WHO Head Dr. Margaret Chan:
"Asia is Critical to Global Success of the MDGs"
By Bruce Heilbuth
BETTER COVERAGE World Health Organisation Director-General Dr. Margaret Chan (second from right) walks past a woman and her baby at an immunization clinic in Singapore. Dr. Chan considers increased measles immunization coverage in young children as one of the most significant health achievements in Asia.
Photo by AFP
World Health Organization (WHO) Director-General Dr. Margaret Chan has been an enthusiastic supporter of the Millennium Development Goals (MDGs). Born in Hong Kong, China, in 1947, she initially studied to be a teacher but then enrolled for a medical degree at the University of Western Ontario alongside her husband, David Chan.
Since graduating, Dr. Chan has had an illustrious history of service in public health. In June 1994 she became the first female in Hong Kong, China, to head the Department of Health, where she gained public attention with her effective management of outbreaks of avian influenza in 1997 and severe acute respiratory syndrome (SARS) in 2003. In 1997, she ordered the slaughter of 1.5 million chickens after a strain of avian flu killed six people. This decisive response is widely credited with preventing the spread of a potentially fatal virus.
Dr. Chan was recruited by the 193-member-state WHO in 2003. When she was appointed Director-General in 2006, she became the first person from the People’s Republic of China to head a United Nations agency. Her areas of special focus include improvements in the health of women and “people in greatest need.”
Peers report that she has an inclusive management style and is engaging and easy-going. She once reportedly sang a song from Rodgers and Hammerstein’s musical The King and I in front of civil servants from the United Kingdom’s Department for International Development.
In an interview with Development Asia’s Bruce Heilbuth, Dr. Chan discusses the progress of MDGs in Asia, achievements, and what disappoints her most.
Development Asia: What is your reaction to the recent report on the MDGs and the progress made toward reaching the healthrelated goals in Asia?
Margaret Chan: The continuing high levels of maternal mortality in many countries in Asia are a huge disappointment. [Yet] if we look at levels of child mortality, which provides a good summary of overall progress toward the health-related goals, the overall picture is positive. In eastern, southeastern, and western Asia, the child mortality target may well be met by 2015 or shortly thereafter.
In Bangladesh and Nepal, striking declines in under-5 mortality have been observed in recent years. But there’s been much slower progress in southern Asia and countries such as Afghanistan and Pakistan are not on track.
Asia’s a very large region, home to nearly 60% of the world’s population, so what happens there is important for global progress overall.
Development Asia: What do you regard as the most significant achievements in Asia?
Margaret Chan: There are many, in addition to the reductions in child mortality just alluded to. For a start, measles immunization coverage in young children has shown remarkable progress. Only a few countries have coverage rates at 70% or lower. Unfortunately these include large countries, such as India and Afghanistan.
Another success story is use of contraception, which has expanded all over Asia and is generally accompanied by reductions in fertility, especially among adolescents. The ability of women and couples to plan for the timing and number of their children is closely associated with better health.
There’ve been falls in tuberculosis prevalence rates and mortality across Asia, and HIV has declined in many Asian countries. However, these declines have been offset by increases in parts of central Asia, so [it’s] something of a mixed picture.
It’s encouraging that governments are prioritizing health. Per capita government expenditure on health increased in Asia between 2000 and 2006. In the People’s Republic of China (PRC), the figure doubled from $42 in 2000 to $88 in 2006. For the WHO South-East Asia Region as a whole, the figure increased from $16 per capita to $29.
But this has to be compared with a per capita government expenditure globally of $455. When governments are spending so little, the shortfall has to be made up by individuals and families, often incurring catastrophic expenses that push the whole family into poverty. Again a mixed picture.
Development Asia: What disappoints you most?
Margaret Chan: Maternal mortality. It’s a result of many factors including poor access to care, failure to prevent unwanted pregnancies, and women’s low status in many societies.
We’ve known for over 20 years that most maternal deaths and the deaths of infants they’re carrying can be prevented if women receive good care during pregnancy and childbirth. Yet in southern Asia, more than half of births take place without skilled care. Only one pregnant woman in every three receives the WHO-recommended minimum of four antenatal care visits.
These figures reflect the weak state of health systems in many countries. In the WHO South-East Asia Region, there are only 5 doctors per 10,000 population compared with a global average of 13 per 10,000. The availability of essential medicines is also poor.
Development Asia: What are the biggest remaining challenges in Asia?
Margaret Chan: To maintain progress in national averages for the health-related indicators while doing a better job of
addressing in-country disparities.
Gender inequities are persistent. In some countries, including the PRC and India, child mortality rates are higher among girls than boys—an unacceptable situation. Over the past 20 years, the female disadvantage has persisted in India and may even have worsened in Nepal and Pakistan. By contrast, in Bangladesh, this gender disparity has been overcome.
There are stark differences in health status according to socioeconomic conditions such as household wealth, education, and place of residence. In Viet Nam, for example, despite relatively low levels of child mortality, children living in rural areas are twice as likely to die before they’re 5 than those in urban areas.
Development Asia: In 2007, you were quoted as saying that “health has never before received such attention or enjoyed such wealth.” Has that changed, or do you see it changing?
IN CONFIDENCE World Health Organisation Director-General Dr. Margaret Chan and United Nations Secretary General Ban Ki-moon hold a news conference in Geneva in May 2009. Dr. Chan has been an enthusiastic supporter of the Millennium Development Goals.
Photo by AFP
Margaret Chan: Spending on health by governments and their development partners has increased significantly over the last decade. Official development assistance for health rose from $6.5 billion in 2000 to more than $14 billion in 2006, and the total is greater if money from major foundations and private donors is included.
We’ve also seen innovations in the way financing for health has been managed and raised—from a levy on airline tickets to the selling of bonds to finance immunization and advance market commitments to stimulate development of vaccines.
In the past, health spending has been a casualty of recession. While the political prominence afforded to global health will continue, we have to be concerned about the impact of the worldwide downturn on resource flows. Lowincome countries, while having nothing to do with the causes of the crisis, are likely to be badly affected by its consequences.
It’s encouraging to see many governments making wise choices to protect basic services. Few of the poorest, however, have the resources to spend on the kind of stimulus packages we’ve seen in richer and emerging economies. It’s therefore even more important for donors to stick to their commitments. It would be a terrible mistake to cut aid at the time that it’s most urgently needed.
Development Asia: The MDGs aren’t without their critics. One dismisses them as “ideological cover” for Western neoliberals. What’s your response?
Margaret Chan: The goals have been a powerful tool for keeping the world’s attention on development issues through a time of competing priorities. Measuring quantifiable targets provides a powerful reminder of where progress toward the goals has been made, and where it’s still lacking.
In part, the power of the goals derives from their specificity—identifying clear and common priorities, all of which contribute to reducing poverty. They’ve helped focus development around core themes and given an accountability framework for countries and their development partners. And they’ve drawn attention to the importance of better coordination among stakeholders and highlighted the critical need for functioning health systems.
The reporting process has spotlighted the weakness of countries’ statistical and information systems needed for accurate and timely monitoring of progress.
But the MDGs tend to focus on national results, which we know can mask inequities in countries and regions, as well as gender inequities.
One issue WHO continues to stress is the broader context of health beyond the MDGs. We know that by 2030, 8 of the 10 leading causes of death will be linked to noncommunicable diseases and conditions like mental disorders, injuries, and violence.
These aren’t problems confined to the developed world. They’re of growing importance in many Asian countries. Addressing risk factors—such as tobacco use, unhealthy diets, being physically inactive, and the harmful use of alcohol—and the consequent socioeconomic impact of cancer, cardiovascular and chronic respiratory diseases, and diabetes depend not just on health care services but also on action in a variety of policy domains.
Many health outcomes depend on policies beyond the health sector, whether it’s import duties on essential drugs and technologies, employment and housing policy affecting early childhood development, laws that discriminate against people with AIDS, or restrictions on movements of people or livestock to prevent the spread of epidemics.
Development Asia: Much of the MDGs’ progress in health obviously depends on political will, a nebulous driver even in certain times. What can be done to ensure that Asian governments and their agencies do what they’ve said they’re going to do?
Margaret Chan: The high visibility of the reporting process helps maintain attention and stimulates political will. We know government ministers pay attention to their country MDG reports and that civil society and the media have become vocal contributors to the debate on how to accelerate progress.
Building political will is one thing, maintaining it is another. It’s important that momentum be sustained over the time it’ll take to achieve the MDGs and other health-related goals.
We’re at the stage where international and national political leaders are paying attention to them. But we must make sure [countries] can access the financial, technical, and human resources commensurate with the nature and size of the challenges they face. •
Bruce Heilbuth has worked as a journalist and foreign correspondent on four continents. For the best part of 10 years, he was editor-in-chief of Reader’s Digest magazine’s Australasian and Asian-English editions.
|
Printer-friendly Version
Email to a Friend