27
to a woman and she will do well it has
been amazing I mean the momentum the
achievement of this movement of us see I
was a bit upset when I heard you know
Teresa said the term primary health care
disappear from the Acholi gender and she
was correct why and this is one thing I
learned for David Cho and having been in
37:02
global health for 40 years yes I know
young but I'm not I'm 72
so anyways fashion it's just like woman
it's the same thing applies to health in
the old days we call it hell for all
based on primary health care and people
got so misunderstood about primary
health care and there was other problems
as well the fight between the clinical
people and the public health people and
37:33
some people say that it is absolutely
hopelessly utopian and for those of you
who remember our respect to dr. mala
he was instrumental in promoting the
concept of hell for all I had the
privilege to work with him during my
tenure and I asked him one question and
which I would like to share with
38:03
colleagues here what went wrong with
hell for all because she's so good it's
all about justice it's all about
addressing inequity he's a mongrel
because we don't give people the mean
to deliver it so Karissa at that time a
very brilliant woman so that's why
you're now the regional director a
powerful that's a promotion isn't that
so anyways as a Karissa take you forward
38:37
and let's implement hell for all through
primary health care but now we call it
UHC because politicians are very
forgetful they like well just like women
they like fashion so now the fashion is
we call it you exceed and all the stars
were aligned we get the world's guru and
he'll only kick bush was one of them and
we just put this movement forward right
and I have to say for a retired person
39:10
this is really music to my ears
now the last point I'd like to make why
global consensus is so important the UN
General Assembly in 2015
leaders of the world adopted s e-g 2030
leaving no one behind and for China in
this case I like to make a reference to
China the president of China presidents
eating ping actually he attended this
39:42
meeting he support his strongly support
multilateralism and he strongly support
global governance and he kept his
promises so he went home the poor
Minister of Health has to develop
something they call healthy China 2030
exactly to keep his promises because he
is one of the leaders the world leaders
that adopted that 2030 agenda so there's
40:15
no two ways about it
so now universal health coverage is a
big thing in China about 95 percent of
1.4 billion people were covered of
course you may say that it's very basic
is primary health care yes when you have
the means I advise the Chinese
government you just move up the ladder
because no country no matter how wealthy
you are can do it in one step so ladies
gentlemen support multilateralism
40:46
support women and support global
consensus it's important for Humanity of
this world thank you
[Applause]
Thank You Margaret
I think it's always important to have
also these political perspectives and to
see how political will is created how it
wanes how it comes back and I think
particularly global health is very
subject to a whole lot of fashions as
you call them and it's good that we are
41:24
sort of coming back to to the core and
of course also last year was the meeting
in Astana which followed up on the alma
mater declaration on primary health care
and also contributed to this rediscovery
this recommitment they're very lucky to
have here with us dr. snow who is the
president of the global solutions
initiative as I said and that brings
together think tanks from all around the
world to work on global solutions for
41:57
the SDGs in particular dr. snow if you
hear all these health people speaking
and you relate that to the overall
commitment you have made to help
implement the sustainable development
goals you hear how the whole
intersexuality the whole of government
approach is so central how do you think
health needs to enter into your
initiative how does your initiative need
to perhaps consider health more and
where can you be helpful what's your
42:29
advice also to all these health people
should they do something differently or
are they on a good track I'm very
grateful to be on this panel and
particularly following Margaret Chan
who's made an absolutely essential point
which is that global consensus is
absolutely vital to establish UHC and
the Japanese g20 which we supported
43:01
through the think tanks has made a very
important first step to put it on the
global agenda
now the next step I believe is
establishing a powerful narrative that
will get us there say why do we not
achieve global consensus and one
important answer is we don't have a
powerful narrative
I believe that UHC the establishment of
43:32
it is analogous to the abolition of
slavery around the world and slavery did
not get abolished through a high-level
declaration alone it was important but
not the only thing the narrative is
really important now what is it that
could provide the substance of a
narrative and I will give a shot at it
right now we have diseases of want and
44:04
we have diseases of plenty the diseases
of want are in the poor countries and
they will not be able to overcome them
on their own and they will need support
from the affluent countries and
elimination of these diseases of want is
possible technically by sharing
information generating necessary skills
redistributing a small amount of income
but it's not done and it's not done
44:36
because the people in affluent countries
and their governments don't want to do
it otherwise it would have been done so
the right question to ask is not how do
we do it
but how do we get the people in the
affluent countries to want it and that
is what the narrative does and then
there are diseases of plenty
like obesity tobacco-related disease
depression burnout diabetes various
45:07
cancers etc etc and we have the ability
to eliminate them too and don't do so
and the question there is into my mind
another wrong question is asked and that
was in a question that you addressed
that is medicine deals primarily with
treatment and not with prevention and we
should look at health rather than
disease and in order to and I believe
45:42
that these two wrong questions and the
two answers are related to one another
and I suggest in order to focus ideas
fix the mind suppose we compare as has
been done before healthcare with
aviation security modern medicine people
can live unhealthy lives that's their
democratic right but if they fall ill
46:13
then it is the job of the state to cure
them and the question is that is that
the best way to think about it now with
regards to airline safety the equivalent
of that would be we allow pilots to fly
without license we eliminate security
checks but if a plane falls from the sky
then we will be there and rescue these
people and get them to the hospital
46:44
and as a result this is a would be a
very expensive operation right because
lots of planes would fall from the sky
lots of people to be rescued private
enterprise could make this turn this
into a good business but it would be
inefficient so what we have in place
currently is an airline safety procedure
globally that is virtually entirely
voted to prevention servicing aircrafts
47:17
every few months is mandatory
information about weather conditions
automatically available to everyone and
pilots and personnel other personnel get
formal rigorous training in airline
safety many safeguards are in place that
are implemented automatically all major
accidents are investigated by a national
body and the reports are published
without without question and pilots are
47:46
usually immune from prosecution now and
first and most importantly the safety of
all passengers is considered equally
important regardless of what they paid
for their plane tickets if they pay more
than that goes into comfort and luxury
is not into safety now suppose we had
this approach to health you know what
where would this take us well everyone
would get mandatory health checks
information about health healthy living
would be automatically available
48:19
everyone would receive rigorous training
in health maintenance in school at work
and elsewhere rules for protecting
health would be rigorously enforced
bottom up as as you said local level is
really important um health safety checks
would be in place automatically at home
workplace elsewhere all major outbreaks
of diseases would be investigated and
reports would be published
doctors would receive immunity from
48:50
prosecution and basic health of all
people would be given equal attention
regardless of what they paid for health
care and variations in health
expenditures would go into comfort and
luxuries that's where we would be now
interestingly enough I claim that this
narrative would push us in an important
new direction because it would allow the
local level regional Nash
49:20
levels to work in continents with one
another
it would allow different countries to
join forces within the g20 proposals
that Japan is made driving in the same
direction and it would focus us on
something else the most important
doctors in this new scheme would be
ourselves obviously we'd rely on a lot
of health professionals but to say that
49:52
this is a social contract this is not
just the social contract that's binding
on the government it's a social contract
that is binding on every individual and
to get a narrative in place where every
individual feels that they have an
obligation an obligation to society that
then gives rise to obligations from
their government obligations from all
other governments abroad would pull this
50:24
together and hopefully make it happen I
think in the second round just have one
other point to make and that is how
precisely we can make it happen thank
you for that
so I'm sure the speakers will come back
to this proposal I think there's a lot
of interface that you highlighted which
is also what we in the public health
will discuss around the determinants of
health
50:58
so that we we see that while you know it
is in many cases difficult for people at
this stage because there is no social
contract on health to actually fulfill
their individual obligations if there is
no Framework Convention on tobacco
control implementation and every time I
go through an airport I'm sort of
attacked by the the sale the selling of
of cigarettes and vaping products and
51:31
you know continuously an environment
that doesn't help us so I think your
point also that narrative will need to
include you know that environment which
is so much in terms of determining our
health
karissa I'd like to come back to you
because in some cases if we look back
some of the countries in your region
were actually leaders in taking us
forward around primary health care
universal health coverage I think
52:04
particularly Brazil played a very
important role in providing access also
to AIDS care etc where do you see the
situation in your region now and what
are the challenges we say health is a
political choice and it seems that some
countries are not really taking that
choice right now and well aware that you
know you will not be speaking about
individual countries given your role but
where do you think you know that
52:35
political choice is is positioned from
the top from the bottom how can one move
the universal health and primary
healthcare agenda forward politically so
thanks to this question I I think the
history is important so in the Americas
there is a very strong history of
commitment to the right to health it is
enshrined in many constitutions and in
53:07
fact citizens take it albeit the the
higher middle class take it very
seriously because governments have faced
legal challenges and based on the right
to health so there have been a number of
mandates and resolutions that members
did themselves have have participated in
crafting so in 2006 we had the renewal
of primary health care that began the
whole movement for hell for all again
53:38
and over the time political governments
have changed but they remained they
remain true to the central issue of
health as a human right true this is
under attack by one or so countries but
generally that continues to hold if if
we look in 2014 they passed the whole
resolution and universal access you know
and universal health coverage and access
54:11
to social determinants of health and
they true there was very strong
political commitment around this and we
see this year that they have passed the
strategic plan with entitled equity at
the heart of health and they they have
20 28 or so targets and and indicators
but many of them rooted in the health
system many of them rooted in access
issues many of them rooted in health as
54:44
a right also the increasing of the
public expenditure on health so despite
the political changes and there
continues to exist in the region a very
strong political commitment for access
to health now we also have to
acknowledge that
the Americas is the world's most
inequitable region so this inequity
feeds into from time to time social
55:17
strife and and and and within this
context the the recent movements in
terms of the crises and many of the of
the countries that we are having know in
the Americas really is a pushback on
that inequity that people no longer feel
that it is acceptable that they don't
have equitable access to this to health
to uh to work to education and that this
55:49
masses are pushing back we have had some
sterling examples in our region Brazil
as you as you mentioned routed sues Cuba
with its own unique system as well but
many of the countries the global
monitoring report made made this fact
very very clearly that we we have an
index in terms of utilization of health
services that's the highest in all of
the world in in our region
so yes the commitment continues for
56:22
instance this year we've had two years
ago we've had a push back on
reproductive health and and the right to
do that
but there is such solidarity among our
member states that usually they can
arrive at a negotiated a negotiated
decision to move forward and within that
general context what we see replicated
at the national level it's their
56:54
regulations their legislation in fact
many countries have passed legislation
at the national level in support of
universal health coverage in health
health reforms based on primary health
care so I I think this it is it is it is
holding strong and yes our region aims
to be the first region to
universal access to health coverage
thank you thank you Karissa and thank
57:24
you for drawing attention to the global
monitoring reports that was prepared for
the high-level meeting that I would
recommend to you if you're interested in
more data on this development get in gee
can I come back to you and ask you
perhaps for a glimpse like Karissa gave
us for her region in terms of the
African countries you know where do we
see leadership both you know from heads
of state and government but also where
57:54
is there strong civil society movements
where is there a call Adam and also for
universal health coverage for
community-based services etc could you
give the audience a slight glimpse of
that thanks Ilona I think one of the
challenges we had and we were moving
towards the high-level meeting in
getting together civil society is that
many of the society voices saw
themselves as either in this disease of
a disease there was actually a big
58:25
difficulty in trying to see people who
saw themselves as suppose Society for
health systems in fact I don't think
there's anyone llevas to raise their
hand who can say I'm super society for
health systems many people being HIV TB
malaria will be insecure productive
health so that was a big challenge
people's movement exactly and when you
get back to the country that's the same
challenge we find that even when you try
to put suicide together the challenge of
getting cross-cutting for society voices
is really difficult and I think even as
I move forward to answer a question I
58:55
think that's one area we must invest in
and we must that can needs to be built
as a public good to create health system
civil society and support them because
most of the support right now is very
vertical in Africa I have some very good
champions here for universal health
coverage and their people engagement
I see the Minister of Health in Uganda
here Minister of Public Health from
Guinea Bissau
and I think I was as I was coming year
so the minister from Ghana all these
people who are actually very actively
pushing in country because at the end of
59:27
the day listening to the conversations
here by Margaret Chan and what
is always saying global consensus is
critically important but local action is
more important that if you have global
consensus but no local action then you
can have no movement for the people the
people do not actually feel the effect
of the declarations so when we look at
the countries you look at Rhonda for
example making great progress we look at
Kenya now with a political declaration
political choice but movement needs to
59:57
happen so we have a place where we need
to jump you look at the CEO Pia you look
at Uganda now doing its national health
bill you look at South Africa so there's
a lot of movement going on I think what
I find missing is that local action
requires active civil society because
the promise must turn into action and I
think this is where we are not seeing a
lot of movement because again the civil
society is clustered into groups of
01:00:26
vertical ization if we can now take this
declaration and move down and say we
want to engage our society not
necessarily through activism but working
with government step by step to ensure
that the promises governments are making
actually put into action because as we
say governments report to their people
everyone has a boss and the boss of
government is the voters so if we can't
have an effective from from the voters
then we will not have the activities
happening so for me that's the next
really big step and then we can match it
together with all the health system
01:00:59
building blocks including the most
critical which is financing which we'll
talk about later yeah thank you very
much somebody wants it clap I saw
Margaret since were discussing country
level things could you say a word or two
more about how this is developing in
China I mean a tremendous challenge as
you've indicated strong political will
from the highest leadership so how is
China developing its UHC system now what
are the goals in 2030 China 2030 and
01:01:35
what can perhaps be learned from that
very strong political commitment thank
you Ilona as I was listening to dr. J at
GG your six asks of the high-level
meeting on you exceed the political
decoration I was counting how many China
has met that's very important and you
01:02:09
put the first one as political
leadership and I like to share with you
some of the Chinese experience or
lessons that we can learn political
commitment followed by financial input
and oversight to make sure things are
being implemented often time there's a
lot of talk particularly at the global
level maybe even in the at the level
01:02:40
local level talks is cheap right do we
have the mechanism to hold policymakers
governments to account to ensure
transparency so the measurement piece
the monitoring piece is extremely
important but all that would only happen
if government well of course you need to
take advantage of the political system
within the country and use it to pass
01:03:13
advantage how can you move the needle
get the attention of the political
leaders political leaders are only
interested in votes so
if you have an election cycle as in the
case of Australia every three years as
in the case of us every four years as in
the case of some other countries every
five years and so on so forth
find the right moment and work with the
leader for them to appreciate the call
01:03:44
from the people now in China there were
two sayings I don't know how to
translate that into English in putas wah
it says can Bing Lankan being great
meaning it is difficult to really see
doctor when I'm sake and it is very
expensive to seek healthcare that was
the development at some point in China
and the call from the people caught the
01:04:15
attention of the political leaders so
they begin to move forward and in fact
the World Bank many universities and
Abaco were among the you know group of
people that have been advising the
Chinese government to find its own
mechanism so it to put it in a nutshell
I was counting on the sixth US and many
of them were met
for example political leadership making
01:04:45
sure no one is left behind and that is a
big deal for China poverty elimination
and making sure that no one is left
behind irrespective of which group of
Lordaeron 56 minority group in in China
so and of course the quality of care now
we have quantity now the quality we need
to continue to improve so or you know
what I'm saying is investment investment
01:05:16
and then moving together so that's why
in this boil forum Corvo Health Forum
I'm bringing in all the stakeholders
including the industry I know that when
I was director general of the big show
some of my members says get very uptight
when I talked to the industry
for example I have PMA why are you
laughing why are you smiling so you you
you you you feel the pain right so when
01:05:46
I was asked by mr. ban ki-moon as well
as the poll forum to take forward global
health the first question I asked is
does WH ofensa apply to me for those of
you who know fencer I said you know now
I'm a free woman
I'm a retired person I will do the right
thing in in the interests of the health
of people so I need to work with the
industry but one thing very clear
01:06:19
without conflict of interests and we
need to also honor the right balance of
access to medicines vaccines and
affordable costs industry if they don't
make money what are they they are not
charity let's be frank if you drive the
price to so low that they are not making
a profit they will exit and then you
don't have the solutions that you need
for for keeping people in good health so
01:06:51
I've been working with industry in this
platform we are close but we are very
transparent and making sure there's no
config ventures because I you know then
is to echo what you said global
consensus requires global governance get
all the stakeholders together to find
solutions for people because I do not
hear the word people yet you know we
01:07:23
need to listen to the voices of people
well my famous saying actually the
current director-general
he must be monitoring my speeches and he
said that you know Margaret Chan always
say remember the people and that's true
so where is the voices of the people now
civil society may think that they are
representing the people some do some do
not so we need to be careful so don't
01:07:56
forget the big toe fencer Thank You
Margaret that leads to dr. noosa and
maybe some response on that side because
you know there is concern in terms of
what Margaret said where the industry is
perhaps not investing to the extent we
would like to see it take the
antimicrobial resistance agenda for
example some of the vaccine development
is an example and you might come back to
01:08:31
that so you know how can we move that
forward how can it be a common agenda
for UHC where you know we're all trying
to to come together and produce those
global public goods that were mentioned
thank you this is a very challenging and
inspiring the moment because I will try
not to bring several thoughts I've heard
together and I could not possibly
prepare for this I've heard one and a
01:09:01
half years ago I heard someone say in in
a breakfast meeting in Davos there's
only one public good and that's money
and so I was I was just wondering now
how to bring this aviation construct and
and do the final step on the parallel
that you that you drew we would need an
industry for universal health coverage
and that's why creating business models
01:09:32
for social matters is so absolutely
important although these are baby steps
the industry will not significantly
invest into things which don't make
sense to them the question is to what
extent do we need to do more do we need
to leave our comfort
zone and be at least catalytic for
example when it comes to antimicrobial
resistance how can the industry maybe be
catalytic in blended financing
instruments and there are ways and we
01:10:04
will during the next days maybe hear a
little bit more on this as well and you
spoke also about the narrative now I am
a I'm a fan and a believer that language
determines what people think and what
people do it's by language and the right
narrative is so critically important
individually what does that mean what
01:10:34
does it mean now in terms of the private
sector and the language the private
sector uses words internally for sure as
flagships blockbusters doesn't really
resonate with ministries of health if I
was a Minister of Health
it would certainly not resonate with me
I want to hear prevention I want to hear
how the private sector can work within
the system be asked to contribute and
01:11:06
not to lead always but to contribute to
elements of Health System strengthening
and understand that ultimately those
little elements will help increase a
market an absorptive capacity of a
system which eventually poses something
which is very meaningful for industry a
market Margaret I'm very happy that
you've mentioned the role of monitoring
and evaluation because I can share a
01:11:37
story of my own disruptive journey
within a big multinational company four
years ago when we started a non
communicable disease access program we
said we need to we need to do something
better than in the past for sure at
least one thing we need to embark on
monitoring and evaluation independently
and as a matter of fact Boston
University only agreed
when we also said let's make not only
01:12:08
the protocols but the entire data set
even our contract with them publicly
available you cannot believe what what
kind of disruption this has been
internally but I survived I'm still here
and you can look into the data and
interestingly the data is not just
favorably for for our company we have
not achieved everything you wanted to
achieve now let's learn from it and this
is this is what is so so critically
01:12:39
important changing individually the
narrative and the words we use not to
lead and own but to contribute and to
share not only announce something for PR
reasons but look at the outcomes no one
would start a clinical trial without
mentioning the Primus primary efficacy
and safety endpoint yet some companies
still go out and say this is what we do
we donate 1 million now for an NGO and
01:13:10
we await a report does that matter to me
it does not matter anymore one person
and I conclude with this one person once
said to me how I'd be aware of one thing
you cannot not lead so it's not on only
high-level declarations it's on all of
us in this room it's on you individually
what can you do how can you contribute
how can you break down one perception
01:13:42
that you may have had about the public
sector about multinational companies
about civil societies it's about
rethinking the language that we use and
exploring things we can do together all
of us in this room thank you thank you
thank you
that's a nice lead-in to Frederick I
mean you are deputy CEO of a coalition
and if you could say a bit you know how
does that coalition function and what is
01:14:15
your ultimate outcome what is it that
you want and why is it that you know
this innovative research is so critical
in trying to move our UHC agenda forward
and why does it need all those partners
to be able to really do it hmm thank you
yeah thank you for that segue because I
here we are a partnership and we are a
coalition that sort of sits between you
know public sector are both interests
and partners as well as the private
01:14:45
sector because I mean back to the
Margaret Chan's point that the industry
needs some incentives to actually
function or to do its job and and we
said it was set up on the cause of a
market failure you know there were there
was a realization that when you have
major outbreaks like the Ebola outbreak
in West Africa in 2014 they there were
products that were sort of in the
pipeline but nobody had had the
incentive to actually take them forward
01:15:16
so so that's you know the phase on debt
for four Sepi trying to find that
balancing point between securing access
in the sense that well point one you
need actually to have products to
discuss access but then of course it's
also critically important to use the
public funds that we get in such a way
that access is maximized and that that
ultimately the products that we develop
which are vaccines for epidemic the
01:15:48
infectious diseases are available for
those that need them when they need them
and and that is of course easily said
but the the devil is in the details of
actually how you you implement that and
so we have moved from sort of a very
detailed focus on on how to do that to a
more principle based where we have a
number of mechanisms for actually
making sure that the products that get
developed are developed in such a
01:16:21
fashion that the costs of the making
them is kept low that the you know any
profit in top that is controlled that
the prices are controlled at the end of
the day and that there are mechanisms to
distribute these products between
countries thank you and it shows you
know the need for partners who are
willing to invest it's very interesting
and that will lead me to dr. snow again
is that in Geneva for example partly
01:16:52
through the support of the Swiss
government a group of investors has come
together investors for the sustainable
development goals and for a whole week
last week they discussed you know in
what way do major investors need to
change their approaches in order to help
achieve the the SDGs because frequently
we only talk about companies but we
don't really talk about the whole
investment world and yeah where they
01:17:22
choose to put their money and who they
choose to move forward and we've had
first discussions so you know how one
can bring those investors to the health
table I mean the global health economy
is Dubai people you know are not quite
in agreement when this will be but some
say you know at the latest by 2021 the
global health industry is going to be
ten trillion dollars that's a lot of
01:17:52
money that's a lot of investment which
doesn't always go where it should be
going and of course the majority of that
investment and that money is still in
the developed part of the world so if
you put on your economists hat doctor
snow and think about you know how would
you structure how would you motivate
incentivize this investment community to
say well you know you might have looked
at some of the other STDs invest you
01:18:24
know in the healthy cities or
invest in climate change through you
know new kinds of approaches and
innovations
how would you motivate them for health
using your narrative probably exactly
basically fresh water economists will
say there's only one way to motivate
people and that is through monetary
incentives and that bypasses the whole
01:18:54
structure of thought within which we
operate the values the social norms and
so forth and therefore providing a
setting through a narrative that
motivates them is I think our first task
now in looking for such a setting that
will motivate investors I believe once
in a generation traps one reads a book
01:19:24
that changes one's entire picture of how
this in health system is to be
established in the world and that
happened to me relatively recently and
that was booked by Detlef accountant
called the health formula which is very
simple and like all important ideas it's
obvious in retrospect we are there's
01:19:56
great so basically the formula is that
your health depends on your biology your
of your body it depends on your
environment and it depends on your
actions so if you're going to do it in a
formula H health is some function of
they are DEA biology environment action
now that changes everything to my mind
01:20:29
in terms of motivating investors from as
well as motivating society let me just
say a word before going on
we talk about human rights and health as
a human right we should think of mutual
obligations within a value system and
this formula helps provide the framework
for exactly that it gives us not a
symptom calls relate symptom related
01:21:01
approach to health but rather a cause
related let me give you an example
diabetes high blood pressure arterial
sclerosis gout arthritis heartburn gall
stones breast cancer intestinal cancer
prostate cancer often arise from
overweight as we find in this book so
what is overweight caused by well it's
01:21:33
caused by sedentary work and recreation
habits that is due to the way we
construct buildings and our social
settings so if we look at environment
and action what is the environment well
we want to change our environment as you
said limit our ads for unhealthy
products sit in appropriately designed
chairs exactly et cetera actions take
brisk walks do sport to reduce stress
01:22:04
lose weight avoid sugary foods and so
forth now if you think of the mutual
obligations in which people are embedded
in society those are really things to
take to heart and then if you think
about the role of government naturally
you think firstly of prevention in order
to deal with this and if you want to
motivate investors there is a whole slew
of things that can be done to counter
overweight that will then feed into all
01:22:37
these different diseases now there are
countless other examples that can be
given but if we just keep in mind the
simple formula that health depends on
your bodily functions in your biology
your advice
new action and then to think about how
to motivate an entire society to achieve
health then I think we're on the right
track
thank you very much dr. snow we started
late we have five more minutes I want to
01:23:08
ask the other speakers to respond to
that and just give me just one or two
sentences on this motivation of society
to generate health where do you think it
would start and where do you think the
group let me say it in general that you
come from can most contribute to it how
about two sentences each act and society
there is different incentive mechanisms
01:23:41
we need to spell them out and try to
cater to them okay
different interests I think alignment of
incentives is sort of the key word and
you know from from from where SEPA sits
it's clearly we survive we're a new push
mechanism there needs to be alignment of
other mechanisms who will buy vaccines
at yong-dae just as an example and so I
think alignment of incentives and having
01:24:12
incentives for the right things would be
changing I agree and disagree at the
same time I think which obligation is
really critical but at the same time
must be enabled by governments removing
barriers to help with job Legation
because then you tell people to be to
have the mesh obligation but they can
access clean water they can access
toilets they have poor security then you
have a challenge so it must be put in
construct in that contract that the
coming has the responsibility to remove
01:24:44
the barriers so we can then meet the
obligation that's why thing I have to
say the next thing I have to say is that
and I hope these are their final
comments are they because they something
on the - are there that domestic
resources in their own are not enough
because in many Elemis
[Music]
collect taxes you didn't steal them like
they're stolen and you'll kill them to
help you still end up with fifty dollars
per capita primary health care costs a
minimum of 80 to 100 dollars per capita
multilateralism is critical for
01:25:15
achievement or EHD finally to Margaret's
point people are not recipients of
health care health is made by the people
they are co-creators and therefore the
mug be central to every health system
that we built people must be at the
center thank you
Thank You Marvin well Ilona I think you
know that phrase maybe you were one of
those who initiated that health is
political a global level we talked about
01:25:45
the importance of global consensus and
global governance by global agreement at
the local level it involves the
government and all the stakeholders
everyone has a role to play
I mean you know in China we you say to
use to say kwang-ho needed arepa susana
in order to make sure you don't have
diabetes you don't have heart disease
and so on and so forth
make sure you eat properly and then
01:26:17
healthy lifestyle but it's easy so in a
nutshell health is political both at the
global level and at the local level it
requires all stakeholders to find a
consensus to move forward thank you and
Karissa I think you need to empower
people you need to empower the ordinary
man on the street that he can demand
from his government that he or she can
01:26:47
also take responsibility for their own
health and that they they can push
partners towards a global social
movement I I think putting people at the
center is very important give me one
minute I think we're at a moment that we
must be extremely careful in the whole
USC movement we have to make sure that
for the last time that it works and for
that you will
01:27:18
need passion that endears last night
somebody talked about passion passion
that endures because there will be hard
times and the way that your passion
drives you and continues to make you
both an advocate and an actor for
people's health is going to be in
importance so thank you thank you
Karissa and that takes me to Adrienne
rich who said a wild patience has taken
me so far I think that's what we often
01:27:48
need in global health please say thank
you to this fantastic panel
[Applause]
and thank you very much for coming and
you heard from Carissa and others you
are the movement take action thank you