FIFTIETH WORLD HEALTH ASSEMBLY GENEVA, 5-14 MAY 1997

Transcripción

1 WHA50/1997/REC/2 _WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ FIFTIETH WORLD HEALTH ASSEMBLY GENEVA, 5-14 MAY 1997 VERBATIM RECORDS OF PLENARY MEETINGS CINQUANTIEME ASSEMBLÉE MONDIALE DE LA SANTÉ GENÈVE, 5-14 MAI 1997 COMPTES RENDUS IN EXTENSO DES SÉANCES PLÉNIÈRES GENEVA GENÈVE 1997

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3 PREFACE The Fiftieth World Health Assembly was held at the Palais des Nations, Geneva, from 5 to 14 May 1997, in accordance with the decision of the Executive Board at its ninety-eighth session. Its proceedings are published in three volumes, containing, in addition to other relevant material: Resolutions and decisions, annexes and list of participants - document WHA50/1997/REC/l Verbatim records of plenary meetings - document WHA50/1997/REC/2 Summary records and reports of committees - document WHA50/1997/REC/3 For a list of abbreviations used in these volumes, the officers of the Health Assembly and membership of its committees, the agenda and the list of documents for the session, see preliminary pages of document WHA50/1997/REC/l. In these verbatim records speeches delivered in Arabic, Chinese, English, French, Russian or Spanish are reproduced in the language used by the speaker; speeches delivered in other languages are given in the English or French interpretation. The texts include corrections received up to July 1997, the cut-off date announced in the provisional version, and are thus regarded as final. AVANT-PROPOS La Cinquantième Assemblée mondiale de la Santé s'est tenue au Palais des Nations à Genève du 5 au 14 mai 1997,conformément à la décision adoptée par le Conseil exécutif à sa quatre-vingt-dix-huitième session. Ses actes sont publiés dans trois volumes contenant notamment : les résolutions et décisions, les annexes qui s'y rapportent et la liste des participants -document WHA50/1997/REC/l, les comptes rendus in extenso des séances plénières - document WHLA50/1997/REC/2, les procès-verbaux et les rapports des commissions - document WHA50/1997/REC/3. On trouvera dans les pages préliminaires du document WHA50/1997/REC/l une liste des abréviations employées dans la documentation de l'oms, l'ordre du jour et la liste des documents de la session ainsi que la présidence et le secrétariat de l'assemblée de la Santé et la composition de ses commissions. Les présents comptes rendus in extenso reproduisent dans la langue utilisée par l'orateur les discours prononcés en anglais, arabe, chinois, espagnol, français ou russe, et dans leur interprétation anglaise ou française les discours prononcés dans d'autres langues. Ces comptes rendus comprennent les rectifications reçues jusqu'au début juillet 1997, date limite annoncée dans leur version provisoire, et sont donc considérés comme finals. -iii -

4 ПРЕДИСЛОВИЕ Пятидесятая сессия Всемирной ассамблеи здравоохранения состоялась во Дворце Наций, Женева, с 5 по 14 мая 1997 г. в соответствии с решением Девяносто восьмой сессии Исполкома. Документы сессии опубликованы в трех томах, содержащих также другие материалы: резолюции и решения, приложения и список участников - документ WHA50/1997/REC/1 стенограммы пленарных заседаний - документ WHА50/1997/REC/2 протоколы заседаний и доклады комитетов - документ WHA50/1997/REC/3 Перечень аббревиатур, используемый в этих документах, состав президиума Ассамблеи здравоохранения и комитетов, а также повестка дня и перечень документов сессии приводятся в начале документа WHА50/1997/REC/1. Что касается стенографических отчетов, то выступления ораторов на арабском, китайском, английском, французском, русском и испанском языках воспроизводятся на языке оратора; выступления на других языках переведены на английский или французский язык. Указанные тексты включают поправки, полученные до июля 1997 г., - предельного срока для предварительных вариантов, с учетом чего эти поправки рассматриваются как окончательные. -iv -

5 INTRODUCCIÓN La 50 a Asamblea Mundial de la Salud se celebró en el Palais des Nations, Ginebra, del 5 al 14 de mayo de 1997,de acuerdo con la decisión adoptada por el Consejo Ejecutivo en su 98 a reunión. Sus debates se publican en tres volúmenes que contienen, entre otras cosas, el material siguiente: Resoluciones y decisiones, anexos, y lista de participantes: documento WHA50/1997/REC/1 Actas taquigráficas de las sesiones plenarias: documento WHA50/1997/REC/2 Actas resumidas e informes de las comisiones: documento WHA50/1997/REC/3 En las páginas preliminares del documento WHA50/1997/REC/l figuran una lista de las siglas empleadas en estos volúmenes, la composición de la Mesa de la Asamblea y de sus comisiones, el orden del día, y la lista de documentos de la reunión. En las presentes actas taquigráficas los discursos pronunciados en árabe, chino, español, francés, inglés o ruso se reproducen en el idioma utilizado por el orador. De los pronunciados en otros idiomas se reproduce la interpretación al francés o al inglés. Las actas contienen las correcciones recibidas hasta julio de 1997, fecha límite anunciada en la versión provisional, y por consiguiente se consideran definitivas. -v -

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7 序 言 根据执行委员会第九十八届会议的决定, 第五十届世界卫生大会于 1 卯 7 年 S 月 5 日至 14 曰在日内瓦万国宫举行 会议记录分三卷出版, 除其它有关材料外, 其内容 包括 : 决议和决定 附件及与会人员名单一文件 WHA50/1997/REC/1 全体会议逐字记录一文件 WHA50/1997/REC/2 各委员会摘要记录和报告一文件 WHA50/1997/REC/3 各卷中使用的缩写清单 卫生大会的官员及其各委员会的组成 议程及会议文 件清单, 见文件 WHASO/IG^/REC/L 先行页 阿拉伯文 中文 英文 法文 俄文或西班牙文发言的逐字记录, 用发言人使 用的语言刊载 ; 其它语言的发言用英文或法文译文刊载 这些记录只釆纳了 1 卯 7 年 7 月份以前收到的更正, 这是临时文本中宣布的截止日期, 因而它们是最后的文本 -VÜ -

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9 Second plenary meeting 12CONTENTS Preface iii First plenary meeting VERBATIM RECORDS OF PLENARY MEETINGS 1. Opening of the session 1 2. Address by the representative of the Director-General of the United Nations Office at Geneva 2 3. Address by the representative of the Conseil d'etat of the Republic and Canton of Geneva 3 4. Address by the President of the Forty-ninth World Health Assembly 4 5. Appointment by the Committee on Credentials 6 6. Election of the Committee on Nominations 6 First report of the Committee on Nominations 8 Second report of the Committee on Nominations 9 Third plenary meeting 1. Presidential address Adoption of the agenda and allocation of items to the main committees Announcements Review and approval of the reports of the Executive Board on its ninety-eighth and ninety-ninth sessions Review of The world health report Fourth plenary meeting Debate on the reports of the Executive Board on its ninety-eighth and ninety-ninth sessions and on The world health report Fifth plenary meeting Debate on the reports of the Executive Board on its ninety-eighth and ninety-ninth sessions and on The world health report 1997 (continued) 77 Sixth plenary meeting 1. First report of the Committee on Credentials Debate on the reports of the Executive Board on its ninety-eighth and ninety-ninth sessions and on The world health report 1997 (continued) 106 -ix -

10 Page Seventh plenary meeting li nAwards 1Presentation of the Léon Bernard Foundation Prize 1Presentation of the Dr A. T. Shousha Foundation Prize 1Indexes (Names of speakers; countries and organizations) Presentation of the Jacques Parisot Foundation Medal Presentation of the Ihsan Dogramaci Family Health Foundation Prize Presentation of the Sasakawa Health Prize Presentation of the Comían A. A. Quenum Prize for Public Health in Africa Presentation of the United Arab Emirates Health Foundation Prize Francesco Pocchiari Fellowship Eighth plenary meeting 1. Earthquake in the Islamic Republic of Iran: expression of sympathy Second report of the Committee on Credentials First report of Committee A First report of Committee В Second report of Committee В Election of Members entitled to serve on the Executive Board 168 Ninth plenary meeting 1. Second report of Committee A Third report of Committee В Third report of Committee A Fourth report of Committee В Fifth report of Committee В 171 Tenth plenary meeting 1. Committee on Credentials Fourth report of Committee A Sixth report of Committee В Review and approval of the reports of the Executive Board on its ninety-eighth and ninety-ninth sessions Selection of the country in which the Fifty-first World Health Assembly will be held Announcement 177 Eleventh plenary meeting Closure of the session

11 TABLE DES MATIERES Pages Avant-propos iii Première séance plénière COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES 1. Ouverture de la session 1 2. Allocution du représentant du Directeur général de l'office des Nations Unies à Genève 2 3. Allocution du représentant du Conseil d'etat de la République et Canton de Genève 3 4. Allocution du Président de la Quarante-Neuvième Assemblée mondiale de la Santé 4 5. Constitution de la Commission de Vérification des Pouvoirs 6 6. Election de la Commission des Désignations 6 Deuxième séance plénière 1. Premier rapport de la Commission des Désignations 8 2. Deuxième rapport de la Commission des Désignations 9 Troisième séance plénière 1. Discours du Président de l'assemblée Adoption de l'ordre du jour et répartition des points entre les commissions principales Communications Examen et approbation du rapport du Conseil exécutif sur ses quatre-vingt-dix-huitième et quatre-vingt-dix-neuvième sessions Examen du Rapport sur la santé dans le monde, Quatrième séance plénière Débat sur les rapports du Conseil exécutif sur ses quatre-vingt-dix-huitième et quatre-vingt-dix-neuvième sessions et sur le Rapport sur la santé dans le monde, Cinquième séance plénière Débat sur les rapports du Conseil exécutif sur ses quatre-vingt-dix-huitième et quatre-vingt-dix-neuvième sessions et sur le Rapport sur la santé dans le monde, 1997 (suite) 77 Sixième séance plénière 1. Premier rapport de la Commission de Vérification des Pouvoirs Débat sur les rapports du Conseil exécutif sur ses quatre-vingt-dix-huitième et quatre-vingt-dix-neuvième sessions et sur le Rapport sur la santé dans le monde, 1997 (suite) 106

12 Pages Septième séance plénière Distinctions 149 Remise du Prix de la Fondation Léon Bernard 149 Remise du Prix de la Fondation Dr A. T. Shousha 151 Remise de la médaille de la Fondation Jacques Parisot 152 Remise du Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille 153 Remise du Prix Sasakawa pour la Santé 156 Remise du Prix Dr Comían A. A. Quenum pour la Santé publique en Afrique 158 Remise du Prix de la Fondation des Emirats arabes unis pour la Santé 160 Bourse Francesco Pocchiari 164 Huitième séance plénière 1. Tremblement de terre en République islamique d'iran : témoignage de sympathie Deuxième rapport de la Commission de Vérification des Pouvoirs Premier rapport de la Commission A Premier rapport de la Commission В Deuxième rapport de la Commission В Election de Membres habilités à désigner une personne devant faire partie du Conseil exécutif. 168 Neuvième séance plénière 1. Deuxième rapport de la Commission A Troisième rapport de la Commission В Troisième rapport de la Commission A Quatrième rapport de la Commission В Cinquième rapport de la Commission В 171 Dixième séance plénière 1. Commission de Vérification des Pouvoirs Quatrième rapport de la Commision A Sixième rapport de la Commission В Examen et approbation des rapports du Conseil exécutif sur ses quatre-vingt-dix-huitième et quatre-vingt-dix-neuvième sessions Choix du pays où se tiendra la Cinquante et Unième Assemblée mondiale de la Santé Communication 177 Onzième séance plénière Clôture de la session 178 Index (noms des orateurs; pays et organisations) 183 -xii -

13 A50/VR/1 pagel VERBATIM RECORDS OF PLENARY MEETINGS COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES FIRST PLENARY MEETING Monday, 5 May 1997,at 10:00 President: Dr A. J. MAZZA (Argentina) PREMIERE SEANCE PLENIERE Lundi 5 mai 1997, 10 heures Président: Dr A. J. MAZZA (Argentine) 1. OPENING OF THE SESSION OUVERTURE DE LA SESSION El PRESIDENTE: Se abre la sesión. Distinguidos delegados, señoras, señores: Como Presidente de la 49 a Asamblea Mundial de la Salud tengo el honor de inaugurar la 50 a Asamblea Mundial de la Salud. Me complace dar la bienvenida en nombre de la Asamblea y de la Organización Mundial de la Salud a las siguientes personas: Sr. Yves Berthelot, Secretario Ejecutivo de la Comisión Económica para Europa en Ginebra, quien representa al Director General de la Oficina de las Naciones Unidas en Ginebra y al Secretario General de las Naciones Unidas; Sra. Christine Sayegh, Presidenta del Gran Consejo de la República y Cantón de Ginebra; Sr. Guy-Olivier Segond, Consejero de Estado de la República y Cantón de Ginebra, que representa a las autoridades de Ginebra; Sr. Walter Gyger, Representante Permanente de Suiza ante las organizaciones internacionales en Ginebra y Observador Permanente ante las Naciones Unidas; Sr. Michel Rossetti, Vicepresidente del Consejo Administrativo de la Ciudad de Ginebra; Sra. Caroline Dalleves Romaneschi, Presidenta del Concejo Municipal de la Ciudad de Ginebra; Sr. Pekka Tarjanne, Secretario General de la Unión Internacional de Telecomunicaciones; Sr. Tyrone Sutherland, Oficial de Asuntos Científicos, quien representa al Secretario General de la Organización Meteorológica Mundial; Sr. Cornelio Sommaruga, Presidente del Comité Internacional de la Cruz Roja; representantes de los organismos especializados de las Naciones Unidas y representantes de los distintos órganos de las Naciones Unidas; y delegados de los Estados Miembros. Yo quisiera extender una especial bienvenida a Andorra, que pasó a ser Miembro de la Organización Mundial de la Salud el 15 de enero de 1997 en razón de su incorporación a las Naciones Unidas y de su aceptación de la Constitución de la Organización Mundial de la Salud, según lo previsto en el Artículo 4 de la Constitución. También doy la bienvenida a los observadores de los Estados no Miembros, los observadores de la Orden de Malta, del Comité Internacional de la Cruz Roja y de Palestina; los representantes de organizaciones intergubernamentales y no gubernamentales que mantienen relaciones oficiales con la Organización Mundial de la Salud. Me complace también tener entre nosotros a los representantes del Consejo Ejecutivo.

14 A50/VR/1 page 2 2. ADDRESS BY THE REPRESENTATIVE OF THE DIRECTOR-GENERAL OF THE UNITED NATIONS OFFICE AT GENEVA ALLOCUTION DU REPRESENTANT DU DIRECTEUR GENERAL DE L'OFFICE DES NATIONS UNIES A GENEVE El PRESIDENTE: A continuación cedo la palabra al Sr. Berthelot, Representante del Director General de la Oficina de las Naciones Unidas en Ginebra y del Secretario General de las Naciones Unidas. M. BERTHELOT (représentant du Directeur général de l'qffice des Nations Unies à Genève): Monsieur le Président, Monsieur le Directeur général de l'organisation mondiale de la Santé, Excellences, Mesdames, Messieurs, en cette occasion solennelle que constitue la réunion annuelle de l'assemblée mondiale de la Santé, j'ai le plaisir et le privilège de m'adresser à vous et de vous transmettre tous les voeux que forme le Secrétaire général de l'organisation des Nations Unies pour la réussite de vos travaux. Alors que nous nous apprêtons à commémorer l'an prochain le cinquantième anniversaire de l'organisation mondiale de la Santé, il est bon, me semble-t-il, d'évoquer aujourd'hui comment les réformes entreprises par l'oms depuis quelques années s'intègrent dans les réformes d'ensemble de l'organisation des Nations Unies. Au cours de ses récentes interventions devant les publics les plus divers, le Secrétaire général de l'onu, M. Kofi Annan, s'est plu à répéter que les réformes en cours avaient pour objet de rendre l'organisation plus efficace et mieux à même de faire face aux problèmes d'aujourd'hui. A la Conférence ministérielle du Mouvement des non-alignés réunie à New Delhi, il a fait observer que l'onu se devait d'être encore davantage à l'écoute des besoins des Etats Membres, et notamment des pays en développement. C'est ainsi qu'il a déclaré : "L'engagement en faveur du développement est l'un des principes directeurs de l'activité de l'organisation des Nations Unies. Les activités de maintien de la paix et de rétablissement de la paix font parfois la une des journaux, mais, qu'il s'agisse des ressources ou de la transformation des conditions de vie, l'oeuvre accomplie par l'onu dans le domaine du développement est beaucoup plus importante. Nous devons donner au concept de sécurité un sens plus large, car nous ne pouvons édifier la paix et la prospérité sans réduire la pauvreté. Nous ne pouvons établir la liberté sur les fondements de l'injustice.". Dans ce contexte, la communauté internationale a opté sans équivoque pour une approche intégrée des problèmes du développement. Il est important que l'organisation mondiale de la Santé ait, dans cet esprit, fait en sorte que la santé soit prise en compte dans toutes les grandes conférences internationales qui ont marqué ces dernières années, telles que le Sommet mondial pour le développement social, la Quatrième Conférence mondiale sur les femmes ou la Conférence des Nations Unies sur les établissements humains. La santé occupe une place privilégiée dans tous les plans d'action issus de ces conférences, et cela prouve qu'il existe désormais un certain consensus sur le fait que les progrès dans le domaine de la santé et dans les autres domaines du développement sont interdépendants. La santé est également perçue comme allant de pair avec la sécurité, et elle est devenue de ce fait un élément des processus de paix. La participation de l'oms aux actions d'assistance humanitaire et de secours d'urgence révèle que l'organisation a commencé à s'adapter à ce nouveau rôle. Mais elle va devoir apprendre à fonctionner dans un contexte de crise très différent de celui auquel elle était habituée et qui privilégiait une diplomatie traditionnelle menée essentiellement auprès des ministères de la santé publique. Les situations d'urgence se caractérisent par des luttes internes, des tensions politiques et même parfois par l'absence de tout le gouvernement. Dans ces cas-là, l'efficacité de l'oms est tributaire des coordinations internationales tant sur le terrain qu'entre les institutions. La nécessité de participer aux secours d'urgence comme celle d'intégrer santé et développement appellent une présence permanente de l'organisation dans les différents pays, ce qui faciliterait les tâches de coordination et la mise en place de services de santé axés sur les soins de santé primaires. En effet, la santé pour tous est un but dont l'humanité s'est rapprochée, et il est utile de rappeler ici les progrès qu'on doit à l'oms, notamment dans la lutte contre certaines maladies comme la variole et dans la diminution de la mortalité infantile grâce, entre autres, aux vaccinations et à l'amélioration de la nutrition. D'autres maladies transmissibles telles que la poliomyélite et la lèpre sont également battues en brèche. Mais la santé pour tous à l'horizon 2000 n'est pas acquise, comme en témoignent la résurgence de la peste, les épidémies de méningite, de diphtérie, de tuberculose et de choléra ainsi que l'apparition de maladies nouvelles telles que la fièvre à virus Ebola et le SIDA.

15 A50/VR/1 радез Les problèmes de santé publique se posent maintenant d'emblée à l'échelle planétaire. La mondialisation, les modifications de l'environnement et du climat ainsi que les mouvements massifs de population sont autant de facteurs propices au développement des infections. Il est donc indispensable de réaffirmer que la santé demeure l'un des objectifs prioritaires de la communauté internationale et de veiller à ce que les contraintes politiques et économiques ne compromettent pas cet objectif. C'est pourquoi j'invite l'oms à adopter des stratégies volontaristes et, pour les populations les plus désavantagées, à établir, entre autres, des indicateurs de santé qui fourniraient des repères utiles lors de l'élaboration des stratégies de santé et de développement. Vous avez devant vous, Monsieur le Président, un ordre du jour chargé qui reflète bien les défis auxquels l'organisation reste confrontée. Je vais donc conclure en formant des voeux pour que l'assemblée de la Santé qui s'ouvre aujourd'hui aboutisse à des propositions courageuses dans l'intérêt de tous les peuples des Nations Unies. Je vous remercie de votre attention. El PRESIDENTE: Muchas gracias, señor Berthelot. 3. ADDRESS BY THE REPRESENTATIVE OF THE CONSEIL D'ETAT OF THE REPUBLIC AND CANTON OF GENEVA ALLOCUTION DU REPRESENTANT DU CONSEIL D'ETAT DE LA REPUBLIQUE ET CANTON DE GENEVE El PRESIDENTE: Seguidamente, el Sr. Guy-Olivier Segond se dirigirá a la Asamblea en nombre de las autoridades federales, cantonales y municipales de Suiza. M. SEGOND (représentant du Conseil d'etat de la République et Canton de Genève): Monsieur le Président, Monsieur le Directeur général, Mesdames et Messieurs les délégués, Excellences, Mesdames et Messieurs, à l'occasion de l'ouverture de la Cinquantième Assemblée mondiale de la Santé, j'ai le plaisir - l'honneur aussi - de vous souhaiter, au nom des autorités fédérales, des autorités cantonales et des autorités communales, la bienvenue à Genève et en Suisse. En cinquante ans, depuis la fondation de l'oms, le monde a bien changé politiquement, économiquement et socialement. Après Г effort de reconstruction qui a suivi la Seconde Guerre mondiale, après les luttes de libération nationale et après l'indépendance de nombreux nouveaux Etats, la rivalité Est-Ouest a été progressivement remplacée par la dynamique Nord-Sud. La globalisation de tous les problèmes a bouleversé le cours ordinaire des choses et, grâce au prodigieux développement des nouvelles technologies de la communication, le monde est devenu un. Chacun le sait et chacun le voit, ces dernières années, de formidables forces de changement sont nées. Les attitudes politiques et culturelles à l'égard de l'etat se sont profondément modifiées. D'importants problèmes démographiques et sociaux liés aux migrations, au vieillissement et à l'exclusion ont surgi et, partout dans le monde, il y a des mouvements amples et puissants en faveur d'une réforme des systèmes de santé. Dans le monde occidental, où en sommes-nous? Habitué à une expansion facile, entraîné par des progrès technologiques spectaculaires et légitimé par la demande de patients toujours plus exigeants, le système de soins a longtemps évité les choix et même les questions. L'Etat lui a toujours donné les moyens nécessaires. Aujourd'hui, les difficultés économiques et budgétaires rendent plus délicat le partage des moyens publics. La compétition entre les grandes fonctions de l'etat se fait donc plus vive. Le système de soins, longtemps privilégié, se trouve dans une situation nouvelle pour lui. A la logique des besoins soutenue par les soignants et les soignés répond dorénavant la logique des moyens défendue par les contribuables et les assurances-maladie, qui n'arrivent plus à assumer des coûts qui croissent plus rapidement que la capacité collective de les financer. Pour éviter une société à deux vitesses dans laquelle l'égalité d'accès à la santé deviendrait un slogan, il ne suffit donc pas de rationaliser le système de soins, il faut développer une approche nouvelle. D'abord, l'accent doit être mis sur la promotion de la santé et la prévention des maladies et des accidents en orientant l'effort vers les

16 A50/VR/2 page 4 catégories de population les plus vulnérables. Ensuite, les services de soins doivent évoluer vers une médecine plus communautaire. Le développement des soins à domicile, de la médecine ambulatoire et de la médecine de famille est indispensable. Enfin, l'amélioration de l'environnement social - l'emploi, le logement, les relations sociales - doit aller de pair avec l'amélioration de l'environnement physique - les questions liées à l'eau, à l'air ou au bruit. En outre, pour réduire les écarts entre les différentes catégories de population, il faut passer par un mode de financement plus solidaire du système de santé, fondé sur une assurance-maladie obligatoire, aux cotisations proportionnelles aux revenus, assurant l'égalité entre hommes et femmes, entre jeunes et aînés, entre riches et pauvres et entre malades et bien-portants. De manière plus générale, l'évidence est là : le bon état de santé d'une population dépend de mesures qui ne sont pas toujours d'ordre médical. Protéger l'environnement, bien aménager le territoire, lutter contre le chômage, assurer une bonne formation sont autant de mesures qui peuvent avoir davantage d'effets sur la santé d'une population que des investissements technologiques lourds dans des systèmes hospitaliers. Tout cela est très intéressant, me direz-vous, mais cela ne concerne que le monde occidental. C'est vrai. A l'échelle mondiale, le problème de santé le plus immédiat tient à l'importance des maladies et des décès prématurés provoqués par des pollutions de l'eau, de l'air, des sols et des aliments. Les problèmes sont, vous le savez bien, particulièrement graves dans le monde en développement où, chaque année, cinq millions d'enfants meurent de diarrhée causée par les pollutions de l'eau et des aliments, où 267 millions de personnes sont infectées par le paludisme et où des centaines de millions de personnes souffrent de parasitoses intestinales handicapantes. Ce sont là des fléaux ordinaires et ces fléaux ordinaires n'intéressent guère les médias, mais les chiffres sont hallucinants et l'afrique, où trois personnes sur cinq n'ont pas accès à la médecine, paie un tribut particulièrement lourd. Chaque année, le paludisme tue plus de enfants, plus de 2000 enfants par jour, Mesdames et Messieurs. Bien sûr, périodiquement, des progrès décisifs dans la mise au point de vaccins contre les maladies tropicales sont annoncés, mais,sur le terrain, ces vaccins n'aboutissent pas encore. Pourquoi? Parce que la recherche, si active dans le domaine de la reproduction et de l'hérédité, se heurte à des obstacles majeurs? Je ne le crois pas. La recherche n'aboutit pas parce que les vaccins, malgré le volume impressionnant de la demande mondiale, n'ont qu'un attrait mineur pour l'industrie. Les gains sont faibles, les contrôles sont astreignants et le marché se limite aux pays pauvres. Dans ce contexte, le rôle de l'oms est clair. Comme l'indique le Rapport sur la santé dans le monde, 7997,elle doit prendre les mesures permettant de prévenir les maladies et de réduire la somme de souffrances et d'incapacités qui en résulte. L'OMS doit donc soutenir activement la création de l'institut international des Vaccins et trouver des financements à l'échelle mondiale permettant d'encourager la recherche jusqu'au passage à la production. Monsieur le Président, Monsieur le Directeur général, Mesdames et Messieurs, pour développer les dix vaccins essentiels, il faut un milliard de dollars en dix ans. Qu'est-ce qu'un milliard de dollars? C'est en réalité - ou ce serait - le produit d'une taxe de 0,01 % sur un jour de transactions financières internationales, qui s'élèvent, en vingt-quatre heures, à dix mille milliards de dollars! Je remercie donc l'oms des efforts qu'elle déploie pour convaincre les gouvernements et je vous souhaite aux uns et aux autres d'excellents travaux consacrés à la seule cause qui importe : les progrès de la santé à travers le monde. Je vous remercie. El PRESIDENTE: Muchas gracias, señor Segond. 4. ADDRESS BY THE PRESIDENT OF THE FORTY-NINTH WORLD HEALTH ASSEMBLY ALLOCUTION DU PRESIDENT DE LA QUARANTE-NEUVIEME ASSEMBLEE MONDIALE DE LA SANTE El PRESIDENTE: Señores delegados: Ha pasado un año desde la 49 a Asamblea Mundial de la Salud que tuve el alto honor de presidir. Todavía queda en mi recuerdo el intenso trabajo realizado y la firme voluntad de todos los Estados Miembros para aunar esfuerzos con el fin de dar más y mejor salud a toda la población. Cabe recordar que en los seis días que duró la Asamblea se trataron los 48 temas incluidos en el orden del día y que el pleno aprobó

17 A50/VR/3 page 5 26 resoluciones. Este importante hecho se debió en gran parte al trabajo comprometido y responsable realizado por todas las delegaciones, tanto en el pleno como en las reuniones de las comisiones principales, así como al valioso aporte de los representantes del Consejo Ejecutivo y de la Secretaría. Todos los participantes contribuyeron a superar el desafío inicial marcando un nuevo hito en la Organización. Es mi aspiración que esta experiencia sirva de ejemplo en el futuro con el fin de acortar la duración de próximas Asambleas, mejorando al mismo tiempo su eficiencia y productividad. En esa oportunidad se trataron, entre otros temas, importantes cuestiones vinculadas con la compleja problemática de la salud, como la prevención y la lucha contra las enfermedades transmisibles; la reforma de la Organización Mundial de la Salud y respuesta a los cambios mundiales; la colaboración de la OMS dentro del sistema de las Naciones Unidas y con otras organizaciones intergubernamentales y la asistencia sanitaria a los países con mayores necesidades. En este último año el Consejo Ejecutivo desarrolló un intenso trabajo con el fín de definir las orientaciones de la Organización en el próximo milenio, profundizando en consulta con los países el análisis de los aspectos conceptuales y de las estrategias futuras en la renovación de la meta de la «salud para todos». Asimismo, el Consejo avanzó en el estudio sobre la conveniencia de la revisión de la Constitución de la Organización, que a mi criterio exige una identificación previa de las necesidades específicas de la reforma. En caso de existir dichas necesidades sólo deberían realizarse los cambios puntuales que fueren necesarios o imprescindibles. No obstante, comparto la idea de que por ahora no existen en la Constitución vigente limitantes al accionar de la Organización ni elementos que imposibiliten avanzar en los procesos de transformación propuestos. Durante la Asamblea que hoy se inicia examinaremos el proyecto de presupuesto por programas, que fue analizado por el Consejo Ejecutivo en el mes de enero pasado. Es importante destacar que es el segundo presupuesto estratégico de la Organización. También trataremos del Informe sobre la salud en el mundo 1997: vencer el sufrimiento, enriquecer a la humanidad que este año pone especial énfasis en las afecciones crónicas. Cabe destacar que en los últimos años se ha acelerado en el mundo el fenómeno de la transición demográfica que, junto con el de transición epidemiológica, han dado lugar a la llamada transición sanitaria, que influye sobre las políticas y estrategias de salud a nivel mundial, regional y nacional. Conforme nos señala el Informe sobre la salud en el mundo 1997, casi la mitad de los 52 millones de muertes producidas en 1996 se debieron a enfermedades crónicas. Las principales causas fueron los trastornos cardiovasculares, el cáncer y las infecciones respiratorias crónicas. Cabe recordar que en el Informe sobre la salud en el mundo 1996, bajo el lema «Combatir la enfermedad, promover el desarrollo» se destacó que las enfermedades infecciosas son la causa de muerte de aproximadamente 17 millones de personas en el mundo por año y que afectan a otros cientos de millones más. Frente a este desafío, la OMS y los Estados Miembros han puesto especial énfasis en disminuir y controlar las enfermedades infecciosas y en particular las enfermedades emergentes, como las fiebres hemorrágicas, las nuevas formas de la enfermedad de Creutzfeldt-Jakob y el resurgimiento de procesos infecciosos por E. coli, como el síndrome urémico-hemolítico, entre otras. La transición demográfica epidemiológica y sanitaria constituye otro de los principales desafíos que debemos atender de forma prioritaria. Cabe señalar que la OMS también prestó especial atención a la administración y difusión del conocimiento científico y al uso racional de los recursos. Quiero destacar con satisfacción el énfasis puesto por la OMS en promover el desarrollo y el control de calidad de la tecnología médica. Considero que la Organización debe asumir un papel protagónico en la difusión de la información científica. El desarrollo de técnicas susceptibles de ser aplicadas sobre el genoma humano, incluyendo las técnicas de clonación,han generado un nuevo campo que exige ser analizado y estudiado en profundidad desde distintas ópticas: científicas, éticas y morales. En este sentido hemos solicitado que se trate en la presente Asamblea la prohibición de la clonación en la reproducción humana. Asimismo debemos continuar la tarea iniciada con el fín de consolidar el liderazgo de la Organización en el establecimiento de normas de calidad y control de los productos biológicos y de servicios a nivel mundial y regional, con el fin de asegurar la homogeneidad y transparencia en los controles de calidad, inocuidad y eficacia de la tecnología médica, fundamentalmente con el objeto de garantizar el mercado internacional de los mismos. Habiendo transcurrido un año de intenso trabajo me permito reiterar las dos premisas que señalara en mi exposición al asumir la presidencia de la 49 a Asamblea Mundial de la Salud: que la Organización pertenece a los Estados Miembros y que es necesario que el proceso de reforma en curso continúe y se profundice. En este sentido, la participación de los Estados en el proceso de reforma reafirma tal pertenencia. Ello exige avanzar con urgencia en los ajustes programáticos y continuar con el análisis de los cambios estructurales. Es necesario definir las prioridades mundiales y adecuarlas al nivel regional y a las realidades de cada uno de nuestros

18 A50/VR/1 page 6 propios países para actuar en forma global mediante el uso racional de los recursos disponibles. Debemos avanzar en la búsqueda de la equidad social en salud, teniendo claro que es imposible lograr dicha equidad sin un marco ético y solidario, con criterios de eficiencia y calidad que garanticen el desarrollo sostenible de nuestros pueblos. Esto nos obliga a reforzar nuestros esfuerzos para alcanzar la ambiciosa meta de la salud para todos. En tal sentido, considero que una planificación estratégica que respete las características propias de cada país nos permitirá avanzar en la descentralización operativa, en la programación local, en la participación social y en la articulación y cumplimentación intra y extrasectorial. La Organización Mundial de la Salud debe poner especial atención en mejorar cada día su proceso técnico У administrativo de gestión para desarrollar el protagonismo que le es propio dentro del sistema de las Naciones Unidas y profundizar su liderazgo frente a los cambios mundiales. Las distintas regiones de la Organización deben desarrollarse y adecuarse a las realidades que les son propias, manteniendo su identidad en el marco de un pluralismo ideológico. La cooperación vertical debe adecuarse a las necesidades propias de cada país y la Organización debe promover la cooperación horizontal entre los Estados Miembros. Las representaciones de la OMS en los países deben ajustar su estructura y su complejidad, en base a las políticas nacionales de salud, a las necesidades locales y a las realidades del medio, de común acuerdo con las autoridades sanitarias nacionales, que deben ser sus interlocutores válidos en todo momento. Los Estados Miembros, por su parte, a través de sus ministerios de salud deberán fijar sus propias políticas, asumiendo el liderazgo que les corresponde para logar la plena vigencia del derecho a la salud. Señoras, señores: Hace veinte años, la 30 a Asamblea Mundial de la Salud decidió que el principal objetivo social de los gobiernos y de la Organización en las próximas décadas sería que todos los ciudadanos del mundo alcanzaran en el ano 2000 un nivel de salud que les permitiera desarrollar una vida social y económicamente productiva y solicitó al Consejo Ejecutivo y al Director General que reorientaran el trabajo de la OMS en pro del desarrollo de la cooperación técnica y la transferencia de recursos para la salud, de acuerdo con una de las más importantes funciones de la Organización: ser la autoridad en materia de coordinación y dirección del trabajo sobre la salud internacional. A sólo tres anos y en las puertas del tercer milenio, ese desafío se mantiene constante. Muchas gracias. A continuación suspenderé brevemente la sesión para que nuestros distinguidos invitados puedan abandonar la sala. 5. APPOINTMENT OF THE COMMITTEE ON CREDENTIALS CONSTITUTION DE LA COMMISSION DE VERIFICATION DES POUVOIRS El PRESIDENTE: Trataremos a continuación el punto 2 del orden del día provisional: «Establecimiento de la Comisión de Credenciales». Se pide a la Asamblea que nombre una Comisión de Credenciales de conformidad con el artículo 23 del Reglamento Interior. A tenor de ese artículo, propongo para su aprobación los 12 Estados Miembros siguientes: Bahamas, Bhután, Congo, Ghana, Luxemburgo, Pakistán, República Islámica del Irán, Rumania, Santo Tomé y Príncipe, Uruguay, Uzbekistán y Vanuatu. Hay alguna objeción? Si no hay ninguna objeción, declaro nombrada por la Asamblea la Comisión de Credenciales que acabo de proponer. A reserva de lo que decida la Mesa de la Asamblea y de conformidad con la resolución WHA20.2, la citada Comisión celebrará su primera reunión el martes 6 de mayo por la tarde. 6. ELECTION OF THE COMMITTEE ON NOMINATIONS ELECTION DE LA COMMISSION DES DESIGNATIONS El PRESIDENTE: Abordaremos a continuación el punto 3: «Elección de la Comisión de Candidaturas». Esta elección se realiza según lo establecido por el artículo 24 del Reglamento Interior de la Asamblea. De acuerdo con dicho artículo, se ha elaborado una lista de 25 Estados Miembros que voy a someter a la consideración de la Asamblea. Permítanme señalarles que al elaborar esta lista se ha aplicado la siguiente distribución por regiones: África: 6 Miembros; las Américas: 5; Asia Sudoriental: 2; Europa: 6; Mediterráneo Oriental: 3; y Pacífico Occidental: 3.

19 A50/VR/1 page 7 En consecuencia, les propongo los siguientes Estados Miembros: Antigua y Barbuda, Bélgica, Brasil, Camboya, China, Colombia, Ex República Yugoslava de Macedonia, Federación de Rusia, Francia, Gambia, Indonesia, Kiribati, Lesotho, Madagascar, Malawi, Maldivas, Malí, México, Omán, Paraguay, Qatar, Reino Unido de Gran Bretaña e Irlanda del Norte, República Centroafricana, Turquía y Yemen. Desean formular alguna observación o proponer adiciones a la lista? Puesto que no hay observaciones, declaro elegida la Comisión de Candidaturas. Como ustedes saben, el artículo 25 del Reglamento Interior, que define el mandato de la Comisión de Candidaturas, señala también que rías propuestas de la Comisión de Candidaturas se comunicarán sin demora a la Asamblea de la Salud». La Comisión de Candidaturas se reunirá a las horas en la sala VII. La próxima sesión plenaria se celebrará a las horas. Se levanta la sesión. The meeting rose at 10:50. La séance est levée à 10h50.

20 A50/VR/2 page 8 SECOND PLENARY MEETING Monday, 5 May 1997,at 12:00 President: Dr A. J. MAZZA (Argentina) later: Mr Saleem I. SHERVANI (India) DEUXIEME SEANCE PLENIERE Lundi 5 mai 1997,12 heures Président: Dr A. J. MAZZA (Argentine) puis: M. Saleem I. SHERVANI (Inde) 1. FIRST REPORT OF THE COMMITTEE ON NOMINATIONS 1 PREMIER RAPPORT DE LA COMMISSION DES DESIGNATIONS 1 El PRESIDENTE: Se declara abierta la sesión. El primer punto de nuestro programa de trabajo es el examen del primer informe de la Comisión de Candidaturas. El informe figura en el documento A50/25. Invito al Presidente de la Comisión de Candidaturas, Dr. Mukiwa, a pasar a la tribuna a leer el informe. Dr MUKIWA (Chairman of the Committee on Nominations): The Committee on Nominations, consisting of delegates of the following Member States: Antigua and Barbuda, Belgium, Brazil, Cambodia, Central African Republic, China, Colombia, France, Gambia, Indonesia, Kiribati, Lesotho, Madagascar, Malawi, Maldives, Mali, Mexico, Oman, Paraguay, Qatar, Russian Federation, The former Yugoslav Republic of Macedonia, Turkey, United Kingdom of Great Britain and Northern Ireland, and Yemen met on 5 May Dr W.B. Mukiwa (Malawi) was elected Chairman. In accordance with Rule 25 of the Rules of Procedure of the Health Assembly and respecting the practice of regional rotation that the Assembly has followed for many years in this regard, the Committee decided to propose to the Assembly the nomination of Mr S.I.Shervani (India) for the Office of President of the Fiftieth World Health Assembly. Election of the President Election du Président de l'assemblée El PRESIDENTE: Muchas gracias, Dr. Mukiwa. Hay alguna observación? Como no hay observaciones ni otras propuestas, no será necesario proceder a una votación, ya que se ha presentado un solo candidato. Por lo tanto, 1 See reports of committees in document WHA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

21 A50/VR/2 page 9 de conformidad con el artículo 80 del Reglamento Interior, sugiero que la Asamblea apruebe la candidatura presentada por la Comisión y elija a su Presidente por aclamación. (Applause/Applaudissements) Por lo tanto, se elige Presidente de la 50 a Asamblea Mundial de la Salud al Sr. Saleem I. Shervani, a quien invito a ocupar su lugar en la tribuna. Mr S.I. Shervani (India) took the presidential chair. M. S.I. Shervani (Inde) prend place au fauteuil présidentiel. Your Excellencies, Honourable Ministers, Ambassadors, delegates, Mr Director-General, I would like to thank this august Assembly for their trust in electing me as the President of the Fiftieth World Health Assembly. Taking this opportunity, I would like to express my appreciation to Dr A.J. Mazza, my predecessor, for his contribution to the last World Health Assembly. I shall deliver the customary address later today, and we will now continue with our work. 2. SECOND REPORT OF THE COMMITTEE ON NOMINATIONS 1 DEUXIEME RAPPORT DE LA COMMISSION DES DESIGNATIONS 1 I now invite the Assembly to consider the second report of the Committee on Nominations. This report is contained in document A50/26. May I ask the Chairman of the Committee on Nominations to read out the second report of the Committee. Dr MUKIWA (Chairman of the Committee on Nominations): At its first meeting held on 5 May 1997, the Committee on Nominations decided to propose to the Assembly,in accordance with Rule 25 of the Rules of Procedure of the Assembly, the following nominations: Vice-Presidents of the Assembly: Dr A. M'Hatef (Algeria), Dr J.F. Oletta (Venezuela), Mr S. Eleghmary (Libyan Arab Jamahiriya), Mrs M. de Belém Roseira (Portugal), Dr Zhang Wenkang (China). Committee A: Chairman - Dr R. Campos (Belize). Committee B: Chairman - Dr T. Taitai (Kiribati). Concerning the members of the General Committee to be elected under Rule 31 of the Rules of Procedure of the Assembly, the Committee decided to nominate the delegates of the following 17 countries: Argentina, Bulgaria, Côte d'ivoire, Cuba, Eritrea, France, Japan, Morocco, Mozambique, Myanmar, Russian Federation, Seychelles, South Africa, Sweden, United Arab Emirates, United Kingdom of Great Britain and Northern Ireland, and United States of America. Election of the five Vice-Presidents Election des cinq vice-présidents de l'assemblée I invite the Assembly to pronounce in order on the nominations proposed for its decision. We shall begin with the election of the five Vice-Presidents of the Assembly. Are there any comments? There being no comments, I propose that the Assembly declare the five Vice-Presidents elected by acclamation. (Applause/Applaudissements) 1 See reports of committees in document WHA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

22 A50/VR/2 page 10 I shall now determine by lot the order in which the Vice-Presidents shall be requested to serve should the President be unable to act in between sessions. The names of the five Vice-Presidents have been written down on five separate sheets of paper, which I am going to draw by lot. The Vice-Presidents will be requested to take the Chair in the following order: Mr S. Eleghmary (Libyan Arab Jamahiriya), Dr Zhang Wenkang (China), Mrs M. de Belém Roseira (Portugal), Dr J.F. Oletta (Venezuela), and Dr A. M'Hatef (Algeria). I request the Vice-Presidents kindly to come to the rostrum and take their places there. Election of the Chairmen of the main committees Election des présidents des commissions principales We now come to the election of the Chairman of Committee A. Are there any comments? There being no comments, I invite the Assembly to declare Dr R. Campos (Belize) elected Chairman of Committee A by acclamation. (Applause/Applaudissements) We have now to elect the Chairman of Committee B. Are there any comments? There being no objections, I invite the Assembly to declare Dr T. Taitai (Kiribati) elected Chairman of Committee В by acclamation. (Applause/Applaudissements) Establishment of the General Committee Constitution du Bureau de l'assemblée We shall now look at the establishment of the General Committee. In accordance with Rule 31 of the Rules of Procedure, the Committee on Nominations has proposed the names of 17 countries, the delegates of which, added to the officers just elected, would constitute the General Committee of the Assembly. These proposals provide for an equitable geographical distribution of the General Committee. If there are no observations, I will declare those 17 countries elected. I see there are none and therefore they are so elected. Thank you. Before adjourning this plenary meeting, I would like to remind you that the General Committee of the Assembly will be meeting immediately in Room VII. The members of the General Committee are the President and the Vice-Presidents of the Assembly, the Chairmen of the main committees and the delegates of the 17 countries you have just elected and whose names I shall now repeat: Argentina, Bulgaria, Côte d'ivoire, Cuba, Eritrea, France, Japan,Morocco, Mozambique, Myanmar, Russian Federation, Seychelles, South Africa, Sweden, United Arab Emirates, United Kingdom of Great Britain and Northern Ireland, and the United States of America. The next plenary will be held this afternoon at 14:30. The meeting is adjourned. The meeting rose at 12:35. La séance est levée à 12H35.

23 A50/VR/3 page 11 THIRD PLENARY MEETING Monday, 5 May 1997,at 14:30 President: Mr Saleem I. SHERVANI (India) TROISIEME SEANCE PLENIERE Lundi 5 mai 1997,14h30 Président: M. Saleem I. SHERVANI (Inde) 1. PRESIDENTIAL ADDRESS DISCOURS DU PRESIDENT DE L'ASSEMBLEE Excellencies, distinguished delegates, Dr Nakajima, colleagues and friends, it is indeed a great honour for the entire South-East Asia Region, my country, India, and for me personally to be elected President of the Fiftieth World Health Assembly. I express my sincere thanks for the honour and the trust bestowed on me, especially as this year coincides with the celebration of India's fiftieth year of independence. With your cooperation and the Secretariat's support, I am confident that we will be able to conclude our business successfully and on time. I take up my duties with a sense of humility, and have faith that this meeting of minds will lead to a new understanding, reinforcing our efforts to serve the world community better. As we avail ourselves of this unique opportunity, let us undertake to share our experiences and knowledge, and help each other in overcoming the obstacles that stand in the way of securing better access to health for our people. Better endowed and more progressive countries must be prepared to share the burden of countries which are poor. Whatever we may decide and undertake to do as a world community should also have a time-bound framework for action. It is a formidable task and, as the foremost international organization responsible for the health of people the world over, we, the members of WHO, must reinforce the Organization's leadership and reassert the Assembly's role in the most fruitful way. These sentiments take an added significance this year as the World Health Assembly holds its fiftieth session. As we rededicate ourselves to achieving the goal of health for all, I feel proud and privileged to recollect that India has been associated with this Organization since its inception. In fact, India played a pioneering role in establishing the World Health Organization, as well as in drafting and approving its Constitution. The International Health Conference adopted the Constitution of the World Health Organization in 1946 in the wake of the devastation left by the world war. In the ensuing years, the nations of the world have come together to promote the cause of global health. Fifty years ago the world gave WHO a mandate to direct and coordinate international health work and provide technical support to countries. We have witnessed the shining achievement of the eradication of smallpox from the world and the near-eradication of guineaworm infection. We have also seen how, through the continuous mobilization of its technical know-how and other resources, the World Health Organization has succeeded in strengthening the capabilities of national governments in health planning, in effective management of communicable diseases, in developing human resources and in setting laboratory norms and standards for foods, drugs and nutrition. As we approach the next millennium, we observe a rapid transition on all fronts: political, social and economic. In endeavouring to enhance the well-being of our people, especially the less fortunate, we face

24 A50/VR/3 page 12 formidable challenges. These include high population pressure, the changing age profile of much of the world's people, and the double burden of disease and the onset of emerging and re-emerging diseases, further compounded by microbial and parasitic resistance to therapeutic agents. These problems have been further aggravated by the degradation of the environment, rapid urbanization, malnutrition and high levels of illiteracy exacerbated by poverty, which remains the world's deadliest disease. In addition, not only in industrialized countries but also in the developing world, changes in lifestyle, cardiovascular diseases, high blood pressure, cancer, diabetes and mental health problems have become a major threat. They have led to the growth of complicated noncommunicable diseases, calling for heavy investment hardly envisaged even a decade ago. This situation will undoubtedly bring about a sharp rise in the demand for in-patient care. Major investments will be needed in terms of staff, equipment and training and, in many countries, in setting up additional health facilities. While more efficient technologies and the development of new vaccines against bacterial and parasitic diseases give us greater hope and an opportunity to share expertise and the fruits of research,a new professional challenge - that of improving the management of referral systems - now confronts us. The poor must not be squeezed out of the health system by attempts to answer the demand for treatment of chronic disease amongst the better-off. We must help them to participate fully, and investments in hospital care should not crowd out essential investments in primary health infrastructure, including the provision of drugs in the urban slums and remote rural areas, where the poorest people live. The time has come when we have to recognize that the private sector is also an important provider of primary health care, and we need to draw on it much more in order to improve our capacity for overall planning and quality improvement. Our challenges include the fact that one billion people, one-fifth of the world's population, live on less than a dollar a day, and many others remain far below what can be termed a decent quality of life. This ought to be unacceptable in a world which has so much. More progress has been achieved in raising standards during the last half-century than at any other time in human history. But still the challenge persists, and appears to grow. The private health sector, whether nongovernmental, community-based or based on private ventures, has been making major contributions for centuries. Until about a hundred years ago private providers were the only source of health care and even today they account for a larger share of spending than public sources. The government's role has expanded only in the current century. Currently, an estimated 50% of all global spending for health care comes from the private sector. Meanwhile the population in many of the countries has grown in the same 50 years with the near tripling, if not quadrupling, of the urban population. Millions of people now live in cities in abject poverty in unhygienic tenement houses, illegal squatter colonies, even on pavements with no shelter at all. A large number of these are women and children. We cannot but depend on the private sector to whom, in any case, people first turn for ambulatory care. But governments have a responsibility to regulate the sector and we must identify effective ways of doing so to protect the consumer and to contain costs while building meaningful partnerships founded on mutual trust and an understanding of each other's role. As a part of the health reforms being taken worldwide, we must call for a more efficient allocation of resources, greater individual freedom in demanding and securing a basic package of services, and help strengthen institutional capacity within the health system. We must encourage the devolution of responsibility and management. Health sector reforms necessarily carry with them special opportunities and also special risks. As policy-makers we have the opportunity to redesign the health services and introduce healthfinancing mechanisms aimed at avoiding escalation of costs, long waiting lists and excessive prescription of drugs. We must promote policies which are relevant, aimed at containing costs, expanding consumer choice and improving the quality of services. At the base of these policies lies the need to protect highly vulnerable populations of women, children and the elderly who are entitled to receive specially designed services. Secondly, we must secure an affordable access to a package of basic services for the whole population. I represent a region where one-fourth of the world's population lives. Although we have high population growth, ours is a society with strong cultural bonds and an inherent spirit of sharing and caring. We have been fortunate in achieving success in joint collaboration between the countries of the South-East Asia Region. We have successfully evolved common border strategies for malaria, synchronized immunization dates where feasible, and cooperated with each other in sharing technical know-how, expertise and training. We need to now move towards a similar interdependence amongst regions to foster the establishment and growth of a world health order where health becomes an essential plank for securing a better quality of life. We need to have a global mechanism for monitoring health status and forecasting the spread of contagious diseases. We need to continuously arrive at a consensus on the adoption of policies. We seek affirmative action in favour of health. Health must be seen as a responsibility which has to be

25 A50/VR/3 page 13 shouldered by the whole society. To that end, we must strengthen a collaborative process which helps governments to secure a more meaningful place for health as it impinges so acutely on human life. In the past year, there has been a glimmer of hope in the treatment of HIV/AIDS through the use of multidrug regimens. Simultaneously, the remarkable scientific achievement of cloning a mammal from the cells of a sheep's udder has opened up scientific vistas of enormous potential. These achievements, however, stand tempered by the fact that the costs of multiple drugs needed for HIV treatment are today a prohibitively expensive option, and therefore still out of reach. The cloning technology has raised ethical questions which are being addressed in different forums. Suffice to say that as a world community we have to be alive to the comparative merits of each case and draw whatever is the best for mankind from new discoveries. In benefiting from new discoveries, we must also acknowledge the place of traditional systems of which many countries in the world are justly proud. We must not ignore these systems in our zeal to subscribe to modern science and technology alone. India alone has contributed three fully fledged systems of medicine known as Ayurveda, Siddha and Unani, which along with yoga and naturopathy contain a wealth of scientific knowledge and literature that has provided an effective response to diseases like arthritis, rheumatic disorders, asthma, neurological disorders, liver diseases and leukoderma. These are complete systems of medicine based on authentic texts developed through centuries of research and experience. To keep pace with modern-day expectations, they have been given a legal framework and an organized structure. Standardization has been undertaken. Well-designed courses leading to registration of practitioners exist. It may be worthwhile to consider convening an international conference for discussing traditional systems of medicine to create awareness, to dispel misconceptions and to make positive recommendations for adopting them where feasible. In the next few days, as we address the items on the agenda, we will have the pleasure of rewarding outstanding achievements that have promoted the cause of world health. Committee A will look at what WHO plans to do during the period , the Tenth General Programme of Work and the first for a new century. It will also discuss, among others, where the world stands in reducing the menace of HIV/AIDS and sexually transmitted diseases, malaria and other tropical diseases, and tobacco use. Committee В will examine the Organization's financial and administrative health and reforms, its policy and strategies as well as our relations in the United Nations family. Issues of shared interest including the world's marine environment and chemical safety will also be addressed. We live in a world of interdependence. Advances in information technology have truly made our planet a global village. This provides an excellent opportunity for promoting health and creating public awareness aimed at changing people's behaviour and lifestyles to achieve better health for all. The transfer of technology and technical know-how on concessional and preferential terms from industrialized to developing countries is required in the true sense if we are to realize the fruits of cooperation. I would like to urge those who have already achieved the best health indices to assist and cooperate fully with the endeavours of those who are yet to attain the goal of health for all. Our combined efforts will surely provide the spirit of caring, sharing, solidarity, and service so vital for the success of our deliberations. 2. ADOPTION OF THE AGENDA AND ALLOCATION OF ITEMS TO COMMITTEES ADOPTION DE L'ORDRE DU JOUR ET REPARTITION DES POINTS COMMISSIONS PRINCIPALES THE MAIN ENTRE LES The first item to be considered this afternoon is item 8 of the provisional agenda, "Adoption of the agenda and allocation of items to the main committees", which was examined by the General Committee at its first meeting earlier today. The General Committee examined the provisional agenda for the Fiftieth World Health Assembly, document A50/1, as prepared by the Executive Board and sent to all Member States. The General Committee recommended the following changes to the provisional agenda contained in document A50/1 : deletion of item 11, "Admission of new Members and Associate Members (Article 6 and Rule 115) [if any]", since no new applications had been received; deletion of item 22.4, "Amendments to the Financial Regulations [if any]"; and deletion of item 23, "Supplementary budget for [if any]". Does the Assembly agree with these recommendations?

26 A50/VR/3 page 14 Before we proceed to adopt the agenda, I wish to report to the Assembly that the General Committee also considered the addition of supplementary agenda items, for which two proposals had been received by the Director-General. The first proposal was to include a supplementary agenda item on "Cloning in human reproduction". The Committee agreed to include this item on the agenda. Are there any comments? I see none. The supplementary agenda item is accordingly included. The second proposal was to include a supplementary agenda item "to invite the Republic of China (Taiwan) to participate in the World Health Assembly as an Observer". The Committee recommended not to include this item on the agenda. Are there any comments? I would like to give the floor to the honourable delegate of Nicaragua. El Sr. PRADO (Nicaragua): Muchas gracias, señor Presidente. Permítame felicitarlo por su elección y desearle todo éxito en el desempeño de sus nuevas funciones. Señor Presidente, el Gobierno de Nicaragua, a través de su Representación Permanente en Ginebra y de conformidad con el artículo 12 del Reglamento Interior, hizo llegar al Director General, Dr. Nakajima, una solicitud de adición de un punto en el orden del día de esta magna Asamblea. En esta oportunidad que se nos brinda queremos reiterar dicha petición, que rezaría como sigue: «Admisión con estatuto de Observador ante la Asamblea Mundial de la Salud a la República de China (Taiwán)». El Gobierno de Nicaragua, mediante esta petición, vela por el firme respeto de los propósitos constitutivos de la Organización Mundial de la Salud. En este caso preciso, el párrafo preambular 3 de la Constitución de la Organización dispone que «La salud de todos los pueblos es una condición fundamental para lograr la paz y la seguridad, y depende de la más amplia cooperación de las personas y de los Estados». En este sentido, dado el compromiso innegable del Gobierno de la República de China (Taiwán) de mejorar sustancialmente la salud mundial de los países pobres y subdesarrollados, siempre ha demostrado en la práctica su solidaridad efectiva. La República de China (Taiwán) ha practicado la ayuda con hechos y no con promesas en los países del Tercer Mundo. Hay que hacer notar que estamos por entrar en el siglo XXI, en el cual tenemos que luchar por que cambien las mentalidades, ya que el resto que hoy hay que tomar en esta tierra es como una sola patria, olvidando las fronteras. Dado que el mismo desarrollo de la humanidad está afectando nuestra civilización y a esto hay que agregarle las adversidades naturales que va a encontrar nuestro globo terráqueo, con todo respeto, estimados delegados de esta Asamblea, os expongo esta realidad para que superemos nuestro pensamiento aun de frontera o de países, y que un país amigo de todos como la República de China (Taiwán) sea introducida en esta ocasión como Miembro Observador. Muchas gracias, señor Presidente. Are there any other comments? I give the floor to the honourable delegate of Dominica. Mrs PAUL (Dominica): Mr President, let me on behalf of the Dominica delegation extend sincerest congratulations to you on the attainment of this high office and to wish you well as you seek to lead us throughout the deliberations. Mr President, we are in support of the proposal to grant observer status to the Republic of China (Taiwan). It is our belief that contagious diseases know no national boundaries and that to prevent contagious diseases from spreading requires the participation and cooperation of all countries in the world. The Republic of China (Taiwan) has a population of 21.4 million people. Indeed, it is important that we, as an Organization seeking to attain the highest level of health for all the peoples of our countries, recognize that any outbreak of disease in the Republic of China (Taiwan) can affect, in fact, many countries in that hemisphere and spread throughout the world. I would trust that as Members of this Organization we would, from a humanitarian point of view, and recognizing that the health of one country can suddenly have an impact not only on our social situation but also on trade relations with other countries, be able to give our support to this proposal. Thank you very much, Mr President.

27 A50/VR/3 page 15 Thank you. I would now like to give the floor to the honourable delegate of Senegal. M. NGOM (Sénégal): Monsieur le Président, je voudrais tout d'abord vous féliciter pour votre élection à la tête de notre Assemblée et vous souhaiter un plein succès dans votre mission. La délégation du Sénégal voudrait appuyer la requête qui a été faite par le Nicaragua, conformément à l'article 12 du Règlement intérieur de l'assemblée de la Santé, parce que cette demande d'inscription d'un point supplémentaire à l'ordre du jour concernant l'invitation de la République de Chine (Taiwan) à participer en qualité d'observateur aux travaux de l'assemblée nous semble venir à point nommé. La délégation sénégalaise est vivement préoccupée, en effet, par le sort des 21 millions d'habitants de la République de Chine (Taiwan) qui se trouve exclue des activités dans le domaine de la santé, et plus particulièrement celles de l'oms. Or, par vocation universelle, l'organisation mondiale de la Santé doit demeurer le creuset de toutes les aspirations de bien-être de l'humanité et offrir par là même une vision de solidarité entre les nations. Le monde d'aujourd'hui est certes caractérisé par des incertitudes, des angoisses en matière économique, sociale et sanitaire. La tentation de repli sur soi demeure, mais ce monde est également chargé de mutations porteuses que seules l'entente, la solidarité et la compréhension entre les peuples peuvent assurer. Il nous faut donc démarquer les problèmes de santé de toute considération politique car, dans ce domaine plus que dans tout autre, les défis qui se posent à la communauté internationale requièrent la contribution de tous les acteurs de la société internationale. Les problèmes de santé ne connaissent ni barrière idéologique, ni frontière nationale. Nous considérons donc que l'objectif de cette démarche n'est pas de demander ni l'adhésion de la République de Chine à notre Organisation, ni son admission en tant que Membre associé ni même en qualité d'observateur auprès de l'organisation; il s'agit simplement d'inviter ce pays à participer en qualité d'observateur aux travaux de la Cinquantième Assemblée mondiale de la Santé. Cette démarche ne devrait point être interprétée comme un signe d'hostilité ou de défiance à quelque pays que ce soit; au contraire, plus qu'une conviction, elle est la marque d'une volonté politique de dévouement pour ce grand dessein qu'est la nécessité de la coopération internationale dans le domaine de la santé. Je vous remercie. Thank you very much, honourable member from Senegal. I would like to give the floor to the delegate of Gambia. Ms ISATOU-NJIE SAIDY (Gambia): Mr President, like my previous colleagues, I wish also to congratulate you on your appointment to this position. Now, The Gambia also believes that we should look at this issue very seriously, and we support the previous speakers with regard to this request to allow the Republic of China (Taiwan) to observe this particular meeting, in conformity of course with the same Rule of Procedure, Rule 12, as highlighted by my previous colleagues. As you said in your speech, health for all is an intrinsic right deserved by everybody, and I think, that for reasons of justice and equity, the people in the Republic of China (Taiwan) also have a right to participate in enhancing global health. Since health, as we all agree in WHO, is seen and should be seen as a nonpolitical issue and nonconflicting at that, we feel that this request should be considered. It should also be noted, of course, that we have made this request to ensure that the People's Republic of China (Taiwan) is allowed to observe this meeting. Thank you very much. Thank you very much. I would like now to give the floor to the delegate of China.

28 A50/VR/3 page 16 Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 主席先生, 由子这是中国代表团第一次在大会上发言, 所以请允许我祝贺您当选第五十届世界卫生大会的主席和其他各位副主席以及主要委员会主席的当选, 我相信本届大会在你们的领导下一定会取得圆满成功 尽管总务委员会已经作出了决定, 极少数国家不顾国际法准则和联合国大会及卫生组织的有关决议, 仍公然提出所谓台湾申请作为世界艾生组织观察员的问题的提案, 这个提案明目张胆的企圉在卫生组织制造 两个中国 或 一中一台, 不仅严重地侵犯了中国的主权, 粗暴地干涉了中国的内政, 同时, 也是对 联合国宪章 联大第 2758 号决议和本組织 组织法 及 1972 年第二十五届卫生大会 WHA25. 1 号决议的肆意践踏, 中国代表团对此表示強烈的遣责和极大的愤慨 希望本组织会员主持正义, 捍卫联合国宪章和本组织 组织法 的宗旨和原则, 支持中国代表团的立场和总务委员会的决定 主席先生, 众所周知, 台湾自古以来就是中国的领土,1943 年的开罗宣言和 1945 年的波茨坦公告再次确认了中国对台湾的主权 迄今为止已经有 159 个国家与中国建立了外交关系, 他们都承认世界上只有一个中国, 中华人民共和国政府是代表全中国及其人民的唯一合法政府, 台湾是中国不可分割的一部分 25 年前, 联合国大会第 26 届会议以压倒多数通过了具有历史意义的第 2758 号决议, 该决议以明确无误的语言承认中华人民共和国政府的代表是中国在联合国的唯一合法代表, 中华人民共和国是安理会 5 个常任理事国之一, 并恢复了中华人民共和国在联合国的一切合法权利 据此, 中国在联合国的代表权问题从政治上 法律上和程序上得到了公正彻底的解决 根据联大决议, 世界卫生组织子 1972 年第二十五届世界卫生大会通过了 WHA25. 1 号决议, 恢复了中华人民共和国在世界卫生组织的一切权利, 承认中国政府为世界卫生组织内代表中国的唯一合法政府 主席先生, 联合国和世界卫生组织都是由主权国家组成的政府间的国际组织 根椐联合国和世界卫生组织的协定及本组鍥的 組织法, 世界卫生组织是政府间协定建立的联合国专门机构之一, 组织法 第三章关于成员的条款明确规定, 只有国家才有资格提出申请加入本组织, 台湾作为中国的一个省, 没有资格申请加入世界卫生组织 根据卫生大会的议事规则, 如果要申请作为观察员也只有中国政府才有资格这么做

29 A50/VR/3 page 17 主席先生 台湾问题纯属中国内政, 只能由中国人民自已来解决, 任何国家都无权插手和干涉 以任何理由 任何方式提出台湾在本组织的代表权问题都是对中国主权和领土完整的严重侵害 都是对中国内政的粗暴干涉 中国人民对此决不能容忍 中华人民共和国政府一向关心台湾人民的健康事业 并且也愿意将台湾省的卫生状况向世界卫生組轵提供, 并将卫生组织的政策传达给台湾省 我们将会希望通过会谈寻求积极的有建设性的解决办法 就此做出妥善安排 台湾是中国领土不可分割的一部分, 关子台湾 2100 万人口的健康问题是中国政府义不容辞的责任, 为了加强台湾卫生界同人对世界卫生组织的了解, 并最终服务于台湾人民的健康事业, 我们愿意釆取可行的措施 主席先生, 中国政府和人民维护国家主权和领土完整的坚定立场得到了绝大多数国家的支持 为维护 联合国宪章 和世界卫生组织 組鍥法 的权威性, 更严格的按照联合国大会和卫生大会的决议和它的 议事规则 办事, 我建议大会拒绝这一提案, 以便我们能有充分的时间就大家更关心的卫生健康问题进行讨论 谢谢主席先生 I thank the honourable delegate of China, and I would like to give the floor to the honourable delegate of the Solomon Islands. Mr SUPA (Solomon Islands): Mr President, may I first of all congratulate you on your election to the Office of President of the Fiftieth World Health Assembly. Mr President, we wish to dispute the General Committee's recommendation not to invite the Republic of China (Taiwan) to participate as an Observer. The Solomon Islands fully supports and endorses Taiwan's application to the World Health Organization for observer status. The Republic of China was one of the founding Members of the World Health Organization in Sadly, in the wake of the United Nations General Assembly's adoption of resolution 2758 in 1971, the Republic of China was forced to withdraw from the Organization in This indeed deprives the right of 21.4 million people of the Republic of China (Taiwan). The Preamble to the Constitution of WHO states very clearly that WHO believes that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Accordingly, such fundamental human rights are inherent, inalienable and free of political connotations. This conviction has influenced the Solomon Islands to fully support the Republic of China (Taiwan)'s bid with WHO. The Republic of China (Taiwan), in our view, must be given observer status. Finally, Mr President, contagious diseases know no national boundaries. Thus to prevent contagious diseases from spreading requires the participation and cooperation of all countries throughout the world, including Taiwan. Mr President, thank you for giving me the floor.

30 A50/VR/3 page 18 I thank the honourable delegate of the Solomon Islands, and now I give the floor to the honourable delegate of Pakistan. Mrs AZHAR (Pakistan): Mr President, first of all, the Pakistan delegation would like to express its disappointment that the Assembly, instead of focusing on the agenda items, is actually discussing a request which is aimed to challenge the sovereignty of a Member State of WHO. This issue was decided a very long time ago, 26 years ago by the United Nations General Assembly, and 25 years ago by the Health Assembly, that the People's Republic of China is the sole legitimate representative of the people of China. Therefore, instead of wasting our time in a discussion that will have no logical conclusion, we would like to suggest that we focus on the more important issues before us and discuss them. Thank you very much. I thank the honourable delegate of Pakistan. I would now like to invite the honourable delegate of Swaziland. Dr DLAMINI (Swaziland): Mr President, may I,like all the other delegations before me, congratulate you on your appointment to head this Assembly. The delegation of Swaziland believes that health is the right for all people of the world and the delegation also believes that the World Health Assembly is a nonpolitical assembly concerned with issues of health. It also believes that communicable diseases do not know any boundaries. It also believes that the 21 million people of the Republic of China (Taiwan) do deserve to be people that have all rights to all forms of health. We also believe that, if we really mean to attain health for all by 2000, this Assembly should not exclude any group of people in the world. My delegation hereby supports the move by Nicaragua to have on the agenda the application of the Republic of China (Taiwan) for observer status in this Assembly. It would be sad to watch the Health Assembly taking the partisan view to a nonpolitical problem and turn it into a political agenda. We hereby urge you, Mr President and the Assembly to have included in the agenda for consideration the application by the Republic of China (Taiwan) for observer status, because those people of China are indeed people who deserve all the rights to health. I thank you, Mr President. I thank the honourable delegate of Swaziland and I would now like to give the floor to the honourable delegate of Grenada. Mrs DUNCAN (Grenada): I too would like to congratulate you on your recent post as President of the World Health Assembly. Mr President, I too would like to support the proposal concerning the granting of observer status to the Republic of China (Taiwan). Given the mandate of this august body, I think it is important for us to ensure that all people of the world are afforded the opportunity to participate in programmes of health. The World Health Organization continues to call for health for all. How can we achieve this if we continue to disallow some countries because of politics? Mr President, I have had the opportunity to visit the country of the Republic of China (Taiwan) and I have seen for myself how 21 million people of that nation work together to develop their country. A country which has developed itself from being independent - not only cultivating some basic agricultural crops to feed its people - to a known economically affluent country, more improved than some countries of the world who are Members of this very Organization and who are considered internationally as world powers.

31 A50/VR/3 page 19 We have heard that despite the fact that the Republic of China (Taiwan) is no longer a Member of this Organization they have continued to maintain their public health system in accordance with standards stipulated by WHO, and have never ceased to extend aid to countries of the world with which they have friendly relations. They have also indicated their willingness to provide further assistance. With the difficulties faced by the world with the emergence of new deadly diseases and the re-emergence of old diseases, we who are involved in health care of our people must ensure that we maximize all available resources and work together in our fight to maintain the health and well-being of our people. It is clear, Mr President, that the Republic of China (Taiwan) is very serious about the health and well-being of people the world over, by virtue of their overall medical support and assistance to countries less fortunate than themselves. I therefore wish to join with my colleagues who have spoken before me on this issue and to recommend that the Republic of China (Taiwan) be granted observer status at this meeting. Finally, Mr President, my colleagues from Saint Lucia who are not able to be here with us at this meeting today have asked me to indicate to you, Sir, that they fully support the application by the Republic of China (Taiwan) for observer status. Thank you Mr President. Thank you very much. I thank the honourable delegate of Grenada, and now give the floor to the honourable delegate of the Central African Republic. Le Dr DJENGBOT (République centrafricaine): Monsieur le Président, la République centrafricaine voudrait joindre sa voix à celle de ceux qui vous ont félicité et vous souhaite plein succès. Les raisons qui incitent la République centrafricaine à appuyer la proposition du Nicaragua sont les suivantes : protéger le droit aux services de santé de 21,4 millions d'habitants, échanger les résultats des recherches médicales approfondies, aider les pays en développement à améliorer le niveau des soins médicaux à travers la coopération médicale. L'OMS étant une organisation humanitaire apolitique, nous souhaitons que tout le monde puisse bénéficier de son attention si nous voulons atteindre l'objectif qu'elle s'est fixé elle-même : la santé pour tous. Je vous remercie. I thank the honourable delegate of the Central African Republic, and now give the floor to the honourable delegate of El Salvador. El Dr. ANGULO (El Salvador): Muchas gracias, señor Presidente. En nombre de la delegación de El Salvador, considerando que la salud debe ser para todos, nuestro país, de conformidad con el artículo 12 del Reglamento Interior, apoya la propuesta de la hermana República de Nicaragua para conceder el estatuto de Observador a la República de China (Taiwán). Muchas gracias. I thank the honourable delegate of El Salvador,and now I would like to give the floor to the honourable delegate of Côte d'ivoire. Le Professeur KAKOU GUIKAHUE (Côte d'ivoire): Je voudrais féliciter le Président de cette Cinquantième Assemblée mondiale de la Santé et lui souhaiter plein succès.

32 A50/VR/3 page 20 J'estime qu'il faut être logique. Je ne pense pas que les conditions qui avaient amené l'assemblée générale de 1972 à prendre une décision aient changé. C'est la raison pour laquelle je voudrais que nous nous attelions aux problèmes de santé que nous avons décidé de discuter, sans créer des problèmes inutiles. J'appuie le Pakistan et également la Chine populaire qui n'acceptent pas que nous accordions un quelconque statut à la République de Taiwan, que l'on appelle aussi République de Chine (Taiwan). Allez-y comprendre quelque chose. Je vous remercie. I thank the honourable delegate of Côte d'ivoire, and I would now like to give the floor to the honourable delegate of Guinea. Le Dr DRAMÉ (Guinée): Monsieur le Président, à l'instar des délégués qui m'ont précédé, je voudrais tout d'abord vous féliciter pour votre élection à la tête de la Cinquantième Assemblée mondiale de la Santé. Je voudrais également féliciter les Vice-Présidents et les autres membres du bureau. Nous hésitons tous autant que possible à politiser les sessions de l'assemblée de la Santé. Cependant, pour en préserver la bonne atmosphère, nous devons prendre en compte l'environnement dans lequel nous évoluons. Et l'on sait bien que les grandes stratégies de santé sont aussi des choix politiques. C'est pourquoi notre délégation, afin d'éviter toute situation ambiguë, recommande que la requête demandant d'accorder le statut d'observateur à Taiwan ne soit pas acceptée, d'autant que l'onu a réglé ce problème sino-chinois il y a plusieurs années. I thank the honourable delegate of Guinea, and I would now like to give the floor to the honourable delegate of Saint Vincent and the Grenadines. Mr JACK (Saint Vincent and the Grenadines): Thank you Mr President and, like all the other speakers before me, I wish, on behalf of this delegation, to extend to you our sincerest congratulations. Mr President, on the issue of the proposal put forward to include the Republic of China (Taiwan) as observer to this body, I have to communicate that my delegation, recognizing the contribution made by the Republic of China (Taiwan), and which it continues to make, must be recognized in our efforts to further develop health, and therefore in recognition of these efforts we believe that it would be most fitting if the Republic of China (Taiwan) were to be encouraged by being included in this body as an observer, and with that, Mr President, I should thank you. Thank you very much the honourable delegate of Saint Vincent and the Grenadines. I would now like to give the floor to the honourable delegate of Argentina. El Dr. MAZZA (Argentina): Señor Presidente: Nuestra delegación quiere reiterar lo manifestado en la Mesa de la Asamblea en cuanto a la inconveniencia de incluir este tema en el orden del día. Hemos manifestado allí expresamente que el tema es de carácter político, que ha sido definido por las Naciones Unidas y que en todo caso debería discutirse en ese ámbito, limitando a esta Organización a la discusión de aquellos temas que son de su interés particular en su condición de organismo especializado de las Naciones Unidas. Por tal razón, proponemos que no se incorpore ese punto al orden del día de la Asamblea.

33 A50/VR/3 page 21 Thank you very much, the honourable delegate of Argentina. I would now like to give the floor to the honourable delegate of Cuba. El Dr. DOTRES MARTÍNEZ (Cuba): Señor Presidente: La delegación cubana se opone a la propuesta ya que consideramos improcedente y fuera de lugar el aspecto que se plantea. Hay problemas de salud de millones de ciudadanos de los países que están representados en esta Asamblea que no estamos tratando. Estamos hablando de un aspecto eminentemente político, que no tiene a nuestro juicio espacio en este foro, como han manifestado otros colegas. Desde 1971, la Asamblea General de las Naciones Unidas tiene reconocido que la República Popular China es la única y verdadera representación del pueblo chino en las Naciones Unidas. El resto es un asunto interno de los chinos, tal y como ha manifestado el delegado de ese país. Mi delegación está convencida de que el problema de la salud de los 21 millones de chinos de Taiwán es un asunto interno del pueblo chino, y confía, según lo declarado por el delegado de la República Popular China, en que se buscará la solución más conveniente. Muchas gracias. I thank the honourable delegate of Cuba, and delegate of the Dominican Republic. now would like to give the floor to the honourable El Dr. VASQUEZ (República Dominicana): Señor Presidente, señores Miembros de la Mesa: Nuestra felicitación a usted, señor Presidente, y al resto de los elegidos en la mañana de hoy. La República Dominicana quiere dar testimonio de su posición con relación a este asunto que ocupa a esta 50 a Asamblea Mundial de la Salud. Creemos que la Organización Mundial de la Salud es una dependencia de las Naciones Unidas y que no puede contribuir a segregar a ningún estamento territorial ni étnico del mundo. Tenemos entendido que Taiwán es un estamento territorial que, independientemente de la voluntad de los Estados aquí presentes, tiene sus propias leyes y, en consecuencia, tiene su Estado. Entendemos que la Organización Mundial de la Salud, y en consecuencia esta Asamblea, debe adherirse a la pluralidad, no puede adherirse a dictámenes de bloque alguno. Pensamos que permitir que Taiwán sea Observador en la 50 a Asamblea Mundial de la Salud y en futuras Asambleas significa que ese país tendrá acceso a tecnologías y políticas de salud a las que actualmente Taiwán no tiene acceso en el ámbito de la cooperación externa. La República Dominicana piensa que tal vez sea ésta la mejor forma, la mejor manera de acercar dos sistemas de atención de salud que han permanecido durante muchos años separados. Por consiguiente, la República Dominicana respalda la propuesta del hermano país de Nicaragua en el sentido de que Taiwán sea designado Observador en la Asamblea Mundial de la Salud. Muchas gracias, señor Presidente. I thank the honourable delegate of the Dominican Republic and would now like to give the floor to the honourable delegate of Nepal. Dr SIMKHADA (Nepal): Thank you, Mr President. As my delegation is taking the floor for the first time let me express our deep satisfaction and happiness in seeing you assume the office of President of the World Health Assembly. Your leadership makes all of us as South Asians proud, and my delegation will fully cooperate with you to make this Assembly address all the major problems of health in the world today. His Majesty's Government of Nepal fully recognizes the People's Republic of China as the sole and legitimate representative of the Chinese people. So my delegation, in conformity with the relevant United

34 page 22 Nations resolutions, fully supports the position stated by the distirtguished representative of the People's Republic of China and endorses the tradition of the General Committee not to endorse this item on the agenda. Thank you very much, Mr President. I thank the honourable delegate of Nepal and now would like to give the floor again to the honourable delegate of China. Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 谢谢主席先生让我第二次发言 我觉得在上述的所有支持台湾作为观察员的发言当中都用了所谓 " 中华民国 这种称呼, 在世界芏生组织论坛上出现这样的两个中国的论调, 是多年以来所没有的 这一现象让人惊讶, 让人痛心 这样的一个问题难道是个技术问题吗? 我觉得, 有一些国家代表的发言, 他们在说, 卫生组织不是一个政治性组织, 是一个技术性组织 但是, 在这个论坛上挑起这个政治议题的又是谁呢, 我觉得讨论这一个议题, 不是一个简单的技术问题, 我们应当看到它背后隐藏着的东西 我觉得, 关于吸收观察员, 世界卫生组织的议事规则是有规定的, 是卫生大会的议事规则第三条 只有三类情况可以申请作为观察员, 第一类是主权国家, 他们巳经申请成为 WHO 成员但还没有得到批准 ; 第二类是一部分领土或若干领土, 代表他们国际关系和外交事务的主权国家巳经代表他们申请成为卫生组织的准成员, 但还没有得到批准的 ; 第三类是与卫生組织有正式关系的政府间或非政府间的组织 台湾不属于其中的任何一类 由于世界上只有一个中国, 台湾是中国的领土, 是中国的一个省, 所以只有中国政府才有资格代表台湾申请作为观察员, 其它国家是不能这么做的, 这是一个原则性的问题 正像我刚才发言当中谈到的, 不是一个表面的技术性间题, 而是是不是要槁 两个中国 和 一中一台 " 的政治间题 如果这个问题耽误了卫生大会的日程, 这也是少数国家不顾历史事实, 不顾过去的重要决议, 也不尊重全中国人民感情 这样一个政治问题是少数国家挑起的, 正像我刚才所说, 中国政府在这个领土主权完整的相关的问题上是没有任何调和余地的 所以我希望, 绝大多数主持正义和社会公理的国家能够支持中国的立场, 并且也支持总务委员会作出的正确决定, 拒绝将这一议题列入议程 谢谢主席

35 A50/VR/3 page 23 Thank you very much, honourable delegate of China. I have three more speakers on my list. Is the Assembly agreeable to closing the list of speakers? I see that there is no objection. The list is closed. I would now like to give the floor to the honourable delegate of Myanmar. Mr AYE (Myanmar): I thank you Mr President. Mr President, on behalf of the Myanmar delegation may I first congratulate you on your assumption of the Presidency of this Assembly and wish you every success in your endeavours. Mr President, the Union of Myanmar established diplomatic relations with the People's Republic of China in Our country strictly adheres to the one-china policy. Moreover, United Nations resolution 2758 recognized the Government of the People's Republic of China as the sole legitimate representative of all the people of China. Taiwan is a province of China and is an inalienable part of the People's Republic of China. We cannot support any attempts to interfere in the internal affairs of China. Our delegation also cannot support Taiwan as a member of WHO nor can it be granted observer status. We do not support the inclusion of this subject in the agenda items of the Assembly. I thank you Mr President. Thank you very much the honourable delegate of Myanmar. Now I give the floor to the honourable delegate of Kiribati. Dr TAITAI (Kiribati): Thank you, Mr President, and let me join the others to congratulate you also on your election to the post of President of this Assembly. The Kiribati delegation supports the General Committee recommendation not to include a supplementary item which is to invite the Republic of China (Taiwan) to participate in the World Health Assembly as an observer. Kiribati recognizes the one-china policy and would like to leave any necessary political discussions on this matter to other United Nations forums which are more competent and better equipped to deal with such issues. Thank you, Mr President. I thank the honourable delegate of Kiribati and now would like to give the floor to the honourable delegate of Egypt. Dr BADRAN (Egypt): I would also like to join my colleagues in congratulating you on the assumption of the presidency of this Assembly. My delegation finds that it supports the decision of the General Committee not to include the item on the inclusion of Taiwan as an observer. We think that, although WHO is of course a scientific community and a health community, yet it also has to take account of and abide by the decisions of the United Nations. Therefore, we support the decision of the General Committee not to include this item on the agenda. Thank you. Thank you very much, the honourable delegate of Egypt. I believe we have one more speaker, the delegate of Papua New Guinea, who had requested the floor before we closed the list, so I would like to give the floor to the honourable delegate of Papua New Guinea. Dr TEMU (Papua New Guinea): Mr President, the Papua New Guinea delegation also congratulates you on your appointment and will support you during the deliberations of this Assembly. The Papua New Guinea delegation concurs with the position of the delegation of the Republic of China and requests the Fiftieth World Health Assembly, through

36 A50/VR/3 page 24 you Mr President, not to entertain this agenda item. The Papua New Guinea delegation recognizes this as a purely political matter which should therefore be appropriately handled as an internal affair by the sovereign independent State of the People's Republic of China. The Papua New Guinea delegation requests closure of the debate on this issue and seeks its referral to the People's Republic of China. Thank you, Mr President. Thank you very much, the honourable delegate of Papua New Guinea. I understand from the discussion that there are Members who wish to see this item included as a supplementary agenda item. We must therefore proceed to a vote. I give the floor to the Legal Counsel to explain the procedures. Mr TOPPING (Legal Counsel): Thank you, Mr President. The situation is as follows. We have, on the one hand, a recommendation by the General Committee not to include this item as a supplementary agenda item. I repeat, this has been a proposal by the General Committee not to include this item on the agenda. On the other hand, several delegations are opposed to this proposal. The proposal of the General Committee is the proposal that is being voted on. In a few minutes the President will ask all of those in favour to raise your nameplates. This will be a vote in favour of the General Committee recommendation not to include this as a supplementary agenda item. I think the honourable delegate of Nicaragua wishes to speak on a point of order, so I give the floor to the honourable delegate of Nicaragua. El Sr. ROSALES (Nicaragua): Muchas gracias, señor Presidente. La delegación de Nicaragua discrepa ligeramente del Reglamento Interior y de la forma en que lo está leyendo el Asesor Jurídico. El artículo 33 del Reglamento Interior dispone que: «... la Mesa de la Asamblea, previa consulta con el Director General y a reserva de lo que la Asamblea de la Salud pueda disponer:... establecerá el orden del día de todas las sesiones plenarias de la reunión». De la frase «a reserva de lo que la Asamblea de la Salud pueda disponer» se deduce que la Asamblea de la Salud tiene que pronunciarse sobre la propuesta formal hecha por la delegación de Nicaragua y apoyada por otras delegaciones. Muchas gracias, señor Presidente. Thank you very much the honourable delegate of Nicaragua. I will give the floor again to the Legal Counsel to make his comments. Mr TOPPING (Legal Counsel): Thank you, Mr President. My interpretation of the situation is on the basis of Rule 12, which says that a supplementary agenda item may be added if, upon the report of the General Committee, the Assembly so decides. It is on the report of the General Committee that the Assembly is so deciding. Rule 33 relates to the functions of the General Committee. I do not see that that alters the effect of Rule 12 on this point and therefore, Mr President, I advise you to maintain the position that the issue before the Assembly is the recommendation by the General Committee not to include this item on the agenda. Now continuing, if I could, to explain my position so that everyone will understand when you are asking everyone to raise their nameplates: when the President asks for those in favour to raise their nameplates, this is a vote in favour of the General Committee recommendation not to include this item on the agenda. Those against do not agree with the recommendation and they want to see this item placed on the agenda. Thank you, Mr President.

37 page 25 I think the position has been explained by the Legal Council, so I would now call for the vote. The list of speakers is closed so only those who want to raise a point of order can be given the floor - is Nicaragua asking to speak on a point of order again? Yes? I give the floor to the honourable delegate of Nicaragua. El Sr. ROSALES (Nicaragua): Señor Presidente: La Delegación de Nicaragua siente mucho tener que seguir discrepando de la interpretación del Asesor Jurídico, pero es soberanía de la Asamblea de la Salud decidir sobre la propuesta formal hecha por la República de Nicaragua y apoyada por múltiples delegaciones. El artículo 12 en ningún momento condiciona una decisión de la Asamblea Mundial de la Salud a una aprobación de la Mesa. Lo que prevé el artículo 12 es que la Mesa informe sobre sus recomendaciones en relación con las solicitudes de los Estados Miembros, lo cual no significa que la Asamblea Mundial de la Salud no pueda pronunciarse sobre una propuesta formal de un Estado Miembro. La aprobación de la Mesa no es una condición para el pronunciamiento de la Asamblea; por lo tanto, señor Presidente, lo que se tiene que poner a votación nominal es la propuesta formal de Nicaragua de que los países que apoyen el otorgamiento del estatuto de Observador a Taiwán voten a favor, los que se oponen voten en contra y los que se abstienen, se abstengan. Así de sencillo, y no a la inversa. Repito, no es de ninguna manera condición la aprobación de la Mesa. Esta Asamblea tiene que decidir. Muchas gracias. I thank the honourable delegate of Nicaragua and now would like to give the floor to the honourable delegate of China. Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 谢谢主席 我再一次发言 注意到这个问题它的题目是审议总务委员会的决定, 所以我觉得法律顾问作出的决定是对的 另外, 如果要对总务委员会的决定进行表决的话, 我建议以唱名方式进行表决 I believe Côte d'ivoire also has a point of order, so I will give the floor to the honourable delegate of Côte d'ivoire. Le Professeur KAKOU GUIKAHUE (Côte d'ivoire): Merci, Monsieur le Président. Excusez-moi, mais nous ne suivons plus la délégation du Nicaragua. Reprenons les faits comme ils se sont passés. Le Président de l'assemblée de la Santé a abordé la question de l'adoption de l'ordre du jour, puis le Nicaragua a pris la parole pour rappeler qu'il avait adressé une lettre à la Direction générale pour apporter un amendement à cet ordre du jour. Comme on n'en parlait pas, il l'a rappelé. Donc je pense que nous sommes en train de discuter de l'ordre du jour et que le Conseiller juridique a tout à fait raison de poser la question comme il la pose. Je ne vois pas pourquoi le Nicaragua reprend la parole. Excusez-moi, mais nous sommes en train d'adopter l'ordre du jour. Le Nicaragua a rappelé une requête qu'il

38 A50/VR/3 page 26 avait adressée à la Direction générale et dont il n'entendait pas parler. Donc le Conseiller juridique a tout à fait raison de poser la question comme il la pose. Je vous remercie. I thank the honourable delegate of Côte d'ivoire. I would like to maintain the position explained by the Legal Counsel. If Nicaragua wants to appeal against that position I would like to give them the floor again. El Sr. ROSALES (Nicaragua): Señor Presidente: Las reglas de procedimiento están claras: están establecidas en el Reglamento Interior de esta magna Asamblea. Repito, en ningún momento esta Asamblea puede supeditar una decisión soberana a lo que pueda o no decidir la Mesa. La Mesa es un órgano restringido de la Asamblea Mundial de la Salud, que es el órgano soberano. Sin embargo, si usted pide, Señor Presidente, a esta magna Asamblea que siga el Consejo del Asesor Jurídico, entonces la Asamblea debe decidir a cuál de las dos propuestas debe concederse prioridad: a la propuesta de la Mesa de la Asamblea o a la propuesta de la delegación de Nicaragua. Eso es lo que tenemos ahora que decidir. Muchas gracias. I thank the honourable delegate of Nicaragua. I believe the honourable delegate of the Netherlands also wishes to speak on a point of order. Ms TERPSTRA (Netherlands): Thank you very much, Mr President. Well I think there is total confusion. I agree with you that we are in the process of adopting the agenda and, as far as I am aware, there is nobody who has asked for a vote so why should there be a vote? I thank the honourable delegate of the Netherlands but, as I said, there are some Members who wish this item to be included as a supplementary agenda item. We must therefore proceed to a vote. I still hold the position that has been explained by the Legal Counsel, so now I would like to put this proposal to the vote. I give the floor once again to the honourable delegate of Nicaragua. El Sr. ROSALES (Nicaragua): Señor Presidente: Creo que estamos dándole vuelta al tarro. Tenemos que aclarar, creo que para bien de todos, cuál es la situación. El Asesor Jurídico pretende que lo que se tiene que votar es la propuesta de la Mesa. La delegación de Nicaragua piensa que lo que se tiene que votar con prioridad es la petición formal que ha hecho hace unos momentos. Como Presidente de la Asamblea, va a tener usted que someter a votación cuál de las dos propuestas tiene que votarse en primer lugar: la de la Mesa o la de Nicaragua, que ha sido apoyada por múltiples delegaciones. Ésa es la decisión que tenemos que tomar ahora; luego, en función de la decisión que tomemos, votaremos sobre la propuesta de la Mesa o la propuesta de Nicaragua. Muchas gracias. I thank the honourable delegate of Nicaragua. I believe the honourable delegate of India also wishes to speak on a point of order,so I would like to give the floor to the honourable delegate of India.

39 A50/VR/3 page 27 Ms GHOSE (India): Thank you very much, Mr President. My delegation would not have wished to take the floor at this point in time, but I think that we are being slightly indisciplined ourselves. The Legal Counsel to the World Health Assembly is the ultimate adviser to the President. All of us may have different interpretations of the rules but when we are in a confusion, when we are in disagreement we rely on the advice of the Legal Counsel which is why he is here. The Legal Counsel has, in fact, advised this Assembly that, in accordance with Rule 12,the recommendation of the General Committee to reject the proposal of Nicaragua should be voted upon. This, to my delegation, is extremely clear. The proposal of Nicaragua was made formally to the Director-General of the World Health Organization. In accordance with the rules, the Director-General forwarded this for consideration to the General Committee. The General Committee considered it and unanimously agreed to reject it. In accordance with the rules, you Mr President brought this decision of the General Committee to the World Health Assembly. In the World Health Assembly, there is disagreement on the unanimous recommendation of the General Committee. Therefore, the vote will have to be on the basis of the General Committee's recommendation, and I think this should be made very clear because I think the issue is getting very confused. The Legal Counsel is our Legal Counsel; he is here to advise the World Health Assembly and to advise you. All of us may have different interpretations, but I do not think we have the right to insist on our individual interpretations. So, Mr President, I hope that my intervention has been of some help. We are quite ready to go ahead with the vote, but I believe that a roll-call vote was called for. Thank you. I thank the honourable delegate of India and now I would like to give the floor again to the Legal Counsel. Mr TOPPING (Legal Counsel): Thank you Mr President. Just to try to clarify things again, in accordance with the advice I gave to the President, the proposal before this Assembly is the recommendation of the General Committee not to include this item as a supplementary agenda item. There was a point of order by Nicaragua challenging that interpretation. The President ruled on that and said that he maintained my interpretation. Now, as matters stand, that is the interpretation that will be applied unless Nicaragua insists on challenging that interpretation, the ruling of the President, and appeals against that ruling. That would then require that that appeal be put to a vote to this Assembly, so therefore, Mr President, you may wish to determine whether the delegate of Nicaragua is prepared to accept your ruling. If not, then we would have to vote on his appeal. Thank you. I would ask the honourable delegate of Nicaragua if he is in agreement with what the Legal Counsel has said and with my interpretation. El Sr. ROSALES (Nicaragua): Señor Presidente: La delegación de Nicaragua sigue pensando que la interpretación del Asesor Jurídico es errónea. Sin embargo, creemos que es importante que esta Asamblea tome ya una decisión al respecto. Nicaragua no va a poner objeciones a la propuesta del Presidente, pero sí quiere dejar constancia de que la interpretación del Asesor Jurídico discrepa de lo que Nicaragua deduce del Reglamento. Muchas gracias. I thank the honourable delegate of Nicaragua. I think the honourable delegate of Jordan wishes to speak on the point of order. I give the floor to the honourable delegate of Jordan.

40 page 28 Dr. KHARABSHEH (Jordan): ^ J ^ ^ ^ \ JLXJ JLAA ^S- jî ЯЬЕЛЗ! JÛAJLP ^alii í JLaipÍ C^^Î^Jl c^jl^ I I^Jit yjl (J^ Á^jlül cejb-lj I thank the honourable delegate of Jordan. Now we can go to the vote. I would like to ask the honourable delegate of China whether he would maintain his request about the roll-call vote, or can we just go for a general vote? I give the floor to the honourable delegate of China. Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 谢谢大会主席 我坚持唱名表决的方式 谢谢 I would like to give the floor again to the Legal Counsel to explain the procedure. Mr TOPPING (Legal Counsel): Thank you, Mr President. There has been a request under Rule 74 of the Rules of Procedure for a rollcall vote. Any delegate may request a roll-call vote and that shall then be taken in the English or French alphabetical order of the names of Members; this year it is in the English alphabetical order. The name of the Member to vote first shall be determined by lot, for which case you should put your hand in the bag to pull out a letter... the letter "D" - Democratic People's Republic of Korea. Therefore the roll-call vote will commence with the Democratic People's Republic of Korea. Each name will be called out and the delegation of the name being called out should indicate "Yes", "No" or "Abstention". "Yes" is in favour of the General Committee's recommendation not to include this item, "No" is against that recommendation. We should then proceed. I believe the honourable delegate of Dominica wishes to speak on a point of order. I will give the floor to the honourable delegate of Dominica. Mrs PAUL (Dominica): Mr President, I would like to seek clarification from Legal Counsel as to whether a proposal for a rollcall vote by any Member is automatic. Previously, the President indicated that we would determine whether we would vote by acclamation or by roll-call. So may we please have some clarification from Legal Counsel? I give the floor again to the Legal Counsel.

41 A50/VR/3 page 29 Mr TOPPING (Legal Counsel): Thank you, Mr President. There has been a request for a role-call vote under Rule 74. A single request is sufficient and therefore that has to be honoured. Once voting has started, only points of order concerning the method of carrying out the vote can be taken, nothing else. A vote was taken by roll-call, the names of the Member States being called in the English alphabetical order, starting with Democratic People's Republic of Korea, the letter n D" having been determined by lot. The result of the result of the vote was as follows: In favour: Afghanistan, Albania, Algeria, Andorra, Angola, Argentina, Australia, Austria, Bahrain, Bangladesh, Barbados, Belgium, Belize, Benin, Bhutan, Bolivia, Botswana, Brazil, Brunei Darussalam, Bulgaria, Cambodia, Cameroon, Canada, Cape Verde, Chile, China, Colombia, Congo, Cook Islands, Côte d'ivoire, Croatia, Cyprus, Czech Republic, Democratic People's Republic of Korea, Denmark, Ecuador, Egypt, Eritrea, Estonia, Ethiopia, Finland, France, Gabon, Germany, Ghana, Greece, Guinea, Hungary, Iceland, India, Indonesia, Islamic Republic of Iran, Ireland, Israel, Italy, Jamaica, Japan, Jordan, Kenya, Kiribati, Kuwait, Lao People's Democratic Republic, Lebanon, Lesotho, Libyan Arab Jamahiriya, Lithuania, Luxembourg, Madagascar, Malaysia, Maldives, Malta, Mauritius, Mexico, Monaco, Mongolia, Morocco, Mozambique, Myanmar, Namibia, Nepal, Netherlands, New Zealand, Nigeria, Niue, Norway, Oman, Pakistan, Papua New Guinea, Peru, Poland, Portugal, Qatar, Republic of Korea, Romania, Russian Federation, Samoa, San Marino, Sao Tome and Principe, Saudi Arabia, Seychelles, Singapore, Slovakia, Slovenia, South Africa, Spain, Sri Lanka, Sudan, Suriname, Sweden, Switzerland, Syrian Arab Republic, Thailand, The Former Yugoslav Republic of Macedonia, Togo, Trinidad and Tobago, Tunisia, Turkey, Uganda, United Arab Emirates, United Kingdom of Great Britain and Northern Ireland, United Republic of Tanzania, Uruguay, Vanuatu, Viet Nam, Yemen, Zaire, Zambia, Zimbabwe. Against: Burkina Faso, Central African Republic, Dominica, El Salvador, Fiji, Gambia, Grenada, Guatemala, Haiti, Honduras, Malawi, Nicaragua, Paraguay, Saint Vincent and the Grenadines, Senegal, Solomon Islands, Swaziland, Tonga, Tuvalu. Abstaining: Bahamas, Costa Rica, Palau, Panama, United States of America. Absent: Belarus, Burundi, Djibouti, Guyana, Mali, Marshall Islands, Federated States of Micronesia, Nauru, Philippines, Rwanda, Saint Kitts and Nevis, Saint Lucia, Sierra Leone, Uzbekistan. The proposal was therefore adopted by 128 votes to 19,with 5 abstentions. Il est procédé à un vote par appel nominal,les noms des Etats Membres étant appelés dans l'ordre alphabétique anglais. Le premier appelé est la République populaire démocratique de Corée (Democratic People's Republic of Korea), la lettre "D" ayant été choisie par tirage au sort. Le résultat du vote est le suivant : Pour : Afghanistan, Afrique du Sud, Albanie, Algérie, Allemagne, Andorre, Angola, Arabie Saoudite, Argentine, Australie, Autriche, Bahreïn, Bangladesh, Barbade, Belgique, Belize, Bénin, Bhoutan, Bolivie, Botswana, Brésil, Brunéi Darussalam, Bulgarie, Cambodge, Cameroun, Canada, Cap-Vert, Chili, Chine, Chypre, Colombie, Congo, Côte d'ivoire, Croatie, Danemark, Egypte, Emirats arabes unis, Equateur, Erythrée, Espagne, Estonie, Ethiopie, Ex-République yougoslave de Macédoine, Fédération de Russie, Finlande, France, Gabon, Ghana, Grèce, Guinée, Hongrie, Iles Cook, Inde, Indonésie, Iran (République islamique d,),irlande, Islande, Israël, Italie, Jamahiriya arabe libyenne, Jamaïque, Japon, Jordanie, Kenya, Kiribati, Koweït, Lesotho, Liban, Lituanie, Luxembourg, Madagascar, Malaisie, Maldives, Malte, Maroc, Maurice, Mexique, Monaco, Mongolie, Mozambique, Myanmar, Namibie, Népal, Nigéria, Nioué,Norvège, Nouvelle-Zélande, Oman, Ouganda, Pakistan, Papouasie-Nouvelle-Guinée, Pays-Bas, Pérou, Pologne, Portugal, Qatar, République arabe syrienne, République de Corée, République démocratique populaire lao, République populaire démocratique de Corée, République tchèque, République-Unie de Tanzanie, Roumanie, Royaume-Uni de Grande-Bretagne et d'irlande du Nord, Saint-Marin, Samoa, Sao Tomé-et-Principe, Seychelles, Singapour, Slovaquie, Slovénie, Soudan, Sri Lanka, Suède, Suisse, Suriname, Thaïlande, Togo, Trinité-et-Tobago, Tunisie, Turquie, Uruguay, Vanuatu, Viet Nam, Yémen, Zaïre, Zambie, Zimbabwe. Contre : Burkina Faso, Dominique, El Salvador, Fidji, Gambie, Grenade, Guatemala, Haïti, Honduras, Iles Salomon,Malawi, Nicaragua, Paraguay, République centrafricaine, Saint-Vincent-et-Grenadines, Sénégal, Swaziland, Tonga, Tuvalu.

42 A50/VR/3 page 30 Abstentions : Bahamas, Costa Rica,Etats-Unis d'amérique, Palaos, Panama. Absents : Bélarus, Burundi, Djibouti, Guyana, Iles Marshall, Mali, Micronésie (Etats fédérés de), Nauru, Ouzbékistan, Philippines, Rwanda, Sainte-Lucie, Saint-Kitts-et-Nevis, Sierra Leone. La proposition est donc adoptée par 128 voix contre 19, avec 5 abstentions. There is a request to speak from the honourable delegate of the Dominican Rèpublic. I give the floor to the honourable delegate of the Dominican Republic. El Dr. VASQUEZ (República Dominicana): Señor Presidente: La República Dominicana no fue llamada a votar. Nuestra votación es: no. Thank you very much, but I would like to give the floor to the Legal Counsel. Mr TOPPING (Legal Counsel): The Dominican Republic was not called because it has lost the right to vote by a decision of the Health Assembly for being in arrears in payment of its contribution. I give the floor to the delegate of the Dominican Republic. El Dr. VAZQUEZ (República Dominicana): Señor Presidente: Tan sólo queríamos aclarar que no sabíamos que se hubiera precisado qué países pueden votar y cuáles no. Quisiéramos saber si se ha votado con ese espíritu y con esa determinación de antemano, porque de lo contrario la República Dominicana reclama que todo lo que se ha hecho es vano, porque habría que saber quién está al día y quién no. The honourable delegate of China is requesting the floor. Is that in explanation of the vote? I give the floor to the honourable delegate of China. Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 谢谢主席先生 在结束了这个投票之后, 我想再讲两句话 第一 非常感谢所有主持正义的国家支持总务委员会的正确决定 这说明, 我们大多数会员国是主持公道的 ; 第二 非常遗憾, 为这个本不该存在的议题耽误了这么长时间 我希望今后不要再出现这样的情况 谢谢主席先生

43 A50/VR/3 page 31 I thank the honourable delegate of China. The recommendation of the General Committee not to include this item is adopted. May I therefore assume that the Assembly agrees to adopt the provisional agenda as amended and with the supplementary agenda item on cloning in human reproduction? Are there any comments? The agenda is adopted as amended. Regarding the programme of work, since the Assembly has agreed to consider the supplementary agenda item on cloning, does the Assembly agree to the proposal that this item be discussed in Committee В after it has completed discussion of item 31 on Tuesday, 13 May in the afternoon? It is so decided. A revision of document A50/1 reflecting the changes will be distributed tomorrow morning. The provisional agenda of the Assembly was prepared by the Executive Board in such a way as to indicate a proposed allocation of items to Committees A and В on the basis of the terms of reference of the main committees. The General Committee has recommended that the items appearing on the agenda of the plenary as amended which have not yet been disposed of be dealt with in plenary. As to the items appearing under the two main committees in the provisional agenda, they should be allocated as shown in document A50/1 Rev.l which will be distributed tomorrow. It is understood that later in the session it may become necessary to transfer items from one committee to the other depending upon each main committee's workload. I take it that the Assembly agrees with this recommendation. It is so decided. 3. ANNOUNCEMENTS COMMUNICATIONS I wish now to make an important announcement concerning the annual election of Members entitled to designate a person to serve on the Executive Board. Rule 101 of the Rules of Procedure reads: At the commencement of each regular session of the Health Assembly the President shall request Members desirous of putting forward suggestions regarding the annual election of those Members to be entitled to designate a person to serve on the Board to place their suggestions before the General Committee. Such suggestions should reach the Chairman of the General Committee not later than forty-eight hours after the President has made the announcement in accordance with this Rule. I therefore invite delegates wishing to put forward suggestions concerning these elections to submit them to the Assistant to the Secretary of the Assembly not later than Wednesday afternoon, 7 May at 16:00,in order to enable the General Committee to meet to draw up its recommendations to the Assembly regarding these elections. For the remainder of this afternoon, in accordance with the decision of the General Committee, the plenary will hear the introductions to items 9 and 10,review of the Executive Board reports and review of The World Health Report 1997, incorporating the Director-General's report on the work of WHO. The programme of work for tomorrow, Tuesday, and for Wednesday will be as follows: on Tuesday, 6 May, the plenary will continue with the debate on items 9 and 10; Committee A will meet concurrently. In the afternoon, the debate on items 9 and 10 will continue in the plenary and Committee В will hold its first meeting. The Committee on Credentials will hold its first meeting at 14:30. On Wednesday, 7 May, in the morning, the plenary will consider the first report of the Committee on Credentials and continue and complete the debate on items 9 and 10; Committee A will meet simultaneously with the debate on items 9 and 10, and Committee В will meet following the conclusion of plenary. In the afternoon, there will be no plenary but both Committees A and В will meet. On Thursday, 8 May, there will be no plenary in the morning, but both Committees A and В will meet and will continue in the afternoon until 17:00, when the plenary will meet to deal with item 13, "Awards" and its subitems. On Friday, 9 May, there will be no plenary meeting. Committees A and В will meet in the morning and afternoon until 17:10,when the General Committee will meet to draw up the list for the annual election of Members entitled to designate a person to serve on the Executive Board and to review the programme for the remainder of the week. Does the Assembly agree with these proposals concerning this programme of work of the Assembly? It is so decided. I would also like to remind the few delegates who have not yet submitted their formal credentials that they should hand them over to the Secretariat of the Credentials Committee in office A.671 in this building before 12:00 tomorrow.

44 A50/VR/3 page REVIEW AND APPROVAL OF THE REPORTS OF THE EXECUTIVE BOARD ON ITS NINETY-EIGHTH AND NINETY-NINTH SESSIONS EXAMEN ET APPROBATION DES RAPPORTS DU CONSEIL EXECUTIF SUR SES QUATRE-VINGT-DIX-HUITIEME ET QUATRE-VINGT-DIX-NEUVIEME SESSIONS We shall now pass on to item 9 of the agenda, "Review and approval of the reports of the Executive Board on its ninety-eighth and ninety-ninth sessions". Before giving the floor to the representative of the Executive Board, I should like to explain briefly the role of the Executive Board representatives at the Health Assembly and of the Board itself, in order to avoid any uncertainty on the part of some delegates on this matter. The Executive Board has an important role to play in the affairs of the Health Assembly. This is quite in keeping with WHO's Constitution, according to which the Board has to give effect to the decisions and policies of the Health Assembly, to act as its executive organ and to advise the Health Assembly on questions referred to it. The Board is also called upon to submit proposals on its own initiative. The Board therefore appoints four members to represent it at the World Health Assembly. The role of the Executive Board representatives is to convey to the Health Assembly, on behalf of the Board, the main issues raised during the discussions and the flavour of the Board's discussion during its consideration of the items which need to be brought to the attention of the Health Assembly, and to explain the rationale and nature of any recommendations made by the Executive Board for the Assembly's consideration. During the debate in the Health Assembly on these items, the Executive Board representatives are also expected to respond to any points raised whenever they feel that a clarification of the position taken by the Board is required. Statements by the Executive Board representatives, speaking as members of the Board appointed to present its views, are therefore to be distinguished from statements of delegates expressing the views of their governments. I have pleasure in giving the floor to the representative of the Executive Board, Mr Ngedup, Chairman of the Board. Mr NGEDUP (representative of the Executive Board): Mr President, Mr Director-General,honourable delegates, Excellencies, ladies and gentlemen, on behalf of my fellow members of the Executive Board, I congratulate you, Mr President and the Vice-Presidents for the confidence that the Assembly has placed in you for directing its work. It is my pleasure as representative of the Executive Board to report on highlights of the work of the Board during its ninety-eighth and ninety-ninth sessions. I am here with three of my colleagues and we would be pleased to respond to any questions you may have on the Board's deliberations. A written statement has been submitted to you in document A50/2. At its ninety-eighth and ninety-ninth sessions, the Board continued its follow-up of WHO reform and response to global change which it had begun at its ninety-third session. It considered reports on the role of WHO country offices and personnel policy and practices. It will keep under review the reforms being made in these important areas. The Board has requested the Director-General to submit to the session following the Health Assembly a draft policy for the twenty-first century for the renewed health-for-all strategy and urged the Director-General to ensure involvement of Member States in the process of preparing this global health policy. The Board also adopted a resolution which recommends to the Health Assembly a resolution linking the renewed health-for-all strategy with the Tenth General Programme of Work, programme budgeting and evaluation. In the context of reform, the Board decided to continue the mandate of the special group on the review of the Constitution of WHO. The Board has also decided to broaden the mandate of the special group to questions relating to WHO's regional arrangements. A progress report is to be made to the Board at its forthcoming session. A meeting of the special group to discuss regional arrangements was held on 3 and 4 April. That meeting agreed that another meeting on the matter should be held at the time of the Health Assembly. This meeting has now been scheduled for 10 May. The Board considered the proposed programme budget for the financial period ,which is submitted to the Health Assembly for review and approval. In connection with this consideration of the proposed programme budget, the Board adopted a resolution on programme budgeting and priority-setting

45 A50/VR/3 page 33 which requests the Director-General to take certain factors regarding budget developing, priority-setting, budgetary savings and multilateral coordination into account for the proposed programme budget for and future biennial budgets. The Board also adopted a resolution on WHO collaborating centres which recommends to the Health Assembly a resolution aimed at better utilization and promotion of WHO collaborating centres. The Board considered seven progress reports on technical matters submitted as requested by previous resolutions and decisions. Five of these reports are forwarded to the Health Assembly for consideration; they concern, prevention of violence, reorientation of medical education and medical practice, reproductive health, tobacco or health, and HIV/AIDS and sexually transmitted diseases. In addition, the Board adopted resolutions on guidelines on the WHO Certification Scheme on Quality of Pharmaceutical Products moving in International Commerce, the quality of biological products moving in international commerce, and World Tobacco Day. Reports on these matters are also forwarded to the Health Assembly. The Board adopted four resolutions on control of tropical diseases, recommending resolutions to the Health Assembly dealing with lymphatic filariasis, malaria, dracunculiasis and African trypanosomiasis. The Board adopted two resolutions relating to collaboration within the United Nations and with other intergovernmental organizations. It approved the proposal that the Executive Board of UNFPA be invited to join an expanded UNICEF/WHO Joint Committee on Health Policy to be named the WHO/UNICEF/UNFPA Coordinating Committee on Health. It also adopted a resolution on persistent organic pollutants in response to a request from the UNEP Governing Council. This resolution and the resolution on protection of the marine environment are being forwarded to the Health Assembly. Under personnel matters, the Board adopted resolutions on geographical representation and employment and participation of women in the work of WHO, both of which recommend resolutions to the Health Assembly. Finally, having reviewed a report on the method of work of the Health Assembly, the Board adopted a resolution recommending to the Health Assembly a resolution revising certain aspects of its method of work. The resolution is designed to make it possible to achieve savings through a rationalization of the Assembly's work. I should like to express the appreciation of the Board at having the opportunity to present this report to the Assembly. Thank you Mr Ngedup for your excellent statement. I should like to take this opportunity of paying a tribute to the work of the Executive Board and, in particular, to express our appreciation and our warm thanks to the outgoing members who have contributed very actively to the work of the Board. 5 - REVIEW OF THE WORLD HEALTH REPORT 1997 EXAMEN DU RAPPORT SUR LA SANTE DANS LE MONDE, 1997 I give the floor to Dr Nakajima, Director-General so that he may present, under item 10 of the agenda lhe World health re P ort, incorporating his report on the work of WHO. Dr Nakajima you have the floor.' The DIRECTOR-GENERAL: Mr President, excellencies, honourable delegates, ladies and gentlemen, last month, on World Health Day, WHO called on its Member States and all other partners in health to mobilize an effective response to the global threat of infectious diseases. Two weeks ago, the Scientific and Ethical Review Group of the WHO-based Special Programme on Human Reproduction reviewed the issue of cloning and its potential risks and benefits for human beings. Today, with its 1997 issue of The world health report, WHO is providing the public health community with a sharp analysis of the emerging epidemiological transition and its dramatic implications for human well-being.

46 page 34 These are just three examples of WHO's day-to-day activities but they give some idea of the range of our responsibilities. These responsibilities derive from the obligation placed upon us by our Constitution to direct and coordinate international health work so that all the people of our Member States can have equitable access to health. In 1995 our first issue of The world health report highlighted the gaps in health between the rich and the poor. It stressed the need to reassess the health situation and its determinants, and to rethink our healthfor-all strategy so that new policies and partnerships could be defined that would enable us to bridge these gaps. In this spirit, we have undertaken a worldwide consultation, with all interested partners, to explore the biomedical, social, institutional and economic approaches that can help us to further the equitable development of health globally in the years to come. The 1996 issue of The world health report alerted the international community to the continuing threat of infectious diseases. It gave an overview of the premature death and disability they cause,as well as the huge losses in trade and economic development. It also reviewed some of the main factors that account for the re-emergence of infectious diseases. These include economic and ecological changes, new industrial practices, increased movement of goods and populations, inadequate water and sanitation systems, and, equally importantly, inadequate health infrastructure. WHO has always been at the forefront in the fight against infectious diseases. In recent years, we have intensified our prevention and control activities against these diseases, which kill about 17 million people each year and disable many millions more, a large proportion of whom live in developing countries. The special campaigns for the eradication of poliomyelitis and dracunculiasis and the elimination of leprosy, Chagas disease and other diseases have made very encouraging progress. Some countries and even some regions have already reached their goals, others are approaching the certification stage, and others are in the surveillance phase. The formidable effort currently being deployed by Africa, led by heads of state, to achieve universal immunization against polio is a remarkable contribution to global health development and deserves our full support. Tuberculosis, malaria and HIV/AIDS are major causes of suffering and death in the world today. They involve many difficult biomedical, social and economic challenges. The fact that we now have a new and effective strategy for controlling one of them, tuberculosis, has been hailed as an important public health breakthrough. The strategy has been developed and tested extensively in different countries by the programme set up in 1993 in WHO to stimulate a global effort to control tuberculosis. "DOTS" (Directly Observed Treatment Short Course) is not only curing patients but also helping to contain the risk of drug resistance. The recent development of antiretrovirals used in triple therapies against HIV/AIDS is also a remarkable achievement and a source of hope for people living with AIDS. Many questions remain unanswered,however, about long-term effectiveness and side-effects, and just as importantly about the accessibility of the treatment to so many people in the world who urgently need it. These are technical and ethical issues to which WHO is particularly alert and on which we held a special consultation just last week. Efforts continue to promote integrated community-based strategies for malaria control and to find more effective technologies for prevention and treatment. WHO's activities in the area of global surveillance and control of infectious diseases have included the coordination of emergency response to epidemic outbreaks such as dengue haemorrhagic fever, Ebola, cholera, meningitis, dysentery and yellow fever. Some of our interventions have been in complex emergency situations, to ensure technical support for humanitarian assistance to refugees and displaced populations. We have paid particular attention to networks for the surveillance of diseases and antimicrobial resistance and have supported capacity-building for this at country level. We have continued our work for standard-setting on drugs, biologicals and medical devices. The revision of the International Health Regulations is in progress and will provide us with an updated and more flexible instrument to respond more effectively to the health requirements of the new social and economic global environment. The emergence of spongiform encephalopathies and their possible cross-species transmission, the outbreaks of Ebola haemorrhagic fever, and the recent epidemics of food poisoning caused by E.Coli 0157 have required us to respond quickly to the changing nature of public health. WHO has maintained close contact with the relevant experts and organized consultations as necessary to monitor the situation and provide advice on the various issues involved. These are issues that show the complex links between health policies and industrial, technological and economic policies, and the need for ways to manage and regulate them. They also show that better use must be made of epidemiology to anticipate future trends and health needs. This is what The world health report 1997 attempts to do, concentrating on chronic conditions, disability and ill-health caused by noncommunicable diseases. These diseases, which include cancer, diabetes,

47 page 35 and cardiovascular diseases, cause more than 24 million deaths a year and a vast range of disabilities. They appear later in life but are the result of long years of exposure to behavioural and environmental risk factors. Between 1990 and 1995, the number of people in the world aged 65 and above increased by 14%. In the coming 25 years, it will increase by another 82% globally - more than 100% in the developing countries and about 40% in the developed countries. This calls for major changes in the organization of health services. In 1996,more than 15 million deaths and a much larger number of cases of severe disablement were caused by circulatory problems such as heart disease and stroke. Of these deaths, approximately 64% occurred in developing countries and 15% in countries in economic transition. In 1996 cancer caused 6 million deaths, of which 4 million occurred in developing countries. More than 10 million new cases appeared globally, of which nearly 60% were in developing countries. Cancer patients and their families and friends endure a particularly heavy burden of anxiety and suffering. Conditions and effectiveness of treatment are gradually improving, however, and many types of cancer are both preventable and curable. Lung cancer causes about one million deaths a year, most of which are preventable since 85% of the cases in men and 46% of those in women are caused by smoking. It is estimated that no fewer than 135 million people in the world are suffering from diabetes and this number is expected to double in the next 25 years. Diabetes can seriously restrict people's autonomy and lead to complications such as heart disease, renal failure, gangrene, and blindness. Major risk factors for chronic diseases are improper diet, physical inactivity and smoking. Although more research needs to be done to elucidate the genetic and lifestyle-related factors as well as the infectious agents involved in these conditions, preventive action can already be taken. We have promoted several multicentre, multicountry projects, such as INTERHEALTH on noncommunicable diseases, through the WHO Collaborating Centres, working with national institutions, professional associations and private foundations. The chronic conditions dealt with include asthma (in the GEMA project), diabetes (DIABCARE), cardiovascular diseases (CARMEN), circulatory diseases (MONICA) and nicotine dependence (CINDI). Within these projects WHO has coordinated epidemiological studies, set up global computerized databases, and developed and disseminated protocols for prevention, treatment and rehabilitation. We have supported health worker training and health education and promotion strategies in these areas. We are carrying out similar work in the areas of rheumatology, oral health and hereditary diseases such as thalassaemia, sickle cell disorder, haemophilia and cystic fibrosis. The WHO International Agency for Research on Cancer, in Lyons, deals with all cancer-related research issues, including epidemiology. It works in close collaboration with our Geneva-based programmes, in particular those dealing with occupational health, environmental health and chemical safety. Other chronic conditions requiring urgent attention include blindness, mental disorders and substance abuse. Nearly 45 million people in the world are blind. Most of this blindness is treatable or preventable, but persists for want of access to affordable eye care. In close partnership with nongovernmental organizations, we have been particularly active in promoting prevention, treatment and rehabilitation for conditions such as trachoma and cataract. After successful completion of the onchocerciasis control programme in 11 African countries, co-sponsored control activities have been undertaken in other countries where this disease is endemic. Mental and neurological disorders affect hundreds of millions of people. In many countries, drugs to treat conditions such as epilepsy and schizophrenia are not available. Age-related forms of dementia such as Alzheimer's disease are becoming more common worldwide. The serious challenges ahead include improving mental health at the primary health care level, as well as providing neuropsychiatrie care, essential drugs and essential psychosocial interventions. In this area, in 1996, WHO produced guidelines on primary prevention, essential treatments, and basic principles relating to patients' rights. It also supported the development of a major intersectoral initiative called "Nations for Mental Health". Substance abuse is growing,starting earlier in life, and shifting to new products such as amphetamines. These trends are particularly worrying because of their links with organized crime, and because of the selfinflicted and interpersonal violence to which substance abuse often leads. Drug injection is becoming increasingly common, with the additional risk of spreading HIV/AIDS, hepatitis В and C, and other bloodborne infections. All of this represents new and heavy demands on the health system. And it is not just a matter, when setting priorities, of choosing between noncommunicable and infectious disease programmes, for the two are not always separable. For example, in addition to specific genetic factors, some infectious agents have been shown to be associated with the etiology of chronic diseases, such as Helicobacter pylori in the case of

48 A50/VR/3 page 36 stomach cancer. These diseases also share common risk factors related to lifestyles and the environment. In all cases, prevention is urgently needed. Prevention must be fully recognized as the guiding principle of public health policy. In the long run, it is the only way to achieve cost containment and to reduce the incidence of diseases and the harm they do to individuals and societies. The current worldwide effort to rethink health systems will only succeed if it takes this approach to the so-called "double burden" of infectious and noncommunicable diseases. In doing this our concern is to increase not only life expectancy but disability-free health expectancy. WHO, its staff, its programmes and its administration, are ready to support the new effort required to promote this inclusive approach to health development. We have organized various consultations on issues such as the reorientation of medical education and practice, health system development, essential public health functions, human resources for health, nursing and midwifery services, community health care, traditional medicine, social security and sustainable funding, and new approaches to care. All these issues are central to the policies and activities that must be brought in to support the new health-for-all strategy that our Member States will finalize and adopt in The thorough reform process I have been conducting for the past four years has helped to shape a streamlined, more flexible and more focused Organization. The outcome is enhanced effectiveness and accountability. Within this reform process, the organizing principle has been to redefine structures according to the functions and activities to be carried out. Programmes have been redesigned to encourage the sharing of expertise and avoid duplication. The availability of a clear statement of each programme's functions will facilitate both the definition and the evaluation of its priorities, planned activities, goals and targets. This improves management through closer budgetary and operational monitoring. The reform has also improved coordination and consultation among the regions. Decentralization to the national level has been enhanced by the clarification and strengthening of the role of WHO representatives. Greater flexibility and delegation of authority contribute to enhancing people's sense of responsibility and initiative at all levels of the Organization. This has gone together with the revision of our administrative, financial and personnel procedures and policies to ensure transparency and quality of performance. The development of our Management Information System will play a crucial role in ensuring communication between all our offices and our Member States. At this session, the Health Assembly will consider the proposed programme budget for For the second time, this document is organized as a strategic planning tool. In preparing it we have greatly benefited from the collaboration of the Executive Board and its Programme Development Committee, and its Administrative, Budget and Finance Committee. This is a transitional programme budget in that it reflects current priorities and at the same time prepares for our activities under the Tenth General Programme of Work as they will develop in the twentyfirst century. This programme budget follows our administrative and programme structures as they have been redesigned at all levels of the Organization to respond to global change. Subject to our statutory obligations within the United Nations system we have made every effort to contain costs, and thanks to the dedication of our staff we have continued to work efficiently while doing this. I wish to stress, however, that the Organization has to have sufficient resources to be fully operational and effective. It will be the responsibility of this Health Assembly to provide the Organization with the means to fulfil its mission. WHO's reform must be seen as a continuous process. Changes are taking place at an accelerated pace in the world, and health sector reform is still under way in most countries. The ongoing consultation on the renewal of WHO's health-for-all strategy has helped us and our Member States to assess jointly the Organization's role in promoting health development globally. To advance our goal of health for all, WHO has had to carry out tasks which can be grouped under three main headings: information, normative activities, and technical support. This broad categorization helps to highlight the main areas of need that are common to our Member States. It also helps us to ascertain what benefits Member States feel they can obtain from our activities and expertise, and what comparative advantage they see in WHO. Information must be understood here as consisting not only of the collection and dissemination of data but also of a careful process of validation and analysis. The tracking of epidemiological trends, the definition and monitoring of health indicators and determinants, as well as the worldwide exchange of knowledge based on science and experience, are all part of WHO's information function. WHO's role in the area of research must be seen in this light: it must stimulate and guide scientific work by providing information on actual public health needs, and help countries make practical use of the relevant knowledge and technology. Through advocacy for health, WHO must also alert policy-makers and the general public to health problems and opportunities.

49 A50/VR/3 page 37 WHO's normative activities include the definition and harmonization of technical and ethical standards and, less stringently, guiding principles on health policies, products and practices. In view of the accelerated development of biomedical and information technology, it is particularly important that we should define technical and ethical standards which protect the health and dignity of human beings. This has always been a core concern of our programmes, as illustrated by their work in areas such as reproductive health, quality and accessibility of drugs, disability, genetic disorders, clinical research and organ transplants. The universal membership of our Organization, and its close familiarity with conditions in the field, place it in a unique position to facilitate national and regional debate on such matters, so that a meaningful consensus can be reached at global level. The emergence of new diseases and the growing pressure of industrial and trade policies make such consensus indispensable. Our responsibility towards our Member States and their people, however, does not end with the production of information, standards and strategies. All these must be tested in the field to evaluate their usefulness and undertake revisions where needed. We must be ready to provide technical advice and support to the countries that lack the necessary resources, structures and experience. Our task is then to help them adapt health policies, monitor outcomes, and build up their own capacity. The demand from our Member States has been particularly pressing not only for disease control and prevention but also in areas such as family health, ageing, drug policies, human resources and health system development. In this regard, one of our essential tasks is to act as a catalyst for technical cooperation, especially among developing countries. In 1998,we will celebrate WHO's fiftieth anniversary. At that time, you will adopt a New Health Charter that sets out the principles of health development and international cooperation in the twenty-first century. In doing this, you will express your own vision of WHO and clarify the functions and partnerships through which you consider that the Organization can best fulfil its role in the future. Mr President, distinguished delegates, as this Assembly reviews the Organization's achievements and addresses its long-term perspectives, particularly the health-for-all strategy for the twenty-first century, I remind you that a nomination and selection process for new leadership of WHO will commence in approximately two months' time. Under new procedures, the 32 members of the Executive Board and all 191 Member States will be invited to nominate candidates. Next January the Executive Board will nominate a new Director-General who will be considered by the Fifty-first World Health Assembly for appointment to a term beginning 21 July The specific criteria for candidates to be considered by the Executive Board for the post of Director- General are set out in Executive Board resolution EB97.R10, supplemented by World Health Assembly resolution WHA49.7. In addition, I believe that the next Director-General should be committed to the renewed health-for-all strategy and to the achievement of its goals, particularly universal access to primary health care based on equity and social justice. I further believe that this person should be widely experienced in and sympathetic to the many and varied health cultures and value systems in the world, and should be able to incorporate them harmoniously into every WHO programme and activity. The next Director-General must also be committed to WHO's reform as a continuous process in the light of a changing world political, economic and social situation. I have been fortunate in that, throughout the two terms of office which I have served as Director- General, many people have steadfastly supported my efforts to make this Organization more effective and responsive to the changing needs of the governments and the peoples of all its Member States. Many of the things I set out to accomplish have been or are being realized, especially in our main mission of fighting against diseases and for the well-being of people, but also in preparing renewed health-for-all policies for the next century and in the first thorough reform of WHO in its fifty-year history. WHO deserves a smooth leadership transition which will continue the ongoing reform at all levels without disruption or discontinuity. I have decided not to stand in the way of a new generation which seeks to lead this Organization and have taken the decision not to seek another term with only the best interests of the Organization and its Member States in mind. More than one year remains of my last term, a crucial year for WHO and its Member States in preparing for a twenty-first century which will put people and their health at the centre of global development. Mr President, distinguished delegates, as you prepare to renew WHO's strategy and leadership, you will also want to reflect on the unchanging mission of the Organization and the values that guided its creation. WHO was entrusted half a century ago with the mission of laying the foundations of peace and security through international cooperation for health development. WHO's founders believed that sustainable peace would be achieved when people learned to live and work together and when prosperity and security could be shared by all. Our founders were also convinced of the equal worth and dignity of all human beings.

50 A50/VR/3 page 38 They viewed health as a basic need and a universal right which all people should be able to enjoy in order to develop their potential to the fullest. The World Health Organization deeply identifies with the values of justice, solidarity and mutual respect which our Constitution upholds. They are the values that guide our efforts to achieve health for all with the participation of all. Thank you, Dr Nakajima, for your eloquent words. We will now adjourn and we will start with the honourable delegates who will speak on items 9 and 10 of the agenda tomorrow at 9:00. The meeting is adjourned. The meeting rose at 17:45. La séance est levée à 17h45.

51 A50/VR/2 page 39 FOURTH PLENARY MEETING Tuesday, 6 May 1997, at 9:00 President: Mr Saleem I. SHERVANI (India) later: Mr S. ELEGHMARY (Libyan Arab Jamahiriya) Dr ZHANG WENKANG (China) QUATRIEME SEANCE PLENIERE Mardi 6 mai 1997, 9 heures President: M. Saleem I. SHERVANI (Inde) puis: M. S. ELEGHMARY (Jamahiriya arabe libyenne) Dr ZHANG WENKANG (Chine) DEBATE ON THE REPORTS OF THE EXECUTIVE BOARD ON ITS NINETY-EIGHTH AND NINETY-NINTH SESSIONS AND ON THE WORLD HEALTH REPORT 1997 DEBAT SUR LES RAPPORTS DU CONSEIL EXECUTIF SUR SES QUATRE-VINGT-DIX- HUITIEME ET QUATRE-VINGT-DIX-NEUVIEME SESSIONS ET SUR LE RAPPORT SUR LA SANTE DANS LE MONDE, 1997 Mr S. Eleghmary (Libyan Arab Jamahiriya), Vice-President, took the presidential chair. M. S. Eleghmary (Jamahiriya arabe libyenne), Vice-Président, assume la présidence. The PRESIDENT ÛJLa Jiùî Ji Jjîr (JyfáJ ijjjj^ ^J) 丨 J f) V-W-^1 b«jlîjl;»> J cj^il J ^ iy ijijli jljis ИлЬ Л ùlaisll Jl -LPÎ ûî ijî.j 气 jjoji ijjb ÎJU ûî JJ Js^ l^uijl» f y ùî tijudl ^JsxJl j jjjljlç$ y» (JbJl ^ Â^aJL ^büi iiïlu ^ ÂTjU^JI ûî ijj ijj»jjl L.Î.Lf^L- tljo^j- ^ 3.«uJl Ai ijj]\ Vrjiy U/" Jjjliiil aiixijl JiUuJl I_gJrljj^ ^JUoJl IÁA ^ji i;jjjlïj çjjâjil)t Lj^^j Âj^wJl 1咨 'Jb?.,t.iî ou-л. jj \ UJLp S^x^^Jl m t s ^ J 1 1^ J^ ^ (jjlùdl ^-Jbs-Jl JLS'Jj rjv ^o^jlja -Y ôjb^^jl elül ^ O Î U4Î )jî j^j-i ^jx^xsj ^ ^ j buaijl ^Js- ÛîluJl y^y <_jl ^jj ^LJÜI ^pjjk >\ LJ_sb^Lsi- 广 â^e-x» Âj^JbJl ^Twajl к^ялл- ^ i^lxjl iwjujl ÂjjLJl Jf>\yS \ (_ s ip jjía] ИJ\ eulicjl J^S j dlji cixi m ^ ^ d\ ^i ^ ^ JP of üílujl ^ ÁTjLi^Jl J, ^ ij»^ СУ,j>r 力 blj. Д./i:.»il ^íp Í»jL» Jjj^^JI tjjáj^jli L^j ^J^" ill-ub jí ^sbl^-jl e^uilj^o dj^ur ÛLo c c J \ y C^JLAJ L)Î j^í ^^-AjJ^l^Ji 4«iii ^ JjJ-^Jl ^JJ ^ьмо Ubji ^yu^s tbbjlajl c-->jjluji ^ c^»jl^* ^JJ 1 y j ^-Jl 0jJjJLuJl Ô^LJl e^jb^ó 尸 j.o^jijuji j AJ-o-P ^W^JJ ^a^iji ^ J Ü I V 4 1 Л Г çun ^ujl J\ V ^ UlT dli

52 A50/VR/3 page 40 MÎ J-4 ai 4jL j-o^b^ujl ô^ljl J^^ Vuj LAzJS' ^IaJI ojj^ P^i ^Jbî*^ vl-o- ^ujl V < S J \ ^ U Ü (^SУ Jij.J5ÜJ j^^uls' Jl ^-fùî jî J^ (iu^u JjSl a^isol OÎ JJj.ИлЛ aj-ül ^ 产 Sn û, Jl ÍÁ^I) ^jjl fu-l" oí tas_íi íi! jjjb^ujl fru-î 丨 J_s olii» 01J t^o^ijl i^îli L.UJ ^Ijii^l 'Ц W^Jl j-jui J 尸 j.^,-ujl - ÎJb^uil js> Jjj^Jl odi^j] ôuil Â^UJl frbl jtâsîwji ^î opl^. ^^ЛГ ^ oí JJ OU^ IJJ^UU oî ^i Oiiil j-ujl ùi jîj.soi^jl ^ jjjb^jl.âjo^sij CJ^M^ji g:» W J^j IjJiaj ùi ùb L-vA J 产 *L5 ^^ J jî ^rt-ujl jj-ua^ii yoij.j 气 ù ^ ^ j b vb J.L^^J^ jjluj 3-<JS0l j^k^î. Lii'j js' ЬJJjw El Dr. VALENCIA (Colombia): Señor Presidente de la 50 a Asamblea Mundial de la Salud, señores Ministros de Salud, señores miembros de las delegaciones a la Asamblea, señor Director General de la OMS, señores funcionarios de la OMS, señores miembros del Cuerpo Diplomático, señores observadores en la Asamblea, señoras y señores: Asumo como un gran honor para mí y para mi país el hecho de inaugurar las intervenciones de los Ministros de Salud en esta importante Asamblea. Aprovecharé esta oportunidad para presentar a ustedes algunas ideas que espero puedan contribuir a las deliberaciones que realizaremos, así como a las conclusiones a que se llegue para bien de la salud de las gentes de todo el mundo. Para comenzar, presento a todos ustedes un saludo cordial del señor Presidente de Colombia, Dr. Ernesto Samper, saludo que es el de todos los colombianos y que hago extensivo a los pueblos aquí representados. La esencia de mi mensaje en esta Asamblea es un llamado a la reconsideración de ciertos patrones tradicionales del sector salud, una respetuosa invitación al cambio. Traigo de mi país experiencias constructivas que estoy seguro generarán grandes esperanzas. Desde enero de 1995 entró en vigencia en Colombia una ley que significa la transformación radical y muy ambiciosa de la financiación y prestación de los servicios de salud. En esencia, tal disposición pone en vigencia un seguro nacional de salud que se financia a través de impuestos a la nómina y contribuciones de los ciudadanos con capacidad de pago y por impuestos generales que subsidian la afiliación de los pobres. Este mecanismo de seguro busca una cobertura universal y el acceso equitativo a un plan de servicios claramente definidos. El proceso de cambio generado por la vigencia de esa ley ha sido bastante rápido y muy dinámico. Comienzan ya a evidenciarse resultados que desafían la postura de los más escépticos. En los últimos tres años, la cobertura del aseguramiento en salud en Colombia ha pasado del 22% al 60% de la población. Por primera vez en la historia de nuestro país, seis millones de pobres disfrutan de un seguro de salud en el cual cada jefe de familia puede elegir a la entidad aseguradora y puede elegir entre un grupo de proveedores de servicios que ella le ofrece. El Ministerio de Salud ha asumido el rol de formulador de políticas. Gente con disciplina profesional y destrezas que antes se consideraban ajenas al manejo del sector salud han comenzado a analizar los problemas de la salud y de sus servicios desde ópticas novedosas, que aportan útiles elementos de juicio en la conducción de los programas sectoriales. Ha sido un proceso difícil y está lejos de ser un hecho consolidado. En realidad, nos hemos visto abocados a dificultades grandes. Una posición bastante prevalente ha sido la de jugar al fracaso prematuro del modelo con la esperanza de volver por los viejos fueros. Esta postura se ha ido debilitando de manera progresiva ante demostraciones evidentes en el sentido de que jugando con las nuevas reglas se pueden solucionar problemas considerados insolubles. No quiero venderles un modelo a ustedes. Es más, quiero dejar ante este auditorio mi oposición y la de todos los técnicos de mi equipo ministerial a que ante ciertos éxitos precoces de la experiencia de Colombia se inicien acciones para exportarla y transplantarla a otros países. Lo que sí quiero es resaltar la necesidad de acometer un cambio en el sector salud. En la perspectiva global, un hecho importante para sustentar una reforma al sector salud proviene de retos como los que se plantean con muy preocupantes cifras y perspectivas en el Informe sobre la salud en el mundo 1997, al cual se refirió ayer el señor Director de la Organización Mundial de la Salud, Dr. Nakajima. A los problemas que todavía están lejos de resolverse y que se asocian de modo directo con la pobreza y la inequidad se han sumado rápidamente los de las patologías y dolencias crónicas con alto contenido de sufrimiento y discapacidad frente a un escaso y casi siempre costoso acervo de medios para prevenirlas, controlarlas y curarlas. Estoy convencido de que los sistemas tradicionales de financiación, organización y provisión de servicios de salud se quedan cortos frente a estos retos. No estoy seguro de que los enfoques que se están

53 page 41 ensayando en algunos países sean la respuesta apropiada. Sin embargo, estoy convencido de que es preciso innovar y buscar respuestas, pues no es posible aplazarlas en la indefinición. La experiencia que antecede, así como las ideas que he esbozado han impulsado a Colombia, que en este momento preside el Grupo de Países No Alineados, a proponer dentro del Grupo una serie de ideas y de acciones para apoyar la reforma. Para terminar con mi llamado al cambio quiero, de la forma más respetuosa y cordial, afirmar que no sólo se requiere cambio en el interior de los países. Se requiere también transformación en los organismos internacionales y por parte de las entidades multilaterales. En esta Asamblea quiero referirme en forma específica a la OMS. Comenzaré reconociendo la acción valiosa, y en muchas ocasiones definitiva, que ha ejercido la Organización frente a los múltiples problemas que afronta la salud. Quiero invitar a mis colegas de todo el mundo, en especial a los Miembros de los países no alineados y a los dignatarios de la OMS, a que intensifiquen las actividades en beneficio de la anhelada transformación. No intento formular soluciones específicas. Eso es parte del orden del día de deliberaciones. Quiero, apenas haciendo gala de un poco de audacia, sugerir algunas ideas generales. Creo que debería cambiarse la concepción de la planificación a largo plazo por una visión y acción estratégicas que tengan una gran sensibilidad hacia problemas y situaciones específicas en los países y en ciertos grupos de población. Es mi opinión que, para lograr los anteriores rasgos, en la Organización se requieren mecanismos que presionen un espíritu de renovación y cambio dentro de su cultura. El cambio de mentalidad entre los funcionarios de la Organización sería el elemento sine qua non para lograr lo propuesto. Señor Presidente, señores delegados: Quiero agradecer su amable atención y desearles a todos que el trabajo que hoy comienza rinda frutos en la consecución de objetivos que estoy convencido son comunes a todos nosotros. Mr MULINGE (Kenya): Mr President, Mr Director-General, distinguished delegates, ladies and gentlemen, I wish to congratulate the President and his bureau on their election to steer the Fiftieth World Health Assembly. I would also like to congratulate the Director-General and his Secretariat for the World health report 1997, entitled Conquering suffering, enriching humanity. This report is particularly relevant to Kenya and indeed to the whole African Region, where for the last few years, we have had a period of severe drought. This has left many families suffering, famine-stricken and vulnerable to infectious diseases. We are grateful to all the friendly countries and international agencies which came to our assistance during the difficult time, and we continue to appeal for further support. Mr President, last year, we joined the world health community in the accelerated effort to eradicate polio. National immunization days were held throughout the country in August and September I am pleased to report that this effort was very successful, with 80% of all children under five years being immunized. The same event will be repeated this year, and we hope to achieve even greater success. Allow me to express our appreciation to Rotary International, USAID, WHO, UNICEF, JICA and all agencies which assisted us in this effort. AIDS and tuberculosis cases have also continued to increase, despite well coordinated prevention and control programmes. AIDS cases increased by while there were 7000 additional cases of tuberculosis compared to the previous year. During the year, we have initiated an integrated programme of dealing with AIDS and tuberculosis by sharing and targeting the available resources. Mr President, ladies and gentlemen, I wish briefly to touch on the issue of regional conflicts, as this has severe adverse effects on the health of the population. The last year has been a particularly difficult one for the Great Lakes region. Leaders in the region have been involved in joint efforts to resolve the regional conflict and civil strife in the affected countries. In this context, I am glad to report that several summits were held in Nairobi, Kenya, chaired by His Excellency, President Daniel Arap Moi and attended by Heads of State from the Region. These efforts will continue under the umbrella of the Organization of African Unity and in collaboration with the United Nations. I take this opportunity to plead to the world community to assist those who have been displaced and who are suffering as a result of the prevailing situation. In the area of health policy Kenya has been at the forefront in the implementation of health sector reforms. A major dimension already in place has been the restructuring and reorganization of the sector towards a decentralized system. This includes creating an enabling environment for nongovernmental organizations and the private sector to offer more and better health care services. I wish to state that the Kenya Government is firmly committed to the reforms that are aimed at improving the health status of all people.

54 A50/VR/3 page 42 Mr President, our emphasis in the primary health care approach has continued. This includes areas such as safe motherhood, maternal and child health care, control and prevention of communicable diseases such as malaria and respiratory infections, mental and oral health care. We are also focusing on substance abuse and prevention of injuries, especially due to road traffic accidents. In conclusion, Mr President, distinguished guests, delegates, ladies and gentlemen, we in Kenya would like to join the world health community in enhancing and promoting good health. In this way the theme of The world health report 1997, Conquering suffering, enriching humanity, will become real. Dr MARANDI (Islamic Republic of Iran): In the Name of God, the Compassionate, the Merciful: Mr President, Mr Director-General, Excellencies, ladies and gentlemen, at the outset I would like to congratulate the President and Vice-Presidents on their election and to express my appreciation to the Director-General for his excellent report. A review of the fifty years' performance of the World Health Organization shows remarkable success in physical aspects of health, but we have not been as successful in mental, social and, particularly, spiritual aspects. Health should not be considered as an ultimate goal in itself but only a preliminary step on the path that may lead to the final goal of spiritual ennoblement. The theme of the Health Assembly this year, Conquering suffering, enriching humanity, confirms that comprehensive promotion of health is accomplished only when it leads to the enrichment of humanity. This is also in line with the established definition of health as the promotion of physical, mental and social wellbeing, which collectively enables man to walk in the path of virtue. The objective of conquering suffering is feasible only when comprehensive health care is available everywhere, for everyone without discrimination; and when health personnel are committed to human values. In the Islamic Republic of Iran, in accordance with our religious values and our Constitution, we have been able to minimize discrimination in our health care system. At the present time 85% of our rural and 100% of our urban population have access to primary health care. In the third evaluation report on the implementation of health-for-all strategies, the health indicators show minimum disparity between men and women as well as between urban and rural population, and in some cases even better records for villagers. Our advances in various fields of health we owe, at least in part, to the experience we have gained from others; we in turn are prepared to share this experience with those who are interested. Currently we are preparing the 25-year socioeconomic and cultural development plan in my country. Abiding by the Islamic teaching, we are emphasizing the spiritual aspect of health and the equitable provision of health care in this plan, which provides healthy lifestyle and reduces mental stress. Before concluding, I would like to point out three main issues: First, despite the socioeconomic consequences and burden of noncommunicable diseases, the hazards of communicable diseases should not be ignored. Emerging and re-emerging infectious diseases are a real concern. Negligence in this regard could cause a worldwide catastrophe. Secondly, conquering suffering requires, above all, full and extensive cooperation at the international level. There is no "friend or foe" in this area. The sole enemy is disease, and we should all join hands to confront it. Assistance from developed States is a necessity. But more essential is the need to eliminate the existing restriction on the transfer of material, equipment and technology under various pretexts. Removal of this barrier will immensely enhance the capacity and capability of developing States and their potential for contributing to others. Thirdly, in order to materialize the annual themes of the Health Assembly, I would like to recommend that a plan of action be prepared for future slogans, and that all delegations report their performances regarding the themes to the succeeding sessions. In conclusion, Mr President, I would like to call for closer collaboration among the Member States regarding promotion of health for all, and reiterate that as long as in any corner of the world one human being is not enjoying a healthy life our conscience should not be at rest. May God bless our efforts to serve humanity. Professor SUJUDI (Indonesia): Mr President, Mr Director-General, distinguished delegates, ladies and gentlemen, first of all, I would like to congratulate the newly-appointed office-bearers of this Assembly. It is indeed a great honour for me to have this opportunity to share my views with you about Conquering suffering, enriching humanity.

55 A50/VR/3 page 43 Over the last two decades, the health status of the world's population has improved, and life expectancy has risen rapidly in the developed countries. However, beneath the encouraging facts and many other unquestionable advances lie unacceptable disparities in health. For most of the people in the world today every step in life, from infancy to old age,is taken under the twin shadows of poverty and inequity. Widening gaps in health status are developing, not just between regions and countries, but also between whole groups within the populations of those countries. As a consequence, health trends vary from place to place. While in most developing countries,like the Asian countries, most of the people have been prone mainly to communicable diseases, they are now increasingly affected by noncommunicable diseases. This condition is being vastly aggravated by the new, emerging and re-emerging infectious diseases. Thus a double burden of ill-health is plaguing the developing countries. In more developed countries, most infectious diseases are well under control. In those countries, it is the noninfectious diseases, particularly cancer, circulatory diseases, mental disorders and other chronic diseases, that now pose the greatest threat. The global situation shows that the elderly population (aged 65 years and above) will increase by more than 80% during the next 25 years. It is vital to realize that increased longevity does not come free. A huge increase in human suffering and disability are foreseen in the coming century, which must be confronted today. Rapidly growing health expenditure, on top of existing scarcity of resources for health, is therefore inevitable. World health spending is enormous. In 1990,public and private expenditure on health was about US$ 1.7 million million, or 8% of the total world income. The high-income countries spent almost 90% of this amount, at an annual average rate of US$ 1500 per person. Meanwhile the developing countries spent about US$ 170 thousand million, or 4% of their GNP, at an annual average of only US$ 41 per person, less than one-thirtieth of the amount spent by rich countries. The global health problems of the future are awesome, but the situation is not hopeless. We need a universal awareness of the problems and collective willingness to solve them. Concerted efforts are needed to alleviate these controversial conditions. We should realize that, regardless of the health budget in terms of GDP, in developing and as in developed countries alike, health reforms are indispensable. Countries, particularly those in the developing world, can no longer afford to deal with the problems of communicable and noncommunicable diseases sequentially as in the past; we must now address them simultaneously. It is time to call for comprehensive action to address all the determinants of ill-health. Primary health care, which has been proven to be the most cost-effective approach, should be maintained. However, an integrated package of disease-specific interventions, incorporating both primary and secondary care for the most prevalent diseases, would be more efficient. The advocacy role of WHO is essential. The WHO leadership should therefore pursue at all times the highest attainable standards of physical, mental and social wellbeing as a fundamental human right. Now we are aware that Dr Nakajima has strongly indicated that he intends not to extend his term as Director-General; although WHO's Constitution would allow him to run again as Director-General, he prefers to give way to other candidates. The statement reflects his dignity as a distinguished WHO leader who has dedicated his career to the advancement of WHO, to people's welfare and to humanity. Under Dr Nakajima's leadership, important achievements in world health development have been made, and he has laid the ground for WHO reforms so that the Organization has become more efficient, flexible and decentralized. One such achievement concerns the hundreds of millions of infants and children who have been immunized under the Organization's guidance; some communicable diseases will be eradicated or eliminated in the very near future, thus increasing the life expectancy of millions; there are many other achievements that are impossible to mention here. I would therefore like to take advantage of this opportunity to extend my deep appreciation to Dr Nakajima, who has done so much to develop our Organization and define its future objectives. Finally, it is my sincere hope that this Fiftieth World Health Assembly will contribute to the formulation of a global health vision and mission for Conquering suffering, enriching humanity in the coming century. Mrs SHALALA (United States of America): Mr President, Dr Nakajima, distinguished delegates, it is an honour to address the Fiftieth Health Assembly. The United States President Theodore Roosevelt once said "Nine-tenths of wisdom is being wise on time". This is our time. Today we are poised at a critical juncture in the distinguished history of the World Health Organization. The Director-General has announced that he will not seek another term. We

56 page 44 respect his decision and applaud the important contributions he has made to our Organization. We applaud his leadership in forming international partnerships. We applaud his contributions to management reforms, his contributions to the health and development of countries in greatest need. We applaud his contributions to our international fight against new and re-emerging diseases, and our ongoing battle to eradicate poliomyelitis by the year 2000; to eliminate the ancient scourge of leprosy; and to achieve childhood immunization rates above 80%. Now is the time for each of us to lend our strongest support to the critical work Dr Nakajima must complete in the last year of his tenure, especially the renewal of health for all, and now is the time to plan for the future. We must build on Dr Nakajima's foundation, and choose a new Director-General who can help WHO lead and succeed over the next 50 years and beyond. First, we have a vision of a Director-General who can find new ways of meeting new health challenges. As our citizens live longer, we will need new ways of protecting their health. As noncommunicable diseases, like those related to tobacco, become the leading cause of death and disability, we will need new ways of educating our citizens, particularly our younger citizens, to prevent them. And as violence continues to plague us, we need to turn our public health agenda into a force for action and a bridge for peace. That is especially true with land mines. As President Clinton told the United Nations General Assembly, "our children deserve to walk the earth in safety". Second, we need a Director-General who can make WHO the international leader for health in the twenty-first century. We need someone who will be a passionate advocate for health, including environmental and women's health. He or she must send a clear message to every political and financial leader: there can be no effective social or economic development without good health. Under a new leader, WHO should set standards for nations: to improve the quality of pharmaceutical and health services; set guidelines for clinical and public health practice; and create indicators to monitor the health of our international community. Under our next leader, WHO must continue to coordinate global surveillance to predict major health threats, and spur action among nations to prevent them. It should mobilize global partnerships to help promote effective health systems in all countries, and it should serve as a gateway to an international network of health experts coming from WHO, from UNICEF, the World Bank, UNAIDS, nongovernmental organizations, the private sector, and a revitalized network of WHO collaborating centres. How will WHO be able to accomplish all of this? That brings me to my third point. We need our new leader to demand management that is tough, smart, strong and transparent. All of us have budgets, and all of us must live within them, and all of us are expected to make our programmes more effective and efficient. WHO is no different: we need the Executive Board to play a central role in setting priorities for our regular and our extrabudgetary activities. We need to strengthen our fiscal control and personnel system; and within WHO, we need to strike the right balance between fostering creative regional solutions and speaking with one international voice for health. And we need a leader who can make it happen. Which brings me to my fourth and final point: to realize our promise in the twenty-first century, we need a Director-General for the twenty-first century. A Director-General with a commitment to the most vulnerable citizens and the countries in greatest need, someone with the ability not only to set goals and strategies, but to communicate them to the globe. Yes, to health professionals, but also to politicians and to financial institutions, to every citizen of the world. The next leader of WHO must be able to manage a complex international organization, blessed by a vital and a diverse staff, and they must have the diplomatic skills to resolve conflicts, to promote health and safety, both inside and outside the health community. But our next leader will not be able to do any of this alone. No matter if a nation is big or small, rich or poor, all should be part of a collégial process; all must have a chance to participate. Whatever affects one of us affects all of us. As member governments we must ensure that our best scientists and public health experts continue to see WHO as an integral part of their distinguished careers. We must do our part to promote the health of all people, and in doing so we must recommit ourselves to this unique organization, to its mission and its future, and into the twenty-first century. Mr President, I would like to close by adding my personal thanks and the appreciation of the United States Government to Dr Nakajima for his work over the last nine years. He has fought hard for WHO and even when dealing with tough issues he has maintained an excellent relationship with my country's health leaders. We will work closely with him during the last year of his service to continue WHO's progress to improve the health of all the peoples of the world. Mr YAMAGUCHI (Japan): Mr President, Mr Director-General, distinguished delegates, ladies and gentlemen, on behalf of the Government of Japan, I have the pleasure of presenting our position concerning the promotion of world health.

57 A50/VR/3 page 45 This year's World health report warns that the world now faces a "double burden" of chronic noncommunicable diseases and infectious diseases. With the background of recent global economic development, unhealthy lifestyle factors such as unbalanced diet, lack of exercise, smoking, and excessive drinking now prevail among developing countries. At the same time the world's population is ageing rapidly. As a result, it is anticipated that suffering and disability due to chronic diseases will become much greater, as exemplified by a projection that mortality due to cancer and diabetes will double during the next two-anda-half decades. It is increasingly important to achieve not only longer life expectancy but also "health expectancy" by preventing disability due to chronic conditions. In order to counter effectively the dual threat, and bearing in mind the characteristics of chronic conditions as being difficult to cure completely, the report sets out well-targeted proposals for action. We are determined fully to contribute to such health strategies of WHO and hope to see WHO strengthen its activities in areas where its comparative advantage exists in coordination with Member States and its extensive network in the scientific community. Japan has experienced a major shift in the leading causes of death, and today, cancers and circulatory diseases account for two-thirds of all deaths. Furthermore, the expansion of the elderly population continues to have an impact on Japan's demographic profile. With this background, Japan has undertaken various measures for chronic diseases control. For example, health education programmes to promote healthy lifestyle, and screening-and-consultation programmes, are widely undertaken in schools, workplaces and communities for the prevention and early detection of chronic diseases. Encouraging results have been observed and, to take some examples, decreased intake of salt, improved management of hypertension, and a significant decrease in death due to strokes have become apparent. Japanese food, which is rich in protein and low in fat, is considered to be healthy - as you ascertained for yourselves during yesterday's reception at the Japanese Ambassador's residence! However, we are experiencing a recent increase in animal fat intake. We have to recognize that difficult challenges remain with regard to changes in personal behaviour, while facing the threat of infectious diseases such as Escherichia coli О 157; thus we are strongly committed to fighting against the "double burden". Finally, I should like to make a remark on the position of the Director-General, Dr Nakajima, which was presented yesterday with regard to next year's election of the Director-General of WHO. Since his appointment as Director-General in 1988, Dr Nakajima has vigorously undertaken the reform of the Organization in a difficult situation which calls for strengthening of its efforts to meet growing health needs on the one hand, and coping purposefully with severe financial constraints on the other. In addition, Dr Nakajima s able director-generalship has greatly contributed to the promotion of world health in many of its aspects: to give some examples, major progress has been made with regard to worldwide efforts to fight against diseases such as poliomyelitis and leprosy; WHO's leadership in health has been clearly demonstrated in international conferences on women's health, population, sustainable development and the environment; and steady development of a new health strategy for the twenty-first century is in progress. I am totally confident that all the Member States gathered here today will continue to cooperate in the worldwide efforts to counter threats to world health, and to continue initiatives for reform concerning regional arrangements and programme prioritization, in order to further the achievements to date made under the leadership of Dr Nakajima, while respecting the decision of the Director-General himself. Ms HERFKENS (Netherlands): Mr President, Mr Director-General, distinguished delegates, firstly I must apologize for the absence of Ms Terpstra, Head of the Netherlands delegation, who had to leave Geneva early this morning to answer questions in Parliament. On behalf of the European Union, I would like to express our gratitude to Dr Hiroshi Nakajima. Indeed, as earlier speakers have pointed out, under his leadership the World Health Organization has accomplished important achievements in areas such as the fight against communicable diseases. During his term in office the reform process, which WHO urgently needed, was set into motion and the foundation was laid for the drawing-up of its new global policy for the twenty-first century. I sincerely hope that Dr Nakajima's efforts in promoting the interests of the Organization and in improving the state of global health will be rewarded with the adoption by this Assembly at its next session of a renewed policy that would enable WHO to continue fulfilling its role as the lead agency in health. Speaking on behalf of the Member States of the European Union, I should like to mention what we have accomplished since the last World Health Assembly, and what we hope to achieve at the forthcoming Council of Health Ministers of the European Union in June.

58 page 46 Since last year, action programmes on cancer, AIDS and other communicable diseases, drug dependence, and health promotion, prevention and education, have been agreed by the Council and the European Parliament. Programmes aimed at facilitating the exchange of experience, stimulating networking between institutions and NGOs and, finally, promoting innovative projects. Cooperation with international organizations in the field of health, such as WHO, is included. The 1996 Council meetings devoted to health paid special attention to the issue of transmissible spongiform encephalopathies (TSE) in view of the major crisis which occurred in the European Union in that year owing to the BSE epidemic. Creutzfeld Jakob Disease (CJD) surveillance data are now systematically collected and analysed for the European Union. The Council also adopted a resolution on a strategy to ensure blood self-sufficiency and the safety of blood transfusion in the European Union. Moreover, the need to promote the integration of health protection requirements in other Community policies was stressed by the Council of Health Ministers. At the Council meeting on research, last December, it was decided to allocate additional funds for research on TSEs (including food safety aspects), for vaccines and viral diseases, and for drugs. With regard to health research, only ten days ago an international conference on the theme "Innovative research and appropriate health care for the citizens of Europe" was held in the Netherlands. Among the topics for discussion were the European Union's role with regard to innovative health research, health economics, prevention, ageing and genetics. The findings of the conference will be published by the European Commission. Recently a number of environmental health issues were considered by the Council. Important legally binding instruments have also been adopted, such as the Council Directive on ambient air quality assessment and management. Last March the Council meeting on development cooperation agreed on a community programme to support developing countries in their efforts to minimize the spread of HIV and the AIDS epidemic and to assist them in coping with its impact on health and social and economic development. The programme will be directed primarily at the poorest and least developed countries and the most disadvantaged sections of the populations of developing countries. All this clearly illustrates the commitment of the European Union to health issues, not only in the Member States, but also in other countries, both in Eastern Europe and in the developing world. In view of the forthcoming meeting of the European Union Council of Health Ministers, let me inform you about some of the major items on its agenda. The Netherlands will submit a resolution on the legal aspects of international transfer in organs, and tissues of human origin, and present a working document on the implementation of the resolution on blood and blood safety, adopted during the Irish Presidency. Furthermore, a resolution on professional standards of doctors relocating in the European Union will be presented, which may lead to tailor-made adaptations to the existing European directive on the free movement of doctors within the European Union. In our view, a European network for epidemiological surveillance and action against infectious diseases is needed to facilitate prompt detection of such diseases and ensure that Member States are informed thereof. A common position on this subject should be agreed during the June Health Council meeting. An agreement is expected to be reached on the health monitoring programme leading to greater comparability of health indicators and data in the European Union, thus providing, inter alia, a valuable future input to WHO. Last but not least the Presidency intends to have a discussion at the Health Council on the principles and priorities for establishing a new Framework for Public Health in the European Union. I now come to the last part of my speech, in which I will say a few words on behalf of my own country, the Netherlands. The reason for the increased prevalence of chronic diseases not only in the Netherlands, but throughout Europe, isa familiar one: epidemiological transition, improvements in therapy, resulting in the postponement of death without the prospect of recovery, lead to higher prevalence rates for chronic diseases. Previously, health care in the Netherlands was focused mainly on a few, severe, chronic disorders such as cancer and cardiovascular disease. But while there has been spectacular progress in the treatment of these life-threatening diseases, the treatment of other not life-threatening chronic diseases has not kept pace. In recent years the Netherlands Government has changed its policy focus. Nowadays the focus is on problems affecting all the chronically ill rather than on problems related to one specific disease. These problems concern the following: (1) improvement of care and quality of life; (2) reduction of social disadvantage by, for instance, access to the job market and insurance; (3) creating a better understanding of chronic illnesses by providing public information as well as education and training to care providers and patients; and (4) promoting research. A national Committee on the Chronically 111 has been set up in order to implement this new policy and to promote and fund innovative projects. Unfortunately, the position of patients is still relatively weak compared to other parties in the health care system. We are trying to improve this by supporting patients'

59 page 47 organizations and strengthening their legal representation. This year the National Patients Foundation was able to start work, thanks to government support and funding. The above-mentioned actions show how the priority area of chronic diseases is being translated into Netherlands health policy. As The world health report clearly illustrates, noncommunicable diseases have come to present an enormous challenge, not only in what we call a developed country, such as the Netherlands, but in many developing countries as well. The report rightly speaks of global epidemics. However, it should not be forgotten that in many developing countries, the burden of infectious diseases still weighs more heavily than the burden of noncommunicable diseases. Other countries are confronted with what is known as the double burden of disease. We therefore favour a differentiated, targeted approach towards health system development in all countries. Universal blueprints simply do not work. The principle that prevention is better than cure is very well reflected in the report. My Government strongly supports this view and thus funds activities which contribute to the prevention of these chronic illnesses. Finally, I must admit that we have mixed feelings regarding the renewal of the health-for-all-strategy. In our opinion, not enough progress has been made so far. Since participation of Member States is crucial, we suggest that WHO and Member States double their efforts in order to speed up this important process. We call upon Member States to give active support to the renewal process in kind or by secondment, as has been done by the Netherlands and other countries. In conclusion, we sincerely hope that the discussions during the Assembly and the forthcoming Executive Board will enable us to adopt in 1998,the year that marks WHO's fiftieth anniversary, a meaningful, substantial and realistic new strategy in order to achieve health for all. Mrs JEAN (Canada): Mr President, the World Health Organization has already entered the fiftieth year of its existence. Since its early beginnings in 1948, our Organization has done much, accomplished much and changed considerably to respond to the needs of a world that has been changing even faster. At this point I would be remiss if I did not acknowledge the contribution of Dr Nakajima during the past nine years in the life of this Organization. The world health report 1997 vividly illustrates how different our world is from that of 50 years ago. Noncommunicable diseases, which until recently have been seen as problems of the industrialized countries, will shortly surpass infectious diseases as the main cause of death worldwide. This new world demands of us a new vision of health and WHO's role in achieving health. It demands new leadership to take us into the twenty-first century. It demands a new management focus and a clear sense of priorities for the Organization. Canada has a view of what those priorities should be. We believe that the key roles of WHO are: Firstly, to provide the basic normative functions to Member States, including international standard-setting in relation to areas such as the classification of diseases, pharmaceuticals, and medical devices. This is the foundation on which our Organization is built. We must preserve and expand it. Secondly, to design collective solutions to collective problems. These are problems which no one country can deal with effectively. The development of a global disease surveillance and response system is a clear example of such an area. It is vital to human security in the twenty-first century. Thirdly, to deliver specialized technical cooperation. We believe WHO's role, as a specialized agency of the United Nations, is to help with needs assessment, to assist in developing creative solutions to problems, and to build capacity within national governments. Its role is not to assume responsibility for the implementation of solutions or the transfer of financial resources. Fourthly, we believe that WHO should have a "client-oriented" approach within a welldefined mandate. WHO must continue to meet the needs of Member States, but it must do so within its mandate and in recognition of its finite resources and capacity. Finally, the above must be carried out within a management framework which demands excellence, transparency, and an awareness of fiscal realities. These are not priorities which lend themselves to easy solutions. But we believe they provide the Organization with a firm footing for its work in the next century. As an illustration, let me refer to one of these priority areas, designing collective solutions to collective problems. (The speaker continued in French.) (L'orateur poursuit en français.)

60 A50/VR/3 page 48 La consommation de tabac est probablement l'un des plus importants déterminants mondiaux des maladies non transmissibles, et son influence s'accroît. Au Canada, nous avons présenté un nouveau projet de loi en vue de lutter contre cette cause de maladie et de mauvaise santé. La nouvelle loi vise à réduire la tabacomanie en limitant les occasions qu'a l'industrie du tabac d'attirer les fumeurs mineurs. En empêchant cette industrie de recruter de nouveaux fumeurs chez les jeunes, on fera littéralement disparaître ce marché. Au Canada, nous reconnaissons bien sûr que les initiatives que nous pouvons prendre à l'intérieur de nos pays ne sont pas suffisantes. Par exemple, nous ne pouvons seuls lutter contre la contrebande et contre la promotion en faveur du tabac qui vient de l'extérieur. Nous avons demandé à l'oms d'assurer le "leadership" de la lutte mondiale engagée contre le tabagisme et d'en faire la coordination. Le Canada trouve encourageants les efforts déployés par l'organisation en vue d'élaborer une convention-cadre pour lutter contre le tabagisme. Mais il faut faire beaucoup plus. L'OMS doit immédiatement accorder une grande priorité à la lutte contre le tabagisme. Le Canada estime que l'oms devrait mettre cette bataille au nombre de ses principales activités pour la prochaine décennie. La réforme de l'oms et le renouvellement de la stratégie prônant la santé pour tous nous donnent l'occasion de réfléchir à l'avenir de l'organisation. Nous savons que l'évolution qui se produit dans le monde nécessite de nouvelles politiques, de nouveaux programmes et de nouvelles compétences en gestion. Dans le zèle que nous mettrons à nous demander ce que devrait être l'oms et à en discuter, il ne faudra pas oublier que son plus grand avantage tient à sa capacité de réunir tous ses Etats Membres autour d'une même table. L'OMS doit conserver ses précieuses racines universelles et développer davantage ses partenariats pour une action intersectorielle dans le domaine de la santé. Comme l'a si bien dit un Directeur régional : "Si l'oms ne peut être utile à tous ses Etats Membres, elle ne le sera à aucun.". Comment l'oms peut-elle continuer d'être utile à tous ses Membres? En solidifiant d'abord son rôle de leader en matière de politique internationale de santé et de coordonnateur de programmes mondiaux de santé. Enfin, tous les Etats Membres doivent assumer la charge toujours plus grande des maladies non transmissibles et considérer les maladies nouvelles et émergentes comme une préoccupation commune. Voilà pourquoi le Canada croit qu'il faut en priorité perfectionner les systèmes mondiaux de surveillance des maladies. Notre présence ici aujourd'hui confirme notre engagement envers une OMS essentielle, forte et renouvelée. Ensemble nous atteindrons cet objectif. Mr S.I. Shervani (India), President, resumed the presidential chair. M S.I. Shervani (Inde), Président de l'assemblée, reprend la présidence. ï thank the distinguished delegate of Canada for her statement. I wish also to thank the first Vice- President for having replaced me in my absence. Before we continue with the debate on items 9 and 10 of the agenda, I have an announcement to make concerning the fourth meeting of the special group of the Executive Board for the review of the Constitution of WHO. The fourth meeting of the special group will take place on Saturday, 10 May, commencing at 09:00 in Room XVII,as mentioned in today's Journal. In addition to members of the special group, members of the Executive Board may attend if they have expressed to the Secretariat their interest in doing so. Furthermore, representatives designated by Member States may participate under Rule 3 of the Rules of Procedure of the Executive Board. Member States should designate their representatives in writing, either through official channels or through the chief delegate at the Health Assembly. These communications should be given to the Assistant to the Secretary of the Health Assembly, Room A.658, by Thursday, 8 May. Documentation for the meeting will be distributed on Wednesday, 7 May. We may now continue with the list of speakers, and I give the floor to the distinguished delegate of the Russian Federation and I invite to the rostrum the distinguished delegate of Thailand. Professor DMITRIEVA (Russian Federation) Проф. ДМИТРИЕВА (Российская Федерация) Уважаемый господин Председатель, уважаемый Генеральный директор, уважаемые министры, дамы и господа, Всемирная организация здравоохранения приближается к своему пятидесятилетнему юбилею. За этот период произошли существенные изменения. И хотелось бы подчеркнуть, что

61 A50/VR/3 page 49 сегодня в силу своего высокого профессионализма и универсальности ВОЗ является единственной международной организацией, способной быть лидером в решении как глобальных, так и региональных проблем здравоохранения. В этом хотелось бы отметить личную большую заслугу г-на Накадзимы. На наш взгляд, г-н Накадзима - это целая эпоха в развитии Всемирной организации здравоохранения. Мы благодарны г-ну Накадзиме за тот вклад, который был уже сделан, и надеемся, что еще оставшийся год будет также весьма плодотворным. Мы с уважением относимся к решению г-на Накадзимы о том, чтобы не выдвигать свою кандидатуру на следующий срок. На наш взгляд, следующий этап, по-видимому, потребует определенного дополнения в работе по реализации лидирующей роли Всемирной организации здравоохранения. В частности, на наш взгляд, эта работа должна быть дополнена более существенной координацией усилий с другими международными организациями, работающими в сфере здравоохранения. Это будет в интересах дела, а может быть, это будет также еще и на пользу сбережения ресурсов. На это обратил внимание Исполком на своей январской сессии в резолюции EB99R. 13. Настало время всем нам серьезно рассмотреть пути выхода из финансового кризиса, и процесс реформирования нашей Организации, на наш взгляд, требует серьезного ускорения. Хотелось бы подчеркнуть еще одну вещь. Правительство нашей страны, несмотря на все финансовые и экономические сложности внутри страны, продолжает планомерное погашение задолженности по взносам в регулярный бюджет ВОЗ. Безусловно, в России не больше денег, чем в других странах, но Россия рассматривает Всемирную организацию здравоохранения в качестве одного из наиболее важных специализированных учреждений системы ООН. Уважаемые делегаты, представленный данной сессии Третий доклад о состоянии здравоохранения в мире посвящен в основном хроническим неинфекционным заболеваниям. Но мне хотелось бы также подчеркнуть, что одновременно мы услышали и серьезный отчет о работе ВОЗ за год. На наш взгляд, это является весьма удачной практикой, поскольку делегация получает полное впечатление о проделанной ВОЗ работе и также о работе, которая была проделана государствами - членами ВОЗ. Мы полагаем, что Исполкому следует поддержать практику представления отчетов о работе ВОЗ на Ассамблее здравоохранения. А сделано за прошедший год очень много. ВОЗ, на наш взгляд, адекватно и оперативно реагировала на возникающие проблемы. Наша страна выражает благодарность всему Секретариату штаб-квартиры и Европейскому региональному бюро ВОЗ, а также всем государствам-членам, которые оказали помощь в реформировании российского здравоохранения. Сегодня с этой трибуны уже не раз поднимался вопрос о роли табакокурения в здоровье населения, и мне приятно сообщить, что в конце мая в Москве будет проходить Всероссийская конференция под девизом: "Мир без табака", и мы надеемся, что г-н Накадзима, а также г-н Асвалл примут в ней участие. Насколько мне известно, на Конференции будут вручены очень серьезные награды политическим лидерам, которые сделали в этом направлении очень серьезные шаги. Теперь еще несколько слов непосредственно по докладу. Отмеченная в докладе ситуация с хроническими заболеваниями в мире на фоне происходящих демографических процессов справедливо вызывает озабоченность практически во всех странах. В настоящее время главным "убийцей" становятся хронические неинфекционные болезни, которые сегодня уже ответственны почти за половину всех смертных случаев. В России на первом месте среди причин смертей находятся сердечно-сосудистые заболевания, на втором месте - онкологические заболевания. Как видите, именно неинфекционные заболевания являются в России главной причиной смертности. Какой же вывод мы должны сделать? На наш взгляд, мы должны сделать очень важный вывод о необходимости сбалансированности приоритетов, с тем чтобы предотвратить возможность улучшения состояния здоровья одной группы населения за счет другой. Вопрос инфекционных заболеваний был, есть и будет приоритетным. Мы отлично знаем, что инфекции, как только мы о них начинаем забывать, мгновенно начинают нам мстить. Однако выбор приоритетов, безусловно, должен быть четко увязан с организационными и с финансовыми возможностями Организации. В нашей Организации уже есть опыт, когда при формировании Программного бюджета при установлении приоритетов используется не только перемещение ресурсов, но и структурная

62 A50/VR/3 page 50 перестройка программ. Хотелось бы, чтобы Всемирная организация здравоохранения сохранила гибкость в этом вопросе. На мой взгляд, сегодня это является особенно важным. Важными приоритетами Организации, по-видимому, должны оставаться вопросы международного законодательства, направленные на охрану здоровья; разработка необходимых стандартов медицинского, санитарно-гигиенического, противоэпидемического и фармацевтического обслуживания; широкий обмен между странами результатами новых научных исследований, а также методических разработок. Мы все обеспокоены сложным финансовым положением Организации в последние годы. Есть ли выход из этой ситуации? С одной стороны, мы видим сложность финансовой ситуации, с другой стороны, предъявляем Всемирной организации здравоохранения все большие требования. Мы требуем активизации работы. По нашему мнению, есть пять необходимых условий для решения этой дилеммы. Во-первых, это коллективное определение приоритетов, так, как мы это делаем сегодня. Во-вторых, это программно-целевое планирование, и оно уже себя оправдало. Третье - это повышение эффективности деятельности Организации, в том числе за счет привлечения других международных организаций, работающих на систему здравоохранения. В-четвертых, - это контроль эффективности использования выделяемых ассигнований по принципу "наименьшие затраты - наибольшие выгоды". И пятое - это безусловное снижение расходов на административные нужды. Следует привести расходы Организации в соответствие с ожидаемыми поступлениями взносов от государств-членов. Уважаемые делегаты, мы уверены, что государства-члены смогут добиться того, чтобы Всемирная организация здравоохранения вышла из того сложного положения, которое сегодня создалось. Она, безусловно, выйдет обновленной и готовой к вызовам двадцать первого века. Мы заслушали вчера чрезвычайно интересный и содержательный доклад г-на Накадзимы, и тот курс, который был провозглашен в этом докладе, курс и на реформы, и на привлечение новых специалистов, вызывает у нас большой оптимизм. Спасибо за внимание. Dr SANGSINGKEO (Thailand): Mr President, Mr Director-General, distinguished delegates, ladies and gentlemen, it is a great honour for me to address this Assembly on behalf of the Government of Thailand. Permit me to congratulate you, Mr President and Vice-Presidents, on your election to high office at the Fiftieth World Health Assembly. I would like also to extend my appreciation to Dr Nakajima and his staff for the excellent preparation of the report to this meeting. It is a joy to witness the World Health Organization's continuing efforts in supporting and working with all Member countries to bring a better health status and a higher quality of life to all people worldwide, regardless of differences in race or political and religious beliefs. My delegation and I commend your continuing effort towards the better health and happiness of mankind. According to The world health report 1997, there has been a remarkable change in the health situation of Member countries all over the world. In the South-East Asia Region, there has been a decline in birth and death rates as a result of improvement of health status. However, we must accept the fact that rapid economic growth and advances in science and technology have also led to changes in lifestyle that have affected people's health to a large extent. Clearly, life expectancy has been prolonged, resulting in an increasing elderly population and a greater relative burden of noncommunicable disease. Although communicable diseases still prevail, noncommunicable diseases are now emerging as one of the leading causes of death, responsible for more than 24 million deaths a year in our Region. Thailand and other developing countries which are becoming newly industrialized are now faced with tackling such chronic noncommunicable disease. We realize that the pandemic of chronic disease and the magnitude of human suffering from such illness are immense and critically affect not only individuals, but also produce a negative impact on family and society. This phenomenon can obstruct progress in overall health development programmes, at national, regional and global level. It is very important for all countries to pay great attention to this issue, that is, to relieve people of the misery of chronic disease. More effective countermeasures are needed for prevention and control. As the common risk factors of chronic disease, such as unhealthy lifestyles and inappropriate diet are very well known, existing cost-effective methods for disease detection and management must be further applied in parallel with other specific interventions. In most countries, including Thailand, control and prevention

63 A50/VR/3 page 51 programmes, including health promotion through regular health education and public campaigns, have served to raise public awareness of health risks and to encourage improvement in human behaviour. In this regard, a number of activities, such as anti-smoking campaigns, healthy cities projects, regular exercise campaigns, campaigns against drinking and driving, health services for the elderly and consumer health protection have been launched in Thailand. I strongly agree with the recommendation made by WHO for the application of an integrated approach, a comprehensive package for chronic disease control in which prevention, diagnosis, treatment and rehabilitation, including training of health professionals, are incorporated. I greatly appreciate WHO's efforts under the leadership of Dr Nakajima, to deal with this crucial issue, which is one of the major challenges of the twenty-first century and one of the Organization's priority areas for 1998 and I would like to assure you of Thailand's willingness to co-operate in international action on the prevention and cure and care of noncommunicable diseases. We also heartily welcome the expansion of WHO's role in this challenging intervention programme and have high hopes that the concerted efforts of all Member countries in this collaborative undertaking will be successful. Dr DURHAM (New Zealand): Mr President, Mr Director-General and distinguished delegates, New Zealand would like to commend WHO on its work in preparing The world health report The report concentrates on noncommunicable diseases and chronic conditions and highlights some excellent work carried out by WHO in the past year. We also join other delegations in applauding the contribution that Dr Nakajima has made to this Organization, his leadership and the dignity he has shown in paving the way for a new leader to take WHO into the twentyfirst century. New Zealand would like to offer some observations on the Organization's efforts for charting out a future direction. It is commendable that WHO recognizes the increasing burden of noncommunicable diseases on a global scale, but it is also important that the Organization does not overextend itself in terms of what it seeks to achieve. In an environment of financial restraint and tight budgets, WHO would benefit from concentrating its efforts on those areas which will result in measurable health gain for the global population and reduce inequalities in health. Primary health care will always be imperative for well-being. This was identified as the basis for the Ninth General Programme of Work and specific priorities were identified in relation to communicable diseases, promotion of primary health care, reducing avoidable disabilities, the universal access to essential health care services, and promotion of environmental health and healthy lifestyles. WHO retains the unique position of being a multilateral organization singularly devoted to health issues, and can provide functions that no other international body can. Particularly important is the surveillance and control of international public health risks such as communicable diseases. The Organization has shown considerable success in this area. This function is particularly important in light of the fact that many infectious diseases are re-emerging globally, such as tuberculosis. New Zealand also supports the view that WHO should focus on health promotion and disease prevention. Amongst other initiatives, The world health report recommends as a priority a global campaign to encourage healthy lifestyles. As many chronic and noncommunicable diseases are caused by lifestyle factors such as tobacco and alcohol abuse and lack of regular physical activity, the promotion of healthy lifestyles, particularly to children and adolescents, is a crucial factor in preventing and controlling such diseases. Cooperation with governments on legislation and on pricing and taxation which supports the prevention of noncommunicable diseases must also be encouraged. I would like to reiterate New Zealand's commitment to improving and promoting indigenous health. We commend the Organization's work in this area, and the Director-General's recent report to the Executive Board on the International Decade of the World's Indigenous Peoples. The Third Conference: "Healing Our Spirits Worldwide" will be held in Rotorua,New Zealand, in February New Zealand would encourage delegates to participate in this conference, which will contribute to the objectives of the International Decade and strengthen international cooperation in addressing common health problems faced by indigenous peoples. Women's health is another area which New Zealand will continue to encourage as an important priority for WHO. This is necessary if we really are to conquer suffering and enhance humanity. Women play a crucial role in the health care and well-being of the world's population, specifically that of children and older people, as women remain the primary care-givers in society. By investing in women's health and education, the family and society at large will benefit. The development of a "gender" policy for the Organization might provide a useful tool to raise awareness of gender issues and encourage the use of gender analysis in all programme planning and evaluation.

64 page 52 The spotlight remains on reform at the United Nations in 1997; not just on reform of the United Nations itself, but on all constituent bodies as well. There has been welcome progress in some areas, but the international community expects all United Nations agencies to continue to strive to modernize in order to become leaner, more cost-effective, more responsive and more relevant. Duplication of work amongst agencies must be eliminated. The Executive Board's resolution on programme budgeting and priority-setting is a welcome sign that increased importance is placed on the strategic direction and efficiency of the Organization. It is important that steps be taken to implement fully the recommendations in this resolution. To achieve progress on its goal of health for all in the twenty-first century, WHO must renew its mission statement and its focus. This means that it must concentrate its priorities, clarify its implementation strategies, improve its monitoring and evaluation mechanisms and refine its management structures. Only real organizational reform - structural, managerial and financial - can ensure that the Organization will retain its leadership role in global health in the twenty-first century. Only then can we reduce suffering and enhance humanity. Mrs WALLSTROM (Sweden): Mr President, Mr Director-General, distinguished delegates, we have been asked to speak on a very demanding subject: Conquering suffering, enriching humanity. The world health report 1997 focuses on chronic diseases, but I would like to start with our children - the new generation whose chances for a healthy life are still unequal between and within countries. Can equity or fairness be more easily understood and acted upon than by giving all children in the world - both boys and girls - the same right to healthy growth and development? Sweden, as many other countries, considers the health of children and young people a cornerstone of our society. In the efforts of increasing life expectancy and enriching humanity, improved child health has the highest priority. It is unacceptable that in this world which we together represent here today, every year some 12 million children die before they reach their fifth birthday. Most of these deaths are preventable. Sweden commends WHO's shift from an approach based on single diseases to one based on the integrated management of childhood diseases. With this approach we also need to develop measures to deal with psychosocial disorders in children. The renewed health-for-all strategy, therefore, must continue to put emphasis on child health. It might be a traditional approach, and we recognize it from the WHO Constitution. The fact, however, remains: an individual's health is largely established during childhood, and it determines in turn the individual's chances for welfare and good living conditions later in life. Many young people are destroying their lives with narcotics. To fight drug abuse is not merely a matter of funds or budget lines, but also of values and the will to act. To fall back on harm reduction measures, in the absence of effective demand reduction and control of drug trafficking, is to accept defeat and to abandon the most vulnerable - the young. Health services of the future will meet a more demanding general public. The younger generation is already today calling for competence, accessibility and information, and they want more influence. It is also my firm belief that continued good health care in the twenty-first century is closely linked to enable people to participate in both prevention and care. We human beings do not expect a life without suffering. We are prepared to make sacrifices to help those with greater needs. There must, however, be a fair health system, in which people can participate. There must also be a value system that people can understand and share. Ethical questions are becoming more and more difficult. It is, indeed, not easy to match decision-making and guidance on these questions with the rapidity of biomedical progress that is testing the boundaries of ethical principles. I wish it could be possible to deal with these issues in a more anticipatory way rather than mainly reactively, as is the case today. To be in the forefront is important, and we need WHO to prepare for the introduction of new medial research results in such a way that all people and countries can benefit from the progress in science and technology. I would welcome WHO playing a more active role in ethical standard-setting. The role of the State is to balance ethical and human rights principles with effective health interventions. This goes for broader public health measures as well as more specific technologies such as organ transplantation. It is very important that WHO comes out clearly also on which ethical principles should guide us. As examples of this need, I could mention areas such as communicable disease legislation, mental health and services for persons with disabilities. I would also like to see a debate in our Organization about the right to information on

65 A50/VR/3 page 53 health. It can never be acceptable that a woman is denied information on sexual and reproductive health matters that are vital to herself and her family. In which international instrument or WHO statement will she find her support? All of us look forward to a good and long life - for ourselves and for all our family members. We take it for granted that increased life expectancy is regarded as fundamentally good and enriching humanity. But in the political debate and in studies on health services, ageing is repeatedly addressed in terms of burden or costs to society. Sweden has one of the oldest populations of the world. During the last decades, both years and health have been added to life. Even if most individuals enjoy health for longer periods than ever before, the total demand for care and social support is increasing. So far it has been possible to meet these needs. But we are facing a vulnerable situation. I therefore believe that values and ethics now must be placed higher on the political agenda than pure economics. Otherwise, it will be very difficult to alleviate suffering and sustain inter-generational solidarity for health for all. Sweden has made strong commitments to the work of WHO and has requested reforms to better meet challenges and opportunities for health development. We do so out of our traditional position of bridging the gap. WHO is a decisive factor in the struggle for equity in health. To this end, the Organization deserves reform, resources and dedicated support, particularly from the rich countries. WHO must stand strong to pursue the cause of a renewed health for all for the twenty-first century. Dr LEPPO (Finland): Mr President, Mr Director-General, distinguished delegates,ladies and gentlemen, I have first to apologize for Mrs Mônkàre, our Minister for Social Affairs and Health, who had to return to Finland early this morning to attend a debate in Parliament. On behalf of the Government of Finland, allow me to congratulate you, Mr President, on your election to the presidency of this Fiftieth World Health Assembly. Our congratulations also extend to the other members of the bureau. The world health report 1997 emphasizes the role of chronic conditions in developed and developing countries. In the developed world, infectious diseases are largely under control and it is chronic noncommunicable diseases that cause most of the disease burden. Chronic noninfectious diseases are, however, also gaining importance as a major threat to health in developing countries. With increasing life expectancy and the adoption of unhealthy lifestyles like cigarette-smoking, alcohol consumption and diet, rich in saturated fats, chronic diseases are rapidly increasing. As a result two different epidemics - an epidemic of infectious diseases and an epidemic of noninfectious diseases - exist at the same time in many populations, a situation commonly known as the double burden of disease. Finland has witnessed a remarkable decrease in mortality and morbidity from coronary heart disease. The age-adjusted coronary heart disease mortality today is almost 70% lower than in the peak years of the 1960s. Several analyses indicate that the decline is mostly due to healthier diet, a decrease in cigarette smoking and effective screening, as well as pharmacological and non-pharmacological treatment of hypertension. Lung cancer is also rapidly declining in Finland; we expect to have the lowest lung cancer mortality in Europe by 2010, a development made possible by the lowest smoking prevalence now in Europe. What can be done to conquer the epidemic of chronic noncommunicable diseases? I would like to outline essential measures which have proved efficient at national level. First, the emphasis must be on prevention. Secondly, prevention of chronic diseases requires collaboration from practically all sectors of society - ministries, nongovernmental organizations, the scientific community and the private sector, including industry. Thirdly,a health system based on primary health care has a key role in the control of chronic diseases. Health education, screening of people at risk, and collaboration with other actors in the community are important functions of the primary health care system. Indeed, successful control of chronic diseases requires an active health policy, strong intersectoral collaboration, and an emphasis on health promotion and primary health care. I would emphasize that no programme implementation in either communicable or noncommunicable diseases can be effective without a well-functioning health system. We should resist the temptations of narrow and short-term vertical approaches and bear in mind that programme delivery requires a system operating at all levels, from local to international. Strengthened health systems development is also needed in WHO to deal with the challenges of the next decade, and to achieve successful implementation of programmes for the prevention of both infectious and noninfectious diseases at national level. Strengthening health systems based on primary health care can succeed only if there is an adequate level of financial support both from the regular budget of WHO and from extrabudgetary resources.

66 A50/VR/3 page 54 Finally, a few words about the reform process. The delegation of Finland wishes to express its appreciation to the Director-General in facilitating WHO's activities to respond better to the changing environment. Positive developments have taken place, in particular through strategic programme budgeting. A vital element of WHO's reforms is the ongoing process on the renewal of the health-for-all strategy. We are of the opinion that renewal of that strategy poses a major challenge to WHO in strengthening its role as the lead agency in the health sector. The delegation of Finland looks forward to the outcome of the preparatory process and to the implementation of the global health policy for the twenty-first century. Mr BARTOLO (Malta): Mr President, Director-General, distinguished delegates, due to unforseen parliamentary duties, the honourable Minister for Health, Dr Michael F arrugia, has had to curtail his visit to this Health Assembly. He conveys his sincere apologies, extends to all the participants his best wishes for a fruitful meeting and looks forward to future cooperation with all Member States. On behalf of the Government of Malta, I would like to congratulate you, Mr President, on your appointment. The Maltese Government, and particulary the Ministry of Health, promises its support to you in your onerous task. I would also like to congratulate the Director-General and the Secretariat on their dedication, which also reflects the excellent work performed by the Organization. Our thanks go to all the WHO staff for their contribution to improving the health of citizens of this world we live in. We know that all the regional offices, and particularly our Regional Office for Europe, have made a substantial contribution -often against all odds and sometimes at risk to their lives - to fulfil the tasks and mission of our Organization. This is done with efficiency, effectiveness and dedication. We know that the turbulent political situation in several parts of the world, and especially the situation we have seen close to hand in the North of the Mediterranean, has led to new health problems which have in turn given rise to new pressures and priorities vis-à-vis our health dimensions in Europe and the world. We are grateful to all the WHO staff members, in all the regions, for the sterling work they have performed. The world health report for this year has focused on one of the major problems we are now facing in many Member States: the result of lengthening life expectancy and changes in lifestyle has not only created problems relevant to the changing structure of society, and thus the framework on which our health services have to be modelled, but has created a need for the development of health services that are more focused on prevention than on care. Adding years to life has posed global problems not only because the numbers of our elderly population have exponentially increased, but also because these numbers need more medical care; this sector of our world population is posing new challenges in the treatment and care of cancer, circulatory diseases, mental disorders - especially dementia - chronic respiratory conditions and musculoskeletal diseases. Many of these diseases which were previously referred to as diseases of affluence are also showing an increase in many of the less developed countries. As The world health report rightly states, this is not being helped by the increased use of tobacco, alcohol and drugs. The report once again highlights the seriousness of the situation and has indicated the way ahead for prevention and control. We are very aware of the need for more education for health prevention and more efforts by our Member States for the promotion of health, focusing not only on the prevention of infectious diseases but also on the non-infectious ones. The promotion of a healthier lifestyle should help to reduce the risks of disease from smoking, heavy alcohol consumption, inappropriate diet and inadequate activity. It is also the vehicle to help improve reproductive and maternal health, curb occupational hazards and reduce situations of stress at the place of work. Malta has all along supported health efforts at global, regional and sub-regional level. We have always stressed the importance for countries of working together in a spirit of cooperation and support. We have to share resources; we have to share expertise and ensure that this is available to all who require it. We need to tackle global health problems with global strategies. Malta has started doing this with the establishment of the International Institute for the Ageing, which not only helps to provide expertise to many other Member States but also has been instrumental in establishing strategies and resources on a global scale. We have to ensure that on the eve of a new millennium we are made responsible for the use of our facilities and that we look not only at the increase in the number of years that our population is living to, but - more important - at the quality of all their life. Finally, my delegation reiterates its support for the conclusions and the priority areas identified in this document, and we would also appeal to all the other Member States to join together in concerted action to support WHO in its proposals. This can only be done by giving the Organization the full support and political commitment necessary to see a better world as we reach the threshold of the new millennium.

67 A50/VR/3 page 55 Mr SOHN (Republic of Korea): Mr President, Mr Director-General, distinguished delegates, ladies and gentlemen, on behalf of the delegation of the Republic of Korea, I would like to extend my heartiest congratulations to you on your election, Mr President, and wish you every success in your forthcoming endeavours. I would also like to express my sincere gratitude to Dr Nakajima for his leadership of WHO, and indeed for his dedication to health promotion for the people of the world. Mr President, I am honoured to have the opportunity to address you on this very special occasion. The fiftieth anniversary of the World Health Assembly is truly a momentous occasion which provides us with an opportunity to reflect upon both the successes of the past and the challenges of the future. The past halfcentury has been characterized by major progress in the battle against communicable diseases. Smallpox, polio and leprosy have been conquered. During the same time period, global average life expectancy at birth has risen from 50 to 65 years of age. With these remarkable accomplishments fresh in our minds, now is the time for us to focus our efforts on the challenges of the coming century. We are facing new challenges in the form of emerging, re-emerging and new diseases. We must simultaneously tackle both infectious diseases and rising instances of chronic degenerative diseases. Such chronic diseases are becoming more and more prevalent, accompanying longer lifespans and therefore implying prolonged periods of suffering and greater physical, mental and economic burdens on the community. Mr President, and distinguished delegates, new means and strategies are required if we are to meet effectively the challenges and needs of the changing world health situation. WHO should be reborn with a new vision for the next century. In order to ensure its continued viability, the Organization's overall goals, functions and structure will have to be rethought and reshaped. First, WHO's mandate should be expanded to promote quality of life through a wider vision of health which focuses on people's physical, mental and social well-being. Health is more than just a bureaucratic goal. I would like to see health recognized internationally as a basic human right. Second, in confronting health issues and problems, the current diseasespecific, intervention-oriented approach should give way to an integrated strategy combining related sectors of our society such as politics, economics, the social sciences and education. Third, an international protocol should be established by which all Member countries recognize health.problems as a shared responsibility. The hardest hit victims must not stand alone in the search for solutions. We should pledge to act in concert to resolve global problems. Above all, commitment of advanced countries should be stressed as critical in the mobilization of technology and resources. Mr President, the Republic of Korea recognizes the challenges which lie ahead and is ready to make every effort and lend its full support in cooperation with other Member countries in realizing a new and effective vision for the next century. As part of this effort, the Korean Government has decided to host the International Vaccine Institute in the belief that this ground-breaking endeavour will contribute to the promotion of world health, particularly in developing nations. Taking this opportunity, I wish to express my sincere hope that the members here will endorse the establishment of this Institute. Mr President, the efforts of the past 50 years represent only the beginning of what needs to be accomplished. We must look forward to the next 50 years and beyond. In doing so, I call upon all those gathered here today to share their hopes, their ideas, their ingenuity, and their commitment in working together in creating a new vision for WHO. Dr AMATHILA (Namibia): Mr President, Mr Director-General, honourable delegates, distinguished guests, ladies and gentlemen, the Namibian delegation joins other nations in congratulating you, Mr President, on your election as President of this Fiftieth World Health Assembly and wishes you and your able team all the necessary strengths and wisdom to steer this august assembly through its business. The theme of The world health report 1997 is Conquering suffering, enriching humanity. The report focuses on a crucial topic which is already affecting most developing countries. The demographic transition of developing nations lies at the heart of critical levels of tomorrow's health care and needs. The change in population structure in developing countries places new demands on the management of age-related chronic disorders in the face of static and declining resources. Unless the approach to management of the demographic transition is carefully planned and mapped out, there is a considerable risk that already scarce resources will be diverted from essential services such as reproductive health, the Expanded Programme on

68 A50/VR/3 page 56 Immunization and control of communicable diseases, including malaria and HIV/AIDS, while rural imbalances and inequities in service delivery will be accentuated. Namibia, though a developing country, already has to cope with the double burden of disease. It is experiencing the problem of demographic transition. In this regard, diseases of the circulatory system and cancer were among the first 10 causes of death in Indeed, all diseases of the circulatory system ranked as the premier causes of deaths registered in 1995,with cancer as the sixth cause of death. As a result, the Namibian Government has had to set up facilities to cope with the increasing number of cancer sufferers. There are other problem areas which are also a matter of concern to the Namibian Ministry of Health: an alarming increase in mental health problems - manifested as an increasing incidence of suicide in the Northern part of Namibia; the impact of domestic or other violence on the quality of life of families and communities; the negative effect of occupational diseases and accidents on the overall development of the country; and the number of disabled persons trying to enter the mainstream of socioeconomic development are among the depressing issues related to the theme of The world health report The question is how to cope with the double burden of disease in the face of dwindling resources - how to balance the expanding demand for health care, the pressing needs of poor communities, improvement of access and equity and the desire for quality assurance. Satisfactory strategies to meet the challenges of the transition within the financial means of most of our countries have not been developed. There is therefore an urgent need to reassess health sector priorities in developing countries. Governments may need to create new institutions and reconfigure old ones to build the capability required for policy analysis,formulation, implementation, monitoring and evaluation. The technical and analytic capabilities required will include demographic analysis, epidemiological surveillance, economic and financial analysis, health technology assessment and control, and environmental monitoring and control including occupational safety. New policies need to be formulated and plans of action developed to manage the risk inherent in demographic transition. Policies should put into perspective the definition of the level of needs and modalities to address those needs before any costly interventions and technology are adopted. A plan of action that among others will include the following must be considered: (1) strategies to ensure that gains achieved through the implementation of primary health care will not be eroded and compromised by diversion of resources to address the chronic problems of an ageing population; (2) development of affordable alternatives for the prevention and management of chronic diseases and problems of the demographic transition; (3) capacity-building in the areas of research, epidemiological surveillance of chronic diseases development, demography and economic and financial analysis. Furthermore, the role and importance of donors and other partners in health development cannot be overemphasized. We have been true partners in the hard and fierce fight against communicable diseases. Let us face this new challenge together in the twenty-first century. The bottom line is that demography and disease will not wait. Hard and sometimes painful decisions need to be taken. Rationing of resources for health is a universal phenomenon, the question is not whether to ration, but how to ration. Political judgement must be illuminated with economic and medical realities. I thank the distinguished delegate of Namibia for her statement and for the kind words addressed to the Chair. I now give the floor to the delegate of Panama, on behalf of the Central American countries: Belize, Costa Rica, El Salvador, Nicaragua and Panama, and I invite to the rostrum the delegate of India. La Dra. MORENO DE RIVERA (Panamá): Señor Presidente: Permítame transmitirle en nombre de los países de Centroamérica (Belice, Costa Rica, El Salvador, Honduras, Nicaragua y Panamá) nuestras congratulaciones por su elección como Presidente de esta magna reunión. Tenga usted a bien transmitir este beneplácito a los demás distinguidos delegados que lo acompañan en las tareas directivas. Distinguidos delegados y delegadas: Centroamérica se congratula por hacerse presente en esta Asamblea, donde las experiencias, las esperanzas y los esfuerzos de todos los países del mundo pueden exponerse en un ambiente de reflexión seria y de respeto mutuo. Es importante aprovechar la ocasión para contribuir, utilizando adecuadamente los canales institucionales establecidos con energía y determinación, a la transformación de la Organización Mundial de la Salud en un organismo cada vez mejor de desarrollo de nuestros pueblos. Nuestro

69 A50/VR/3 page 57 deseo al participar en este debate general es transmitirles la visión centroamericana sobre lo que hemos hecho У deseamos hacer, sobre las condiciones de salud de nuestros pueblos y las respuestas institucionales a sus necesidades, y sobre nuestras apreciaciones más importantes acerca de lo que necesitamos que sea la OMS. Debemos comunicar con mesurada satisfacción que la situación de salud en Centroamérica continúa mejorando, lenta y difícil pero constantemente, gracias a un esfuerzo por mejorar nuestras economías en el marco de un desarrollo humano sostenible, lo que ha significado fortalecer los regímenes democráticos, la apertura de participación a la sociedad civil organizada y el proceso de integración económica, política y social de la región. En la reunión del sector salud de Centroamérica se ha consolidado la participación de las entidades de seguridad social, así como la de las entidades gubernamentales rectoras del manejo del ambiente, ya que nos hemos propuesto sobrepasar el ámbito tradicional y estrecho asignado al ambiente en el sector salud, limitado a la dotación de agua y al saneamiento básico, para incluir la preocupación por los recursos naturales renovables, por los contaminantes ambientales físicos, químicos y biológicos, y por el ambiente psicosocial, invisible en la mayoría de las intervenciones sanitarias a pesar de la epidemia de violencia humana que abate el planeta en este fin de siglo. Las enfermedades emergentes y reemergentes han venido a complicar las condiciones de salud de los humanos y las humanas que vivimos en Centroamérica. El cólera, el dengue y la malaria, el SIDA, la tuberculosis y la leishmaniasis se han convertido en nuevas amenazas, así como los brotes epidémicos de leptospirosis y encefalitis equina y el peligro permanente de la fiebre amarilla. La región afronta estos retos fortaleciendo las estructuras de los programas sanitarios y la coordinación intersectorial así como los lazos de cooperación interpaíses,sobre todo en las regiones interfronterizas, integrando la salud como preocupación importante en los procesos de integración económica y social. La lucha contra estos flagelos se ha unido a esfuerzos ingentes para mantener al istmo libre de la poliomielitis, eliminar el sarampión y el tétanos neonatal y proteger adecuadamente a la población de las otras enfermedades inmunoprevenibles. Asimismo, estamos disminuyendo también significativamente la incidencia y la prevalencia de otras enfermedades diarreicas agudas y mejorando la prevención y el control de las deficiencias de micronutrientes, sobre todo en niños y mujeres en edad fértil, así como disminuyendo en general las tasas de desnutrición. Hemos ampliado y mejorado el suministro de agua segura para el consumo humano y el saneamiento del ambiente. La protección de los recursos naturales renovables, de las cuencas y costas y los incipientes esfuerzos para enfrentar el reto de la contaminación industrial son también parte del enfoque amplio con que la región se plantea la conservación y el mejoramiento de la salud del ambiente. Existe, por tanto, una preocupación creciente por el abuso de plaguicidas, pesticidas, fertilizantes y sustancias químicas peligrosas, por lo que damos particular atención al progreso de la actual negociación de un instrumento jurídicamente Asimismo, hacemos ingentes esfuerzos para la prevención y control de los diferentes tipos de desastres naturales a que está expuesta nuestra región. El aumento de la morbilidad y la mortalidad debida a accidentes, abuso de sustancias y a la violencia física tiene en nuestra región una significación cada vez más preocupante, no sólo por lo que significa en términos de años productivos y vidas perdidas, sobre todo de jóvenes, sino muy especialmente porque evidencia un deterioro inaceptable de las condiciones de salud mental existentes en la región, producto de un ambiente social agobiado por las exigencias de las transformaciones económicas estructurales, por los remanentes psicosociales de las guerras fratricidas recientes y, en general, por un desarrollo humano dificultado por las inequidades políticas, económicas y culturales que todavía permean nuestro tejido social. La reducción de la transmisión del virus de la inmunodeficiencia humana adquirida y de las otras enfermedades de transmisión sexual nos ha exigido recursos materiales y humanos importantes. Sin embargo, los resultados no son del todo halagadores. No obstante, hemos logrado acrecentar la participación ciudadana en esta lucha, y el número de organizaciones no gubernamentales dedicadas a trabajar en este área aumenta significativamente. Es menester que el ONUSIDA se transforme realmente en lo que debe ser: un mecanismo ágil y eficiente de canalización de recursos que apoye eficazmente el esfuerzo social de todos los actores, que va en aumento. Es nuestra decisión fortalecer, agilizar y tecnificar los mecanismos de información y comunicación entre las instituciones del sector en todo el istmo y mantener una más adecuada vigilancia epidemiológica, una oportuna y racional toma de decisiones y la transferencia de conocimientos y experiencias valiosas entre nuestros países. Este enfoque regional para abordar los problemas de salud de nuestros pueblos no oculta las diferencias que existen entre las prioridades nacionales, sino que cada país afronta al mismo tiempo ambas perspectivas. Asimismo, creemos que ésta es la manera en que debemos esperar recibir apoyo de organizaciones como los organismos de las Naciones Unidas. En particular, la Organización Mundial de la

70 page 58 Salud debe reflejar en su estructura y en su orientación un empeño por apoyar con el máximo de los cada vez más escasos recursos disponibles los esfuerzos nacionales en el contexto de los análisis regionales. El presupuesto programático debe concentrarse quizás no en enfocar los problemas mundiales de salud de una manera general, sino en flexibilizar lo suficiente los programas de alcance mundial para abrir el abanico de las intervenciones posibles, de tal forma que las decisiones nacionales puedan aprovechar al máximo los recursos que se ofrecen. La larga y hermosa historia de la Organización Mundial de la Salud, que se refleja en esta 50 a Asamblea Mundial de la Salud, puede ciertamente ser continuada y engrandecida mediante la contribución de todos. Especialmente de aquellos países cuyos niveles de vida y de salud deberían permitirles participar de manera más justa y equitativa en las actividades que los países más pobres y menos desarrollados realizan para mejorar la calidad de vida y de salud de sus pueblos, vencer el sufrimiento y enriquecer a la humanidad. Los países centroamericanos, empeñados como estamos en renovar nuestras estructuras sociales, políticas y económicas para lograr un desarrollo humano sostenible, esperamos que nuestra decisión se vea acompañada de esa solidaridad internacional que la OMS representa, y esperamos que con la participación de todos logremos adaptar nuestra Organización a las nuevas exigencias que la salud de nuestros pueblos nos plantea. Mr CHAUHAN (India): Mr President, Director-General, Dr Nakajima, Excellencies, distinguished delegates, ladies and gentlemen, it is indeed a great honour for India to have her Health Minister preside over the Fiftieth World Health Assembly. I deem it a privilege to be able to address this august gathering on this historic occasion. India with its size, diversity and unique history of achievements, often affected by natural disasters has experienced almost every facet of living conditions from world-class facilities to conditions of extreme poverty, from state-of-the-art hospitals to rudimentary primary health centres. We therefore look to the World Health Assembly as a unique opportunity to express our deepest concerns and our foremost challenges in the hope that a meeting of minds will generate new ideas, fresh expectations and a sense of solidarity in meeting our common objective - the health of our people. The nineties have been a difficult period for developing countries in general and poor people and poor countries the world over in particular. The changing epidemiological profiles are creating new health problems and are placing an additional burden on the over-stretched health systems. It is therefore opportune that the World Health Assembly has chosen to address the theme of major chronic noncommunicable diseases. With the rapidly growing burden of noncommunicable diseases there is an urgent need to increase capacity to understand the true prevalence and trends developing within the population. In 1990 noncommunicable diseases accounted for just over 40% of the total loss of healthy lives worldwide; by 2020 their share is expected to escalate to 60%, with the brunt of the increase being borne by the low-income and middle-income countries. In India the burden is expected to almost double in the next 25 years. In November 1996 India hosted a special consultation with the World Bank on future health strategies for our country. In a study conducted for this consultation, it was revealed that between the years 1990 and 2020 a list of 10 leading causes of death would alter dramatically. Diarrhoeal deaths, which are in the third position today, would disappear from the list and ischaemic heart diseases would rise to the first position and contribute 22.7% of the total causes of death. Cancers of the trachea, bronchus and lungs, which did not find a place in the list of 10 in 1990,would now take root. The mortality risk from tobacco use is expected to shoot up from the present 1.4% to almost 13.3%. It would appear that whereas demographic changes are not modifiable, the risk factors as well as access to and use of preventive and curative services are modifiable and this is the time when we should address the future, armed with the knowledge of the problems which are going to beset us. Approximately new cases of cancer occur in India every year, and nearly two-thirds of these are advanced and incurable at the time of diagnosis. Nearly half the number of persons die from this cause each year. It has been estimated that by the year 2020, cancer deaths in India will increase nearly threefold. Let me say a few words on what we have done as a precursor of what will follow. The current cancer control programme in India assists the States in undertaking prevention and early detection of cancer, links that work to the regional cancer centres and strengthens institutions which already have adequate treatment facilities. Oncology wings are being developed in medical colleges and hospitals. Regional research and treatment centres have been established at 11 locations and they offer tertiary care. As a part of the cardiovascular diseases programme which was launched in 1997 on a pilot scale, training manuals have been prepared for both medical officers and paramedics covering simple knowledge

71 A50/VR/3 page 59 of cardiovascular disease, its etiology, risk factors and complications, the range of methods available for diagnosing patients, and treatment at the community level. Several epidemiological surveys have shown that the incidence of diabetes mellitus is on the increase. The current programme is in its nascency and is aimed at primary prevention by identifying the high-risk groups at an early stage and imparting risk-reducing health education to patients and their families. Secondary prevention and prevention of further complications from the disease are also being addressed. Epidemiological surveys have shown that cataract accounts for more than half the blindness cases in the developing countries and South-East Asia alone is the home of one-third of the total blind persons. In India,nearly 12.5 million people suffer from blindness. An ambitious programme has been taken up to conduct 21 million sight-restoring cataract operations. The project has novel features involving the establishment of autonomous district societies, mobile operating teams and international and national voluntary organizations. In the last year alone 2.5 million surgical operations were conducted, which has been a record for the country. The mental health programme was initiated keeping in mind the recent trends and observing the data on the number of psychiatric patients attending general health facilities. Although there are about 43 mental hospitals in the country, they are in dire need of upgrading. A number of measures have been taken to strengthen some of the hospitals by granting them management autonomy and funds for renovation and modernization. A board of visitors has been established for each such hospital. A central mental health authority was set up in April 1992 whose main objective is to review the progress of implementation of the various provisions of the Mental Health Act. State mental health authorities have been established in 14 States to oversee the functioning of the mental health facilities. It is a part of the Indian philosophy that life goes on forever. As a country, we have a long tradition of respect for the old and care for the aged. Even today families look after old parents and give them a life of dignity but it is so much easier to do so if the problems of chronic diseases which are eminently avoidable can be kept at bay for as long as possible. We are committed to reducing suffering and as the country looks forward to improving its age profile, we also seek to imbibe the fruits of science and technology. We do not see health in isolation. We seek to interweave health with the protection of the environment, the upgrading of housing, the reduction of pollution, and the provision of safe work places. We are glad the Health Assembly has chosen to address this new and important facet of health development. India has made a beginning. We hope to contain the problem while there is still time. Professor SKRABALO (Croatia): Mr President, Mr Director-General, distinguished delegates, I would like to express my deep satisfaction with the subject the Director-General has selected to present the world health situation, which together with the subject of World Health Day reemerging infectious diseases - represents most of the problems that we, the Member States, are facing at the end of this century. We agree with the initial premise that human life is becoming longer, but see something that seems to be paradoxical. With the progress of medicine and medical technology, with the efforts of health professionals and with the change in behaviour and lifestyles of the population, mortality is decreasing while morbidity is increasing. People live longer and therefore get more chronic noncommunicable diseases. Chronic noncommunicable diseases are more prevalent in more developed countries, as these have more elderly people. Should we consider this as a paradox? We need to be aware that elderly people are carriers of several chronic diseases and conditions, but should distance ourselves from the outdated attitude, expressed, inter alia, by Cicero some two thousand years ago: Senectus morbus ipsa (Old, therefore sick). On the contrary, we cannot accept old age as a disease: it is a period of life which includes some decline in health. We therefore accept the statement found in the documents prepared for our session - that life expectancy equals health expectancy. This, of course, will depend on the degree to which health professionals accept ideas on health promotion and disease prevention, as well as whether they are ready to work for the promotion and implementation of new, healthy lifestyles, with the overall aim - to use the words of the European Health for All by the Year 2000 policy document - not to add years to life but to add life to years, and that added life means a healthy one. We also agree with the statement that healthy life equals active life. We understand by this that every person should be in all aspects - psychologically, physically and economically - independent as long as possible and not to have to depend on outside help. Allow me to remind you that I am coming from a country that is not only a "very young" country, a new Member of WHO, but also a country which, as soon

72 A50/VR/3 page 60 as it had achieved independence, suffered an aggression which resulted in large-scale destruction of territories previously occupied by Croatia and some other areas. Quite often, health facilities, such as hospitals, were targets of the aggressor. This, of course, caused enormous difficulties, which, however, were in most cases successfully overcome, talcing into account the very difficult existing situation and limited resources available. Our gratitude is here expressed to the World Health Organization for its assistance and support, as well as to other international multilateral and bilateral organizations. In the case of my country, new approaches to health are already being implemented, thanks to the fact that in building our new health system and developing new concepts about health and health care we were free from old prejudices and were not obliged to preserve old clichés and forms. This factor helped us in reaching the decision that, in the reformed or newly built health system, a central role should be given to primary health care, where there is direct and continuous contact between the system and the people, and is most effective in all activities for promotion of health. This is included in our national policy for health for all by the year 2005,with which we are entering the twenty-first century, aware of the fact that at the beginning of the century we need a clear vision and idea of the mission of the health system in the years that are ahead of us. We also took this approach in the two projects we have been implementing with the World Health Organization and with the World Bank: to place primary health care first, to put it at the central point of health development and then to develop special projects for health promotion and disease prevention. In recent years we have noted some positive changes in lifestyles (i.e. in the past year the number of cigarettes consumed in Croatia decreased by 5%!),and we are achieving definite results, of which we are justifiably proud: infant mortality is decreasing and life expectancy is increasing, age-specific standardized death rates are improving for those chronic diseases which are mentioned in the Director-General's report as the most important: cardiovascular diseases and malignancies. In the field of communicable diseases - taking into account our limited resources and the great needs resulting from the aggression we suffered - we have a very satisfactory situation: during the war there was not one outbreak of an epidemic, thanks to the good work of our anti-epidemic services and the high immunization coverage of our children. We are also observing a reduction in the incidence and prevalence of tuberculosis. In conclusion, it is our belief that every country should work to achieve the goal which the Director- General justifiably and wisely placed as the main slogan for his annual report for this year: Conquering suffering, enriching humanity. Professor Zhang Wenkang (China), Vice-President, took the presidential chair. Le Professeur Zhang Wenkang (Chine), Vice-Président, assume la présidence. The President: 副主席 : 感谢克罗地亚代表的发言 由于大会主席 Saleem Shervani 先生缺席, 我荣幸地作为第二副主席主持大会 我们将继续辩论项目 9 和 10 现在我们请法国代表发言, 并请塞浦路斯代表到台前来 Le Professeur GIRARD (France): Monsieur le Président, Monsieur le Directeur général, Mesdames et Messieurs les délégués, Mesdames et Messieurs, M. le Secrétaire d'etat à la Santé et à la Sécurité sociale, empêché, m'a demandé de prononcer son allocution. C'est un grand honneur de m'adresser au nom de la France aux délégations du monde entier réunies à Genève à l'occasion de cette Cinquantième Assemblée mondiale de la Santé. Je tiens d'abord à féliciter le Président et les Vice-Présidents de l'assemblée pour leur élection.

73 A50/VR/3 page 61 L'ampleur des problèmes de santé auxquels nous sommes confrontés - le clonage n'étant pas le moindre 一,les profonds changements économiques et politiques dont nous avons été témoins au cours de cette dernière décennie donnent la mesure du rôle de l'organisation mondiale de la Santé, qui doit pouvoir répondre à ces nouveaux défis. Or, en matière de santé, les succès sont fragiles et susceptibles d'être remis en cause. Les maladies émergentes sont une menace pour tous les pays du globe. La continuité du combat et la globalité des approches sont les deux forces qui ont fait de l'oms une organisation indispensable. Cette année, le troisième rapport sur la santé dans le monde qui vient d'être publié par l'organisation - et je voudrais saluer à cette occasion l'ensemble de l'action du Dr Nakajima - traite plus particulièrement des maladies chroniques. En effet, à côté des maladies infectieuses qui restent une préoccupation majeure, les maladies chroniques non transmissibles menacent tous les pays. La France participera avec ses moyens propres à cette lutte permanente. Quatre maladies sont l'objet d'une attention soutenue dans notre pays : le diabète, les maladies cardio-vasculaires, le cancer et les maladies mentales. Loin de se limiter à prodiguer des soins curatifs, la lutte contre les maladies chroniques doit associer trois démarches : le recours à plusieurs disciplines, la participation active du patient et une bonne coordination des moyens humains et techniques existants. L'action pour un meilleur contrôle du diabète a démontré l'efficacité de ces démarches associées. En ce qui concerne les maladies cardio-vasculaires, le Haut Comité de Santé publique français a fixé comme objectif une réduction de 20 % de la mortalité due à ces maladies chez les personnes de moins de 75 ans d'ici l'an Cet objectif ambitieux est sur le point d'être atteint. Il est vrai que l'enquête MONICA, placée sous l'égide de l'oms et à laquelle la France participe depuis 1985, a été un outil de pilotage précieux. S'agissant du cancer, environ décès chaque année en France sont imputables à ce fléau et, à ce titre, la lutte contre le cancer constitue une priorité nationale. Les mesures préventives de réduction des comportements à risque liés à la consommation de l'alcool et du tabac et l'amplification des programmes de dépistage complètent là aussi l'intervention du système de soins. Enfin, dans le domaine des maladies mentales, de nombreux éléments plaident en faveur de la conduite d'une politique de santé mentale forte. Pour la France, deux indicateurs caractérisent la situation : 12 % des Français consomment au moins un médicament psychotrope depuis un an ou plus et le taux des suicides est en croissance à tous les âges, en particulier chez les jeunes. Ces aspects ont justifié la mise en place de mesures spécifiques. Je me dois enfin d'aborder le thème de la violence qui présente, hélas, tous les caractères d'une épidémie en même temps qu'une tendance à la chronicité. Le Conseil exécutif auquel j'ai l'honneur d'appartenir, lors de sa session de janvier 1997,avait ouvert le débat. La violence est un problème croissant que connaissent aussi bien les pays industrialisés que les pays en développement. Elle revêt plusieurs formes - physique, physiologique, sociale, économique - et frappe toutes les tranches d'âge, toutes catégories sociales confondues, et tous les lieux de vie : la famille, l'école, le travail, la rue. Depuis plusieurs années, notre pays s'attaque à toutes ces formes, notamment à travers le travail des nombreux ministères concernés en étroite synergie avec tous les partenaires impliqués, en particulier avec les organisations non gouvernementales. La maltraitance des enfants a été déclarée grande cause nationale en Le problème de la violence ne se limite pas à un problème de santé : il est multifactoriel par nature et relève de l'ensemble des organismes concernés du système des Nations Unies, qui devront conjuguer leurs efforts pour lutter contre ce fléau en pleine expansion. Par certains côtés, la réponse à apporter dans la lutte contre la violence peut préfigurer les méthodes et les moyens à adopter dans l'avenir pour la santé dans le monde. Pour l'organisation mondiale de la Santé, l'année qui s'ouvre est essentielle. Elle doit permettre la désignation d'un nouveau Directeur général en même temps qu'une avancée significative dans la modernisation des grands concepts sur lesquels se fonde l'organisation : politique de qualité dans le domaine de la santé, développement de nouvelles technologies et de nouveaux traitements et accès de tous à ces technologies et à ces traitements, aide aux pays les moins avancés et, bien sûr, place de l'approche fondamentale "santé pour tous". Mais à l'aube du prochain siècle, les enjeux en matière de santé sont encore plus élevés. Ils concernent l'oms elle-même et son personnel, qu'il faut remercier et dont la compétence n'a jamais fait défaut. Mais ces enjeux concernent aussi l'ensemble des Nations Unies et les autres organisations intergouvernementales. De même que cela peut s'observer au sein des Etats Membres, la santé doit devenir un sujet de préoccupation politique prioritaire au sein des Nations Unies. A tous les échelons, tant dans les Etats qu'au niveau international, il faudra savoir concilier la mobilisation de très nombreux acteurs et un pilotage stratégique fort, capable d'assurer une réponse globale. C'est le défi que les Etats Membres doivent relever. Pour sa part, la France est déterminée à y jouer son rôle. Pour toutes ces raisons, Monsieur le Président, Mesdames et Messieurs, je souhaite vivement que les travaux de cette Assemblée puissent bénéficier à l'ensemble des Etats Membres.

74 A50/VR/3 page 62 Mr SOLOMIS (Cyprus): Mr President, Mr Director-General, dear colleagues, ladies and gentlemen, on behalf of the Government of the Republic of Cyprus, I warmly congratulate the President on his well deserved election. I take this opportunity to express our sincere gratitude to our Regional Director, the Eastern Mediterranean Region staff and WHO staff in general for their hard work and dedication. In 1978,the Alma-Ata Declaration called for a level of health for all by the year 2000 that would contribute to a socially and economically productive life. It is unfortunate that, with less than three years before the dawn of the twenty-first century such a goal seems unlikely to be accomplished. Despite the fact that many countries, at all levels of income, have achieved great advances in health, the pace of progress has been uneven among them and far slower than was hoped for. Morbidity and mortality rates remain alarmingly high, particularly among less developed countries, and millions of children and adults are still dying of conditions that could be inexpensively prevented or cured. The industrialized nations have succeeded in conquering most infectious diseases, but now they have to control chronic,noninfectious diseases, which are caused mainly by urbanization, the modern disturbances of human culture operating from early childhood, and the progressive ageing of the population. On the other hand, developing countries are under the double burden of infectious diseases and of noninfectious diseases. It is undeniable that chronic diseases cannot, as yet, be effectively cured, as was once the case with infectious diseases. However, they can be prevented. Suffering, disability and premature death can be avoided if effective intervention is made on risk factors associated with them, through the promotion of a healthy lifestyle. Although much more will certainly be learnt in the future, very much already is known to help prevention. Cyprus is among those countries that have succeeded in putting infectious diseases well under control. There is strong evidence that cardiovascular diseases, cancer and accidents are now the leading causes of death of Cypriots. The rapid economic development of Cyprus, the rising annual per capita income, the progressive ageing of the population, the changing cultural patterns of life in combination with a low awareness of risk factors for chronic diseases and their prevention have largely contributed to the current situation regarding chronic diseases on the island. The World Health Organization, under the mandate of its Constitution to act as the directing and coordinating authority in international health work, has initiated, directed or supported strategies, projects and programmes aiming at the effective control of noncommunicable diseases. Our Organization has set up demonstration projects in all WHO regions, aimed at modifying the levels of the major common risk factors of chronic noncommunicable diseases in the community. Cyprus is participating in several of these projects. Within the framework of the WHO MONICA project, Cyprus carried out its baseline survey in to monitor trends and determinants of chronic diseases. Soon after, it joined the global INTERHEALTH project and recently, we have applied to join the European CINDI programme, based on the same integrated approach to prevention as the INTERHEALTH project. Taking into consideration that the risk factors for chronic diseases are identified very early in life, a pilot project was initiated among schoolchildren aged years. The project was a combination of a baseline survey on risk factors and a well-documented intervention programme, aiming at reducing risk factors among schoolchildren. The preliminary results of this survey are,i am afraid, extremely depressing. All risk factors for chronic diseases among schoolchildren in Cyprus are extremely high. We are well aware that controlling chronic diseases is a long process that demands integrated,comprehensive action against all the determinants of ill-health. The results of our efforts today are not expected to be seen in the near future. However, I am quite confident that we are on the right path and that our fight against these diseases will result in a successful outcome. We are grateful to the World Health Organization for dedicating The world health report 1997 to Conquering suffering, enriching humanity regarding major chronic, noncommunicable diseases. This gives us the opportunity to reset chronic diseases high in our priorities, to reinforce our strategies and policies and to re-evaluate our projects and programmes. El Dr. MAZZA (Argentina): Señor Presidente, señor Director General, señores delegados: Con gran satisfacción tengo el alto honor de dirigirme a la Asamblea Mundial de la Salud por quinto año consecutivo. En primer término quiero felicitar al Director General por el valioso Informe sobre la saluden el mundo 1997, cuyos conceptos comparto. Es un documento creativo, con un enfoque realista, basado en criterios epidemiológicos y de gran utilidad para los

75 A50/VR/3 page 63 Estados Miembros. Comparto plenamente el hecho de que debemos preocuparnos no solamente por la prolongación de la vida sino también por la calidad de los años que agregamos a esa vida. En mis mensajes anteriores he señalado la posición argentina frente a la compleja problemática de la salud en el mundo y de nuestro país. En el marco de las profundas transformaciones políticas, económicas y sociales que está llevando a cabo el Gobierno argentino y de las Políticas Nacionales de Salud, aprobadas por primera vez, en 1992, por un decreto de la actual gestión de gobierno, el Ministerio de Salud y Acción Social inició un proceso de cambio programático y estructural con el fin de alcanzar la ambiciosa meta de «salud para todos» en el menor tiempo posible y con el mayor beneficio para toda la población. Para ello se definieron, tal como ya lo manifestara en Asambleas anteriores, un conjunto de ejes de acción prioritarios, integrados por distintos programas que se articulan entre sí en base a objetivos comunes. Uno de dichos ejes tiene como objetivo central lograr el liderazgo del sector salud en el contexto social del país, orientando las políticas, estrategias y programas para avanzar en el camino propuesto. Otro está orientado a la transformación del modelo de atención médica para lograr un sistema humanizado, solidario, eficiente y del mejor nivel de calidad posible, con el fin de mejorar la accesibilidad y la cobertura de la población. Un tercer eje tiene como finalidad el desarrollo de una acción sanitaria sostenida con el objeto de disminuir los riesgos evitables de enfermar y morir, promoviendo conductas y estilos de vida saludables. En base a esta estrategia hemos: aumentado la esperanza de vida al nacer, que ha alcanzado un promedio de casi 70 años en el sexo masculino y 77 en el femenino; disminuido las tasas de mortalidad materna e infantil, alcanzando los indicadores más bajos de nuestra historia sanitaria; disminuido la incidencia de tuberculosis, la prevalencia de lepra y avanzado fuertemente en el control de paludismo autóctono; avanzado en la eliminación del sarampión con sólo cuatro casos confirmados serológicamente en el año 1995,sin mortalidad y no existiendo a partir de dicha fecha casos confirmados; avanzado en la eliminación del Triatoma infectans, estimándose que para el año 2000 se podrá certificar el corte de la transmisión vectorial de la enfermedad de Chagas; disminuido la tasa de mortalidad general que alcanzó el 7,5%o; aumentado la cobertura de vacunación de los programas ampliados de inmunización alcanzando el 90% de la población objetivo, habiéndose agregado este año la vacuna mti-hemophilus В y la vacuna triple viral, que se suman a nuevas vacunas incorporadas en los últimos cuatro años. Éstos son sólo algunos de los datos que muestran el alto impacto alcanzado con los profundos cambios estructurales realizados. Y es el inicio de un largo proceso de cambio que debemos continuar. La transición demográfica y la transición epidemiológica tienen plena vigencia en nuestro país, que ha alcanzado desde hace varias décadas indicadores con baja natalidad y mortalidad, generando el fenómeno de la «doble carga», que obliga a enfrentar simultáneamente las enfermedades transmisibles y no transmisibles. El aumento de la esperanza de vida, la disminución de muerte por enfermedades infecciosas y los cambios en la vida cotidiana, a través de los fenómenos de urbanización, contaminación, sedentarismo y malnutrición, se acompañan de un incremento en la incidencia de las enfermedades crónicas, de los problemas sociales, y de cambio de conducta en las poblaciones en riesgo. Todo ello debe enfrentarse tanto desde el punto de vista económico como sanitario. Los factores psicológicos de falta de afecto y sensación de desprotección que presentan las personas mayores, así como las discapacidades y su falta de integración social, generan una problemática especial que debe ser también tenida en cuenta en el accionar sanitario. Comparto el concepto de que el gran desafío actual del sector salud es la vigilancia y control de las enfermedades crónicas. Para afrontar este desafío cabe destacar el avance que hemos logrado en el cambio del modelo de atención médica en el ámbito del hospital público y del sistema de la seguridad social, así como el desarrollo de la estrategia de la atención primaria de la salud. Del mismo modo, los progresos alcanzados mediante la educación sanitaria, cambios de estilo de vida y desarrollo de comunidades saludables han contribuido significativamente al logro de los objetivos propuestos. Cabe destacar la participación de la comunidad de las organizaciones no gubernamentales y otras entidades de base comunitaria que colaboran con los programas que desarrolla el Ministerio con el fin de lograr entre todos la ambiciosa meta social de salud para todos. En el día de hoy, el Director General nos ha informado de su decisión de no postular a un nuevo mandato y quisiera rendirle un cálido homenaje por los importantes servicios que ha prestado a la Organización, además de agradecerle su permanente colaboración. Su determinación abre la puerta a la búsqueda de una nueva conducción en momentos en que la Organización Mundial de la Salud atraviesa una etapa de profunda transformación. Estoy firmemente convencido de que el éxito futuro de la Organización debe continuar apoyándose en el mantenimiento de la cultura organizacional democrática, pluralista y participativa que la ha distinguido hasta hoy. Asimismo, resulta necesario respetar las pautas y valores culturales de las regiones y de

76 A50/VR/4 page 64 los pueblos como una forma positiva de garantizar las diferentes visiones abarcativas del complejo sistema social en que se desarrolla el accionar sanitario. Estos conceptos irrenunciables y la voluntad política de avanzar en la reforma de la Organización nos comprometen a continuar trabajando con el fin de mejorar el nivel de salud y la calidad de vida de nuestras poblaciones. Mme BINDI (Italie) {interprétation de l'italien) : 1 Monsieur le Président de séance, Monsieur le Directeur général, Mesdames et Messieurs les délégués, permettez-moi tout d'abord de féliciter le Président et les Vice-Présidents de cette Assemblée ainsi que les Présidents des Commissions pour leur élection et de leur assurer le plein soutien de la délégation italienne. Le rapport du Directeur général, qui décrit la situation sanitaire dans le monde, met en évidence cette année des problèmes qui, bien qu'étant communs à tous les pays, semblent plus particulièrement concerner les responsables des questions sanitaires dans les pays que l'on qualifie d'industrialisés. Ce rapport souligne les problèmes des personnes âgées, des adolescents, des femmes, des malades mentaux, c'est-à-dire les couches de la population les plus faibles. Il met d'autre part en relief Г importance croissante et indéniable de la prévention, qui est le seul moyen de diminuer l'impact des maladies non transmissibles chroniques, et il mentionne parmi les objectifs poursuivis par l'oms l'effort déployé pour soutenir les systèmes de santé. Je saisis cette occasion pour remercier le Directeur général, le Dr Nakajima, dont nous avons tous apprécié la contribution qu'il a apportée dans l'intérêt de l'organisation et pour la réalisation de ses objectifs. L'OMS joue un rôle fondamental et précieux dans la prise en compte prioritaire des questions relatives à la santé dans les agendas politiques des gouvernements. Il est temps, en effet, de considérer la santé non pas comme un ensemble d'actions réparatrices qui représentent pour l'etat des dépenses sans retour, mais plutôt comme un investissement social indispensable à la croissance économique des pays. La plupart des pays occidentaux, et plus particulièrement l'italie, affrontent un large débat sur la réforme de l'etat-providence, et les ministères de la santé sont fortement déterminés à faire comprendre que la régression des dépenses de santé impliquerait une dégradation générale du système social qui provoquerait à moyen terme une augmentation des coûts publics supérieure à l'épargne prévue. Il est par conséquent indispensable de sauvegarder le budget de la santé dans nos pays, mais il est également nécessaire de l'utiliser en rationalisant et en définissant correctement les instruments de la santé, en établissant dans ce but de nouvelles priorités et en utilisant différemment les ressources. Le respect éthique pour le patient ainsi que le rôle actif dans la gestion des ressources et la promotion de la qualité constituent les éléments de base d'une nouvelle approche de la santé face à une société qui vieillit et qui est toujours plus touchée par des maladies dégénératives, et qui doit augmenter les bénéfices obtenus grâce aux ressources qui sont à notre disposition. Une nouvelle approche des politiques sanitaires ainsi qu'une attribution différente des ressources qui leur sont destinées doivent tenir compte des valeurs et des principes éthiques qui s'inscrivent dans les nouveaux défis de la recherche et de la science, ce qui nous sensibilise à la valeur de la vie du commencement jusqu'à la fin. Je suis convaincue que c'est à l'etat de pourvoir à une assistance sanitaire uniforme dans le respect du principe de l'égalité des droits des citoyens, et je défends avec force le système de santé national caractérisé par le principe selon lequel chacun apporte sa part afin que soient assurés à tous des niveaux essentiels de qualité et d'assistance. J'estime cependant qu'il serait impensable de s'en remettre uniquement à l'etat pour essayer de faire face aux devoirs de l'etat-providence, et des services de santé en particulier, sans pour cela faire intervenir de façon active le secteur tertiaire, expression de la société civile organisée capable d'élaborer des solutions qui apportent une réponse aux nombreux besoins naissants. La politique sanitaire sollicite en effet une solidarité qui engage l'ensemble du corps social et qui en définit le niveau de maturité civile. Le problème de la protection sociale des plus faibles et de l'égalité dans la dignité pour tous doit être placé au centre de la réflexion et de l'action civile. Dans le cas contraire, toute hypothèse de développement finirait par se transformer en injustice et oppression. C'est pour cela qu'aux niveaux international et national, le rôle du volontariat et des associations est toujours plus significatif. Je désire à ce propos rappeler l'engagement humanitaire assumé en cette période par de nombreuses entités dans le but d'alléger la tragédie sociale dans laquelle plonge l'albanie et que l'italie suit avec une attention particulière. En ce qui concerne l'action menée par l'oms, je tiens à insister sur certains points principaux. Tout d'abord, dans le domaine des maladies, je citerai le paludisme, le SIDA, la tuberculose, anciennes et nouvelles affections qui n'ont pas encore été supprimées et contre lesquelles il est nécessaire de renouveler tous nos efforts 1 Conformément à l'article 89 du Règlement intérieur.

77 A50/VR/3 page 65 au niveau international sous la direction de l'oms, que l'on doit de ce fait soutenir politiquement dans la perspective d'une amélioration du niveau d'excellence technique de l'organisation. A ce propos, nous suivons avec un vif intérêt la restructuration interne de la Division de la Lutte contre les Maladies tropicales et nous espérons que l'organisation jouera un rôle majeur dans le Programme ONUSIDA. Je souhaite par ailleurs exprimer ma satisfaction devant l'action menée par la division de l'oms chargée des secours d'urgence et j'espère que l'on continuera de privilégier le rôle de coordination, de préparation et de formation dans ce domaine. En ce qui concerne enfin les réformes des services de santé nationaux, débat crucial pour le développement futur de la santé publique au niveau international, je saisis cette occasion pour saluer le travail effectué par le Bureau régional de l'europe, qui représente pour les pays Membres un point de référence fondamental. Le rôle de promoteur, de médiateur et de coordonnateur joué par l'oms dans le domaine de la coopération internationale est l'un des plus précieux et indiscutables pour permettre à la santé d'utiliser pleinement et dans le monde entier les instruments dont elle dispose afin de réduire de manière efficace et concrète la maladie et la souffrance. Ainsi que l'a dit le Saint-Père Jean-Paul II,sauvegarder, préserver et améliorer l'état de santé signifie servir la vie dans sa globalité. Notre Organisation ne doit à aucun moment oublier que tel est son très haut mandat, qui engendre dans tous les pays du monde respect et espoir. El Dr. DOTRES MARTÍNEZ (Cuba): Señor Presidente, señor Director General, señores colegas, señoras y señores: Mi delegación quiere felicitarle por su elección, señor Presidente. Felicitaciones a nuestro Director General, Dr. Nakajima, por su labor al frente de la Organización Mundial de la Salud en estos últimos nueve años. Además, por el excelente informe presentado: un material que, de estudiarse profundamente, de reflexionarlo, de convertirlo en acción a través de la voluntad política de nuestros gobiernos, permitirá que sean otros los términos cuando volvamos a analizar los temas que hoy discutimos en esta Asamblea. No hay duda alguna de que en este mundo de hoy, ante el tema Vencer el sufrimiento, enriquecer a la humanidad una gran parte de esta humanidad sufre ante la desigualdad y su repercusión en los problemas de salud de nuestros pueblos, sobre todo los subdesarrollados que, además de la pobreza, soportan la doble carga originada por los problemas derivados de la malnutrición, de las enfermedades infecciosas, emergentes y reemergentes y los efectos de las enfermedades crónicas y otros factores de riesgo: las drogas, el tabaquismo, el alcoholismo, los accidentes, el suicidio y la violencia. Las epidemias que se nos vienen encima a partir del incremento de la esperanza de vida pueden evitarse cuando en la verdadera práctica de la vida en la mayoría de nuestros países al paciente se le llama «cliente», a los profesionales de la salud se les llama «proveedores», quedando conceptualizada así la enfermedad como «mercancía», con las implicaciones sanitarias, filosóficas y éticas que ello tiene? Con esta verdad podemos alcanzar la esperanza de salud a que llama esta Asamblea? Están nuestros sistemas de salud jugando el papel que corresponde para cambiar la situación? Mi delegación, señor Presidente, considera que hoy es imprescindible ante esta epidemia de cáncer e hipertensión, de enfermedades cerebrovasculares y trastornos mentales, entre otras, fortalecer la atención primaria de salud, buscar mayor participación comunitaria, más educación y promoción, hacer un especial énfasis en la prevención de estas enfermedades crónicas no transmisibles, con una mayor proyección epidemiológica ante un verdadero análisis de la situación de salud de nuestros pueblos, que a veces hasta desconocen las autoridades. Todo esto ante la realidad de que, si queremos salud, necesitamos equidad, solidaridad, ética, desarrollo y justicia social. Señor Presidente, distinguidos colegas: Cuba, país cruel y anacrónicamente bloqueado incluso para adquirir medicamentos y alimentos, a pesar de lo cual no ha cerrado un solo hospital ni centro de atención médica, lucha incansablemente por la salud de su pueblo, con una tasa de mortalidad infantil de 7,9 por 1000 nacidos vivos, una perspectiva de vida de 75 años; los cubanos hoy vivimos como pobres, morimos como ricos, pues nuestro cuadro de salud está dominado por las enfermedades crónicas no transmisibles, pero ya con una cobertura del 100% de los servicios médicos a la población, en un sistema de salud gratuito, equitativo y universal, donde más del 97% del pueblo está cubierto por médicos y enfermeras de la familia, la comunidad participa activamente y el sistema de salud desarrolla y prioriza en sus programas fundamentales el de la tercera edad y las enfermedades crónicas no transmisibles, destacando la prevención y proyección epidemiológica ante todos estos problemas. Señor Presidente, señor Director General, distinguidos colegas: Permítanme reiterar la disposición de mi país a seguir contribuyendo a la noble tarea de trabajar en pos de la salud mundial en nuestra Organización,

78 A50/VR/5 page 66 abrazar las propuestas de prioridades para la acción y unirnos hoy en esta Asamblea al éxito general que deseamos y al de todos mis colegas ministros en tan difíciles circunstancias de mantener lo que debiera ser ley suprema: la óptima salud de nuestros pueblos. Le Professeur GUIDOUM (Algérie): : çj^j bli^sfl (. jl^^ji J ^ j j c^j\ <ijl 广 Monsieur le Président de séance, Monsieur le Directeur général de l'oms, Mesdames et Messieurs les Ministres, honorables délégués, au nom de la délégation algérienne et en mon nom personnel, je tiens à féliciter le Président de l'assemblée ainsi que les membres du bureau pour leur élection. C'est avec un vif intérêt que nous avons pris connaissance du rapport de M. le Directeur général. Ce rapport dresse un bilan dans lequel, j'en suis convaincu, mes propos s'inscriront. Ainsi, je tiens à souligner les caractéristiques inhérentes à la situation sociosanitaire de mon pays, dans le cadre des profondes mutations et réformes engagées conformément au plan d'ajustement structurel. Certes, les maladies chroniques pèsent de plus en plus lourdement sur notre système de santé. La consommation de médicaments et de matériels et produits médicaux renouvelables pour les maladies cardiovasculaires,les affections respiratoires chroniques, l'insuffisance rénale et le diabète ne cesse d'augmenter, générant des coûts de plus en plus difficiles à supporter. Avec les cancers qui connaissent une nette progression en termes de morbidité et de mortalité, la prise en charge requise pour toutes ces affections s'avère de plus en plus problématique. Par ailleurs, comment qualifier en termes moral et éthique la situation de violence qui prévaut dans mon pays, avec notamment ses conséquences sur la santé physique et mentale à court, moyen et long terme? Comment et pourquoi évoquer le droit à la santé, maintes fois réaffirmé par la communauté internationale, quand le droit à la vie est remis en cause au quotidien par la barbarie et le terrorisme aveugle qui frappent toute la population, même les femmes et les enfants? Avec la résolution WHA49.25 adoptée par la Quarante-Neuvième Assemblée mondiale de la Santé, l'algérie se félicite que la prévention de la violence soit érigée par l'oms en priorité de santé publique. Et c'est pourquoi l'observatoire des droits de l'homme réunira à Alger en septembre 1997 un colloque international sur le thème "Formes contemporaines de la violence et culture de la paix". Concernant la violence, la communauté internationale reste interpellée à l'effet de traduire concrètement sa détermination dans la prévention du terrorisme et la lutte contre ce fléau. Oui, Monsieur le Directeur général, votre rapport met en exergue des réalités sanitaires que nous vivons tous les jours. Mais comment ne pas s'inquiéter par ailleurs de la persistance du péril infectieux, du danger des maladies transmissibles réémergentes et du fait que les inégalités s'accroissent aussi bien entre les pays qu'entre les couches sociales d'une même nation. Sur ces points, le rapport du Directeur général suscite des remarques et observations que nous nous proposons de formuler lors des travaux de cette cinquantième session. Dans mon pays, nous sommes fiers d'avoir jugulé l'épidémie de diphtérie qui nous a frappés entre 1992 et Nous sommes également fiers de tendre vers l'éradication de la poliomyélite et vers l'élimination du tétanos néonatal. Cependant, nous demeurons inquiets de constater que la méningite cérébro-spinale frappe nos voisins sud-sahariens. Nous notons également que les mesures de lutte contre le paludisme restent insuffisantes. Notre inquiétude concerne aussi le caractère inadmissible de la mise sur le marché d'un certain nombre de produits insalubres susceptibles de véhiculer des maladies infectieuses, et ce en dépit des normes internationales en vigueur en la matière. Les actions entreprises dans mon pays en vue d'adapter le système de santé aux mutations socioéconomiques se sont traduites par le renforcement du dispositif organisationnel, dont les grandes lignes peuvent être tracées comme suit. Premièrement, nous donnons la priorité à la prévention en réhabilitant les soins de santé de base, en budgétisant les programmes et en projetant la mise en place de fonds pour la prévention. Deuxièmement, la relance du programme national de maîtrise de la croissance démographique s'inscrit dans une conjoncture favorable caractérisée par une stabilisation du nombre annuel des naissances. Troisièmement, en matière de médicaments, les actions menées ont visé simultanément la relance de l'industrie pharmaceutique nationale, la disponibilité et l'accessibilité des médicaments essentiels, la création de la Pharmacie centrale des hôpitaux, destinée à assurer la fonction de régulation et de disponibilité des médicaments dans les structures sanitaires publiques, la mise en place du Laboratoire national de contrôle des produits pharmaceutiques et la création de l'agence nationale du sang. Quatrièmement, la prise en charge des urgences médico-chirurgicales

79 A50/VR/5 page 67 revêt une acuité particulière, eu égard au contexte du pays, et a fait l'objet de la création de dispositifs de transfert médicalisé dans les grands centres urbains et d'un renforcement des structures ainsi que des ressources humaines et matérielles des services d'urgences médico-chirurgicales. Dans son rapport, M. le Directeur général a pris le soin de citer les rapports présentés en 1995 et en Il est impératif de les garder bien présents à l'esprit si nous ne voulons pas donner l'impression de nous engager vers une santé à deux vitesses. C'est dans cette perspective queje voudrais conclure. Nous sommes confrontés aujourd'hui à un défi majeur au niveau mondial. Comment réaffirmer solennellement les engagements de la santé pour tous? Comment agir de sorte que la dépendance devienne une coopération authentique? Comment permettre aujourd'hui aux populations en général, et spécialement aux enfants iraquiens, libyens, palestiniens et africains, de vaincre la souffrance pour que le droit à la santé ne soit plus perçu par les populations en détresse comme un concept d'opulence, et pour qu'au nom d'un droit imprescriptible, qui est le droit à la vie, ils puissent eux aussi contribuer à l'enrichissement de l'humanité. El Dr. ALBUQUERQUE (Brasil): Señor Presidente, señor Director General, señoras y señores delegados: Le felicito, señor Presidente, en nombre de toda la delegación brasileña por su elección para presidir la 50 a Asamblea Mundial de la Salud. Agradezco al Director General y a la Secretaría el informe presentado ayer sobre la situación de la salud en el mundo. El tema central de esta Asamblea, Vencer el sufrimiento, enriquecer a la humanidad, es extremadamente oportuno ya que los datos del informe y sus pronósticos indican claramente que con el rápido envejecimiento de la población mundial también crece el riesgo del aumento de las enfermedades crónicas. El aumento de la expectativa de vida representa un avance en sí mismo, pero puede tener un mayor valor si estuviera acompañado de altos niveles de calidad, que nos cabe a todos garantizar. Nuestro esfuerzo conjunto deberá estar dirigido, en la medida que sea posible, a evitar el dolor y la incapacidad provocada por las enfermedades crónicas. Es preciso un compromiso firme y decidido de la comunidad internacional en el sentido de prestar cooperación y apoyo a la implementación de políticas y estrategias de combate a las enfermedades crónicas, comprendiendo: la prevención de su aparecimiento precoz, el retardo de su desarrollo, la disminución del sufrimiento y la construcción de un ambiente social favorable a la asistencia a los incapacitados y/o deficientes. Esta colaboración puede asumir diferentes formatos y distintas finalidades, pues se sabe que los factores que influyen en la incidencia de las enfermedades crónicas son variados y ocurren a lo largo de toda la vida, generando así oportunidades para el desarrollo de trabajos en conjunto o asociados en cada etapa: desde la prevención de los factores riesgo y el tratamiento para la cura, hasta la asistencia de los pacientes. Esta tarea es compleja, de gran alcance y difícil, pero impostergable y meritoria, pues constituye una manera de enriquecer a la humanidad. El Gobierno brasileño, y el Ministerio de la Salud en particular, están dispuestos a contribuir en este esfuerzo. Demostramos este compromiso claramente cuando auspiciamos en 1996 la primera Conferencia Internacional sobre el Envejecimiento Saludable, en la cual se aprobó la Declaración de Brasilia. La delegación brasileña apoya en general las líneas prioritarias de acción internacional presentadas en el informe, ya que está de acuerdo con el abordaje integrado y coordenado que en él se propone. Compartimos las propuestas de que es preciso atacar en conjunto los factores de riesgo comunes a varias enfermedades y que es importante establecer una coordinación más perfeccionada entre los servicios dirigidos a la salud física y los destinados a la salud mental. No se puede desconocer, con todo, que para los países en desarrollo, como el Brasil, que viven la transición epidemiológica, este desafío de lucha contra las enfermedades crónicas es aún más grave. En verdad, representa una doble carga sobre su sistema de salud, pues estos países precisan encontrar maneras de disminuir el sufrimiento y los altos índices de incapacidad provocados por las enfermedades crónicas sin dejar de combatir las enfermedades infecciosas endémicas. Dejar de conceder prioridad al combate de las enfermedades infecciosas para privilegiar el tratamiento de las enfermedades no transmisibles seguramente no es la estrategia más adecuada, pues beneficiaríamos a los segmentos más prósperos de la sociedad en perjuicio de los más pobres y así estaríamos aumentando aún más la distancia entre ricos y pobres. Mejorar los niveles de salud de la población de los países en desarrollo exige, en resumen, acciones integradas y de alcance para combatir simultáneamente las enfermedades infecciosas y las cronicodegenerativas. Con esta finalidad, el Ministerio de Salud de mi país acaba de anunciar el Programa de Acciones y

80 A50/VR/5 page 68 Metas Prioritarias, en el cual afirma su compromiso categórico de promover la salud de todos los ciudadanos brasileños, en colaboración con los municipios, los estados y otros ministerios, con el sector empresarial y con la sociedad en general, en vista de mejorar la calidad de vida y apoyar el ejercicio pleno de la ciudadanía. Para afrontar los principales problemas estructurales de la salud, el Ministerio decidió establecer un nuevo sistema gerencial que tiene como elementos esenciales un financiamiento estable, la descentralización de los servicios y la reestructuración interna, la fiscalización permanente del uso de los recursos y la evaluación continua de los resultados. Las acciones y metas para el periodo están divididas en tres grandes áreas. La primera se refiere a la prevención, con énfasis en la asistencia básica y la educación para la salud. Comprende la ampliación de los programas de salud de la familia, el programa de agentes comunitarios y la implementación de farmacias básicas de medicamentos esenciales; la cobertura rutinaria de vacunas y el combate de las endemias; la asistencia al parto y al posparto; la prevención de las enfermedades sexualmente transmisibles y los cuidados a los diabéticos. El segundo conjunto de iniciativas tiene que ver con la mejora de la calidad de los servicios de salud y se concentra principalmente sobre las formas de gestión. Se estimulará la creación de consorcios intermunicipales e interdepartamentales de salud, de manera que las emergencias y los servicios especializados de una determinada región actúen integrada y coordinadamente. También se ampliarán los hospitales de día, los centros de convivencia y las internaciones domiciliarias, entre otras medidas. El tercer eje de actividad se orienta a la movilización nacional en pro de la salud, e incluye el fortalecimiento del Consejo Nacional y los Concejos Departamentales y Municipales de Salud y la divulgación amplia de informaciones sobre el uso de los recursos financieros disponibles. Sin duda, la tecnología es un elemento decisivo de esta estrategia. A este respecto, me permito recordar que se creía hace algún tiempo que los avances tecnológicos podrían ser instrumentos valiosos para disminuir las desigualdades, pero hoy todos admiten que esta percepción optimista no se confirmó en la práctica. Por eso es preciso reorientar el empleo abusivo de los recursos tecnológicos, de manera que puedan ampliar su función social promoviendo la equidad. En mi opinión, si nos dedicamos en conjunto a esta tarea estaremos contribuyendo a la reducción de la desigualdad y enriqueciendo a la humanidad. Para concluir, me gustaría manifestar la buena disposición del Gobierno brasileño para apoyar la adopción de medidas que den prioridad a la prevención, el diagnóstico, el tratamiento y la rehabilitación de pacientes de enfermedades crónicas, aplicar extensamente metas eficaces en relación al costo, para la identificación y el tratamiento de esas enfermedades y acelerar la investigación sobre nuevos medicamentos y vacunas, así como sobre los determinantes genéticos de las enfermedades crónicas. Sin embargo, el firme compromiso de mi Gobierno con el alivio del dolor y del sufrimiento incluye también acciones destinadas al tratamiento de las enfermedades infectocontagiosas que todavía son un problema grave en una extensa área del mundo y exigen la atención redoblada de todos. Antes de concluir, me gustaría agradecer al Dr. Nakajima su trabajo como Director General de la OMS. Mr FOWZIE (Sri Lanka): Mr Vice-President, Mr Director-General, honourable ministers and delegates, ladies and gentlemen, I bring greetings from Her Excellency the President of the Democratic Socialist Republic of Sri Lanka, our Government and our people. I wish to congratulate the President on his election as the President of this historic Fiftieth World Health Assembly. His election is an acknowledgement, by all of us, of his experience and wisdom in matters of health development. May Almighty Allah guide him in steering the affairs of this Assembly. I wish to congratulate the Director-General of WHO on the excellent World health report I also wish to pay tribute to Dr Nakajima for his able leadership of the Organization during his tenure. Mr Vice-President, the World development report 1993, with a heavy technical input from WHO, analyses the distribution of disability-adjusted life-years lost, by cause and demographic region, in the year Noncommunicable diseases accounted for 42.2% of the disability-adjusted life-years lost. The range was from 19.4% for sub-saharan Africa to 78.4% for established market economies. These statistics very vividly tell the story of the threat currently posed by noncommunicable diseases to the health expectancy of the peoples of the world. The major problem with regard to these diseases is that they are very insidious in onset, non-symptomatic until the situation becomes grave and chronic, with lifelong suffering and lifethreatening acute phases. They are also closely associated with lifestyles, and a consequence of the propensity

81 A50/VR/5 page 69 to over-indulge, an unfortunate tendency with so-called "development". It is tragic that the world has not until very lately realized the importance of investing in human development along with socioeconomic development. We have to educate and motivate especially the young regarding, on the one hand, the dangers of unhealthy lifestyles and of becoming too involved in the economic and social rat-race, and, on the other hand, the need to return to our traditional diets, which are the most healthy. The other major strategy should involve screening and the early detection of these dreaded diseases. Thus, community participation is extremely important for the prevention and control of noncommunicable diseases. In screening programmes, it will be to our advantage to use nongovernmental organizations, village leaders and voluntary health workers to supplement the formal health care workers. In the quest for prevention and control of noncommunicable diseases, two important resources need to be harnessed. They are women and schoolchildren. The schoolchildren can be mobilized as agents of change in spreading the message of prevention and control of noncommunicable diseases in the community. Mr Vice-President, the achievements of Sri Lanka in the area of health development are well known, and are held up as an example of wise investment in human development for all developing countries. One of the major reasons for this happy state of affairs in my country is the role played by educated mothers who made correct decisions when it came to safeguarding the health of themselves and their families. The spearhead of the integrated noncommunicable disease prevention and control programme in my country is the well-woman clinics. This is a tribute to the ladies for their part in health development and an acknowledgement of the role they can play in prevention and control of noncommunicable diseases. At these clinics, we screen all ladies over 35 years of age annually, for diabetes, hypertension, cervical and breast cancer, and educate them with regard to noncommunicable diseases in general. In particular, we impress on them the need to look out for tell-tale signs and the need for screening for these diseases. We strongly believe in the axiom "educating a mother is tantamount to education of the whole family and, by extension, the community". Women's groups need to be empowered to join us in the battle against these diseases. Mr Vice-President, the electronic and print media must be careful when trying to do social engineering with the lifestyles of the community. We need to make use of these very same media to project healthy, positive lifestyles. Life skills should form a very important part of the curriculum of the future generations. The tobacco and alcohol industries are two of the most powerful lobbies in the world. In developing countries in particular, the taxes contributed by them are substantial. However, the long-term losses in terms of human suffering, loss of productivity and the expenditure for treatment of illnesses caused by smoking and abuse of alcohol far outweigh the contribution to national income by way of taxes. Advertising of tobacco products and alcohol, and sponsorship of sporting events by the tobacco and alcohol industries, should be banned. In conclusion, Mr Vice-President, ladies and gentlemen, I wish to pay a tribute to WHO for spearheading the global effort to prevent and control noncommunicable diseases. May Almighty Allah bless and guide our collective efforts to eradicate the scourge of noncommunicable diseases worldwide, thereby indeed conquering suffering and enriching humanity! Mr DEVYATKO (Kazakhstan): Г-н ДЕВЯТКО (Казахстан) Уважаемый г-н Председатель, г-н Генеральный директор, уважаемые министры, делегаты, дамы и господа! Прежде всего позвольте мне присоединиться к словам поздравлений руководства нынешней Ассамблеи с успешным избранием и выразить надежду, что работа данного форума будет плодотворной и окажет, безусловно, позитивное воздействие на дальнейшее развитие мирового здравоохранения. Если вспомнить выражение известного д-ра Карнеги, внимание людей через два часа в два раза сокращается. Мы работаем с вами уже четвертый час, но медики - народ закаленный. Мы с большим вниманием выслушали вчера всеобъемлющий и реалистичный Доклад о состоянии здравоохранения в мире и выражаем нашу поддержку данного документа, а также большое уважение и восхищение значительной и четкой работой, проведенной Генеральным директором и Исполнительным комитетом по подготовке данного доклада и проектов резолюций по нему. Девиз преодоления страданий, укрепления гуманизма, предваряющий Доклад, близок и понятен всем странам, в том числе нашему Казахстану, находящемуся, как

82 A50/VR/5 page 70 и ряд других стран, в состоянии переходного периода нашей экономики. В этой связи мне хотелось бы выразить глубокую признательность Всемирной организации здравоохранения в понимании проблем, временно стоящих перед нашим государством. Казахстан и Всемирная организация здравоохранения сотрудничают на регулярной официальной основе по многим различным приоритетным направлениям с 1992 г. Практически все значительные действия по реорганизации здравоохранения, подготовке его новой законодательной базы проходят с участием консультантов из ВОЗ, и мы учитываем их советы и рекомендации. Учитывая изменения, происходящие в нашем обществе, для здравоохранения Казахстана приоритетным является разработка стратегий дальнейшего развития, закрепленных в законодательном порядке. Много в этом направлении уже сделано. В нынешнем году правительством Республики начата разработка всеобъемлющей стратегии социального развития. К участию в этом процессе приглашены ВОЗ, а также другие заинтересованные учреждения ООН и другие международные организации. Мы рассчитываем на плодотворное сотрудничество. Примером подобного сотрудничества могла бы послужить совместная деятельность в нашей стране Министерства здравоохранения, ВОЗ и других организаций по реализации задач, поставленных Всемирной организацией здравоохранения по искоренению на Земном шаре таких грозных заболеваний, как полиомиелит, лепра, корь, по контролю и снижению заболеваемости инфекционными болезнями, включая туберкулез, а также по охране здоровья матери и ребенка. Среди других вопросов нас серьезно тревожат проблемы экологического воздействия на здоровье населения Казахстана, ряд из которых приняли, к сожалению, глобальное значение. В первую очередь в этой связи следует отметить проблему Аральского региона. Мировое сообщество активно участвует в действиях страны по их разрешению. В настоящее время совместными усилиями разработан ряд международных проектов по преодолению кризиса в этом регионе. Большим экологическим бедствием является последствие деятельности в течение сорока лет Семипалатинского ядерного испытательного полигона. Проведение испытаний поставило под угрозу не только общее здоровье людей, но и генетический фонд населения. По основным показателям состояние здоровья и заболеваемость, затронутые воздействием полигона, остаются одними из самых неблагополучных в нашей стране. За последние десятилетия здесь резко обострилась онкогематологическая ситуация. Даже обычные, как мы с вами называем, соматические заболевания здесь протекают с рядом больших особенностей. Последствия деятельности полигона сказались не только на радиационно обусловленной патологии, но и на общей патологической пораженности населения, нервнопсихологическом стрессе и самочувствии людей. Для преодоления этих двух серьезнейших проблем нам необходима поддержка на глобальном уровне, в том числе и со стороны ВОЗ. Значительной областью сотрудничества Казахстана и ВОЗ является охрана материнства и детства. В этой связи мне хотелось бы выразить большое удовлетворение и нашу признательность тому, что ВОЗ высоко оценила деятельность Казахстанского благотворительного фонда Бабек, что выразилось в присуждении Премии Ихсана Дограмачи Президенту этого фонда, первой леди Казахстана, г-же Назарбаевой. Являясь родиной известной Алма-Атинской декларации, принятой на Конференции ВОЗ в 1978 г. и получившей признание во всем мире, Казахстан в своей стратегии здравоохранения намерен продолжать вести линию на укрепление в качестве основного приоритета именно первичной медикосанитарной помощи, являющейся, по нашему мнению, ключом для достижения здоровья для всех, а также наиболее экономически эффективным инструментом здравоохранения в любой стране. В следующем году будет не только юбилейная дата, 50-летие создания ВОЗ, но и 20 лет со дня проведения именно Алма-Атинской конференции, на которой была принята так называемая Хартия здоровья этого века. Я полагаю, что ВОЗ должна каким-то образом отреагировать на эту дату. Главное направление развития здравоохранения Республики Казахстан во многом перекликается с приоритетами, определенными в докладе Генерального директора для международной деятельности в области здоровья, и это позволяет мне сказать, что Казахстан находится в общем фарватере мирового здравоохранения, приложит все возможные усилия, чтобы внести свою лепту в ее деятельность в целях сохранения и укрепления здоровья населения.

83 A50/VR/5 page 71 Есть два небольших пожелания. На наш взгляд, Всемирная организация здравоохранения должна быть более четким главным координирующим, аналитическим и прогнозирующим органом проведения реформ здравоохранения в различных странах. При всем глубочайшем уважении к таким международным организациям, как ЮНИСЕФ, Всемирный банк, Организация по охране окружающей среды, мы полагаем, что приоритетность именно в анализе и прогнозе должна принадлежать ВОЗ. Второе. В каждой стране имеются свои приоритеты, но, как получается на деле известно, что две третьих всех ресурсных возможностей здравоохранения тратится на население, возраст которого выше 50 лет. Как сделать, чтобы хотя бы половину средств мы тратили на предыдущее население? Думаю, что ВОЗ должна здесь сказать свое решение. В заключение хотелось бы, как и все предыдущие выступающие, поблагодарить Генерального директора за его всестороннюю плодотворную деятельность на этом сложнейшем посту лидера мирового здравоохранения. Я думаю, что через несколько лет мы войдем в двадцать первый век, и в наших силах за оставшееся время дополнить эту историю дополнительными фактами, свидетельствующими о еще более тесном объединении стран и наций, преодолении страданий, укреплении гуманизма, реальном достижении здоровья для всех. Спасибо за внимание. Mr YUSUF (Bangladesh): Mr President, allow me to felicitate the President of the Assembly most warmly upon his election to the Chair. His prolific qualities are well-known and we are confident that the stewardship of the Assembly lies in the most capable hands. It is also a matter of gratification for my delegation that he represents a friendly neighbouring country, India, with whom Bangladesh enjoys such close relations. I also congratulate the bureau, which enjoys our fullest confidence. The Director-General's inaugural remarks have set the parameters for our discussions. He is to be credited for his unbiased report on the global health situation, and on the manifold activities of WHO. Mr President, Mr Director-General, distinguished delegates, over the past decade, the epidemiological transition in Bangladesh has accelerated in momentum. Mortality and morbidity due to preventable and communicable diseases have been declining rapidly as a result of intensified collaborative efforts between our Government and our development partners, particularly WHO. The entire population has benefited from our Government's efforts to improve health facilities and to provide better health care. It should be pointed out, more specifically, that our womenfolk and our young children have been the major beneficiaries of our efforts. While we are slowly winning over our centuries-old enemies to health, Bangladesh is now faced with assaults by new enemies. Owing to the rapidly changing socioeconomic conditions and increasing urbanization and industrialization in my country, the lifestyles and health behaviour of our citizens are gradually shifting. We have also witnessed a steady deterioration of our environment. With increasing life expectancy and declining fertility, our population is gradually ageing. Lifestyle-related illness, degenerative, chronic and noncommunicable diseases, are on the increase. Cancer, cardiovascular diseases, diabetes and metabolic and mental disorders are becoming more and more prevalent in our country. Although we do not have a well-established disease surveillance system, we estimate that there are cancer patients in Bangladesh. About new cases are reported each year and approximately die from this disease annually. Regarding cardiovascular diseases, in 1995,over patients were identified and treated. As a comparison, there were only cardiovascular patients in Similarly, the number of registered patients who suffered from diabetic and metabolic disorders increased from in 1980 to in Such a rapid rise in these diseases is alarming and must be arrested with decisive interventions. My Government has already taken up a number of intervention programmes to deal with these looming health problems. Over the past few years, we have established the National Institute of Cardiovascular Diseases, the Institute of Cancer Research and Cancer Hospital and the Bangladesh Institute of Research on Diabetes and Endocrine and Metabolic Disorders. A national mental hospital has long been established and is presently being expanded and strengthened. It is worth mentioning here that Bangladesh Institute of Research on Diabetes and Endocrine and Metabolic Disorders is a reputed WHO collaborative centre in our region. The Institute specializes in diabetes and endocrine and metabolic disorders in a holistic manner.

84 A50/VR/5 page 72 Areas of interest encompass research, prevention and education, modern and indigenous medical treatment and rehabilitation. It is acknowledged that Bangladesh's health sector has been receiving substantial technical and financial assistance from our development partners. Thanks to their assistance, our health sector has made major achievements particularly in the areas of prevention and control of immunizable and other communicable diseases. However, like many other developing countries, Bangladesh is suffering from a double burden of diseases. Most of our development partners focus on communicable diseases, with the exception of a few partners such as WHO. We are yet to receive adequate assistance to prevent and control the noncommunicable diseases which are now emerging as major threats to the health of our citizens. A developing country like ours can ill afford the cost of treating chronic noncommunicable diseases. Following the Meeting of Health Ministers of the South-East Asia Region last year in Indonesia, the issue of "public-private mix" for national health development was assessed. Our Government is exploring the appropriate modalities to involve the private sector in assuming a complementary role in providing health care. With meagre resources to deal with such mammoth problems, we believe that WHO can extend substantial assistance to Bangladesh and other developing Member States in combating noncommunicable diseases in the following areas: (1) technical assistance in disease surveillance, human resource development related to technical skills and diagnostic techniques, and strengthening of institutional management; (2) mobilization of financial resources to improve facilities, diagnostic and treatment equipment and to provide reagents and chemicals; (3) support for institutional linkages between centres of excellence with the aim of exchanging and transferring scientific knowledge and technology. I would like to urge upon WHO to strengthen the Bangladesh Institute of Research on Diabetes and Endocrine and Metabolic Disorders as an international centre of excellence; I would further request that the National Institute of Cardiovascular Diseases be endorsed as a future WHO collaborating centre. Finally, I would like to express my sincere thanks to WHO for assisting our Government in the health sector since the independence of Bangladesh. I look forward to the continuation of this productive collaboration. Mr JAVORSKY (Slovakia) {interpretation from the Slovak)-} Distinguished Vice-President, distinguished Director-General, distinguished ladies and gentlemen, it is a great honour for me, as Minister of Health of the Slovak Republic, to address this distinguished assembly today. The opportunity is for me particularly important because the theme of The world health report 1997, Conquering suffering, and enriching humanity, focuses attention on major chronic noncommunicable diseases, such as cardiovascular diseases, cancer, diabetes and others. I believe that the work of this World Health Assembly will result in recommendations that will support a solution to this important health problem, so that it will not be part of the negative heritage of our coming generations. The "quiet killer" - so we have called cardiovascular diseases in the Slovak Republic - together with cancer and other chronic diseases, account for almost 90% of all deaths in my country and undermine the physical and working capacity of people of productive age. The Constitution of the Slovak Republic ensures that each inhabitant, regardless of his or her social and economic status, has access to health care in accordance with the needs of his or her health status, and implements freedom of choice of health care providers and health insurance companies. Following the successful transformation of the State budgetary system of health care financing into a financing system based on health insurance, future reform in the Slovak Republic will further be aimed at maintaining and continuously improving the quality of health care achieving a balance between State and non-state health care providers, the aim being to reverse the negative trends in the development of the health status of our population and to renew a positive attitude on the part of citizens towards their own health. The National Council of the Slovak Republic and the Government of the Slovak Republic have adopted several legislative measures to ensure an improvement in the health status of the population. They comprise, more particularly, a package of health acts - the Act on Health Insurance, the Act on Protection of the People's Health, the Act on Therapeutic Order - all of which came into force in Today I can say with pride that these Acts have ensured a solid basis for the overall transformation of the health sector in the 1 In accordance with Rule 89 of the Rules of Procedure.

85 A50/VR/5 page 73 Slovak Republic, guaranteeing that health care is provided in accordance with the principles of human dignity, equity, solidarity, professional ethics and patients' rights. Our Parliament recently approved an Act on the Protection of Non-smokers, based on a proposal by Members of Parliament themselves, as well as an Act on Alcohol Misuse. These acts introduce regulatory restrictions on the advertising of tobacco and alcohol. The Government of the Slovak Republic has also approved the Public Health Policy, Strategy, Principles and Priorities of the Environmental Policy; the Concept of Safety and Health Protection at Workplaces; the National Programme of Drug Control; and the updated National Programme of Health Promotion. All the above-mentioned documents are focused particularly on a reduction of major health risk factors, such as smoking, alcohol, unhealthy nutrition, sedentary lifestyle and substance abuse. Despite all these measures, however, the health status of the population of the Slovak Republic is far from satisfactory. Cardiovascular disease in the Slovak Republic is not only a problem of the elderly, but afflicts more and more younger men and recently young women, too. Although mortality due to cancer has stabilized in recent years, it still represents a danger. The incidence of diabetes mellitus is shifting to the younger age groups. Allergies are also a major health problem in our population. Mr President, distinguished delegates, based on the successful control of infectious diseases, the Slovak Republic belongs to the world's developed countries. However, in the field of non-infectious diseases a lot of work has to be done, because our citizens used to claim that their ill-health was due to their physicians or to the health care system. Their feeling of personal responsibility for their own lifestyles and unhealthy diet, or for keeping to the doctor's recommendations, has to be improved by better health education, and also by positive motivation through the health insurance scheme. As shown in the report, the world's highest mortality rates of coronary heart disease are now found in eastern and central Europe. Cardiovascular diseases are a serious health problem in the Slovak Republic. Efficient international cooperation, including the exchange of information and experience under the leadership of WHO, continues to be the key to combat the problems of noncommunicable diseases - the new epidemics of humankind. Distinguished ladies and gentlemen, allow me to use this opportunity to express my thanks to the Director-General of WHO, Dr Nakajima, to the Regional Directors and particularly Dr Asvall, Regional Director for Europe, and to this World Health Assembly for the great efforts and work accomplished in this field. Dr WHITWORTH (Australia): Mr President, Dr Nakajima and colleagues, Australia would like to focus on the Director-General's World health report 1997\ it is a tribute to the work of WHO and the Director-General that we are now turning our attention to noncommunicable diseases as a global health concern. There have been significant achievements globally in containing the effect of communicable diseases. Although life expectancy in countries of greatest need is still alarmingly low, and in some countries is worsening, globally people are living longer and chronic diseases are becoming more prevalent. In many countries, the quality of human life, more than the length of life, is the growing challenge: not so muchlife expectancy as health expectancy. Australia endorses the priority areas for international action identified in The world health report 1997\ integrated interventions; cost-effective methods of detection and management; promotion of healthy lifestyles; and palliative care, all underpinned by quality research. WHO can play a crucial leadership role in identifying best practice globally, and in sharing this experience with those countries grappling with noncommunicable diseases as an emerging health issue. Australia has identified five national health priorities which align closely with the areas identified in The world health report: injury prevention and control; cancer; cardiovascular disease; mental health; and diabetes. Together, they impose an enormous financial and social cost. In addressing these priorities, we are taking a whole-of-system approach, identifying the most appropriate role for governments and the nongovernment sector in adoption of best practice and in addressing some of the underpinning determinants of health such as education, employment and socioeconomic status. Let me illustrate this holistic approach with a powerful example. At last year's Health Assembly, Australia cosponsored the resolution on prevention of violence, which highlighted a leading worldwide public health problem. Only two months before, the Australian people had been stunned by an horrific event which saw 35 people gunned down at the popular tourist site of Port Arthur in Tasmania. The governments of

86 A50/VR/5 page 74 Australia quickly united in a collaborative effort to ban automatic and semi-automatic firearms, and put in place a "gun buy-back" scheme, funded through the national health insurance levy. These policy measures were underpinned by research linking such deaths to the ready availability of firearms. Australia sees population health research as a critical element of an integrated approach to noncommunicable disease control. Our number one research priority is indigenous health. Inequities in health outcomes exist, not only between countries, but within countries. Within Australia, indigenous people suffer from a double-burden of disease. Indigenous Australians die of infectious and parasitic diseases at times the national rate, but are also prone to lifestyle diseases, particularly circulatory and respiratory diseases, and injury and substance abuse. Aboriginal Australians have a life expectancy some years lower than other Australians and we simply cannot allow this to continue. Investment in health and medical research is a collective asset for the peoples of the world. WHO has set up an impressive worldwide network of collaborating centres, and one of the resolutions before this Assembly calls for the better utilization of these centres. In the area of noncommunicable diseases, where so much research is being done globally, there is a major role for WHO in tracking and disseminating this work, and in building collaborative partnerships between countries. As we focus on chronic conditions, we are also confronted with enormously challenging medico-ethical questions. I am pleased that this dimension is alluded to in The world health report. The Australian Health Ethics Committee is examining some of these more complex questions, particularly in the area of genetics. Just as research underpins health practice, so ethical considerations must underpin both. Tobacco is a major contributor to global disease burden. As tobacco consumption declines in the wealthier countries, new markets are being opened up elsewhere. Tobacco consumption and disadvantage go hand in hand. Consumption is most prevalent amongst the poor, and is rising fastest in low-income countries. Tobacco use causes diseases which are expensive to treat and debilitating in their effects, and which kill people during their productive working lives. WHO is to be commended for the lead it has taken in tobacco control and its resolve to pursue systematic solutions. We are sometimes critical of WHO for failing to do enough in particular areas, but we should not lose sight of the enormous demands it faces, the specific nature of its role in international health, and its resource realities. Over the last several years, WHO has faced unprecedented challenges. Let me here pay tribute to the Director-General, who has had to deal with a much more complex and difficult environment than perhaps any of his predecessors. While moving rapidly towards the goal of eradication of old diseases, like leprosy and polio, he has also had to respond to the emergence of new diseases and the re-emergence of old ones thought to be contained. At the same time, enormous change has been demanded of the Organization in response to the changing global environment. The reform process, which the Director-General has directed and steered, has yielded important gains within the Organization: the introduction of programme budgeting and, associated with that, much greater budget transparency; more strategic programme planning and evaluation across the Organization; and a focus on outcomes. The reform process, of course, is not yet complete, with attention now focusing on the exploration of WHO's mission and role in global health. We look forward to this work being largely completed over the next year. We strongly endorse the work under way on several fronts including the Renewal of Health for All and the work of the Executive Board group on constitutional review, in looking at WHO's mission and functions. It is essential that these are realistically framed, and predicated on sound principles. We are also strongly supportive of the call by the Executive Board at its last session "to develop an analytical framework to expedite setting and revision of priorities based on WHO's mandate and on global health determinants and challenges". WHO's first function, as set out in its Constitution, is "to act as the directing and coordinating authority on international health work". The language is significant. WHO is not the sole player, but it should be the technical leader. Its work will have maximum effect where it builds on the strategic partnerships with other organizations in the international system and draws together global expertise on health solutions. This is very relevant to the problem of chronic conditions. There is a wealth of experience globally, which can and should be shared. WHO's unique role, the expression of its leadership in global health, is in drawing together and focusing global activity; in monitoring and analysing global disease trends; in establishing standards for best practice; in disseminating best practice; and in providing technical support. Congratulations to Dr Nakajima, and thank you.

87 A50/VR/5 page 75 El Sr. ROMAY (España): Señor Presidente, excelentísimos señores, distinguidos delegados, señoras y señores: Es para mí un motivo de satisfacción participar en esta 50 a Asamblea Mundial de la Salud y exponer algunas reflexiones sobre la situación global en materia de salud, así como reiterar mi confianza en los objetivos y estrategias de la Organización Mundial de la Salud. Al aproximarnos al siglo XXI, los derechos humanos, la solidaridad, la equidad y el respeto a la diversidad sociocultural de los pueblos adquieren una relevancia no conocida en ninguna otra etapa histórica. De forma paralela, asistimos a una creciente interdependencia entre países en las áreas de actividad política, económica y social: la globalización de la economía, los avances en las comunicaciones, el comercio internacional, con sus potenciales desequilibrios asociados y los problemas ambientales han contribuido a crear una corresponsabilidad mundial de hecho, que exige nuevas soluciones que se puedan traducir en acciones inmediatas en este escenario unificado. Obligatoriamente, y como consecuencia, deberemos incrementar nuestros esfuerzos para construir un futuro que las próximas generaciones puedan heredar con satisfacción y orgullo. Los tiempos que vivimos exigen de la sociedad no sólo una solidaridad sincrónica, sino también diacrónica, para con nuestros descendientes. Por otra parte, el sector de la salud va a afrontar nuevas y crecientes demandas como consecuencia del espectacular aumento de la esperanza de vida, que en las últimas cinco décadas ha pasado de 50 a 65 años de edad en el promedio mundial. Ello conducirá paradójicamente a «epidemias» mundiales de enfermedades crónicas que podrían acarrear importantes niveles de discapacidad y un aumento del sufrimiento humano. Debemos seguir comprometidos con el objetivo de prolongar la vida, pero evitando que los años adicionales vayan acompañados de pobreza, dolor e invalidez. Las enfermedades crónicas tienen un origen plurifactorial. Además de la vulnerabilidad hereditaria, existen causas relacionadas con el modo de vida: tabaquismo, consumo elevado de alcohol, alimentación inapropiada y sedentarismo, entre otras, que pueden ser controladas por la propia persona estando bien informada, siempre que exista un entorno positivo de promoción de la salud. En cuanto a las enfermedades infecciosas, algunas tienen mayor incidencia entre poblaciones con escasez de recursos y en países en desarrollo, y no tardan en resurgir cada vez que la estructura social se quebranta a causa de ajustes económicos, procesos de transición, enfrentamientos armados y otras situaciones de emergencia. En las enfermedades tropicales, otra materia de debate de esta Asamblea, hay que determinar no solamente su incidencia y prevalencia, sino también identificar y evaluar los factores de riesgo y los mecanismos de transmisión para lograr una mayor eficacia a las intervenciones. El balance de seis años desde la creación de la División de Lucha contra las Enfermedades Tropicales ha sido positivo. Durante este periodo, se ha planificado y establecido un sistema viable y eficaz de gestión. Sugerimos a esta Asamblea potenciar los métodos actuales de control de estas enfermedades, mediante el estudio del ciclo biológico de los vectores para así lograr formas de actuación más eficaces y adaptadas a la realidad socioeconómica específica, nacional y subnacional. También proponemos formular y aplicar normas sobre el uso de plaguicidas e investigar nuevos métodos de control vectorial que no produzcan deterioro ecológico. Queremos manifestar expresamente nuestro apoyo a las acciones de la recién creada División de Vigilancia y Control de Enfermedades Emergentes y otras Enfermedades Transmisibles. Permítanme que aproveche esta ocasión para señalarles las características esenciales del Sistema Nacional de Salud de mi país, basadas en los principios de equidad y universalidad de los servicios para todos los ciudadanos (instrumento básico de cohesión social) y la financiación y aseguramiento públicos. El objetivo de la actual política del Gobierno español es consolidar y mejorar el sistema, eliminando rigideces y excesos burocráticos. Las claves de la reforma de la sanidad española radican en la separación de las funciones de financiación y provisión, la autonomía de los centros, dotándolos de capacidad de gestión con participación de los profesionales, competencia regulada entre ellos y libertad de elección de los ciudadanos. Una línea de actuación en el ámbito asistencial que no nos aleja de nuestro principal compromiso: prevenir la enfermedad mediante una constante política de salud pública. Nos es grato compartir las iniciativas de la OMS en la promoción de la salud, en el acopio, validación y difusión de información sanitaria, en el fomento de investigaciones que contribuyan a resolver problemas concretos, así como en su función normativa para elaborar soluciones técnicas y éticas. Para hacer frente a los desafíos de un mundo en evolución, la OMS tendrá que aprovechar su liderazgo para adoptar las medidas necesarias con el objeto de renovar la estrategia de «salud para todos», desarrollando una política integral basada en los conceptos de equidad y solidaridad y situando la salud como motor del progreso e itinerario hacia la paz.

88 A50/VR/5 page 76 Apoyamos la participación de la OMS en la prestación de ayuda de emergencia y en su labor de asistencia humanitaria, realizadas para atenuar los efectos inmediatos de conflictos armados y de desastres naturales. Estas acciones revalidan la legitimación de la labor de la OMS en favor de la paz y la cooperación internacional. Señores delegados, como Ministro del Gobierno español, quiero reiterar que mi país sostiene sus compromisos internacionales como miembro de la Unión Europea y nuestra especial vinculación a las naciones iberoamericanas, con las que tenemos una herencia cultural e histórica comunes. Señor Presidente, quisiera terminar agradeciendo de corazón toda la entrega y dedicación del Dr. Nakajima en su mandato como Director General de la Organización Mundial de la Salud y reiterando la estima de mi Gobierno hacia la OMS, valorando el trabajo y los esfuerzos de la Organización en favor de la humanidad y también manifestando mi convicción de que los debates y las resoluciones que tendrán lugar en esta Asamblea Mundial de la Salud contribuirán a la lucha contra la enfermedad, a la paz y a la solidaridad entre los pueblos en un mundo en acelerada transformación. The President: 副主席 : 谢谢西班牙代表的发言 在休会之前, 我要向各位宣布一个通知 希望就项目 9 和 10 发言但尚未发言的任何代表, 请向大会秘书助理办 公室. 报名, 或在全体会议期间向讲台上负责发言者名单的官员报名 发言 报名将于今天 16: 00 截止 谢谢 我宣布今天上午休会 谢谢大家 The meeting rose at 13:20. La séance est levée à 13h20.

89 page 77 FIFTH PLENARY MEETING Tuesday, 6 May 1997,at 14:30 President: Mrs M. de В. ROSEIRA (Portugal) later: Dr J.F. OLETTA (Venezuela) CINQUIEME SEANCE PLENIERE Mardi 6 mai 1997,14h30 Président: Mme M. de В. ROSEIRA (Portugal) puis: Dr J.F. OLETTA (Venezuela) DEBATE ON THE REPORTS OF THE EXECUTIVE BOARD ON ITS NINETY-FIGHTH AND NINETY-NINTH SESSIONS AND ON THE WORLD HEALTH REPORT 1997 (continued) DEBAT SUR LES RAPPORTS DU CONSEIL EXECUTIF SUR SES QUATRE-VINGT-DIX- HUITIEME ET QUATRE-VINGT-DIX-NEUVIEME SESSIONS ET SUR LE RAPPORT SUR LA SANTE DANS LE MONDE, 1997 (suite) The Assembly is called to order. I am taking over the presidency of the Assembly with pleasure; it is an honour to replace the President in his absence. Before we continue the debate on items 9 and 10 of the agenda, may I remind speakers of the limitation of five minutes on their statements, with the exception of delegates who speak on behalf of a group of countries, who should limit their speech to 10 minutes. Now I give the floor to the delegate of Nepal and I invite to the rostrum the delegate of Turkey. Mr MAINALI (Nepal): Madam President, Mr Director-General, Excellencies, distinguished delegates, ladies and gentlemen, I would like to offer my most sincere congratulations to the President on his unanimous election to the presidency of the Fiftieth World Health Assembly. Congratulations are extended also to the Vice-Presidents, the Chairmen of the main committees and other officials who have been elected to lead this Assembly. My delegation would also like to extend its appreciation to the Director-General, Dr Hiroshi Nakajima for his leadership. Many Member States are entering a period of epidemiological transition, with chronic noncommunicable diseases assuming greater significance and thus posing an increased threat to health. The South-East Asia Region has experienced a steady improvement in the health status of our people, improvement for which we can justifiably be proud. Life expectancy at birth has increased, while morbidity and mortality of infants and children have declined. Immunization programmes have achieved great success, the goal of "Universal Child Immunization" coverage for the EPI-preventable diseases having been achieved in most of our countries. Further, it is expected that diseases such as poliomyelitis will soon be eradicated from the Region. In this respect, I can note with great satisfaction that Nepal has successfully undertaken national immunization days for poliomyelitis during December 1996 and January Although considerable progress has been achieved, infant and maternal mortality rates, and deaths due to infectious diseases remain unacceptably high; too many of our children do not survive infancy; too many of our mothers do not survive their pregnancies or the birth of our children; too many of our sisters and

90 page 78 brothers do not survive infections of childhood and adult life. The incidence of old and new infectious diseases is on the rise; the advent of multiresistant strains of certain diseases, including malaria and tuberculosis, are adding to the difficulties which we face. In response, many of our countries have adopted an "integrated basic health care package" approach to ensure the availability of priority public health measures and essential clinical services that are costeffective and address the most essential health needs of the population. Nevertheless, the limited human and financial resources presently available to many developing and least developed countries permit us to provide only selected elements of these essential services. The range of essential health needs of our citizens cannot yet be met. In reflecting on the need to address noncommunicable diseases, I would hope that the Assembly's deliberations are tempered by awareness, sensitivity and appreciation of the health situation, and health care needs of developing and least developed countries, particularly the need to "bridge the gap" between those who enjoy the benefits of the health care system and those whose basic health needs are often not being met, the rural population, the poor and the underprivileged. As noted in The world health report Bridging the gaps, and reiterated in The world health report 1997, shifting priorities significantly away from infectious diseases toward noncommunicable diseases would benefit the rich at the expense of the poor. As the Health Assembly seeks to devise effective strategies for reducing chronic noncommunicable diseases, I am hopeful that in these times of severe financial constraints Member States will not abandon nor diminish their commitment to the health-for-all principles and beliefs and will ensure that the basic health needs of the poor and most vulnerable groups are not neglected. Finally, on behalf of His Majesty's Government of Nepal, I would like to express our appreciation and continued support for the leadership provided by WHO in health development. Mr ULUÇEVIK (Turkey): Madam President, Director-General, Excellencies, ladies and gentlemen, it is indeed a privilege and a singular honour for me to address the Fiftieth World Health Assembly. It also gives me great pleasure to congratulate His Excellency Mr Shervani, Minister of State for Health and Family Welfare of India, upon his election as the President of this august body. My delegation is confident that under his able guidance the work of this Assembly will be concluded successfully. My congratulations also go to you, Madam President, and the other distinguished members of the Bureau. I assure you of my delegation's constructive cooperation. We have studied The world health report 1997, with the utmost attention. I wish to thank and express our gratitude to the distinguished Director-General and his eminent staff for preparing this comprehensive report. The report and the agenda of the Health Assembly are focused on very important and priority health issues that are of concern for both the developed and the developing countries. The world health report 1997 puts the emphasis on the dramatic increases in life expectancy and the profound changes in lifestyles and their possible combined effects on the health status of the world, the report brings to our attention the possibility of global epidemics of noncommunicable diseases in the next two decades. By pointing out the epidemiological transition for the developing countries, the report gives us a new dimension for our assessment of the health situation when we are combating the old and the new communicable diseases. We share the concern expressed in the report over the double burden on the developing countries, which need to fight on these two fronts. It is evident that in the twenty-first century, health risks will increasingly be shared across countries, and that the health differences between countries will be narrowed. We support the call for increased international cooperation and assistance to face this twofold challenge. We hope to discuss these issues during the forthcoming forty-seventh session of the Regional Committee for Europe which Turkey will be honoured to host in September of this year in Istanbul. The report draws our attention to the changes in the global health agenda. It elaborates the rapid changes in the health indicators of the nations as well as the need and demands of the people and communities in terms of health care services and expectations. These expectations require adaptation of our programmes to ensure quality and acceptability rather than concentrating on coverage and scope. As providers of health we need to face this challenge by developing strategies and plans of action to render longer life as meaningful existence rather than as suffering. Health with its social and economic aspects has become one of the central, crucial and political issues in every country.

91 A50/VR/5 page 79 Turkey gives priority to sustainable development. Health is considered an inseparable part of our overall development strategies. We believe that the concept of Conquering suffering, enriching humanity is very closely related to the challenge of provision of equity in health. Our priorities lie with elimination of poverty and health protection and care for vulnerable groups within society. We look forward to a stronger WHO which will have the necessary means to support life-and-healthexpectancy for the twenty-first century, especially in those Member countries that are endowed with lesser means. Here I wish to refer to the review of the regional arrangements of WHO and express our expectation of a remedy for the unbalanced and unfair distribution of resources between the regions. In this respect I wish particularly to refer to the situation in the European Region, where the number of developing countries has increased recently. Having been compelled to operate under a gradually diminishing resource base, WHO cannot afford to contribute to programmes in countries whose GDP levels are well beyond those of the developing countries. I wish to pay tribute to the Organization's serious efforts in the reform process that is still continuing within the overall United Nations reform. We would like to express our appreciation to WHO for involving all the Member States, and many partners in health, in the process of renewing the health-for-all strategy. We support the Executive Board resolution to link the health-for-all policy with the Tenth General Programme of Work and the programme budget and evaluation processes. Our efforts are all dedicated to a better and healthier future for humanity. In a constantly changing world,who's leadership and contributions are needed to support these efforts. Thank you, Madam President. Dr KNOWLES (Bahamas): Madam President, Director-General, distinguished delegates, on behalf of the people of the Commonwealth of the Bahamas, I wish you, Madam Vice-President, to convey to the President our congratulations on his election to head this Assembly. We also wish to recognize and congratulate Dr Nakajima for his leadership in advancing health care throughout the global community. Madam President, I thank you for this privilege to share in the deliberations with our esteemed colleagues, health leaders from around the world. As we reassess, redirect and renew our global efforts aimed at overcoming human suffering and improving the quality of human life, I am acutely aware of the great and urgent challenges ahead of us, as well as the profound implications of these challenges for the lives of all people now and into the new millennium. Noticeable progress has been made over the past two decades in reducing levels of morbidity and mortality in some countries. The global community can indeed be proud of its achievements in increasing life expectancy and reducing infant and child morbidity and mortality in many of our territories. We have begun to enrich the lives of many individuals and communities by the attention given to the development of primary care services, through health promotion, disease prevention and health education. But much remains to be accomplished. With reference to the document before us, let me first pause to congratulate and thank this Organization for an excellent world health report for I take note of the emphasis that is rightly placed on the direct impact of poverty and economic disparities on the patterns of health in communities. As we confront the challenges of balancing priorities between infectious diseases and the noncommunicable conditions, we must promote simultaneous and integrated action in combating these problems. Our arguments for such lines of action are strengthened with the evidence that in developing countries those in the lower socioeconomic groups have a high prevalence of both. The Caribbean then has a dual focus as we are motivated to bridge the economic gap between the rich and poor. Particular challenges exist for us in the Caribbean subregion whose populations are ageing at increasing rates. As a result of the rapid demographic transitions we are beginning to experience, we must prepare ourselves to accommodate in the very near future large numbers of elderly persons. Some of our limited national resources must be redirected to this end. These changes have major implications for every area of social and economic activity. In the Caribbean subregion, we are losing large numbers of males: we are losing adolescent and young adult males at a rate that is of great concern to us; they represent significant hope for the socioeconomic development of a country, the hope of family unity and stability. They are dying of AIDS, and homicide and other acts of violence. In the Bahamas, AIDS has become the leading cause of death in males of all ages. The pain and suffering of these individuals, their families and our communities are getting worse, not better.

92 A50/VR/5 page 80 Health resources are being stretched to the limit as we struggle to treat the sick and ease the suffering. We encourage WHO to continue its focus on AIDS. However, we must evaluate the removal of this particular programme from WHO, as many in my region have not had access to the support - and indeed feel we have lost the support or face too many unnecessary delays in obtaining support - for our efforts to combat this disease. Also I am here today to say that we must now work harder to save our women. We have an even greater concern for the women, particularly in our region, when we assess the direct and indirect impact of AIDS and other diseases. In the Bahamas, AIDS is the number one cause of death in females between the ages of 15 and 44 years. Community rehabilitation must seek to enrich the lives not only of the mothers and fathers with AIDS but also of the children and other family members who are affected by this disease. In small multi-island States, such as the Bahamas, the consequences of the trafficking of illicit substances, in particular cocaine and marijuana, throughout the region have left us with the full slate of problems that come with high levels of substance abuse and chronic drug addiction. Together with the problem of alcohol abuse, these situations inflict tremendous hardship and suffering on our families, communities, and governments. The impact is felt economically, politically and in many other areas of national development. Our countries' resources are stretched to the limit. Treatment and rehabilitation take a long time, are costly and frequently do not alleviate suffering for individuals, families or communities. Chronic drug abuse, and in particular chronic cocaine use, in women is a significant problem for our country and our region. Current mental health practices do not meet the needs of women and their children. We must accept models of service which do not insist on complete recovery but rather focus on services related to safe housing, health maintenance and prevention of disease transmission. Ladies and gentlemen, within this august body, the clarion call for primary prevention and health promotion is extremely important and must be strengthened. As we consider the way forward, there are particular concerns for so many of our citizens who are already afflicted with advanced stages of noncommunicable diseases particularly cardiac diseases, renal failure and cancer. The reality is that needed health services are costly and are not always accessible. Now we must establish health linkages in the region which will allow us to share technology for health care for those afflicted. We need greater technical cooperation in the region to address violence prevention, substance abuse including alcohol and tobacco, the spread of AIDS, effective screening for early detection of cancer and noncommunicable diseases, and health care for the elderly. We must do this, and at the same time maintain and sustain our current programmes which promote growth and development of our children, healthy lifestyle practices, gender equities, equal standards of care for both rich and poor citizens, and the appropriate and efficient use of medical technology. I thank the delegate of the Bahamas and I give the floor to the delegate of the United Arab Emirates. The delegate of the United Arab Emirates will speak on behalf of the Council of Health Ministers of the States of the Cooperation Council of the Arab Gulf States: Bahrain, Kuwait, Oman, Qatar and Saudi Arabia and on behalf of his own country. A time limit of 10 minutes has been allocated to this speaker, as he will speak in the name of six countries. In order to save the Assembly's time, the delegates of these countries will not take the floor. Now I invite to the rostrum the delegate of Chad. Mr. ALMADFAA (United Arab Emirates): y \ ^Uh ^ ^ ^J 广 ) a I J I i j>j ^xjlp c^^l-j ^jljl-л» JJLLJIe^LJi o l Д - w w J l a^juil А^Я^Г W ) ^bxiv ^l^lil v^l yjl ^cjbxjl JjJÜ (3jUJl ^jss^ J 夕广 CfJL^Î J^yu 01.ДлчЛ Ubi ^jî aiiil JLp OUJJl i^ujjj ylу bljj ÂJL^iib is cuàlul) j^» 4 JlP (Jy>-\ UJ ^ÎCwuJIJ J J 4JL*li!l AJJJ^ ^ (^Juidl ^JLJI ÇLPSII ôl^r JLP J JJjJÂU^Jij Â^LJI lyiil J^U luájujl J^ oljujlj oliuij j^ju OÍ L^-lTU jj^tjüi bu-j 01.^joil J^jJl ùl ^ j 严 : UP ÂkLfT luàujl 己 lb î

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94 page 82 ^з j-^jl ^^JLP JJlJIJ jiaiilj cíjj^jli ^LJ^JI ^Jl jb^sj U ^Jb 广 UJJ^ 1 lül NI C^Jij^Jl jj) \ ^ 4 UAJIJ^JI ULL^JI j jjjb^i Á^-JlíJl 4J>W2Í1 ^jllii Á^Uo^l ^Jâiil S^LpIJ C^jiy^Jl J vju^j ÙUJ I^ U^Nl c-^juj ^ (JJy bujl oî V 丨 j^uiprslij j i 二 v W og^sli OJL-AP J^jji ^^JJ^l Ax^JUjl i^waji ^ c^^ujl S^wajl CUÜlj JLAI cl)^jl oo^l^í jtu^ji jujuji ji ails^nb цль JSii Uupí Jjj^r Js^ jbj ajj^ 气 JJ^J w d i ojub J jljuiîi ^ JI>JJ ^ y U u Sjj^sb JlTJ. ^^ ojlj (j^ujl O^iil ^ l^xju; ^Ij J 尸 ^ W ^^ L-ü!J.Я^-UJl oliidlj LJL-Ы) J^Ui^^b 力 4_JÜi J.Iji^-il J^Al^*j J-^rí ^ LUhljl i^jj^uji 一 ;Î cb 尸 t jlji 4Ü1 jj ^JlP J ^ Jl ^UJJ ^pxjl AJ LJ JJ?-J JP M. KEDALLA (Tchad): Madame le Président de séance, Mesdames et Messieurs les Ministres, Monsieur le Directeur général de l'oms, honorables délégués, Mesdames, Messieurs, c'est pour moi un réel plaisir de prendre la parole à cette Cinquantième Assemblée mondiale de la Santé. Je voudrais tout d'abord saisir l'occasion qui m'est offerte pour vous adresser, au nom du Gouvernement de la République du Tchad et au nom de la délégation tchadienne ici présente, nos vives et chaleureuses salutations. A vous tous, je souhaite la bienvenue à cette auguste Assemblée. Aussi, je formule des voeux ardents pour le succès sans précédent de cette session de La brillante élection de notre Président à la tête de cette Cinquantième Assemblée mondiale de la Santé n'est pas le fait du hasard. C'est un témoignage de son engagement et de sa détermination à préserver et à promouvoir la santé des populations. Qu'il me soit permis de l'en féliciter vivement. Je voudrais relever ici que pendant des années le Tchad, mon pays, a connu une histoire tumultueuse de soubresauts politiques due à de nombreuses difficultés, lesquelles, malgré sa bonne volonté, l'ont amené à s'abstenir de participer des fois aux Assemblées mondiales de la Santé. Cette année, grâce à la détermination de notre Président démocratiquement élu, qui fait de la santé un secteur prioritaire et primordial, nous avons mis un terme à cette situation pour être présents au rendez-vous des pays Membres de l'oms. Cela constitue pour nous un motif de grande satisfaction. Par ailleurs, il importe de noter que, lors de la conférence intersectorielle de 1989, le Tchad a défini sa politique sanitaire axée sor le système de développement sanitaire à trois niveaux, à savoir le niveau central, le niveau intermédiaire et le niveau périphérique. La mise en oeuvre de ce système a conduit au découpage du territoire en délégations préfectorales, en districts sanitaires et en zones de responsabilité. Le fonctionnement de ce système a nécessité la mobilisation d'énormes ressources matérielles, financières et humaines. Grâce à la contribution de l'oms et des organismes d'aide bilatérale et multilatérale, le Gouvernement de la République du Tchad a réussi à rendre ce système opérationnel. Mais les réalisations sont en deçà des objectifs fixés. Néanmoins, je saisis ici l'occasion pour rendre un vibrant hommage aux organismes des Nations Unies, entre autres, le PNUD, la Banque mondiale, l'unicef, Г UNESCO, le FNUAP et l'oms, à l'union européenne et à toutes les organisations internationales gouvernementales et non gouvernementales qui, de loin ou de près, ont contribué au développement du système de santé au Tchad. Aussi, il me plaît de souligner les efforts combien louables que l'organisation mondiale de la Santé déploie plus particulièrement pour aider le Tchad dans sa lutte pour l'éradication des maladies transmissibles et parasitaires, contre les maladies émergentes, pour la mise en oeuvre des composantes essentielles des soins de santé primaires, notamment la santé reproductive, la nutrition et 1 ' approvisionnement en médicaments essentiels et en vaccins, pour la promotion de comportements sains, notamment la santé à l'école, pour l'amélioration de la salubrité de l'environnement, en particulier l'approvisionnement public en eau potable et l'assainissement du milieu, enfin pour le développement des ressources humaines. Eu égard à ce qui précède, je voudrais du haut de cette tribune rendre une fois de plus hommage à la représentation de l'oms au Tchad et, par delà, à celle du Bureau de la Région africaine, et surtout au dynamique Directeur régional, le Dr Ebrahim Malick Samba. Je voudrais féliciter également M. le Directeur général de l'oms et toute son équipe pour la mise en oeuvre des décisions et résolutions de la Quarante-Neuvième Assemblée mondiale de la Santé, dont le Tchad, parmi d'autres pays, a largement bénéficié. Aussi, il importe d'insister sur la résolution WHA49.25 relative à

95 A50/VR/5 page 83 la prévention de la violence, source de spoliation et de dégradation du capital-santé des êtres humains. Cela me paraît être important, car on sait que les conflits armés actuels à travers le monde offrent des spectacles désolants, méprisant complètement la santé des innocents. En ce qui concerne la résolution WHA49.27 relative au VIH/SIDA et aux maladies sexuellement transmissibles, le Tchad se félicite de la réaffirmation du rôle de l'oms en tant que leader dans la lutte contre ce fléau du XX e siècle. Il faut mentionner ici sa contribution à la mise en place des programmes nationaux et, tout récemment, du groupe thématique de l'onusida. La présente Assemblée mondiale de la Santé va ouvrir des perspectives nouvelles pour la préservation et le maintien de la santé des populations. Elle aura en outre à se pencher sur les problèmes de santé liés à l'environnement, à la reproduction, aux maladies tropicales, aux maladies sexuellement transmissibles, au VIH/SIDA, aux produits biologiques entrant dans le commerce international. Il faut dire que ces éléments influent négativement sur la santé des populations et nous attendons tous avec impatience les décisions et les résolutions les concernant. Le Tchad, pour sa part, comme tous les pays Membres de l'oms, s'engage solennellement à faciliter leur application. Encore une fois, je voudrais lancer un vibrant appel à l'organisation mondiale de la Santé pour qu'elle puisse, comme par le passé, aider le Tchad à consolider ses acquis en matière de développement des ressources humaines, d'approvisionnement en matériels biomédicaux, en moyens logistiques et en médicaments essentiels. Mr. FRANHEH (Lebanon): :(ùlj) i-^üj OUJL» JL^Jl 0j-î cj» î j^juil 4_ДлН;^ ^hj cô^lji l^jl c^u-jl e-jl^-vtf»! c^j^jl JLaaJI - l>- I^-^J J маэ L_I*j ^LJJ.çLx^r ÂJLaJ^I SJlJbJl ^ J I J^l ^ ojuili L.Î 丨 oljjkjl Jjy 二 oul^jli.âlyj olîju. JLT L-Jj J L^UÎ IL- OIS" LJj obc^jl J>-bJ ja j VU-jJl J-O oulsc^i Ùll^Jlj LH 一 j a ^Tí ljj3 ^ c^jlí! y 15A LP Llp JLij Ja^yA Ô^bjj v-jaji j^û ^A LftjLÍ^I J \ c U j Jiil j OL-J ^ IJ^y UbJ>r\ ouijojl SsJ.LibJJ Lií 二 Nj^J J^iJ ulil JjjJl ^ ^ 1Ы ^L^iJl ^ y.nvjij '/.nv Jlj Jbr) 丨 j-o / ". Jlaju-Jb^Ls^Jl " " : 汤 ** ^js/l f oj^j ^? S/1 LU ^L-Ma-Jl ; / 4cJLL ^ ^ J ^ ^iji Ti Jti ^U^Jl V^JC4 UjuipI bl>- L-Pliíjl ^LU^J ^ ^ л Л Д^ 芯 Ubi /ГП Jl j ^JÜl ^lijjb 广 JL_PJ e^jbtjl vjail SUJl ks^y y>. ^J^i ûijsíi di JSj.aLlJi O l ^ J a^jl ^ L^JlP JJoj 4 丄 : 广 J L ^ JJ^ji 01.^oJi J ^UlT^i 4 ^ftui ^JaÀ^i OLs^^lli jljls^ij OL>.IjJÜIj AJjJa^*广 L*1 ^J J jjüi 丄 Jlp JLPL-UIIIÍ j j^ji O ^ ójlp C^JUJ Â-^pUi^rij AJ^U^ISI ol»jî JLjp^I Jl^Ü ÓJL- J o^jl ôjjb ç^j L5ip o^jlp LuSO ^ JLÜ^l ^ J^LMJI ^^kii L^UÍ IjJL-m^ o ^ oruji J\ J^J я^^ a^j :^-L L. J-S^ijA çljujij í L-s^y H ^L-Jj^iJ ^-iaji di J^ka x3jj ^ ^ja ^Jlkdl ^A ijbî-lp ÂJ1 ^L^olj j^l^il ^^чьou 3l>«-Jij.vu;Я^Рylb U l J5U jl j^jj JU^Jl ijub J UkuJi 4 u Jl jj^ J 4-yUuJl oijljjji ^ 丄一.rJlj mjl bwail Ojijj 4J l. Jl oju^l Jb^j.^^dí»^Jl (j^iw-^jl ^Js- ЯлчлЗ! ÂJijj]l J-aíJ Jj>rí L^aj J-s^l^lJI l^lviftl SohuLi ^ Lül t ( _ r JJLxJl L^SCjl líli ijy^i ^Síl O ajlíl^^l ouoiíou li-is» J 4JL UÍJ aíl^ Jl IjUJl I^LT ^ Y.. ^ X'j ^ ' V Jl o^íj И 气 4 ^ J /ùw Л^ ^V^ 1 J.^jilsJ JUe (^ju^ji (JlîI^NI (JiíjJI ^jip j»jj JT ^jíj j»jjl JL»Li ójb^ijl ^JLíiILj -ijajl ^sju i je- ^ cjlíj Sjbjbr i;;.^ j j )í jiul jí ^ í^j^j^ll JU-Jl ^Ij-.Sll y ls^ ajlscil - y^jl OÍ y> JjUill Jl U.SUUJI j (JbJl ^ ^ Л Ji: 0Î ÙUJ fuíjl JÜI l^i 2^j ujl J^ 产 ^

96 A50/VR/5 page 84 Professor TAKOV (Bulgaria): Madam President, Mr Director-General, ladies and gentlemen, please allow me, on behalf of the Bulgarian delegation, to extend warm congratulations to the President and all Vice-Presidents on your election to high office at this Fiftieth World Health Assembly and to wish you every success with your important tasks. I would like to take this opportunity to express our endorsement of the presented report on the world's health. The Bulgarian delegation fully supports the intention to put the accent on control of chronic noncommunicable disease and risk factors; provision of adequate care to the elderly and disabled people; promotion of healthy lifestyles and environment as elements of social policy of each country. In the twentyfirst century, health systems will face two major problems: the burden of the socially important noncommunicable diseases, and the communicable diseases - both traditional and emerging. The World Health Organization and its Member States should have at their disposal a wide range of technical, managerial and economical mechanisms in order to meet these challenges. On its part, headquarters should strengthen its coordinating functions aimed at balancing the needs of industrialized and developing countries. We would like to declare our full endorsement of the new health policy of the Organization reflected in the provisional programme budget for and aimed at redirection of financial and technological resources from global and regional to the national level. This would allow us to support to a greater extent the sub-regional and national priorities and needs of the Member States. A number of unsuccessful political and economical reforms were introduced in the Republic of Bulgaria during the last few years. Bulgaria now is one of the European countries with the most drastic drop in the level of output and GDP. This seriously reduces the possibilities for investment in the health sector, aggravates the economic situation in the health care system and leads to deterioration of health indicators. Lack of an overall concept for health care reform and the haphazard introduction of reform measures on a comprehensive scale are leading to a state of complete confusion and loss of direction for further development. The country is currently in one of the worst financial crises of its history. Domestic public debt amounts to 40% of GDP, the foreign debt of the country exceeded eight thousand million United States dollars, inflation hit 311% in This unprecedented crisis aggravated the continuously deteriorating health indicators. The most seriously affected were children and the elderly. A humanitarian appeal was issued to international organizations and bilateral donors for provision of aid, including funds, food and drugs. Madam President, on behalf of the Government of the Republic of Bulgaria, I would like to express our gratitude for the assistance provided by our Organization in collaboration with UNDP, FAO and UNICEF in determining the priorities during the needs-assessment mission in February 1997,as well as for the forthcoming delivery of humanitarian aid to Bulgaria. An anti-crisis programme in the field of health care is under development and will be coordinated at intersectoral level and with nongovernmental organizations. The programme envisages balanced short-term measures for achievement of prompt and tangible results in some critical health care fields, as well as measures for long-term development of the system. The major priorities of the programme include: guarantee of a certain volume of free-of-charge health services in the framework of the primary and hospital care; introduction of adequate methods for health care financing under the conditions of serious economic crisis; restructuring of the system for medical care aimed at cost-containment and effective use of resources; adaptation of the national drug policy to the existing realities; introduction of the structural reform in some priority areas; strengthening of the health promotion and disease prevention policies; optimal allocation of the technical and financial assistance provided by bilateral and multilateral sources. Mr Director-General, Bulgaria will need WHO's expertise for the implementation of this programme. Knowledge and experience of WHO experts would support the introduction of anti-crisis measures for health care stabilization in Bulgaria and prevent some improper actions that could have a serious impact on the health care reform in our country. Le Dr FERREIRA DE MATOS (Sao Tomé-et-Principe): Madame le Président de séance, Monsieur le Directeur général, Mesdames et Messieurs, je voudrais tout d'abord adresser mes félicitations au Président pour son élection à la présidence de la Cinquantième Assemblée mondiale de la Santé, ainsi qu'aux Vice-Présidents et Rapporteurs. Permettez-moi également de saisir cette

97 A50/VR/5 page 85 occasion pour féliciter et remercier le Directeur général, le Dr Hiroshi Nakajima, pour son excellent rapport qu'il a soumis à la présente Assemblée. Ce rapport sur lequel nous sommes invités à faire des commentaires et à proposer des orientations politiques et stratégiques met l'accent sur les maladies chroniques qui, en raison de l'allongement de l'espérance de vie, des changements de comportement et de la détérioration de l'environnement, constituent les principales causes de morbidité et de mortalité dans les pays développés et un motif de préoccupation dans les pays en développement où le phénomène de "transition épidémiologique" est déjà une réalité. Cette préoccupation est d'autant plus grande que d'ici à l'an 2020 le nombre de personnes âgées de 65 ans et plus atteindra 692 millions dans l'ensemble du monde, et que nous sommes conscients que la technologie et les moyens nécessaires au traitement d'un bon nombre de ces maladies impliquent un lourd investissement financier que les faibles économies des pays en développement ne sont pas à même de supporter. C'est-à-dire que par manque de ressources financières et pour respecter les principes de justice sociale et d'équité, les stratégies qui privilégient les actions curatives ne seraient pas les mieux adaptées pour répondre aux besoins réels de nombreux pays en développement. Nous sommes convaincus que les mesures de lutte contre les maladies chroniques telles que le cancer, les pneumopathies chroniques, les maladies cardio-vasculaires et le diabète sucré doivent tenir compte des facteurs de risque communs pour la mise en oeuvre d'une stratégie intégrée qui privilégie les actions de prévention et de promotion de la santé orientées particulièrement vers les enfants d'âge scolaire et les adolescents dans le cadre des soins de santé primaires. Il est évident qu'un effort doit être fait pour que des technologies au coût accessible et adaptées à la réalité des pays soient aussi disponibles à des fins de diagnostic, de traitement et de réadaptation. Les pays en développement ne sont pas en mesure de faire face simultanément aux maladies chroniques et aux maladies infectieuses, y compris les maladies infectieuses émergentes et réémergentes. La collaboration internationale est indispensable à cet effet. A ce propos, je voudrais manifester notre préoccupation en ce qui concerne la politique de croissance nominale zéro suivie ces dix dernières années pour le budget programme et attirer l'attention de la présente Assemblée sur l'importance de l'approbation de l'augmentation de 2% proposée par le Secrétariat pour parvenir à une croissance réelle zéro. Il est possible de réduire la souffrance et d'améliorer la qualité de vie des personnes âgées. Mais il faut pour cela que les pays et la communauté internationale travaillent ensemble avec détermination. Professor DRAEULESCU (Romania): Madam President, Mr Director-General, dear colleagues, ladies and gentlemen, I am highly honoured to express my most sincere congratulations to Mr Saleem Shervani on his election as President of the Fiftieth World Health Assembly and to wish him full success in the discharge of his duties. I also wish to congratulate the other members of the Bureau. I am sure that under your guidance, both the plenary meetings and the sessions will proceed efficiently and produce beneficial results for all of us in the large family of WHO. The report of the Director-General shows a very clear picture of the status of world health with special emphasis on chronic diseases. Increased life expectancy is indeed a major objective of health policies, but let us not forget that quality of life is also important. A longer life should be lived in better health if it is to be meaningful. Health is one of the basic human rights. For this very reason, I believe that we must stress the importance of a global strategy in facing the challenge presented by chronic diseases. We need integrated, thorough and simultaneous measures to be taken against both communicable and noncommunicable diseases. Individual health is influenced by economic and social circumstances, especially in countries with economies in transition, as is the case in Romania. The prevalence and the negative impact of chronic diseases in my country can be illustrated by one single example: cardiovascular diseases are our main cause of mortality. The WHO strategy of internationally integrated action identifies the priorities together with and for the Member States. I take this opportunity to underline the fact that such a strategy can contribute towards an official health-enhancing policy which would also support disease-control programmes. All these have a direct and positive impact on the reform of the health system in Romania and on the implementation of the health-for-all strategy under the specific conditions prevalent in our country. The Health Insurance Bill is now being debated in the Romanian Parliament. The new law creates an economic framework for a direct relationship between the consumers and providers of health services. This

98 page 86 newly defined, realistic and pragmatic relationship provides the prerequisites of the efficient use of resources and strengthens the principle of equity in health care delivery and health promotion. I look upon this Act as an important stage in the reform of the health-system making intersectoral relationships more efficient. Also, the population, which in economic terms is both the main tax-payer for and user of health services, will become aware of and accept responsibility for its own individual health as well as for that of the community. Ladies and gentlemen, I would like to express Romania's readiness to take part in WHO's programmes, and in what we feel is very important, the renewal of the health-for-all strategy. Allow me to thank the Director-General and his team for their tremendous efforts in preparing this session and to express once again my belief that the meeting will produce positive solutions for many of the problems we all face. Dr. SALLAM (Egypt): J-^U-») jjstjjl ùl^j^û 4-j>wall j^-3y J^-î Jj» :J^jl çl^vt O^Ljapíj ^Lo-jj Jlj^ c^pj) Jl^wJI Ja-^i y J-T Ûl 丄 _ 广 J Я315С. JA bwáj L. ЯзЦь^Ь ol.js^i l^lbj V^Ni J^L J jutl^i ^-UPÍ A^PUlPrMij L^i!J <JJLÍI U^UjI J^J Д^^маЛ obopxilj ÂjIP^Ji J lp 4-^lJl dj^m ^JJl Uil ^ / 八 CM.L^ilJUÍ 广力 Я-j^JUJl Д^к^л jj^ ^J.4-wJlp 4-^jb JL^L^ 5^pU^r 丨 J^Uaá^l J^rJLp i d U b Jju^.j Я^Л ^ J^AIPI ^ d L^y c^-s^ Jîj.4JJ я!jjl ^jüj ^br^ V ^iil^ji j^jl Jlj^-Sll ^Sil jl^<jlj1 oul^^l ^ CÛL^NI Jy^S r SjjJlii l 广 UÍ ow 产 NI ЬЬх;! ^Sli y^jü U3U cjikii Зу^- liîlj.^jlpsii 01 dlu J jjüi ^ Ял^аЛ j ihliil j^y Js- Ob ^aii ôjub Jy ^ ùluaj Ajjj^sJi iijju 4_JlT ^bjl 01.^IbJi ^ Vwail ajuji ^^cij Leól^Jl oljk^jl ^ yt bôlso jî JLiJ,4J j^iîl ixl^^l jujjl ^ о ji Ji N ^lâjï (^JJl jbjji L)1 J ja JL»JÜI.OÜÜs^-Jl S^jJl J o \ J * J^S "^ojs- JjjJl IJ^ ÙÎ Á^jJUil.oUJl^LíbLI y. OJb^j L. ^.J ÁjJUjl oljjkjl ^ Á ^ ^ J l ^ ÜL-J^I > ^Lp JLjb» ^jj ^^«jsji\ M ЛХл Á^wajlj OlSwJJ ÓJUJbr Я-s-bJlJ J J-ikll J Á^M^Ul SibjjlJ J ^Sll y 4JISJ^i] objjjí (^L-Jl ^Ijd^l IJL» OL^J MIP> 砧 I JTL^I j Á l3^ j^r y j J j ^ J y 01 J-j ÍJl^Ljl L^jUaPlj tjllp^l ôî^-jl Jl>-Í 二 尸 olj^tj o^-jâ-'j J-^ L^côi^-Jl L^y^À^ l L^-üí Д ^Uxil ouu^-judl 4jIS^ ^Jaj Ji>-ja 0^jli ÍÍLLA OJ^Ó 01 -LjcwJ ^IJ.L^L^j LÍUJJ LPUJ>-IJ LJJÜJ j L^ij.sí) JJ-.S/I ^ l gt.uu Jb.jJ L^ljJlSJ l^iljlaí ÓW Jl a^ru J> a-jul ^wajl Á-Já^ (Jl Í^'yíí Jl-jl ^-jvsj ^t L- jijjaj ^ji. J^j-Jl Ia^Í-jÍj ^üll La>_^pí ^jlil eùijjji ^ J i^jujl ÂJLJ^I jijl ej й ájl ÁJL^J ^j» Ljj^LJI ^ ^"iljl OJ^j OÍ!Лз ^J-Jlj ^líll i^tjl^lj i^lo» си^ч flp ^ ^ ^Ij LJjyl a^üjl S-b^uJl SjjL^ ^ Á^jujl Áí^ajl 5-Jio. JJj ^ -ltíiu cjua;j.aj^jl ^5-sbljSU 洲 I i^ji ) ^ijli 15СЛ 1 ^ ^ Щ ^ 0Î Ui' j^jjül.4_uà^-ejl ^j-j!«3_jjj ^- ij^ju]! Á^TwaJl З^хлл- j^jl HjjJl jjijj Ljá^oli j«ujl ^jjujl Í^J-^SJ l^jjuu^i ^ ÁjI^JI ^ij.зо^эип \JÍ~ U> AJjj ayi ^ -Цл- 4JJb L«j U-prLí'Lj ij^s-r j^ui; (JSl^ ^ oí ^ЬТ ajuijl LsTjUiwJ J^y L-í^ l^ljiil ^ J^jí JÍ _ -Jj^

99 Professor ZHANG WENKANG (China): 尊敬的主席女士, 总干事先生, 各位代表, 首先请允许我以中国代表团的名义, 对当选为本届卫生大会主席和其他各位副主席表示热烈的祝贺 相信在你们的领导下, 本届会议一定能取得园满成功 中国代表团同意世界芷生组织对全球卫生状况的分析, 赞成中岛宏博士将控制慢性非传染性疾疬作为今年世界卫生报告的主题 并对中岛宏博士在担任总干事期间所作出的巨大贡献给子高度的评价和敬意 世界卫生报告中对 19% 年 :2 生状况的描述和健康趋势的预测揭示我们, 慢性非传染性疾病巳不仅仅是发达国家的问题, 它必须引起全球的足够重视 下面我愿就中岛宏博士的报告提出几点具体意见 : 1. 慢性非传染性疾痼不仅严重威胁人类健康, 而且使绝大多数生存者承受病痛和残疾的折磨, 生活和生命质量严重下降, 同时造成沉重的社会和经济负担 因此, 必须向各国和各国政府宣传和呼吁控制慢性非传染性疾痼的意义, 它不仅仅是减少死亡, 更重要的是提高生命质量, 减轻社会负担, 降低医疗费用, 促进人类的进步和社会的发展 2. 当慢性非传染性疾痼替代传染病成为死亡的主要原因时, 健康行为就显得格外重要, 面个人的健康行为需要相应政策和社会环境的支持, 健康促进的渥太华宪章对这一观念进行了详细阐述 因此, 在发展个人能力的同时加强杜区行动, 创造支持环境, 建立有益子健康的公共卫生政策是成功的关键 建议卫生组织在争取高层次政治承诺和政府支持方面作出更多的努力 3. 健康促进是预防与控制慢性非传染性疾病的有效手段, 这一点早巳为一些发达国家的经验所证明 但健康促进是一项复杂的系统工程, 面大多数发展中国家缺乏这种经验和能力 据我们了解, 美国 芬兰 澳大利亚等国家有很多成功的经验, 卫生组织应该积极地促进这些国家与发展中国家的合作, 并更多地提供对发展中国家的支持 4. 鉴于慢性非传染性疾病治愈率低, 残疾率高的特点, 在开展一级预防的同时, 应注意二 三级预防, 在疾病发生发展的每个阶段提供顸防 治疗 护理或康复的机会 因此, 应大力提倡开展社区卫生服务, 建立以健康为中心, 家庭为单位, 社区为基础的预防 保健 治疗 康复一体化的社区卫生服务网络 将慢性非传染性疾病控制作为社区卫生服务和初级卫生保健的重要内容

100 A50/VR/5 page 88 中国代表团赞赏世界卫生组织为控制慢性非传染性疾病所作出的一切努力 中国与其它发展中国家一样正面临着传染病和慢性非传染性疾病的双重挑战 中国代表团赞成和支持世界卫生组织的观点, 各国 ( 特别是发展中国家 ) 再也不能象过去那样轮番应付这些疾病的挑战, 必须同时加以控制 中国政府根据疾病谱的变化, 提出 一手抓传染病, 一手抓慢性非传染性疾病 的卫生策略 将慢性非传染性疾病控制与对传染病的控制一起作为疾病控制的重要内容 中央和地方先后建立了健康教育所, 心脑血管疾病 胂瘤 糖尿病等业务管理和技术的咨询机构, 制定了重大慢性非传染性疾病的防治规划, 幵展了流行病学调查 监测 干顸 健康促进和综合防治的示范活动 19% 年 12 月, 中共中央 国务院召开新中国成立以来第一次全国卫生工作会议, 主要解决我国芷生事业改革与发展的一系列大政方针问题 经大会讨论 修改, 并于今年一月发布的 中共中央 国务院关于 1 生改革与发展的决定 中, 包括了要求各地在 消灭和控制一些严重威胁人民健康的传染病和地方病 的同时, 积极开展对心脑血管疾病 胂瘤等慢性非传染性疾病的防治工作 的重要内容 中国政府感谢世界卫生组织和各国朋友对中国卫生事业发展的一贯支持和帮助, 并愿继续参与和支持全球共同的丑生行动计划 谢谢主席女士 Dr. Al KURDI (Jordan): ^ ^ > JJr^ yl^ül J^L ) ^ -Î oí Í^-JUj J у Л ybwj t^'^l (J-V ju^l ( JJU; J 力 I OJla JiS'J C^lУ S^LJl^wíiJl li^j (^oujm J ^ J jubj ^í i]^i^jl Li; Jl, J UJ^J OrJ J^rrjLP IgJLP jycjlju^sll (_rip t U)l ÁJL^ÍI ^-y^rj C^bJl jjjbjl J l ^LÍJLj J ]\ ÓA ^ i í j. ^ J l J Orj J^-^ (Jb Ju^í jy^ ^ i-jajl Á^wJL yl^ül jijujl à h j ^ fljîl SLiUJl J^^y^y jl^i ùl (/-V ^Ui cjbji xiii.j-ií Já^ J^.j J^ ^JU > 乂 V ul 丨 ^ SjjUJI f Jlp l ^ jlj DÍ oli^il LUÍJ b ULbxJl t JbJl л^ Ja ул our c^l^ij 幻 ywl J Ьу- ^ЧЛ 丨 cjlt Л J J^íj JjJÜl OÎJU dlli JUu.ù^l IIA ^ JjSll ejl^í J->Û OiJÜiJl ^ J, L.IP jjulo > i^jl L^T y / - j J ^ J. Lb" ^ ^ Jl^ J Üí^ bhjl Lfr; ^ J, S 丄 Jl J^íj /U V, JÍ> 丄 Ь Jl Ддр ijijl J^j ^L^iilj ^ ^ J ú j l j OÜ^^Jl 一 yír ÁejUl > iiuni 让 叫 j 一丨 J ^^ d ^ у Л J^l 义 JLJj IJLJ» V^LJl ^ ^ J J r^j S ^ ^ liliî jl-ül IZJ^J^JW S^LJJ ijji cel_j>jl JsUJÎ ^ jfm j*.olscjl ^îiyí l^jü»j ^ lj (/JÜI 力丨 J>\

101 J pi d Û L T J ^PUJ^I onu-jl J J>iii ûi cbljij oia^l J\ JL^JI A50/VR/5 page 89 I^IJ Jlj L> iljb OÍ Ni.цАр 0IT "Lp I^ju ol^ji лрbbj ^ ^^Jl-j JSLJÍJ Ô^LjjJI ХЛз ^ colj ^ijl o l ^ j ^^ li и1л» ol^jl Я^рj; ^^л; OÍ CÍ-^tj j-ji j L i Ü l? L t SLJlxJl c-^w^fj.ь-ljj iyj ôj^s OÍ ^ ^Ju I^UP JLP I^T IJLP с/ oua^i 一 í jí 为 ^ 匕丨 W ) ^ Û I ^ s ^ í ^ ji^jl ^ btij ^! ÂJlxJi ajuí ollijl Я]j^Jlj ^i^j 丨 j S,Sil J^J^I 丄 丄 j l ^ч ^bj^ и^др c^ij! ^ S LP j ^J1 Jlp ^jl^j J ^ ^ j ^L-J^ii s^rl^jlj ^J lj^ J J L P jjjby b 丨 yí 1 ^ J V^lJ ÂJO^-OÏJI UU^ cjlübndj C^IP j 力丨 ^ 4 UÍJL^Jj ^ ^ J^U y djiib csul^jl ^. 丄 ;-r 一, ЯГjlJ^A U : O Í Li» Jjb c^^jj Ы^ Ujl U 产 c^uj ^IJL^ om^^ij j-uajiijlj^ J-S^J OÍ LJ CJL^.0jSOl ÍÍA J JIÂJIj j U x J i J U J l îljj S^J ^ o L ^ l j J l j i y y ^ j 'jd J ^ Ылр! J>p j L^JÍjlyl cujt U. 1Ы l^jlscii SUUJij jjajcóíj ^ üuju o^^ji LJj Jl^Ji ^ JbJl ^ L^T ^L^NIj j^^iil NI J^l ^ J^J yi JL^Jj Lulb 0jSOl ii^ J bwau UT Ü ^ 0Ы ^ IA^pj ùb^jlj. 一 ^ ^ta-^jj 1 ^ LuiLw-j yr^ ojj 4-jUJIj ^.цл уь OlwJVI OÍ ^ ^J û^jsll ^ L ^. â J u A À W ûl с^ъиj ^IJL^ 5-^L-Ji ^ itlj^lj. LUJ ÙL^Î " ^^Ji dilji AbUJl cj^l^ Ub eh jlaiîl JbJJ vl^jl ^Jl ja Jb^i JL^- JÜ 5L>Jb ÙL^I V^l^j! AJ^jS/I Ol^^i ^l^-î ^-U^j ^JLAJI já ) Ak^Jlj ^Jllil A^lSC. I^JÜPJ cjui^jj ol^jj 丨 j oíjijjjl ^ jzji^j^r Übbj. J : 丨 a J ^ I vc^tji Jit. c^bcjjl çlijlj Я^рobc^tJl ja JUJjJl Jl^ ojl^j JUaiil^ ^p obt^jjij ^îijjülj euj Д-i^uSllj 5-o^S/l ajjj^jb L^L^-Ij aisl^jl ôji_ji> Я^С UU 1 J l^ irij^l cju-jl iju ^ O^jSii ^JO^r l5jlp LA^JU J Viuil A^sJl Ukuj Ùl3yjlJ ^LíJl 广 û î Y M ^büi ij JjwÜl J*>ü>- LJÍ e^âpîjj ÛL-J^l J^^lil J^rl ^ja jljlj.0y>r^ ijub^l LUJL. Ь LUoi Jy IJy oljljj ыjijljj ^-UJlJ J? JLALJIPU^-^ 4_Ui 丨 j ^Ujl-^^I j-w^j 二 jjl U^pÍ e^ljlj ) (JJl^ j 4JUÍ1 j J Professor GALDIKAS (Lithuania): Madam President, Mr Director-General, your excellencies, honourable delegates, ladies and gentlemen. First of all I would like to congratulate the presidium and the President on their election and to express my great appreciation to the Director-General, Dr Nakajima, for his excellent statement. Lithuania has a longstanding and increasingly stronger record of collaboration with the World Health Organization. The Organization and especially the Regional Office for Europe has done an enormous amount of work to support health-policy development and to provide technical assistance to the country in the process of health care reform. We greatly appreciate the participation of the Regional Office in our efforts to improve health, prevent diseases and to further develop health strategy. Chronic noncommunicable diseases are the main cause of death, morbidity and permanent disability. Cardiovascular diseases account for 53.6% of all deaths, and cancers for 15.6%. I think these figures are a good reflection of the current state of health of the population in Lithuania. Despite the fact the most recent cardiovascular mortality data show signs of levelling off, chronic noncommunicable diseases remain a very serious issue, along with such infectious diseases as tuberculosis, sexually transmitted and other infectious diseases. Lithuania attaches increasing importance to health and especially to the issues of lifestyle and environmental health. In the further development of the national health policy, in collaboration with the Regional Office for Europe, Lithuania has prepared a document on the health-for-all principles which focuses on reducing the burden caused by chronic noncommunicable diseases through health promotion and disease

102 A50/VR/5 page 90 prevention strategies. Prevention of smoking and healthy nutrition are the key intervention areas in the programme. The National Health Programme was adopted at the recent second National Health Policy Conference attended by health-related nongovernmental organizations, health professionals, health decision makers, representatives of the Parliament, and the Prime Minister of Lithuania. We are pleased to note that good progress has been made in enhancing the effectiveness of health promotion and disease prevention. We would like to support the process of renewal of the health-for-all strategy and greatly appreciate the collaborative efforts and reforms of WHO. We trust that the Organization will continue to assist its Member States in promoting a broader approach to health encompassing social, educational, economic and other aspects. Thank you. Dr VONGSACK (Lao People's Democratic Republic): Honourable delegates, ladies and gentlemen, it is a great honour for us to participate in this Assembly, as the Lao women delegates, and on behalf of the delegation of Lao People's Democratic Republic we would like to express our warm greetings to the Fiftieth World Health Assembly. We sincerely congratulate the President and Vice-Presidents on their election, and are sure that under their wise leadership and direction, this Fiftieth World Health Assembly will achieve a brilliant success. On this auspicious occasion, we would also like to present our sincere appreciation and congratulations to Dr Hiroshi Nakajima for his constant and untiring effort towards the improvement of health in the world community. As we all know, hundreds of millions of people in both the developed and developing world continue to struggle and suffer daily with poor sanitation, unsafe water, malnutrition, gender inequality in health, and from repeated onslaughts of disease, lately including the re-emergence of chronic noncommunicable diseases, as a result of socioeconomic and epidemiological transition together with increasing life expectancy and changes in lifestyle. Our primary task is therefore to come up with new ideas to redefine health policy and health strategy in order to improve living conditions, to conquer suffering, and to enrich humanity. These matters are challenges for all Member States in the twenty-first century, with the partnership of WHO. The chosen themes of Conquering suffering, enriching humanity are indeed important challenges both for the present and for future generations. In the spirit of WHO policy, the advocacy of health empowerment of communities and the design of media strategies for health are basic to the socioeconomic development of each nation and are part of the country's fundamental policy and scientific strategy. The strengthening of partnerships for problem-solving in health, the use of a multidisciplinary and multisectoral approach, the involvement of both sexes, and joint health research studies on the prevalence of disease, disease control and risk factors affecting health and consequences for health these must all be part of a national prevention and treatment policy. At the same time, health care must be reformed at all levels, from primary health care at the grass-roots level to the use of appropriate high technology at the top, central level, in order to enhance the effectiveness of limited resources and to improve health policy, health strategy and health management. The strengthening of the international scientific community, intergovernmental organizations both within and outside the United Nations system, and of nongovernmental organizations and other agencies, with the direct or indirect involvement of WHO as the leading promoter and catalyst - these are inter-country policies and strategies. Many steps have already been taken: the adoption of Agenda 21 at the United Nations Conference on Environment and Development, the World Summit for Children, the World Conference on Education for All, the World Conference on Human Rights, the International Conference on Population and Development, the World Summit for Social Development, the World Conference on the Prevention of Natural Disasters, the Fourth World Conference on Women, and the United Nations Conference on Human Settlements. All these significant events continue to be positive factors, which, together with right policies and right strategies, provide a good basis for a new global partnership for conquering suffering and enriching humanity on this planet. Finally, on behalf of the Lao delegation, we would like to take this opportunity to express our sincere thanks to WHO as well as to other concerned international agencies for their continuous support for health promotion and health development in the Lao People's Democratic Republic. Once again, we wish the Fiftieth World Health Assembly a brilliant success in contributing to improved health for the people of the world.

103 A50/VR/5 page 91 Dr. AL CHATTI (Syrian Arab Republic): :(Á jj-j( Â^yJl Ы Лллги» jjstjüí I» t^-xjip tûyj^mji f.làe-ïj (.l^jj e^ljij oljl^jl ^jjlji i l _ r J>^Jl JL^Jl iijl Js- ûujlil jbjjj y S 二 LJlj o^jl Jl ^LfJb h j ^ ^yjl hj (y r^ V i-jbjl 4 丄 jjljiji ^ ^j^wajl ^JlL ^JÜIj Â^waJb ^bül ^. U J L;^"ц-.ytJ oí J^j tâ^jull bwail ijlj^i о jslijl Jjj^ 广 JJiT.OL-J^/I -ui UJ ijl-jlj Âjjbl ) usil О У JÜI Ja^yjl il ol.jbü!.aiir ^iryi úljüü _ 户 W y ù 丨 J^i LjJ êjlâjl Jl aij* ЯлмаЛ ol.jbüi ^Usû \j S \jja3 jl^ ç^jljlj bjj^ cja, ^ ó w - -J - ^ - í ^. ~ ~ V" J -JJ V" : 1^5" jrb.ujw.1 ol^jl cjjí IJÜ j^jl yj Ájjj^^l x-s/l Jàib- Д-JLJI 产 llpj J ^LlP^ij j AI^w» 0J^oj J ôl^ji ПjJÜl A-jlsáj J^jal»J 4-JL*UJl ci l^u^* d\ A^waJl Ôjijj O.Y Jл^ллЛЗ t-/... /1Г ^ W j 丨 I cl^cjl J^JCJJ Я^лкЛ Я^ЛцЛJ AJUJl Л Ji J ^^Jl 'i - 乃 * 1 ÂJj4\ Âj^waJl LUJl ^ Â^JUjl a^jio..j^x. j!>u y J M ч b" il ц~^jj j >\j*\ ÁJL«JÜ JL JSS/I ^tjilj y JUiL JJj j.ijji r-^ JÎ' Ji-j Jlj^x^Jl ojidl OÎ UT ^ ^ j c i j OlL-^-Jl J-t. i^^jl yl^sh 'фjl OÎ UT.4J2JI» J^L- UJloL^Jl y DjLxiib UJLU ljiyimb Sjljj ^ ÂiixJl o U 丨 j o^l^^lj jm, L^ij ^51 j^l fux^l y Jb" \<\U ruij jjbjl ^"^Jb ^Uül jt 乂!a ^ 0jbdb ^UidlJ. j l  j P y i J ^iwjl r- '/.До r 4 力 J^^ [⑵ 丨 幽 olí cjlfsjlj átjlí^. J.^'UjMI SJb^uJl 广 Sil ^y.j Á^JUJl bwail U^N ajj-ül oujiujl ljj-üi 己 Jj^ JJ ^-io j ts^wail ol-^-büi ^JLMIÍ ^í ijiy ^b L^JLxÍJ'J bwaib (_5-» ól-j^jl J ^ jji lí-^- ^l»!j-«jl Ял^г ^já ^ J l Oil Ji olf.1 алл. Á^sx^oJl ouij V-Jj ^ll ^ 4Y ^í jl ol^-jl Á ljb L.1^ Г y hj^.\ "fu... SUj Г «Jl 气 V. ^ ;lij ^ГТ 丨二 j ^ i J l ^ ÁiJl ÁJf.\y\ L^Jlf- I_..Ut1 J áulit^jl J^k *_ч >y 01 ^Jl J_ftdLi; l Ù o L  P J 产 J JlSo. ÙÎ ijjall o ûl UjÎJ J^J.«Ui ^MJ^Jl.<3«Jl olji J^Lío ^jjlj ^«Jbî^jl j i^iii ^ UL» Á^Jbiil ÁoHu.l )l US' ^ Iji^J LâiJ ijj-üi eujl ^ j^il SJJIP ILu^ JURJ^ Jl»i jj-b 广 y Ljibbl J SjlpL^JIj b r ^ J i ; J*>U V^l úljüjlj UiiJl ùlaijl ^ ÁUbJl ^^IjJl JLP JJl^Ll A^jUJ ^JÜI j SUl«Jl ^ií OÍ ^ Á^bJl!^ ^ ícr 'j-íji djjj ùisl и 尸 5-b^Jl olj^ y- ^Ju l^b^ cjljú 1 Jy j J^bJl il" ^ ùlscjl js olwwjl^jl ojl» Dlb.T.. ull^ ol-l»^ ^Ju <JLJ ^JLWJÁJlo'I^^I, ÁIo'I vua^mi ÁJlk^MI Á^L^Jl Á^LJl JJJÜI úbí joj. Ü-lT ájjj...jl ÁiJl^'yi j^jl j ( j y J l ijy. L^ cfjji J-Tj; iül^ )a^l S^LL 4 j^jl yjl ajj^-^jí )1 c^^i! C^JL^ 广 bül -C^1 ^ ^ u^j^1 ^ J J r ^Л V Jl Y UjL^-.. )t f Ь Ji1 J^ü ^jji 01 J.OJJJL* J3J J>LJÜ1 J J^bJl joljl J^b-'y ^UJlJ c-^jjjüi LftLíu^ AJJ^» ^IwwJ Dr MADUBUIKE (Nigeria): Mr President, Director-General, distinguished delegates, ladies and gentlemen, I have the great honour and delight to address this noble Assembly on the current health situation in my country. Before I do this,

104 A50/VR/5 page 92 however, permit me, Mr President, to convey to you and this honourable Assembly the greetings and good wishes of the Head of State and people of Nigeria. We are pleased to let you know that we are making steady progress in our national development and march towards political and socioeconomic For some time now, we have been compelled development. by contemporary realities to embark on far-reaching reforms in the health sector in my country, in line with such other undertakings in other parts of the world. The priority areas identified for attention in the reforms are articulated national health plan which was presented to the government in in a national health policy and a The national health plan describes the underlying philosophy, overview, goals, objectives, strategies, targets and work plans with cost estimates for each activity, for the period 1996 to the year It also describes the national health indicators for monitoring the implementation of the Plan and improvement in health status nationwide. The government has always placed emphasis on the immunization of children as a strategy for improving child survival, ensuring better health for our children and instilling confidence in the population that their children will survive to adulthood, thereby encouraging them to reduce the number of children per woman. After the decline in immunization coverage from over 80% in the early 1990s to about 30% in 1993, we had to readdress the situation through new strategies. This involved, essentially, renewed political commitment at the highest level, enhanced intersectoral collaboration and extensive social mobilization. developed a five-year action plan for immunization and relaunched the programme in collaboration with the Ministry of Women's Affairs and Social Development and the Family Support Programme which is an initiative of Nigeria's First Lady. The Family Support Programme, in concert with the government, ensured the supply of adequate vaccines and the mobilization of the entire female population in the country for a successful mass immunization month of 1997 to over 95% in many parts of the country. campaign which improved coverage in the last months of 1996 and the first All these efforts point, no doubt, to the emphasis we lay on the issue of disease control - chronic, communicable and noncommunicable, without neglecting the issue of lifestyle. We We are therefore continually strengthening our Department of Primary Health Care and Disease Control to reflect the new reality. Our reforms have placed priority on the development of human resources for health as the through which all the strategies can be translated into action. means There is no doubt that the country has made modest progress in the development of manpower since the attainment of independence in We have started the formulation of a national health manpower policy which would set out appropriate guidelines on staffing requirements, adequate and equitable distribution of trained manpower throughout the country. This effort is now receiving the support of WHO for which we are very grateful. All the major professional groups in the health sector have initiated periodic recertification of their members to promote continuing professional development. Chief executives of health establishments are now undergoing management training regularly to improve their management and administrative skills. Professional chairs are being endowed in management in four of the medical schools in the country and short training courses in health planning and management are also being intensified to ensure that, within a few years, there are enough personnel in the health sector who have been exposed to planning and modern management techniques. The private sector had surpassed and antedated government in the provision of health services in some parts of the country. We have, this year, set up a nationwide committee to articulate an appropriate public/private sector mix for the country. The government will continue to promote private-sector participation in this sector, especially in curative health services and health management, in the hope that such policy would enhance faster development in the sector and free government resources for the development of preventive and promotive health services. A repackaged national health insurance scheme is receiving the serious attention of the government to provide health-insurance coverage for civil servants, employees of parastatals and statutory bodies, private firms and institutions with more than 10 employees, their dependants up to one spouse and four children. The extra dependants can, of course, join as voluntary contributors. In the last two years we have articulated and adopted a national policy on adolescent health in recognition of the health problems of our large young population. This policy focuses attention on the problems of drugs, reproductive health, school drop-out and unemployment among our youth. We are therefore articulating programmes and action plans on adolescent health problems, in line with our adolescent health policy. The problem of re-emerging and emerging diseases is a real threat to my country. is a familiar home to all forms of re-emerging infections without exception. Our environment Among the strategies we have adopted to tackle these familiar and unfamiliar scourges are: improvement of vaccine stocks and vaccination

105 A50/VR/5 page 93 coverage, training of personnel in case and epidemic management, strengthening of our laboratories, and intensified public-health education nationwide. We do hope that when more effective interventions are developed for these new threats, our country will continue to be remembered and given favourable consideration to enable us to solve these problems in our environment. We continue to welcome in this regard the assistance of our friends and remain grateful for their demonstration of goodwill in our efforts to be on top of our numerous health problems. Mr President, ladies and gentlemen, I urge this noble body to continue the good work it has been doing for the greater benefit of mankind and, while doing that, to always bear in mind that we, in Africa, face particularly challenging situations that call for special consideration. My delegation joins other delegations in commending the efforts of WHO in improving the health status of mankind. May I therefore end this brief remark by inviting its Director-General, Dr Nakajima and other high officials of WHO not to fail to visit Nigeria before the end of their tenure to see what we are doing and what we have been able to do so far in our effort to conquer suffering and enrich humanity. I thank you for listening, and God bless you. Mr GUNNARSSON (Iceland): Madam President, Mr Director-General, distinguished delegates, it is a great honour for me to address this Assembly on behalf of the Government of Iceland. I would like to congratulate you, Madam President and the officers of the Fiftieth World Health Assembly on their election. The results of the annual assessment of the world health status and needs, as presented by the Director- General in The world health report 1997, require urgent actions to reduce mortality caused by noncommunicable diseases in all parts of the world. The actions to be taken are particularly important for the new global health policy. To succeed in coping with many serious health problems threatening mankind, WHO has to work closely with the Member States in securing the implementation of actions against diseases such as cancer and heart diseases, diabetes and rheumatism. Last year the Director-General, Dr Hiroshi Nakajima, pointed our attention to the fact that we are standing on the brink of a global crisis in infectious diseases. We highly appreciate the efforts of WHO in responding to these diseases, both emerging and reemerging in many parts of the world. The theme of this year's World Health Day, "Emerging infectious diseases - global alert, global response", reminds us to take a realistic look at these problems and concentrate on improving our systems of disease surveillance and disease control. Iceland has always tried to live up to its duties as a member of the international community. During this century we have seen dramatic improvements in the health situation. Due to bacteriological findings, environmental sanitation and discovery of effective vaccines we have witnessed an epidemiological revolution in our country. We did hope that this could in the future be called the conquest of infectious diseases. However, now again we have to be aware that if we lower our guard some of them and even new ones might become a threat again. Today our main task in improving the health of the nation is to reduce the noncommunicable diseases. In that work we hope to join other countries of the world in the second epidemiological revolution: the conquest of noncommunicable diseases. These are not only the leading causes of mortality in the industrial nations but have become an increasing threat to health in the developing nations as well. Effective methods have been developed for the prevention of heart disease, certain kinds of cancer, stroke, accidents, chronic lung diseases, and cirrhosis of the liver; and the application of these methods has already resulted in dramatic reductions in death rates. Furthermore, through genetic research we hope to be able to draw benefit from the homogeneity of the population. We are convinced that our support to ethically controlled genetic research as regards the investigation of the origins and causes of many diseases will in the future lead to further conquests in the struggle to reduce noncommunicable diseases. For Iceland WHO has during the last decades been important in the transferring of valuable experience in the fields of prevention, pharmaceutical services and health care. The Icelandic health system is to a large extent a product of the cooperation and exchange of ideas between the Nordic countries and the Organization. WHO has played a leading role in the formulation of international policies and in assisting countries in various ways. Through the help of experts and the guidance of plans and programmes developed by the Organization, it was made possible for countries like Iceland to develop their own health policies. Our national health plan from 1991 is, for example, mostly based on the health-for-all strategy. Still, many countries in the world are facing big problems in building up their health systems. These countries need a considerable assistance in the areas such as: prevention and treatment of diseases,

106 page 94 implementation of medical insurance, development of medical science, quality control and distribution of medicines, and, last but not least, implementation of national health plans. We are convinced that WHO is doing excellent work in assisting these countries to develop health care systems. In addition, we are equally sure that many individual countries, which during the last decades have developed both modern and well-performing health care systems, can be of valuable assistance in this mission. Therefore, we have taken part in projects in some of the newly independent countries and hope to be able to offer more help if needed. As documented before this Health Assembly, the strategy for health for all by the year 2000 was aimed at an important goal which we are striving energetically to attain. The updating of the strategy presented at this Health Assembly is very promising, and we urge all governments to renew and strengthen their commitment to achieve health-for-all goals and adopt policies and strategies accordingly. Madam President, I would like to conclude my address by assuring you, once again, of the commitment of the Government of Iceland in contributing to constructive efforts to fulfil WHO's noble mission. El Sr. SOSA RAMÍREZ (Guatemala): Señora Presidente, señor Director General, señores jefes de delegaciones, señoras y señores: Permítanme felicitar al señor Presidente y a los señores Vicepresidentes por su elección y desearles muchos éxitos en su trabajo, así como agradecer al Director General su excelente Informe sobre la salud en el mundo. Hace un año estuve presente en esta Asamblea, anunciándoles la posibilidad de la firma de la paz en mi país. Hoy puedo decir con mucho orgullo que Guatemala empezó este año una etapa nueva en su historia. Nueva porque, después de 36 años de conflicto armado, el 29 de diciembre pasado el Gobierno del Presidente Álvaro Arzú y la Unidad Revolucionaria Guatemalteca firmaron la paz. Vivir en paz significa para nosotros los guatemaltecos la oportunidad de un futuro próspero y promisorio. La gestión del Presidente Arzú y su Gabinete descansa en varios objetivos fundamentales, que fueron plasmados con mucha claridad y honestidad en nuestro plan de gobierno y que se sustentan en los compromisos que en lo político, lo social y lo económico adquirimos frente a nuestro pueblo. Estos compromisos están materializados en los acuerdos de paz, por lo que podemos decir con mucho orgullo y satisfacción que desde el primer día de la administración Arzú, la paz empezó a construirse. En lo político, nuestro plan de gobierno privilegia la democracia participativa y la modernización del Estado. En lo social, promueve el desarrollo humano integral, y en lo económico fortalece la infraestructura productiva. Los guatemaltecos ya estamos observando los primeros resultados del cumplimiento de los compromisos de nuestro Gobierno y de la libertad plena que permite la paz. Hemos reconstruido y construido carreteras como no se había hecho desde hace muchos años; las telecomunicaciones están llegando a los lugares más apartados del país; la exportación de productos no tradicionales sigue creciendo y hemos incrementado sustancialmente la producción de barriles de petróleo. Paralelamente, nuestro Gobierno ha focalizado sus recursos en los sectores prioritarios de la salud y la educación, que están llegando a las aldeas y caseríos más alejados del país, con énfasis en la participación comunitaria. En salud estamos operacionalizando un programa denominado Sistema Integral de Atención en Salud. Este programa resulta del esfuerzo institucional del sector salud bajo la rectoría, dirección y coordinación del Ministerio que me honro en presidir. Por primera vez en nuestra historia, el Ministerio de Salud Pública y Asistencia Social y el Instituto Guatemalteco de Seguridad Social estamos haciendo planeamiento estratégico conjunto y concretando acciones que permitirán aprovechar racionalmente los recursos de ambas instituciones. También por primera vez estamos desarrollando acciones de salud a través de organizaciones intermedias que no son gobierno: por ejemplo, instituciones privadas, iglesias, asociaciones comunitarias, a quienes el Ministerio de Salud les traslada, mediante convenios, recursos financieros, humanos y tecnológicos a través de mecanismos precisos de empoderamiento en un marco de respeto a su autonomía. En el caso de las comunidades indígenas, apoyamos sus formas propias de organización y su enorme potencial de extensión de servicios en el contexto de sus tradiciones culturales y de sus particularidades étnicas y lingüísticas. Hacia el año 2000 esperamos ver consolidada nuestra red integral de servicios que nacen en los Centros de Convergencia Popular y llegan hasta nuestros hospitales del tercer nivel, atravesando nuestros Puestos y Centros de Saliid. Esperamos también para entonces haber institucionalizado en todo el país nuestro paquete de servicios básicos, que deberá permitirnos reducir no sólo las tasas de mortalidad y morbilidad maternoinfantil, sino también la propagación de enfermedades mortales como el SIDA, con un programa novedoso que iniciamos el año pasado.

107 page 95 Señora Presidente, señor Director General, señores delegados: En todo este esfuerzo que se ha sustentado principalmente con recursos de los guatemaltecos ha sido muy apreciada la asistencia complementaria de la comunidad internacional a través de los organismos de cooperación, los gobiernos y el sistema de las Naciones Unidas, por medio de la OPS y del Programa de Cooperación Intensificada de la OMS, lo cual nos ha sido muy útil. A todos muchas gracias. Finalmente, deseo reconocer, Dr. Nakahima, su trabajo y su liderazgo por la salud del mundo, deséandole éxitos en sus actividades futuras. Dr OPOLSKI (Poland): Madame President, Mr Director General, distinguished delegates, ladies and gentlemen, allow me, on behalf of the delegation of Poland and myself, to congratulate you on your election and to extend our congratulations to all our colleagues who have been elected to the highest offices of the Fiftieth World Health Assembly. Allow me also to congratulate the Director-General and his staff on the concise but comprehensive report presented to us, The world health report The report focuses on major chronic noncommunicable diseases and indicates clearly that in today's world we face not only socioeconomic and political but also epidemiological transition, or health transition. This changing pattern of health will continue in line with increases in life expectancy and therefore, since the majority of chronic diseases cannot be cured, we fully agree with the statement in the report that the only realistic response is prevention, as otherwise we can only reduce the suffering caused by them, or provide socio-medical care for those disabled by them. The report indicates that within this changing pattern of health there are old unsolved problems, old re-emerging problems, and new health problems. The report is therefore a condensed overview of the situation that exists within our Organization and calls for urgent action now, as otherwise these unsolved and emerging problems may cause irrevocable damage, far beyond the year This urgent action is, first of all, prevention in the broadest possible sense. And prevention just means the fullest possible application throughout the world, of the essential public health functions. For the majority of, but not all, chronic noncommunicable diseases, prevention in the sense of essential public health functions has become a multisectoral, multidisciplinary and multiprofessional exercise, and the state is in a position to protect its society effectively against a great number of dangers, but not all. The cultivation of health which requires a definite mode of living remains, to a large extent, an individual matter and personal decision. We have to realize that health cannot simply be dispensed to the people. People themselves must want it and fight for it, and they should be taught and educated how to fight. By all of us, that is by the World Health Organization. In conclusion, Madame President, I should like to declare that both as an individual State and as a Member State of WHO we welcome the priorities for action, as formulated in this year's report. We are of the opinion that charting the future is one of the basic responsibilities of our Organization. Thank you very much indeed for your attention. Mr SAW TUN (Myanmar): Madam President, Excellencies, distinguished delegates, ladies and gentlemen, allow me, on behalf of the delation of the Union of Myanmar and on my own, to congratulate the President on his election as President of the Fiftieth World Health Assembly. I would also like to extend my sincere congratulations to the Vice-Presidents. The comprehensive report submitted to the Health Assembly this year provides an incisive overview of the various activities undertaken by the Organization to help countries find solutions to their health problems. My delegation is fully cognizant of the Organization's efforts and anticipates continued progress in its global endeavours for raising the health standards of all people. In my country, a very active control programme for cardiovascular diseases has existed. Under the noncommunicable disease portion of the disease control programmes, three other major causes are also included: diabetes, cancer and snake-bite. There is also a community-oriented mental health care programme, since a sound mind in a sound body is one of the prerequisites of good health. The standard of health of the Myanmar population has improved significantly over the last decades. This is already reflected in the substantial decrease in mortality and morbidity rates. The attainment of political stability, and the implementation of a market-oriented economy have contributed towards this major achievement. The

108 A50/VR/5 page 96 Government, through its primary health care delivery system, has been able to reach the community at the grass-roots level successfully, as reflected in the immunization coverage. To ensure equity in the delivery of health services in the country, especially in the remote area, health facilities as well as health personnel have been assigned and voluntary health workers have been trained to provide primary health care services. Along with other developing countries, Myanmar is in epidemiological transition. On the one hand, infectious diseases are still major health problems. On the other hand, the incidence of noncommunicable diseases such as cardiovascular diseases, cancer and diabetes, is on the rise. Contrary to communicable diseases, the diseases of affluence tend to be life-long, and the key to those problems lie as much with individuals as with the health service. That is why, in Myanmar, we are focusing on motivating individuals to practise healthy lifestyles and behaviour. Weighing the gravity of the infectious as against the noninfectious diseases, the greater problem still lies with the infectious diseases in the developing countries. Diseases such as malaria, dengue haemorrhagic fever and the waterborne diseases continue to take the highest toll in morbidity and mortality. Like other countries we have the problem of HIV/AIDS infection. The origin of the disease is not within our country and its prevalence is confined to the border areas. Since infectious diseases observe no boundaries, coordinated efforts of the neighbouring countries is of prime importance to control the situation. Mental well-being is an important indicator of a healthy lifestyle. We thank WHO for the support given to our country as a result of which mental health care programmes have shifted their basis from the hospital to the community. WHO, since its inception, has played a pivotal role in providing guidance, support and coordination to improve the global health situation. My delegation appreciates the far-sighted initiatives being taken by WHO to bring reforms within its system to meet new and emerging needs. The Union of Myanmar is appreciative of the efforts of WHO and for its valuable contributions in strengthening the health delivery system in the country. With the objective of achieving national reconsolidation and with peace and tranquillity prevailing in the country, development programmes in my country are taking place rapidly with the participation of the people. As a developing nation, the Union of Myanmar needs WHO collaboration and cooperation in our endeavours to reach the national objective of uplifting the health, fitness and education standards of the entire nation. Allow me, in conclusion, to wish all the distinguished delegates a fruitful Fiftieth World Health Assembly. May our collective wisdom and efforts bring us a step closer to making our planet a healthier, happier and a safer place. Thank you, the distinguished delegate of Myanmar. Now I give the floor to the delegate of Zimbabwe who will speak on behalf of the Southern African Development Community: Angola, Botswana, Lesotho, Malawi, Mauritius, Mozambique, South Africa, Swaziland, United Republic of Tanzania, Zambia and on behalf of his own country. The delegates of these Member States will be seated on the rostrum. A time limit of 10 minutes has been allocated to this speaker, as he will speak in the name of 11 countries. In order to save the Assembly's time, the delegates of these countries will not take the floor. Now I invite to the rostrum the delegate of Venezuela. Dr STAMPS (Zimbabwe): Excuse me, Madam President, but I am waiting for my colleagues to come and give me moral support. In the interests of economy of time, I may take the usual felicitations as having been said. I have the honour to present a response to the report of the Director-General on behalf of the 11 countries in sub-saharan Africa which are members of the Southern African Development Community, namely Angola, Botswana, Lesotho, Malawi, Mauritius, Mozambique, South Africa, Swaziland, United Republic of Tanzania, Zambia and Zimbabwe. We thank Dr Nakajima for his report and his efforts on behalf of our region. We also acknowledge the effective changes and efficiencies brought about in our region by Dr Samba in the short time since he was appointed Regional Director for Africa. We present a common submission because we share common problems, and we are developing common strategies to achieve common goals. As a result we have been able to establish clear core values in health; and since health is the key to development, we have the courage to care. Common problems are the resurgence of malaria, the exponential increase in tuberculosis and

109 A50/VR/5 page 97 HIV/AIDS and a shrinking resource base, both in terms of manpower and money. Malaria, for example has in Swaziland shown a threefold increase in cases and a larger than threefold increase in inpatient mortality. Similar statistics are shown by Zimbabwe, Botswana and Namibia. While malaria has been eliminated from Mauritius, the ever present risk of its reintroduction there involves similar prevention programmes, especially given the increase in travel. Drugs are an essential part of our armamentarium and in an economy of scarcity essential drugs and rational prescribing become a higher priority. It comes as no surprise that in Zimbabwe we have approximately the same number of active ingredients on our essential drug list as does Australia. It is also no surprise that Australia followed Zimbabwe, which, as the Director-General's report says, shows that essential drugs are not for poor countries only, or for rural areas only. The concept of essential drugs is a universal necessity, and harmonising drugs policy in our subregion is actively proceeding. Progress has also been made toward developing sound food policies. With re-emerging and new hazards from food, and recurrent shortages due to drought or economic reverses, we are bound to look at quality and security of food supplies. At least one country in our group will have a national food policy within the next three years, and others are working toward that concept. All countries in the region are undergoing health sector reforms. The need to involve the community is important, as just one adverse headline in the media can set back the most carefully planned change. Ministries of health are notoriously poor at public relations,and when they do speak, they tend to be defensive and damage control oriented in their stiff pronouncements. We have not therefore, relied upon externally driven models, but each State has developed its own system of reform - in Zambia the fast-track method, in Zimbabwe the augmentation and devolution process with the pace set by local government, in South Africa radical change to orient the health service to the most needy. Perhaps the most innovative process comes from Mozambique, where the concept of equity has been translated into a practical assessment formula, so that institutions providing the lowest equitable health facilities can be targeted as a priority. In Angola the peace process is contingent upon providing adequate health care for that country as it moves into a normal situation. UNICEF, supported by WHO has tirelessly promoted breast-feeding. The cost of replacing breastfeeding, which is acknowledged internationally as the best form of nutrition for infants, by a substitute derived from cows' milk would equate to between 6.5% and 20.2% of GNP for our countries. In the scenario of HIV, and its now accepted risk of vertical transmission from mother to child through breast milk, the choices for African countries especially in sub-saharan Africa are stark. Are we to accept that our children's survival should be compromised by the risk of infant AIDS in the cruellest sense through the promotion of unlimited, unmodified and unchallenged breast-feeding policies? Surely, as intellectually superior, well-informed and scientifically well-connected persons, WHO and UNAIDS can devise an affordable intervention, using the short course antiretrovial followed up by the provision of female condoms for all lactating women? Since we cannot cure AIDS, initiatives to reduce vertical transmission which have been shown to be effective must be introduced. We hear that a morning-after treatment for HIV exposure has been developed. I am appalled at the suggestion that the possibility of post-exposure HIV transmission prevention should be suppressed because it might affect preventive behavioural change. We have, at all costs, to prevent transmission. We do it for measles by post-exposure vaccination. We do it for meningitis by post-exposure antibiotic prophylaxis. Why in the world do we not do it for post HIV exposure? On this basis we eventually will stop promoting condoms so as to force everyone to be celibate! In our sub-saharan region, the HIV pandemic has reached its crescendo. From some anonymous surveys between 30% and 37% of all antenatal women attending sentinel surveillance clinics are found to be HIV positive. 14% to 40% of their infants will die before the age of five from an HIV-related disease. Their own life expectancy is severely truncated to between two and 10 years after diagnosis. That of their husbands, curiously, perhaps a year or so longer. What right has the world to deny any form of treatment which can reduce this awful prospect? In health, statistics are our daily bread. We live by trends in infant mortality rates, life expectancy, immunization coverage and arbitrary benchmarks whereat infectious diseases, such as leprosy or poliomyelitis become, in the time hollowed phrase, "no longer a public health problem". Yet, for the young mother whose child has just died from an HIV-related conventional infectious disease, statistics have no meaning and no consolation. She is faced with the certainty of her own premature death, precluded by increasingly degrading episodes of disease, disability and hospitalization and the equally certain similar fate of the child's father. And if there are older siblings, they face the future with the certainty of orphandom. Not dignified, respected

110 page 98 orphans from a vehicle accident, or a recognized classical disease syndrome, but the stigmatized epithet of AIDS orphan. As C.S. Lewis put it, every generation has a 100% mortality. What we should not accept is that orderly process being disrupted to our societal disadvantage. In health, Father forgive us, we so often know not what we do. We eulogize our successes. We publicize our therapeutic and immunological advances. We excuse our incompetence to deal with disease syndromes which do not respond with laboratory predetermined predictability to our chemicals and dehumanized "public health" strategies. We complain about lack of resources, lack of funds, lack of research - as though a surplus of any of these has ever really moved human progress forward more than infinitesimally, at a gross opportunity/cost disadvantage. Benjamin Disraeli, who is reputed to have assessed statistics as worse than damned lies, also disliked definitions. We bedevil ourselves with definitions, too. In the struggle for health for all, the development of a new paradigm, "the magic bullet" or the Holy Grail, we have lost sight of our goals. Does health for all mean immortality for all? Does it mean access to treatment regardless of cost, and regardless of individual responsibility? Does a government or State stand or fall by virtue of its success measured in melanoma reduction or breast carcinoma incidence? For most individuals, a health service, so called, is successful if it can provide, at affordable cost, relief of immediate symptoms. Whatever happened to health education? We struggle, not against specific disease, for which cures or management capacity have already been devised, but against attitudes. Principalities and Powers, if you like St Paul's phrase. Where we see that the barrier to health lies in the lack of fundamental facilities, taken for granted and grudgingly paid for in developed societies,like safe, clean water and hygienic sanitation, we have difficulty in stimulating interest in those with the know-how, and become tied tongues in expressing the (to us) obvious benefits when we try to sell the concept to the community. Less than two years ago, a professor of public health from a university in our subregion expressed the view that for rural and commercial farm folk, defecation in the scrubland (the "bush") was preferable to the ventilated improved privy system of controlled disposal of human waste. With views like these, are we to advance? Where we know the vectors, the parasites, the sensitivity and the community immunity to diseases such as malaria or the arboviruses, we provide all the theoretical and clinical inputs to treat cases and limit vector proliferation, but we cannot mobilize transport, access, urgency of treatment or individual awareness. No one dies of malaria contracted in Europe. Why in Africa? Procreation, reproductive and sexual health are integral parts of the wholeness of health set out in the WHO Constitution. Yet somehow morality and the exertion of power, especially of men over women, and old over young, deprive individuals of their individual rights in this respect. The confusion of public health with morality has bedeviled the pursuit of health for all since the dawn of history, and although we repeatedly talk of integrated and holistic health services, this is one area in which we urgently need disaggregation. Who has the right to tell me, as an African, that my culture is inconsistent with "public health". I would not dare so to dictate to a citizen from any other country. Yet the concept of female genital mutilation has now been extended to include all the non-western traditions if they involve so much as satisfying the traditional requirements of virginity, fecundity and maturity before marriage. And because we are too modern to use the authority of the Almighty in our prudish perceptions, we invoke the human created god of "public health" to condemn cultural procedures. What is missed by these carpet bagger social scientists who wish to conquer the world market in morality is that diseases which impair sexual and reproductive health are, in fact, traditionally primordially prevented by wisdom developed over the aeons of human existence by individual communities having regard to their own peculiar, and changing, circumstances. And, meanwhile through the print, electronic and entertainment media our youth are seduced into alien, promiscuous, immoral cultures for which they are unprepared. We do not, as intelligentsia, give credit to indigenous intelligence. But we must not underrate the value of modern biomedical science and technology in dealing with the fall-out from traditional conventions and modernisation of our societies which impacts on health. That is why, in Southern Africa we have paid a great deal of attention to development of human capital in the sphere of health and health care. And I say, with little fear of contradiction, our health professionals are avidly sought and entrapped by wealthier communities throughout the globe. Here, yet again, is the shibboleth which needs to be demolished. We have trained, in the last decade and a half, more health professionals than are currently operating in our own countries. And although, in some instances, there is regional brain circulation most of our brilliant human capital is preyed upon by the big game hunters of the OECD countries. More Zimbabwean nurses run private clinics and nursing homes in Texas than in Zimbabwe.

111 A50/VR/5 page 99 But those who benefit do not respect our needs. In fact they despise our pleas. For the past three years, every physiotherapist we have trained at the University of Zimbabwe has been recruited by one of the rich countries in the North. I complained. I was told that my Government's solution is to pay them more, whilst in the same breath, we are condemned for budget deficits and an unacceptably high taxation rate. Once may be a happenstance. Twice may be a coincidence, but three times is enemy action. I believe in God. I believe most of the human race, in varying ways believes in God. I also believe we must all, ultimately account for our actions to that same God, and in these circumstances, it behoves us to ensure that we are equitable, humanitarian, fair, just and honest in our relations one with the other. Even for those of us who find God too infinite an image to conceptualize, for our own consciences, for our own hopes should reversal of roles occur, we should ensure equitable access to assessment and treatment of health needs and aspirations. Let there be no more hiding of ourselves behind statistics. Let there be no more accusation of guilt and counter accusation of culpability. Let there be a truly global, and enthusiastic acceptance of responsibility for each other's health. And let the year 2000 really be the health-for-all goal. El Dr. OLETTA (Venezuela): Permítanme expresar en primer lugar la satisfacción de mi delegación por la acertada designación de la Presidente. Le deseamos el mayor éxito en sus funciones. Igualmente, al señor Director General por la elaboración del magnífico Informe sobre la salud en el mundo La entrada al tercer milenio nos encuentra en un desfase entre el avance tecnológico biomédico, la persistencia de enfermedades, como la tuberculosis y la diarrea, y la emergencia de otras, como el SIDA. Este señalamiento nos da pie para considerar que la salud no puede convertirse en un hecho económico, en un instrumento de mercado. Por el contrario, concebimos la salud como fuente de riqueza de la vida cotidiana determinada por la paz, la educación, la vivienda, la alimentación, la renta justa, un ambiente familiar estable, la justicia social y la equidad. Todo esto,entendiendo que la responsabilidad de la salud corresponde al Estado, a los trabajadores de la salud y al propio individuo por igual. Se deben propiciar una política y programas cohesionados, que corten cualitativamente la histórica exclusión de grandes sectores poblacionales del mundo, que promuevan la unidad entre el mundo espiritual y material para generar productos que estrechen a las familias y a las comunidades y para que aflore la conciencia social y colectiva, dormida aún en muchos ciudadanos. La estrategia correcta para lograr los resultados de corto, mediano y largo plazo está marcada por el nivel de conocimientos y comprensión que se posea como equipo dirigente. También por el momento político, económico e ideológico del proceso social presente y por la capacidad de conducción, gerencia y operación de procesos que podamos desarrollar. De tal manera, que la tarea fundamental que tenemos no es solamente la del ajuste macroeconómico,la de las reformas del sector, ni la descentralización, sino la del cambio de valores que promueven el paso de una cultura facilista y materialista a una cultura solidaria. Igualmente, los condicionantes socioeconómicos y culturales y sus relaciones con la salud deben ser contemplados en las acciones políticas integradas. El compromiso incluye lograr la articulación de estas políticas con el proceso de globalización, sin descuidar la focalización. Este aspecto tiene mayor importancia en los países donde la brecha social y económica determina la mayor inequidad,sufrimiento y desaceleración del desarrollo humano. Es de destacar que las nuevas tecnologías de la información están permitiendo un acceso al conocimiento más actual sobre prevención o tratamiento de afecciones crónicas invalidantes, cuyos costos son accesibles sólo a un sector minoritario de los países en desarrollo. Los gobiernos deberán implementar políticas que permitan la atención de toda la población con dichas intervenciones, estimulando la investigación en ese campo y desarrollando los centros especializados en producción de productos biológicos necesarios. Las políticas de coordinación intersectorial, interinstitucional e intergerencial, con la incorporación de la participación comunitaria, se aunarán a los esfuerzos por mejorar la infraestructura y el saneamiento ambiental, dándole énfasis a la educación y promoción como mecanismos de prevención de enfermedades infecciosas. El deterioro de los estilos de vida, así como de la salud mental, derivados de la violencia, deberían incluirse como enfermedades emergentes, de las cuales el sector salud no puede aislarse puesto que son causa y consecuencia del deterioro del proceso vital humano. A los países en vías de desarrollo nos toca afrontar el reto de trabajar coordinadamente para prevenir las enfermedades infecciosas, emergentes y reemergentes, mejorar la atención a los problemas de salud reproductiva, frenar la elevada mortalidad materna y al mismo tiempo, con igual intensidad, desarrollar la prevención de enfermedades crónicas e invalidantes. La equidad en salud nos obliga a trabajar en ambos aspectos. Se hacen necesarias políticas de salud integrales donde se contemplen el

112 A50/VR/5 page 100 financiamiento y la legislación adecuados para la prevención, el tratamiento, la rehabilitación de enfermedades cónsonos con los fines propuestos. La acumulación epidemiológica y demográfica deben enfrentarse con compromisos, retos y acciones para lograr la equidad en salud, vencer el sufrimiento y enriquecer el desarrollo humano. Ésta parece ser la tarea urgente a emprender en un futuro inmediato. Muchas gracias, señor Presidente. Dr BERGMANN-POHL (Germany): Mr President, Director-General, ladies and gentlemen, The world health report 1997 has once more shown us that numerous countries are confronted with a double challenge: on the one hand, they must cope with the consequences of infectious diseases which it has still not been possible to bring under control, despite all the efforts in the past. New infectious diseases are arising and there is at present a global renaissance of old diseases. And those countries which, through enormous efforts, have come nearer to the goal of increasing their population's life expectancy are simultaneously faced with the task of combating noncommunicable diseases as effectively as possible. The solidarity of all WHO Member States with one another therefore demands close collaboration in both of these fields and the exchange of experience in order to improve the situation. It depends not least on the practical demonstration of this solidarity whether countries with such, for them, individually insurmountable problems are better able to cope. The Federal Republic of Germany is prepared to contribute its share towards this, for example through using educational and preventive measures to minimize avoidable health risks as far as possible. This is anything other than an easy task, as there is no perfect solution which can be used for all the States concerned. But it is this very fact which makes it absolutely necessary for us to examine this topic in depth. I would like to reiterate; the Federal Republic of Germany is prepared to contribute its share towards the attainment of this objective at any time. Ladies and gentlemen, the more organized solidarity is, the more effective it becomes. The global political changes which have taken place since the end of the 1980s have also made changes in the WHO necessary. We have supported these reforms from the beginning and I share your view, Director-General, that we should use the momentum created by the reforms carried out to date to continue the reform process. The Executive Board has already provided important stimuli. It has now ensured that the Member States participate in the special group for review of the Constitution. The further advances in the prioritizing of programmes, which have been made following extensive discussion in the decision-making bodies, are also to be welcomed. And greater transparency in the presentation of the draft budget is also more than desirable. I would like to state the willingness of my country to collaborate in the elaboration of further reform measures in this area, as we have done in the European Region. Director-General, let me take this opportunity to express my delegation's appreciation of the remarkable contributions you have made to the World Health Organization. Germany subscribes fully to the intervention made by the Netherlands on behalf of the European Union. Allow me, in conclusion, in the brief time available, to mention a topic which deserves worldwide attention: the possibilities resulting from cloning. I do not think that the application of this technology to plants and animals should be fundamentally rejected from the start, because we require this technology for the combating of certain diseases. It offers opportunities for advancements which would otherwise not exist. I would like to remind you in this regard of the development of the so-called "transgenic mice" which created new research possibilities for the elaboration of new ideas for treating diseases. However, in my opinion, there must be an immovable boundary drawn with regard to the application of cloning to humans. In order to prevent even the attempt at cloning human embryos with the aim of producing identical offspring, a worldwide ban on cloning must be imposed. I therefore explicitly welcome your decision, Director-General, to incorporate this topic in the WHO Special Programme of Research, Development and Research Training in Human Reproduction. Dr J.F. Oletta (Venezuela), Vice-President, took the presidential chair. Le Dr J.F. Oletta (Venezuela), Vice-Président, assume la présidence.

113 El PRESIDENTE: A50/VR/5 page 101 Es para mí un gran honor ocupar la presidencia de esta Asamblea en ausencia del Presidente. El Dr. COSTA-BAUER (Perú): Señor Presidente, señor Director General, distinguidos miembros de la Mesa de la Asamblea, distinguidos participantes: Permítame en primer término, señor Presidente, felicitar por intermedio suyo al señor Presidente de esta Asamblea por su elección y la eficaz conducción que asegura el éxito de la misma. Como se señala en el Informe sobre la salud en el mundo 1997 el incremento de la población de ancianos avanza tres veces y media más deprisa que el correspondiente a la población de niños y adolescentes, y un 30% más deprisa que la de adultos. Este cambio en la pirámide de población conlleva una modificación más intensa aún de la pirámide de carga de morbilidad por edades, pues la incidencia de morbilidad, discapacidad y sufrimiento en la tercera edad es unas diez veces mayor que en la niñez y adolescencia. Estas características promedio del panorama mundial tienen aspectos particulares en los países de menor desarrollo. En efecto, en el Perú, como en muchos otros países, no se enfrenta una transición epidemiológica entendida como el reemplazo de enfermedades infecciosas por el de patologías crónicas, sino más bien una acumulación de los dos tipos de enfermedades: las que se curan y las que no pueden curarse pero requieren cuidados. La capacidad de respuesta de las sociedades de menor desarrollo para responder a la epidemia de enfermedades crónicas es limitada en su posibilidad de instaurar y mantener estilos de vida saludables, de introducir programas de detección masivos y de asimilar los costos de tecnologías eficaces. Debido a estas limitaciones y a la imperiosa necesidad de superarlas, los programas de reforma y modernización que mejoran la eficiencia microeconómica y macroeconómica, así como la efectividad y el impacto social de las intervenciones en salud, cobran primera prioridad en la agenda de los gobiernos y de las organizaciones que, como la OMS, comparten esta preocupación. Paradójicamente,el incremento en la esperanza de vida que se viene dando en países menos desarrollados puede presionar,afectar y agravar el equilibrio aún precario de los servicios médicos y de salud pública respecto de las demandas y necesidades de sus poblaciones. Sin embargo, esta paradoja no puede tomarse como un efecto adverso del progreso o del desarrollo, sino más bien como una característica propia del progreso sanitario de inicio reciente y avance acelerado. Es ésta una segunda razón de gran importancia para impulsar y profundizar los procesos de cambio que permitan una mejor planificación y priorización de la inversión sanitaria que realizan los países, así como un uso más eficiente de sus recursos, y el Perú está en estos momentos profundamente comprometido con estos procesos. Debe reconocerse que los países menos favorecidos no pueden desatender la prioridad de las enfermedades infecciosas y de las condiciones sociales que las promueven. En el Perú, son destacables los esfuerzos realizados para mejorar la eficacia del programa para el control de la tuberculosis, así como del de la erradicación de la poliomielitis, y esperamos muy pronto erradicar el sarampión, habiendo ya logrado alcanzar niveles de cobertura crecientes y sostenidos en el área de las inmunizaciones. En este sentido, el mejoramiento de las condiciones sociales y la lucha contra la pobreza constituyen una prioridad de elevado rango en las políticas del Perú y de muchos otros países. El reforzamiento permanente de estas políticas constituye un aspecto ineludible en la búsqueda del desarrollo humano sostenible. La convocatoria de esta 50 a Asamblea Mundial de la Salud revela una situación compleja, que obliga a replantear el modo de apreciar los problemas y de organizar los recursos para solucionarlos. Atendiendo a los datos del informe anual de la OMS, para contrarrestar la epidemia de cáncer y enfermedades cardiovasculares ninguna acción tendría rendimientos mayores que la erradicación del tabaquismo, por lo cual es indispensable proponer una cruzada mundial contra el tabaco que se apoye en estrategias que integren medidas legislativas, pero fundamentalmente esfuerzos sostenidos de información, comunicación y educación. Pensamos que solamente profundizando y fortaleciendo estas estrategias respecto a todas las enfermedades que hoy aquejan a nuestras sociedades, democratizando la información e instaurando una cultura de observancia y de difusión de hábitos saludables en ellas, es como podremos avanzar en la tarea de vencer el sufrimiento que hoy producen las altas tasas de morbilidad prevenibles y evitables en un gran porcentaje. Tampoco podemos dejar de mencionar que los esfuerzos para vencer el sufrimiento y enriquecer a la humanidad mejorando la calidad de vida de nuestros pueblos deben considerar el fortalecimiento de sus reservas morales para reducir el impacto negativo que representa el consumo de drogas tanto legales como ilegales a nivel mundial. Frente a ello, el Perú viene realizando enormes esfuerzos para completar acciones que no sólo

114 page 102 incluyen la prevención y la rehabilitación de la drogadicción como problema que afecta a todos los niveles sociales, sino también la promoción de iniciativas multisectoriales que buscan el desarrollo alternativo como respuesta para atender la dimensión internacional del problema. Creemos que éstos son los principales medios para enriquecer verdaderamente a la humanidad creando las condiciones necesarias para una mejor calidad de vida libre de enfermedades tanto en lo físico como en lo mental. Y en ello el sector salud lleva sobre sus hombros gran parte de esta responsabilidad en todos los países. Quiero finalmente, en nombre del Gobierno y del pueblo peruano, extender nuestro agradecimiento y felicitación muy especial al señor Director General,Hiroshi Nakajima, por los esfuerzos desplegados y la brillante gestión que viene realizando al frente de la Organización Mundial de la Salud en beneficio de los pueblos del mundo. Muchas gracias. Dr REODICA (Philippines): Mr President, Director-General, distinguished delegates, ladies and gentlemen, as we examine the rich experiences provided by and lessons learned during the current century, and consider the options and potential offered by the coming century, we are in awe of, though not necessarily overwhelmed by, the increasing complexity and diversity of our unique yet closely interwoven societies. In particular, we in the health field are facing the unprecedented challenge of radically changing our view of, and approach to, health and development. We have been continually adjusting our bearings as we journey, in varying phases, through the various stages of the mortality and epidemiological transition; but somehow, the going gets tougher through the years. Many of us are still struggling with the so-called double-burden in the face of limited and at time dwindling resources. Every now and then, those of us in the developing countries still have to deal with both preventable and chronic diseases occurring in epidemic proportions. We have to worry about inadequate and inappropriate diets. While we still have to improve the protein and calorie intakes of those with inadequate diets, we also need to provide guidance for our people in selecting proper and healthy foods as their economic situation improves. Also, our increasingly sedentary, urbanized populations must be aware of the need to maintain physical fitness throughout all stages of life. We are forced to confront the growing problem of pollution, occupational hazards and environmental degradation, even as we address the basics of drinking-water supply and safe waste disposal. We are as much concerned with the economics of providing quality care to the economically active population and the elderly, who are most vulnerable to chronic and debilitating diseases, as we are with providing equitable access to basic health services. In this regard, stronger emphasis on providing health services for women will benefit not only this often neglected segment of the population but also those whom they care for - the entire family. Furthermore we contribute to reducing stress and conflict in our environment, even as we institute measures to help our people cope in their workplaces and during disasters and emergencies. Thus, if we are to adhere to the view of our profession, i.e. that health is a fundamental human right, we must be tough - and we need to get going. We must balance the scales through informed and judicious allocation of scarce resources. We must relentlessly pursue not only relevant and coherent policies, but moreover comprehensive and collective action, without losing focus of our primary beneficiary - the individual person in his unique situation, with multidimensional needs throughout the various stages of his life. Having transcended our simplistic disease- and programme-orientation, and guided by our new perspectives, we now need to make the effort to put our new principles into practice. Let us continue to move towards a complete health transition, taking the sociobehavioural context of health as a starting point and providing appropriate information and incentives to individuals, communities and the various stakeholders in health, in order to effect behavioural transformation and instil individual and collective responsibility. We need to act locally on similar but culture-sensitive health sector reforms, such as those being considered at global level by WHO and partner agencies. We shall do whatever it takes to conquer suffering and enrich humanity. That is what the so-called caring externality is all about. We care for the welfare of our brothers, and we feel fulfilled as we contribute to the goal of longer and healthier lives for all. In conclusion, we must reiterate that the vision of a healthy Philippines 2000 promulgated by our President, Fidel Valdez Ramos, is an expression of our country's resolve to join our neighbours and the rest of the world in meeting all the health challenges of the twenty-first century.

115 page 103 M. LAHURE (Luxembourg): Monsieur le Président de séance, Mesdames et Messieurs, permettez-moi tout d'abord d'adresser au Président mes vives félicitations pour son élection à la tête de cette Cinquantième Assemblée mondiale de la Santé. Au nom de ma délégation, je tiens aussi à remercier le Directeur général du Rapport sur la santé dans le monde, 1997, qui cette année s'intitule "Vaincre la souffrance, enrichir l'humanité" et qui met l'accent sur les fléaux qui concernent de plus en plus tous les pays du monde. Depuis le début de son existence, le but principal de notre Organisation et de tous ses Etats Membres est d'augmenter l'espérance de vie moyenne de la population. Quoi de plus logique, d'ailleurs, si l'on se rend compte que dans de nombreux pays cette espérance de vie se situe toujours en deçà de cinquante ans. Quoi de plus logique que de s'attaquer d'abord aux maladies infectieuses qui tuent au moins 17 millions de personnes par an et de lutter contre les épidémies qui déciment des populations entières. Il faut sans aucun doute continuer nos efforts pour empêcher les femmes de mourir en couches, pour réduire la mortalité infantile et les décès des enfants en bas âge. Il faut intensifier notre soutien au programme de vaccination, aux programmes de lutte contre les maladies tropicales, la diarrhée et les infections respiratoires aiguës, la tuberculose, le SIDA et les maladies émergentes, au programme des médicaments essentiels. Le Luxembourg appuie ces programmes de l'oms qui ont fait leurs preuves et il continuera à y contribuer tant que tout ce qui est actuellement possible dans ces domaines n'est pas réalisé. Mais il est temps aussi de s'interroger sur la qualité de ces années de vie gagnées et ceci n'est plus seulement un problème dans les pays industrialisés. Plus la durée de vie s'allonge, plus les maladies chroniques longues, invalidantes, génératrices de grandes souffrances physiques et mentales ainsi que de coûts importants prennent une place prépondérante. Ces maladies sont à l'origine de plus de 24 millions de décès par an et, même si ces décès ont souvent lieu à des âges avancés, on ne peut ignorer ni les souffrances causées, ni les coûts engendrés. De plus, beaucoup de maladies chroniques non fatales, telles que les maladies du système ostéo-articulaire et les maladies mentales, réduisent considérablement le bien-être et la qualité de vie et demandent à nos systèmes de sécurité sociale des investissements qui, bientôt, auront atteint les limites du possible et nous obligeront à faire des choix douloureux. Il est donc normal que les gens misent de plus en plus sur l'espérance de santé plutôt que sur une simple espérance de vie. Désormais, il faudra parler d'années de vie en bonne santé gagnées plutôt que d'années de vie gagnées tout court. Nous comprenons fort bien les dilemmes des responsables d'une organisation qui a comme objectif la santé dans le monde. Faut-il continuer à privilégier la lutte contre les maladies infectieuses qui frappent bien davantage les pauvres que les riches, ou faudrait-il plus prendre en compte maintenant les maladies non transmissibles au détriment des maladies infectieuses, ce qui favoriserait les riches aux dépens des pauvres? Dans un cadre financier limité, la décision n'est pas facile. Jusqu'à présent 一 et je pense que ce n'est que justice -,elle a été prise en faveur des maladies transmissibles dans les pays les plus pauvres. Cependant, nous devons constater qu'au fur et à mesure que l'espérance de vie augmente dans les pays en développement, ces pays commencent à être également frappés par le fardeau des maladies chroniques et si l'on constate que, par exemple, les maladies de l'appareil circulatoire sont déjà maintenant responsables de 25 % de l'ensemble des décès dans ces pays, je pense qu'il est urgent d'insister davantage sur la lutte contre ces maladies. Pourquoi procéder par étapes en ajoutant d'abord des années à la vie et après seulement la vie aux années, si une approche intégrée complète mettant l'accent sur tous les déterminants de la mauvaise santé est possible? Nous soutenons l'approche intégrée proposée dans ce rapport même si le défi est important et si la lutte sera longue et ardue. Nous savons bien que de nombreuses maladies chroniques pourraient être prévenues par l'adoption de modes de vie plus sains et que l'individu peut beaucoup pour sa santé, par exemple en renonçant au tabac, en adoptant une alimentation plus saine et en pratiquant régulièrement de l'exercice physique. Cependant, nous avons malheureusement dû nous rendre compte que ces connaissances ne suffisent pas et que les changements de comportement sont difficiles et lents à obtenir. Ici encore des inégalités persistent. Nous constatons que ceux qui arrêtent de fumer, qui modèrent leur consommation d'alcool et qui font les bons choix en matière d'alimentation sont de nouveau les plus riches, les plus instruits. Si la santé pour tous passe d'abord par le changement de mode de vie, on ne peut pas tout attendre de l'individu. Il faut que la collectivité nationale et internationale exerce son devoir de protection et que les décideurs politiques et socio-économiques mettent tout en oeuvre pour assurer aux populations un environnement social et physique favorisant la santé. Toute stratégie de santé pour tous demande une approche intégrée de l'environnement et du développement socio-économique. Le Luxembourg est prêt à s'engager dans cette voie avec l'organisation mondiale de la Santé. Si mon Gouvernement se préoccupe de la santé des Luxembourgeois, il est bien conscient qu'il a le devoir de contribuer

116 page 104 au développement et à la promotion de la santé d'autres peuples moins nantis. Les fonds accordés dans le cadre de la coopération au développement et de l'aide humanitaire d'urgence ont connu un accroissement considérable ces dernières années. Ils se sont élevés l'année passée à près de 5 milliards de francs belges et atteindront 0,7 % du produit national brut en l'an Les contributions luxembourgeoises aux différents programmes de l'oms ont connu une augmentation de plus de 40 % entre 1986 et Je tiens à réaffirmer ici aujourd'hui l'appui apporté par le Luxembourg à notre Organisation. Monsieur le Président de séance, Mesdames et Messieurs, je souhaite un plein succès à nos travaux et je suis certain que nos débats seront, comme d'habitude, très enrichissants. Mr CHUA JUI MENG (Malaysia): Mr President, distinguished delegates, ladies and gentlemen, on behalf of the Government of Malaysia, I would like to extend our heartiest congratulations on your election. We wish also to thank the Director- General, Dr Nakajima, for The world health report 1997: Conquering suffering, enriching humanity, and for the years that he has devoted to this august organization and to the enrichment of humanity. The rapid development Malaysia is experiencing has contributed to changing lifestyles and increasing life expectancy. Diseases caused by modern lifestyles are increasing, including those related to industrialization, urbanization, and from high-risk behaviour such as smoking, alcohol and drug abuse. We are attracted by the Director-General's use of the new terminology "health expectancy", which he defined as "life expectancy in good health amounting to the average number of years an individual can expect to live in a favourable state". We agree that longer life should be a prize and not a penalty. In Malaysia, for our healthy lifestyle campaigns we have urged our people to strive for "health all the time, quality all your life". Through the healthy lifestyle campaigns that Malaysia started in the year 1991,various communitybased programmes for the prevention and control of cardiovascular and cerebrovascular diseases, diabetes, cancers, AIDS and others are being strengthened. Whilst the healthy lifestyle campaign in the last six years has been disease-specific, this year and for the next five years the campaign in my country is targeted more on behavioural changes, with greater emphasis on active community participation. The stress will therefore be on health promotion, encouraging healthy lifestyles to prevent disease and disability, and on the protection of life through promoting healthy eating, physical fitness, healthy environment, healthy families, mental health, injury control and reducing the impact of diseases. Globally, studies conducted have found that the younger a person starts smoking the more difficult it is for that person to quit smoking. Conversely, youths that smoke are more likely to continue smoking well into adult life. Studies have also found that if youths below nineteen were discouraged from smoking, 90% of them would not smoke in later life. This is because, as we know, nicotine is highly addictive. Nicotine dependency is the most common form of substance abuse and one of the hardest to break. In the United States of America, for example, we are told that 22 million smokers try each year to discontinue smoking, but only 3% succeed over a long-term period. As a result of these studies, including our own research, the Malaysian Cabinet last year made a bold decision that was well accepted by the general public. It was to prohibit by law youths below the age of 19 from smoking, chewing or even being in possession of cigarettes and tobacco products, whether in public or in private. The Cabinet also decided in the larger interests of public health and the control of the tobacco epidemic to prohibit smoking in all governmental buildings, in all air-conditioned buildings such as shopping complexes, in schools, in institutions of learning, at public service counters in all banks, in all sports complexes, meeting halls, airports,on public transport, in cinemas and, of course, in all hospitals and clinics. These measures made are the reflection of my Government's and society's disapproval of the distasteful habit of tobacco smoking. It is hoped that with successful health programmes the double burden of preventing chronic illnesses, along with combating endemic infectious diseases, will be lessened for our people. Malaysia is willing to learn from successful models of integrated programmes from member countries. We wish to learn from WHO's INTERHEALTH project, and the countrywide integrated noncommunicable diseases prevention programme in Europe and other regions. It is our wish too that WHO will assume a pivotal and catalytic role in training and exposure of health professionals to your comprehensive package for chronic disease control. Despite the many challenges faced by WHO, we believe that it remains a key player in the field of noncommunicable diseases and in facilitating exchange programmes, as well as smart partnerships among the member countries and regions. Changing lifestyles due to industrialization and rapid development can lead to increased stress and other psychological and social problems associated with peoples and cultures in transition. These problems need

117 A50/VR/5 page 105 sustainable and active government and community-based programmes drawing on resources from governmental, religious bodies, nongovernmental organizations and the community at large. Apart from studying the epidemiology of social illnesses, the activities should also aim towards a sustainable programme for healthy physical, mental and social development of our children and adolescents. Late last year, my country launched an outreach programme named "Prostar" an anti-aids programme by youth, for youth and through youth, providing knowledge and empowerment in life-skill education, stressing communication interaction skills and disease control, with special emphasis on STDs and HIV infections. Participants will come from schools, universities, youth organizations, such as the Boys Scouts movement, the Girls Scouts, the Red Crescent, young workers in factories and the general workforce. We are training facilitators who in turn will reach out to two-and-a-half million youths by the Year 2000 on the principle of peer education. Mr President, recognizing that health conditions will continue to change in the future, in particular, with the ageing of populations and changing lifestyles, Malaysia agrees with the Director-General ' s call for prioritization of activities for local and international action. Let us hope that this global action will enrich humanity to the conquering of suffering and bring about a better quality of life and health expectancy for all of our peoples. Thank you. El PRESIDENTE: Muchas gracias, señor delegado de Malasia. Hemos terminado con la lista de oradores para hoy. Mañana el pleno se reunirá a las 9.00 horas para examinar el informe de la Comisión de Candidaturas y proseguir luego con el debate sobre los puntos 9 y 10. Se levanta la sesión. The meeting rose at 18:05. La séance est levée à 18h05.

118 page 106 SIXTH PLENARY MEETING Wednesday, 7 May 1997, at 9:00 President: Mr Saleem I. SHERVANI (India) later: Dr A. M'HATEF (Algeria) SIXIEME SEANCE PLENIERE Mercredi 7 mai 1997,9 heures Président: M. Saleem I. SHERVANI (Inde) puis: Dr A. M'HATEF (Algérie) 1. FIRST REPORT OF THE COMMITTEE ON CREDENTIALS 1 PREMIER RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS 1 The Assembly is called to order. Our first item of business is to consider the report of the Committee on Credentials which met yesterday under the chairmanship of Dr J.D. Otoo (Ghana). The report is contained in document A50/28 which you have all received. Are there any comments? It would appear that there are no comments. I therefore take it that the Assembly accepts the report of the Committee on Credentials. The first report of the Committee on Credentials is thereby approved. Before continuing, let me remind you that suggestions concerning the annual election of Members entitled to designate a person to serve on the Executive Board should be submitted to the Assistant to the Secretary of the Assembly not later than today. Committee A will now resume discussions. 2. DEBATE ON THE REPORTS OF THE EXECUTIVE BOARD ON ITS NINETY-EIGHTH AND NINETY-NINTH SESSIONS AND ON THE WORLD HEALTH REPORT 1997 (continued) DEBAT SUR LES RAPPORTS DU CONSEIL EXECUTIF SUR SES QUATRE-VINGT-DIX- HUITIEME ET QUATRE-VINGT-DIX-NEUVIEME SESSIONS ET SUR LE RAPPORT SUR LA SANTE DANS LE MONDE, 1997 (suite) We will now continue the debate on items 9 and 10 of the agenda. The first two speakers on my list are Jamaica and Israel. May I invite them to come to the rostrum. I give the floor to the delegate of Jamaica. 'See reports of committees in document WHA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

119 page 107 Dr PHILLIPS (Jamaica): Mr President, distinguished delegates, firstly, I wish to congratulate you on your appointment as President of the Fiftieth World Health Assembly. The Director-General has produced a very stimulating and challenging report for us this year. This report reminds us that in countries such as Jamaica, despite significant improvement in the life expectancy of our people (which is now 74 years at birth), and despite significant progress in conquering infectious diseases and in attaining epidemiological transition, we do, nevertheless, face a double burden of continuing infectious diseases, including those associated with poor environmental conditions, as well as a growing "epidemic" of chronic and lifestyle-related diseases. Alongside the increasing incidence of heart disease, stroke, diabetes, hypertension and cancer in the over 45 age groups, accidents and violence claim the lives of young males in significant numbers and consume approximately one-third of hospital budgets. Enteric infections, such as typhoid, also persist, especially in poor urban communities, and the incidence of HIV/AIDS continues to increase against a background of high prevalence of sexually transmitted diseases. These multiple challenges pose a dilemma for the development of health services delivery systems. The growing demands, on the one hand, related to community expectations and the rapidly growing costs of technology, on the other, are counterbalanced by the stringent resource constraints faced by my country. How are we confronting this dilemma as we set out to chart the future? The report suggests some priorities for action if we are to achieve better health expectancy. Prime among these is action on health reform. In Jamaica, we have set an ambitious health sector reform agenda to reorient the health delivery system, decentralize management, and to develop sustainable financing through mandatory health insurance. Health promotion to foster healthy lifestyles will form the centre of the strategy and will be underpinned by a conscious decision to invest in future generations. This health development strategy will re-emphasize the primary health care approach, stress prevention, and will also utilize the most cost-effective technologies as we strive to develop partnerships with private and nongovernmental organizations, and to involve the community as a whole. In this matter, WHO has its role to play at the global level. WHO must take the lead in giving emphasis to health promotion and disease prevention rather than overconcentrating on curative treatment, although this is of course important. WHO is well placed to research and bring to the attention of all its Members, tested and proven health promotion and prevention approaches which have effectively controlled both infectious and chronic lifestyle diseases. WHO also has the inescapable task of helping Member States, especially those in epidemiological transition, to develop the national capacity to deal with both the preventive and curative aspects of the job that is to be done. Critical to this capacity-building is the development of the requisite resources, and the bedrock of this development has to be provision of the appropriate skilled human resources. WHO and its regional organizations, including for us РАНО, can play a pivotal role in this task by helping, through regional and country programmes, with the shift of health manpower resources from areas of excess supply to areas of excess demand. Equally, if not more importantly, there is the need for countries to come together and pool resources to develop training programmes and the institutional framework for creating the skilled cadres needed, but which may be beyond the reach of each individual country. Here, too, the energies of this Organization may be usefully employed. In closing, Mr President, I would urge that all of us reaffirm our commitment to "health for all" so that our collective efforts will reduce the growing inequities in health, within and between our countries, so as to reduce the suffering and disability caused by ill-health. We implore the Members of WHO to place at the forefront of their priorities assistance to countries to develop their national capabilities in health services and to give paramount importance to the development of human resources. This course, we believe, will allow us to secure the better future which we all seek. Mr MATZA (Israel): Mr President, first of all, congratulations on your election as President. Director-General, distinguished guests, when we have to face all the issues enumerated in The world health report from maternal and infant mortality - to the quality of life of the elderly and many more - it is no simple task to set priorities, particularly under harsh budgetary constraints. The Director-General's report will be an important resource to all of us in helping to set such priorities.

120 A50/VR/5 page 108 Another important issue to be noted on WHO's agenda is violence and its effects, which have been declared a public health priority. This is a problem which does not only have health consequences, but is also,in some of its forms, the outcome of lifestyles detrimental to health, such as alcoholism and drug abuse. Even more unfortunate and despicable is violence that is intentionally promoted for political purposes. Such terrorism has been especially prominent in the Middle-East conflict, ironically even as peace agreements have been signed and negotiations advanced. Such violence is totally unacceptable! We expect the entire international community to join us in the total and absolute rejection and condemnation of such violence. WHO has a crucial role to play as a catalyst in assisting countries to further develop their health promoting activities. Investing in the young is most important. Schools, youth clubs and community centres all have a role to play in promoting health among young people and preventing violence. Such frameworks can produce youth leadership dedicated to healthy lifestyles, a clean environment, ethics and human values. The world is beset with grave political problems and there is human suffering on all continents, suffering which in many countries has been aggravated by poverty, hunger and ignorance, as well as political conflict. In our region,a long and bitter conflict that has, over the past 70 years, led to violence and the loss of human life on many occasions, finally reached a stage where all the parties agree that differences should be solved at the negotiating table and not through hostilities. These negotiations have already led to two peace agreements: between Israel and Egypt, and between Israel and Jordan. We are determined to continue the process until we reach full peace with all our neighbours, and especially with the Palestinians. However, such a desirable outcome is dependent on the ability of the sides to negotiate freely and fairly, without outside interference or intervention. We are confident that, through face-to-face direct negotiations carried out in good faith, the circle of peace can be widened to include our entire region. The international community has an important role to play in encouraging such an outcome by supporting the parties involved and not interfering in the delicate give-and-take of negotiations. WHO has a vital role to play in promoting health worldwide. It can exert its professional and technical leadership in helping Member States and populations improve their health. While avoiding political considerations, it can engage in activities for the welfare and well-being of all inhabitants on this earth. In the specific context of the Middle East, WHO has made a significant contribution to the advancement of peace through its programme of assistance to the Palestinian council and its efforts to improve the health infrastructure which serves the Palestinian population. Israel supports such efforts which help to build hope for a better future. Yet the Palestinians cannot have it both ways. They cannot cooperate in the field of health with Israel and look for our support both at the bilateral and international levels, while at the same time using this Organization and other United Nations fora to conduct political battles against Israel. Health cooperation and political warfare do not go together. We believe in cooperation. That is the way of the future, and that is the way to go. May I conclude by saying that we desire cooperation to achieve peace and development for the good of all the people of the region. May this Assembly be conducted in a spirit of constructive dialogue and collaboration, and may we all be successful in our deliberations to achieve progress towards the common goal of health for all. Dr KOKÉNY (Hungary): Mr President, Mr Director-General,distinguished colleagues, ladies and gentlemen, it is a real honour for me to address the plenary session of the Fiftieth World Health Assembly. Such an anniversary provides us with an excellent opportunity not only for a situation analysis, but also for renewed priority-setting. However, we are urged and pressed to do so not only because of the forthcoming fiftieth anniversary of the foundation of WHO and the rapidly nearing turn of the millennium, but the more so because we are approaching these outstanding events under circumstances of increasing global and local challenges. May I congratulate the Director-General for the excellent World health report 1997 which throws light on the complexity of the correlation between political, economic, social, human, demographic, lifestyle, health and environmental factors, as well as the need for an integrated intervention to achieve improvements. All this is a specifically accumulated mixture of past, present and future problems in this era of the turn of the millennium. The expression "double burden", used in The world health report 1997 comprises the abovementioned factors and has in itself a double meaning: the burden of infectious and noncommunicable diseases and, at the same time, the burden of growing dependency embracing young and old. Undoubtedly it is WHO which plays, as it should, the leading professional role in a health-promoting rather than a traditional medical

121 A50/VR/5 page 109 approach to these complex problems. The fact that WHO has its network of regional offices, and so possesses the knowledge of special local problems and has the possibility of adopting a bottom-up approach towards priority-setting, is one of the main conditions for the above-mentioned professional leadership at both global and regional levels. Ladies and gentlemen, our region, Europe, has faced a development full of contradictions in this decade. The gaps between healthy and diseased populations are growing at regional, national, sub-national and individual levels. We know that it is impossible to close these gaps, but we have to do our best to gradually diminish them through complex measures. It is a tragic joke of life that even under circumstances of economic recovery, long-lasting regression, imbalance or periods of major transformation still have their negative effects on social and health conditions, and we still have to face dramatically growing needs under conditions of tight resources. This contradiction leads to endangered equity and accessibility and thus urges reforms at both national and international levels equally. The recognition of this fact was the reason why the WHO Regional Office for Europe organized last year the Conference on European Health Care Reforms in Ljubljana, the result of which was the so-called Ljubljana Charter. The first among the fundamental principles laid down in the charter was "driven by values"; that is, "health care reforms must be governed by principles of human dignity, equity, solidarity and professional ethics". This fact emphasizes even more strongly our responsibilities; the political, professional, managerial, financial and ethical responsibilities both of national governments and of intergovernmental organizations. To fulfil these aims, further development of a highly effective management is one of the main tasks, not to say the ethical responsibility, of WHO. Mr President, planning priorities for the next century will be a key issue in the months to come, requiring skills, resources, opportunities, commitment and, above all, clear targets at global and regional levels. Alice in Wonderland was despairing when she asked the Cat which way to follow: "It depends on where you ought to go" answered the Cat. This should be remembered when preparing for the twenty-first century, which we hopefully will enter as Members of a renewed WHO with a modern and effective healthfor-all policy, to contribute to the improvement of the quality of life on our planet. Mr ZORIG (Mongolia): Mr President, Mr Director-General, ladies and gentlemen, first of all, on behalf of the Mongolian delegation I would like to congratulate the President on his election to the chair of the Fiftieth World Health Assembly. I also extend my warmest congratulations to the Vice-Presidents and wish them every success in the work of the Assembly. I would like to express my sincere thanks to the Director-General and WHO's Executive Board for their enormous efforts and the activities carried out during the year, as well as for The world health report 1997 submitted to the present Assembly,which meets with our full satisfaction. The Government of Mongolia highly values the quality and comprehensiveness of the report, which examines the worldwide major chronic noncommunicable diseases in detail, including the present global situation, disease patterns, their major causes and effects on quality of life,future trends and priority areas for international action. We welcome this report as a way of enriching WHO's leading role and guidance in world health problems and putting together all efforts and actions to achieve a common goal and strategies towards health for all. Looking at the official documents and annual development reports issued by international economic and financial organizations such as the International Monetary Fund and the World Bank together with the United Nations agencies, I am convinced that the interplay between health, health policy and development is of growing importance. For good health is not only an important part of the people's well-being, but also contributes to economic growth in many different ways. Therefore identifying the major disease problems, assessing their social and economic consequences and designing appropriate cost-effective health care delivery systems will have a great impact on health policy and strategy development at global as well as at national levels. The heaviest burden of ill-health still continues to fall mostly on the population of developing countries. At the same time, the significant increase in noncommunicable diseases is going to be one of the future challenges for the health and the health systems of these countries; they also have to cope, to a certain extent, with the expensive burden of noncommunicable diseases. In Mongolia, for instance, cardiovascular disease, digestive organ disease and cancer already rank among the five most commonly occurring diseases, and the potential years of life lost due to these diseases amounts to 35% of the total. In other words, we are expecting new challenges and new realities. But the answer to the question of what impact they will have on the overall health situation and how we can respond to them will not be the same for all countries.

122 page 110 Accordingly, different priorities and different approaches need to be recognized in order to maximize the effectiveness of national health systems. I have no doubt that WHO will play a significant role in tackling these challenges despite its limited funds. At the same time,i would like to applaud the increased role of WHO in coordinating international action and ensuring a better channelling of resources to the areas of highest potential outcome. It may require a prioritization of WHO collaborative programmes by shifting to some extent from disease-oriented specific activities to outcome-oriented programmes which can promote internal capacity-building in effective resource management and future sustainability of the programmes. As we know, in the developing world, the resources required to respond to the health problems and challenges are scarce in most cases,and there are many competing goals not only in the health sector but also in the other social sectors. In this respect, I think that a viable and sustainable financing mechanism and efficient resource management capability are desirable for any country which faces such problems,in order to respond to the future health challenges in a more effective way. It may appear that such institutional capacities exist in health ministries; but their functions are often limited for a variety of reasons,including a lack of professionally qualified personnel or enforceable statutory authority. If national health authorities are to be transformed to meet the new challenges, I think that a high priority should be given to empowering health ministries. It would help us create new capacities to elaborate a sound national health policy, based on the local epidemiological situation in the current and future socioeconomic and political context, and to build the new capacity required for policy analysis and management. The new Government of Mongolia is aiming at the establishment of the most efficient, self-sufficient and sustainable health and social safety network based on the widely accepted principles of health protection, promotion and social equality. It is obvious that without economic growth, resources cannot meet social needs and some time must elapse before the benefits of economic reforms are felt. However, this period would be prolonged if the health and social sectors are not effective nor suited to the market and economic conditions. I would like to take this opportunity to thank the Director-General, Dr Nakajima, and the Regional Director for the Western Pacific for their continuing and valuable support to the Government of Mongolia. I wish the Fiftieth World Health Assembly every success, so that it can write another important page of WHO's history. El Dr. BUSTOS (Uruguay): Es para mí un gran honor dirigirme a esta 50 a Asamblea Mundial de la Salud en nombre de mi pais. Quiero felicitar al señor Presidente y a los señores Vicepresidentes por su elección para dirigir esta reunión. El perfil epidemiológico del mundo actual es hoy muy heterogéneo: estratificado social y geográficamente superpuesto entre tipos de patologías que corresponden a condiciones sociales y estilos de vida muy diferentes. Los años venideros determinarán cambios en los patrones de muerte, enfermedad e invalidez, que se expresarán en: retorno de patologías reemergentes que parecían haber sido superadas; ensanchamiento de brechas epidemiológicas para grupos poblacionales extremos; la población atendida por el sector salud en los próximos años tendrá una estructura etaria diferente, que añadirá necesidades y demandas de salud también diferentes a las actuales; la mortalidad por violencia y los accidentes de tránsito traerán problemáticas que afectan a jóvenes de las áreas más desarrolladas. En el Uruguay la expectativa de vida al nacimiento ha alcanzado los 72 años y medio. Debido a la disminución de la natalidad, a la continua disminución de la mortalidad en todos los grupos de edad y al aumento de la expectativa de vida, también se vienen presentando modificaciones en la estructura de la población por edad, configurándose el envejecimiento demográfico. Actualmente el 26,6% de la población tiene menos de 15 años y el 16,5% son mayores de 60 años. Los indicadores de salud muestran características que ubican al país entre aquellos países que completaron la transición epidemiológica, dado que se han controlado las enfermedades infectocontagiosas, con la excepción del SIDA, siendo sustituidas por las enfermedades crónicas. La mortalidad infantil en el año 1966 fue de 17,5 %o. En cuanto a la estructura de morbimortalidad por causas, se observa un perfil epidemiológico similar al de los países desarrollados, siendo las dos primeras causas las enfermedades del aparato cardiovascular y los tumores malignos, con un 38% y un 22% respectivamente del total de defunciones. Estas realidades exigen respuestas realistas para enfrentar el desafío del cambio del milenio. Primero, garantizar el acceso universal a los servicios de atención de salud revisando los sectores más pobres y vulnerables. Es imprescindible asegurar la atención básica de la población, estableciendo paquetes de prestaciones de salud que cubran un conjunto definido de riesgo de enfermedad y daños a la salud para los

123 page 111 sectores desprotegidos. El Uruguay ha fortalecido la atención primaria de salud en los últimos 15 años, pudiendo exhibir como resultado un descenso de su tasa de mortalidad infantil en un 40% y el control de la enfermedad de Chagas a través del corte en la transmisión sanguínea y vectorial de la misma. Segundo, prevenir y controlar los problemas prioritarios de salud. Promover y desarrollar programas y actividades de control de enfermedades transmisibles y no transmisibles, con énfasis en la prevención de las que tienen más repercusión en el estado de salud de las personas de menores recursos que constituyen los grupos más vulnerables: las mujeres embarazadas, madres, lactantes y los niños menores de cinco años. Fortalecer los programas de inmunizaciones contra las enfermedades de la infancia prevenibles por vacunas, manteniendo y ampliando los niveles de cobertura en las áreas de población de riesgo (en Uruguay, la cobertura es del 95% para toda la población para el Programa Ampliado de Inmunizaciones). Controlar las enfermedades de transmisión sexual y el SIDA a través del manejo adecuado de los casos, las acciones sobre el ambiente y los factores de riesgo, la educación de la población, la participación social y la acción intersectorial. Disminuir los accidentes y violencia, en particular contra mujeres y niños, mediante el desarrollo de programas específicos. Tercero, promover condiciones y estilos de vida saludables, promover y participar en acciones orientadas a generar condiciones de vida saludables aptas para un pleno desarrollo humano, soporte del desarrollo económico y social del país. Promover cambios de aquellos estilos de vida perjudiciales para la salud individual y colectiva y estimular actividades de promoción de la salud que fomenten actitudes y prácticas saludables. Promover el desarrollo de estilos de vida saludables potenciando factores protectores individuales, familiares y comunitarios, entre los que se destaca un adecuado peso al nacer, socialización intrafamiliar, recreación, deportes y redes comunitarias de apoyo. Promover ampliamente la participación social incentivando la corresponsabilidad de la sociedad civil, desburocratizando la gestión en salud y haciendo más eficaz la respuesta a los problemas de la comunidad. Finalmente, la delegación del Uruguay desea agradecer la invalorable contribución del señor Director General, Dr. Nakajima, en el fortalecimiento de la Organización Mundial de la Salud, en procura de alcanzar su meta esencial de salud para todos en el año M. COLLA (Belgique): Monsieur le Président, Mesdames, Messieurs, le texte de la déclaration belge vous a certainement déjà été remis. Eh bien, il est destiné aux archives. J'ai en effet envie de vous raconter tout autre chose, quelque chose qui n'a pas été élaboré ou approuvé par mes diplomates, mes spécialistes, mes technocrates, quelque chose qui vient du fond de mon coeur et qui concerne le rôle futur de l'organisation mondiale de la Santé tel que je l'envisage. Première constatation. Il y a des pays, des régions dans le monde où il y a trop de médecins; il y a par contre des pays, des régions où il y en a trop peu. C'est horrible. Trop de médecins, c'est coûteux, c'est même dangereux pour la santé des gens, trop peu c'est encore pire. Alors, c'est une évidence, je crois, le rôle de l'oms est de stimuler une redistribution des potentialités et, avec un peu d'imagination, c'est possible, je crois; il existe des moyens pour le faire. Deuxième constatation. Avoir suffisamment de médicaments appropriés pour tout le monde, techniquement, c'est possible. Néanmoins, il y a beaucoup de pays et une grande partie de la population du monde qui sont en manque de médicaments parce que le pouvoir d'achat est insuffisant, parce que la maladie est trop peu répandue, et alors ce n'est pas rentable. Encore une fois c'est horrible, encore une fois une meilleure répartition est possible et encore une fois ça dépend de nous tous. Alors, toujours dans le domaine des médicaments, et pour faire de notre Assemblée un lieu où l'on discute de réalités concrètes, la délégation belge souhaite présenter au cours de cette session un projet de résolution concernant les risques potentiels liés à la promotion et à la vente des médicaments sur Internet. Troisième constatation. Notre monde connaît de nombreuses organisations politiques et économiques du type international/mondial ou du type régional. Faisons de l'autocritique et prenons l'exemple de l'union européenne. L'Union européenne s'occupe du marché intérieur, des problèmes économiques, à juste titre d'ailleurs. Mais ce qui ne va pas, c'est que la santé publique n'est abordée que de ce point de vue et que ce n'est qu'occasionnellement qu'on s'occupe des problèmes de santé. Je vous donne un exemple : la problématique de la vache folle est traitée par le Conseil de l'agriculture, mais n'est pas discutée par les ministres de la santé publique. Il faut donc un revirement dans le débat politique : la santé publique doit être reconnue comme une valeur primordiale. Mesdames, Messieurs, encore deux constatations. D'un côté, une définition adéquate de la santé dépasse la seule santé physique et comprend aussi des éléments psychologiques, sociaux, culturels et économiques. D'un

124 A50/VR/5 page 112 autre côté, heureusement, les gens vivent plus longtemps, mais une vie plus longue doit être digne d'être vécue. Aussi, une approche et une définition globales de la problématique de la santé et un plus grand intérêt pour la qualité de la vie nécessitent une action mondiale, une action intégrée qui s'adresse à tout le monde (aux jeunes, aux adolescents, aux adultes), avec beaucoup d'attention pour les maladies liées au vieillissement de notre population. Je voudrais, pour terminer, mettre l'accent sur le fait que le rôle et les activités de l'oms ne sont pas seulement importants pour les pays en développement, mais également pour les pays dits "industrialisés". Les moyens de mobilité et de communication dans le monde font, par exemple, que les pays industrialisés sont confrontés de nouveau au phénomène des maladies infectieuses. En raison des obligations morales, tant vis-à-vis du monde entier que vis-à-vis de la situation sanitaire de leur population, les pays industrialisés doivent prendre leur entière responsabilité dans le cadre de l'oms. La Belgique veut y participer pleinement. Г-н ЗЕЛЕНКЕВИЧ (Беларусь): Mr ZELENKEYICH (Belarus): Уважаемый г-н Председатель, уважаемый г-н Генеральный директор, уважаемые дамы и господа, От имени беларусской делегации хочу присоединиться к поздравлениям с избранием Вас, г-н Председатель, на столь ответственный пост. Я бы также хотел поблагодарить г-на Генерального директора и членов Секретариата за хорошо подготовленный доклад о состоянии здравоохранения в мире, являющийся одновременно и отчетом о деятельности ВОЗ. Доклад дает возможность более полно осознать свою роль, свои задачи и направления дальнейшей деятельности в тесном взаимодействии как с руководящими органами ВОЗ, так и с другими государствами-членами. Мы хорошо понимаем значение хронических неинфекционных заболеваний для здравоохранения и разделяем озабоченность ВОЗ данной проблемой. В определенной мере для нашей республики характерны тенденции в изменении здоровья, свойственные для промышленно развитых стран. В частности, наблюдается рост неинфекционных социально значимых болезней, таких, как заболевания сердечно-сосудистой системы, психические расстройства, сахарный диабет, онкологические заболевания. Однако эти изменения имеют ряд особенностей. Старение населения происходит в условиях резкого снижения рождаемости (по сравнению с 1990 г. на 50%) и ожидаемой продолжительности жизни. На состояние здравоохранения Республики продолжают оказывать негативное влияние и последствия катастрофы на Чернобыльской атомной станции, которые прямо или косвенно затрагивают всех жителей Беларуси. За годы после катастрофы заболеваемость раком щитовидной железы у детей выросла в 50 раз. На начало 1997 г. прооперировано 745 детей и подростков со злокачественной патологией щитовидной железы. Решение проблем подобного масштаба, и в частности, предупреждение хронических неинфекционных заболеваний, требует разработки соответствующей государственной политики и объединения усилий на международном уровне. В Беларуси координация действий в данной области осуществляется на государственном уровне в двух направлениях: в рамках государственных и региональных комплексных программ здоровья, а также демонстрационных проектов программы интегрированной профилактики неинфекционных заболеваний СИНДИ. В перспективе предполагается объединение этих двух программ. В рамках программы СИНДИ действует пять демонстрационных проектов: "Профилактика инвалидности", "Кардиология", "Сахарный диабет", "Стоматология", "Обучение населения здоровому образу жизни". Из них наиболее успешно и полно реализуется программа "Сахарный диабет". Решение стоящих перед нами задач невозможно без реформирования системы здравоохранения, и мы надеемся на помощь ВОЗ в этом вопросе. В настоящее время проводится работа по введению еще 18 демонстрационных проектов, охватывающих различные факторы риска хронических неинфекционных заболеваний и организации здравоохранения. Мы считаем, что ВОЗ должна пересмотреть подходы к странам с переходной экономикой и

125 A50/VR/5 page 113 произвести коррекцию своих программ с учетом состояния здравоохранения стран СНГ, так как дальнейшее промедление принятия решения по этому вопросу и соответствующих действий потребует в будущем значительных финансовых затрат. Мы также поддерживаем стратегическую ориентацию ВОЗ на планирование ограниченного бюджета с выделением приоритетов и оценкой стоимости конечного результата. С учетом условий, в которых функционирует здравоохранение Республики Беларусь, важнейшее значение для нас приобретает международное сотрудничество и оказываемое в его рамках содействие. Пользуясь предоставленной возможностью, я хотел бы выразить искреннюю благодарность правительствам Швейцарии, Японии, Германии, Соединенных Штатов Америки, Италии, Нидерландов, Австрии, Международным и общественным организациям за предоставленную и предоставляемую помощь в преодолении последствий Чернобыльской катастрофы. Мы бы хотели также надеяться на получение определенной технической помощи и зарубежных инвестиций, крайне необходимых для фармацевтической и медицинской промышленности Республики. Делегация Беларуси заверяет, что наша республика стремится углубить сотрудничество в рамках ВОЗ, сделать его более эффективным и плодотворным. Благодарю за внимание. Dr. M'HENNI (Tunisia): - C ^ í 4ÜI í^yj^j^jl ^J-JjJluJl mjij oljuwsjl J^a^- c^líji jjjujl o^l^ Á^Uii А^ЛЛЛ- S 二.ô^LJlJ oíjl^ji j ou^în Ь Л ^^Jl ^Juil bwjl u^j 9 A ^ LT^ 购 с/ J J\ jj s^lwjl J^-jlaÍ LIjjJÜi oxfii Jl^pî o jbi ^ jj jiii ^UJ AÍ l5i^jí ^Uil ^JuJl ol^j is V V û b LUT J Ji, 口 0Í,LLUíl. j OLw», M / a^jbi U-prlS'L; JJ JÜI ОД; c^jjl JiííJl J^jJl ùîj Ir-jà^ y. 乙 ûuv» Jírí ^ l^jiyál. ^ ^ J (.^i L- (jjüi J^P-ÜI JLp oíjtjjujl Jbb. ^T ^ OL-J^I.aikJl ùljdj objwjl Jlp J a l J l ^^ül úí ^. 扣 viiiit 广 IjcL, 3-sebül jijl-iül ^ j («JUil ^ ЬХ-AÍL S^bül U ^ Á^iáiJl CJSLPÎ JL bu- 0Î -SI j.-ljblijj OL-J^ÍI i^w» 广 L» cj^il^s ÍL.U j il.lt 气气 气气 Ij 气气 o ^ L.U JSLio c/jjl 气 t(juil^ Á^aJL. ^Uül j yú^ jbí oí ÁjJUil г^а UiiiJ ^Uil jjlji ГЫ ij^ J ^ rlj 丨 Js. ^ЛЛ, <olj CjJbJl ^ l^á JLiî y ùb ijiujl W l Л J>\jJí\ ÂjJUjl ówajl Uiái- xij >Jl Js- Ж J i yj ^liil ^J J 产 í OJjLP ^ ^ СW OIM liuaj UJI ^ oli^ij ájj-^i oü.,.jl ajiüi ^Í^JI i blájjt^j^jí J-.I i Ó jó. oí ui'^t Ûlj-Ju f Л ji^á; c5ju<ai jjujl ^ V^ZaJl 已 U»jSU ejla j Ял-AÍI il Л^ yjjl «jjjjl JoSJ^íj ÚIJJÜI J U4Î二丨 >L Jj^Lio- ^J ^oiujl OIJLLJI ^ 厶 jjbjl ÁJ^ V^idl djjl^jj Á^jJl j Jjj^ jjuí L^i Ь^Л- L^L- a_«rlja Sjj ÂiLsb^b t^îj tú^ iu^jl jijuill ejjo. У'.JbOs- о У lü^^ ^íü ^ J ijjuil bwajl a^jái. UU JÍ 01 Я. i jkjb j J^L 二 L^j^L»; çjjl_p y áj^j tjtf (\y>r\ JUA tejljlj ol Ldp ^зо dbij ÙÎ M Vw» JTLiw. L^J tjl^jlj j JUl»Síl ^ djlii a.;;yji ^ijsli oisl^, jtií L^jll» c^j^jji!a vu; j^-í,.^^jl oújb^. ii^l U,а/^илЛJ Jlyjl L. US' J^i Ù-* J-^1 M íjs- Ji jj-blijl Jij liv^ lill coi-bjl o-^y ûl í^j^ JJL А^Л DÎ ÍSjJ I bwijl j^y i^l-o Uíl^ CJJS'Í J tájujvi Ял^аЛ IjlIjl^. Up -ltjiil ç^ijl jiwl 11»j juijl JLp Á*ÁuJb ^ IjUíl^I j5ojj col-jni J y jill Ájj^jJl SJÚJ 气气 1 j, ^íji Á^JÜI ÁJIJUJI ^UJ OÍ ÁjJbJl i^all ijb- ^ ^sjs J^y y ^yu}\ ^U^r-NI ujj^jl ^^ S^JjiiJl aíual^; liljs\

126 page 114 î^iljj : UaâMIJ i-pu^rmi ^UPjSll ^ J iâjjij Âl^ ^ J ^ J ^ c ol "O" C *L Д* t(3j» Ui Âi л j^jbjl^pî ^Jül Ol^wJl V^j il)l.âtwajl 已 Uai C-ÂÂa^j ^ill ôl^jl '^S- ^jjl L-^. ^LjJI ^ ii^, Y jjuu-jlâi tj'il-jjl JLP yu \ ^jjl L.Î Хл,Г 气"U ol^ai' y ^Jp Â-u^Jl ^bl^sll b^il^j <Л>Wl 户 Y 广 yûj y -bjjl ^I^Sll cbb^l З-л-лЛ J\ JTLJA (J^JJlp ejub *>LPJ^^J^A-ÍJJ (tljil ak^jî ^Jb' Ol^l 产 I < j 4-jlíJ ÇLJLJI CJL-ju cujj JLi^ 4UP cdjllb^jlp Ô J.A^L-^I Â î ^ i 力 Uiil ^ ^yjl JbJbçJl OrJ \ ûli ijul^ A ljb ^ UT bl^ J-^-î y eis^bijl olj^ljij ^ JJ j JaJl ijia JLp iu Jl ùî y» L.J C4 uii ^JUA ^Ull L5JlP ^J^ ^ ^ lp^ tvçcjiojjb jjljoî J V^1 J^^ 二 J-A^ 气气入 ^ ^ ^Sli s-jujl ijüb oí ^ JLP ^ülj.cjuunjl jrj c^uipr^l J^lJ (^^Ч-г ÙÎ ^^JLP tflljl ijub ^ cjltjí OÍ Ljají (^«^UiJ 名 U ALÍJN w d l (J^TJJl.Ц (^óji ei-jb j-xbtj of ЦЛ^ЬJ JU^Jl IДА ^ ojbxjl ÂjoUoi olj^l^ JLP JJJ Ô Я Ы uj ^JLMJI JLP oijlaji o l I Dr A. M'Hatef (Algeria), Vice-President, took the presidential chair. Le Dr A. M'Hatef (Algérie), Vice-Président, assume la présidence. Mr TCHEUL (Democratic People's Republic of Korea): Mr President, I would like to congratulate you on your election to the Presidency. My congratulations also go to the Director-General and his staff on presenting The world health report 1997, which is very comprehensive and informative. My delegation shares the concerns expressed by many previous speakers over the deteriorating health situation. As we can see from the Report, the fight against infectious diseases is far from won, despite advances in antibiotics and vaccine development. Unhealthy social behaviour and lifestyles claim millions of lives every year, and thus violence, drug and alcohol addictions and mental damage have become major targets of our health policy, forcing us to bear a heavy burden. The concepts of equity and solidarity stipulated in the health-for-all strategy are not being properly implemented. Still the majority of the world's population are marginalized from basic and primary health care, and live under the constant threat of new and even re-emerging diseases. Mr President, we appreciate the efforts and successes of WHO in eradicating and controlling deadly endemic diseases, including smallpox and cholera. The DOTS strategy for tuberculosis launched recently is one of the examples of WHO's efforts dedicated to human well-being. Entering the twenty-first century, WHO faces formidable challenges, and to cope with these problems needs very vigorous reforms in its policy and structural readjustment. I would like to elaborate some points. First, to implement the health-for-all strategy more effectively, national programmes for further developing indigenous health care systems should be encouraged. The cost of basic medicines and vaccines are still unacceptably high, making them impossible for many people to afford. When more Member States produce vaccines and basic medicines, health care costs will be considerably reduced. Second, the ever-increasing threat of noncommunicable diseases deserves our concern. But still communicable diseases are a major threat to human kind, and we should maintain our policy of giving first priority to communicable diseases. Third, the world community should pay more attention to drastically changing unhealthy lifestyles. It is a regrettable fact that more and more young people suffer from drug and alcohol addictions and from mental disorders caused by unemployment, social problems and illiteracy. Health education and sound social behaviour should be encouraged to avoid such problems. Fourth, WHO's standard-setting process should be conducted in such a way that individual countries' specific conditions are fully taken into account and that efforts of Member States to formulate national policies on traditional medicine are further supported. Mr President, in conclusion, I would like to assure you that the Democratic People's Republic of Korea will continue to support and participate in WHO's noble work for the well-being of mankind.

127 page 115 Le Professeur ZELTNER (Suisse): Monsieur le Président de séance, Monsieur le Directeur général, chers délégués, la délégation suisse a pris connaissance avec un vif intérêt du Rapport sur la santé dans le monde, 1997 et en remercie le Directeur général et ses collaborateurs. Le sujet "Vaincre la souffrance, enrichir l'humanité", choisi pour les débats de cette année, me donne l'occasion d'expliquer ce qu'il signifie pour un pays comme le nôtre, doté d'un système de santé bien développé, auquel il consacre près de 11 % de son produit national brut. Au début de l'année passée, la Suisse a adopté une nouvelle loi sur 1 9 assurance-maladie qui garantit à l'ensemble de la population l'accès aux prestations de l'assurance de base, mais qui a en même temps accentué les difficultés des personnes défavorisées, telles que les chômeurs et les mères élevant seules leurs enfants. Pour les pays en développement encore davantage, il est primordial d'améliorer le système de santé sans en accroître les coûts ou les primes. Aussi nous paraît-il important que l'oms procède à l'évaluation des mesures curatives d'un coût modéré. Nous approuvons les programmes de promotion de la qualité, comme celui concernant les soins aux diabétiques et la recherche sur cette maladie, qui se base sur la Déclaration de Saint-Vincent. Un régime alimentaire inapproprié est à l'origine d'un grand nombre de maladies, comme le démontre aussi le rapport sur la santé dans le monde. L'application de nouvelles technologies et la globalisation des marchés dans le secteur des denrées alimentaires préoccupent considérablement la population suisse. La mise sur le marché suisse de denrées alimentaires génétiquement modifiées a suscité de très vives réactions allant jusqu'à des menaces de boycott à Г encontre de certains fabricants. Pour les autorités, il est clair que ces nouvelles technologies ne sauraient être utilisées que si elles ne présentent pas de danger pour la santé et si le consommateur garde sa liberté de choisir. Un étiquetage complet nous semble, pour cette raison, impératif même si cela ne nous facilite pas les choses en raison du grand nombre de produits comprenant, par exemple, du soja génétiquement modifié. L'année dernière, le secteur alimentaire a encore été sous les feux de l'actualité à cause de l'épidémie d'encéphalopathie spongiforme bovine. Les résultats des recherches laissant entrevoir la probabilité d'une transmission à l'homme ont suscité des réactions d'une ampleur inattendue. Il en est résulté une grande insécurité dans la population et des difficultés aux niveaux politique et économique. La crise de la vache folle a mis en évidence les différences dans la perception des risques au sein de la population et les problèmes de communication que cela pose. Nous remercions l'oms d'être intervenue rapidement et de manière compétente dans cette crise. Tous les sujets queje viens d'évoquer posent des questions fondamentales relevant de l'éthique. La société humaine en général, chaque Etat Membre et chaque collectivité locale sont confrontés à ces questions. Chaque communauté, certes, est libre de ses choix, mais il serait néanmoins très utile qu'une autorité de réputation impartiale se prononce clairement sur ces questions fondamentales. Nous souhaitons que l'oms le fasse davantage car nous sommes convaincus qu'elle peut et qu'elle doit jouer ici un rôle important en vue de soulager les souffrances des populations dans les Etats Membres, quel que soit leur niveau de développement. Dr. ARAFAT (Palestine): Oli 夕 jjstaj» ^лл Д-Jl câ^ji ^UJl yl^i y LLJl c^ull ^JLJI JL^Jl t^^jl o^i.oujij oljl^jl (J^Jui ^L^ll JJU^Î ^ J-Jj3jJ\ y ^L-^ijj ^^)\ S^L-^b v»ул cj.b.^u Oij 广 Njí í 广 Л ^ JLJI JuJl JjiÁ )í ^ yü NJ.SjjJÜI ùjjb UJ OU^aj 0jl^iib bijjl Ji^y C^U^N L5-ÍP SjlpL^J L^^a-i I J L P ^ij^jl ^-ujl JLwJij U^lTl; ^ 兄 Â у^л 4_i oljbr J^L tjjjjxj^* clícw^r 幻 ( J J Í \ ^lîj JA iô^-t coiolj^s- J^b-Nl J^ Сл' ^J Lililí J cbx-i 一 ; j^2ju OIS" L.JUP tjjjl Uu^LLL. Jüu L. Jii l^aju OL.I CÂPUJI ùjjb Ojjjl» JLÍIpÍj Í^JUÍ I д J j ^ U-^r íj colujlj ^jjl ^J yi (^JJl Lux-i. Orillo L* J-^jJ ojjjo^i (5JLj J Jb ^J ^JÁJ!Aj UL-P ^r ^ jy.01л1 ^Ji-Jl J-J C^JlxJl JJUÍ ^LS^ COrL>- ^ л-lkllj.âjju^ji oubjji J^ i^juyjl ^Jijl l^u-s^lpj 4. J C^jii JL-Jl J jí J-^l J JJLP ^Li ^ J ÂlljN 系 d JS; 0 J c^juji y JSÜ J^í

128 page 116 ù j>utw>j LkÍI juaií ^ jt^sjjbl ^ ЛлЗ L^j Ьс^ал- Аля^аj С. olcjiyi^ ^Jj^o Jbrol! js'jl-ij U J V^iJl J J o \ y d J L^i 己 U=> jî ^ 0 jijiîj ^^LJl îoj OIjSil il)t <oî Ц^>г ùjjj^j cj^sll jjü i «î l J f jjls L.JUPJ.JTLs^Jl Ju» J Jl JbJl? ^ J^.j colïlb-^l çlyj cs^uil Jl ^ I j Jl Jl ^ 二 ^ ol yut  jtx^ajt Я, 4^<Jbî ЯЬj^SCj^Su íj \jум 0jC-yaj ^LÜJU^i Ijsx^l ^уцр jjuioj ^jlp,g...á'il l^vujajj IjjjjJ fljjj j J^S^PJj lût Djj\S3 广 Ljbt^r Ij 黄 :. /» í f. \ ó j i j ^ J l, ( Ц 1 jjjl»jl j^c-jjl ^ С jk j^j UÎJLJ J t4jl«t j^jl ^ В JÍ ^ ivsl^ As^o ji^h^i (jjxb L» Ji' V J.St. Jl 广 y) a^u SJLPIJ t(já_jjl ^LJl ^T ^ iijlij Uyui Jl ;JLÍ7 tujl^mi ajb ^ 4-l^p L-^Jl JUI^I^! tí^ljj JixS SJbJbJl UjI^VI ÔjS^JI OíU-.JUJl l-u fjb J ^^ JL j ÎJu» Jl ojui-l ÂjJuJl ÂjLjJ! «JL» -Lid о^ г US' tjbjx. ^ i-l-, ^iu^l, cbb^ll jyu L^j c^jsîl 啦尸 ol-jl^jb bok^lj VTA j Y乏 X j^sll (_ r ll. (/jl) 广 i Ь_, ÎJb >...I 4 çljl üb JÜár U-UJj.ùliii ^ Olk^NIj j?jjji 0 o l T.ùUal-^l ^ J^LT" I^JlSL^ blij ia,ji^u. ç^yj L. v j J l oljl^ub UlJjíj coujilljl Jll c^uijl j t^l-j^i L^UJ? frl^ jliivi y 一丨 jwl jt^l^í ojl_á) o j ej^j cajà-v...jlj obljjl ÍLÜ Lw» t^ljl Iy Jl^jl ULs-í JJC, J^jií ^Jl ^.l^jl Jud 丨 j UJI^MI b^l ^jljj ^ JojUJl ^Ul ^ o!jjljij ^ ajuiil atjl-j^ji y Ujüsí ^ tj^ J^Lio oí el» ^ (I jv-^lij i_ -»íj.ej_pj yjl Si^Jl y JS' ^ Á^^ÍI^WJlíJI ЯлчпЛ Ôjljj JLiS ÁJ 广 JLP s- CÁS' a_jjojl J ÂsJuM Á^wíil 二 0jbdL Vwajl iap 夕 I M^íií JuÁ jl^^ni ^ íulj Lv^. ^Jóí jjij UÎj Jl Jj> ^ L.O; Js- a ^ w : j j^lîl^m! jíí^l Âi^iTÎ ùl С JLp tlfcj^j»:- J_âiii.^">LJLS J.ST NJ ^LwJl ù-^ U ^-^J J f^ 1 5 NI jl^- J J I ^ ^ ^ N e^jijn f^ljlj d Ji^j. f ->LJb I Uii JT JUiJj J^V 1 J^j ; J U U tljui>î JSO cuubsi Dr HRABAC (Bosnia and Herzegovina): Mr President, ladies and gentlemen, it is an honour to report to the Fiftieth World Health Assembly on the progress made since we last met in We would first like to thank all those countries and organizations which provided support to Bosnia and Herzegovina during the war and are doing so now as we enter the period of post-war reconstruction. In particular we would like to thank the Regional Director for Europe for his commitment to Bosnia and Herzegovina during these difficult times. The current health and health care situation in Bosnia and Herzegovina has been fundamentally affected by five years of conflict. The demography of our country has changed. Major losses in human lives have been sustained, and even greater numbers of people have been disabled. In the new social and environmental conditions that have been created we still lack over houses and an adequate water and energy supply. Food shortages still affect large numbers of our people, and our health care system continues to suffer from the war. There have been major losses in health care personnel, and almost half of all our facilities have been destroyed or badly damaged. Much of the equipment needed to run a health care system has also been damaged or lost. All these changes have inevitably and seriously affected the health of the population and our ability to respond to needs. In addition, the new political and administrative organization of the country following the Dayton Peace Agreement has itself introduced new challenges for the provision and administration of health care. In accordance with the Constitution of Bosnia and Herzegovina, the health care system of the country is now administered by two ministries, namely that of the Federation of Bosnia and Herzegovina and that of the República Srpska. Both ministries are faced with the difficult task of health care reform and reconstruction at a time of severe economic constraint and seriously depleted health care resources. Our Government nevertheless has

129 A50/VR/5 page 117 a clear vision of the future health development of the country, the steps which are needed to achieve that development and the reconstruction on which it must be based. Both ministries of health have prepared the essential documents needed to guide this development, including new health legislation, strategies for reconstruction and project outlines for implementation with the World Bank. Both ministries are working in a complementary fashion using similar concepts and approaches. They are in the process of implementing health care reforms in accordance with trends in other parts of Europe. They include health insurance funded through payroll taxation, decentralization to the district level, strengthening of primary health care through family medicine, a new role for the public health sector, a comprehensive drug policy and mixed ownership and privatization of the health care sector. In order to ensure maximum coordination and cohesion with the outside donor community, and to be able to meet international agreements and conventions, our Ministry of Foreign Affairs is cooperating closely with the health sectors of both entities. Within the Federation of Bosnia and Herzegovina, the Ministry of Health is preparing a comprehensive master plan which includes health care policy, health care strategies and detailed projects and programmes which respond to our priorities. As part of this we have just completed the third evaluation of health care targets for the year 2000,and our health care policy will take the results of this evaluation carefully into account. In cooperation with World Bank experts we have already prepared and started to implement two major projects on rehabilitation of war victims and the essential hospital services. In addition, with WHO, we have prepared a project for primary health care and public health reconstruction. We expect that funds for this project will soon be provided by the World Bank. An equitable distribution of the reconstruction effort in all regions of the country will facilitate the resettlement of refugees and internally displaced persons. In so doing it will improve the overall social and political stability throughout the region. With the International Centre for Migration and Health and the national institute of public health we have conducted a comprehensive assessment of the health and social status of internally displaced persons, and the results of this will help guide the process of resettlement and health development. To achieve a comprehensive reconstruction process throughout the country, the Government of Bosnia and Herzegovina is cooperating closely with the World Bank in the development of local capacities through its project implementation units, which will be capable of addressing the priorities of the health care system. Our Government invites all those who are willing to assist us in the reconstruction process, to do so through these units. We hope that the commitment of the World Bank, WHO and other counterparts will come together and be reflected in the international donor conference to be held in Brussels shortly. The situation facing the country remains challenging, and the transition from an emergency phase to one of redevelopment is not easy. We will continue to need the help and support of the international community for some time to come. The World Bank estimates that it will take US$ 434 million in external financial support to cover the coming four years of reconstruction throughout the country; for example, Bosnia and Herzegovina will continue to be dependent on external sources for much of its essential drug supply as well as many other vital health resources. In summary, Mr President, the Government of Bosnia and Herzegovina is fully committed to taking its health care system out of the emergency phase and into a proactive development process. At the same time it is aware of the heavy burden it is working under. It therefore looks forward to the continued support and participation of the United Nations, bilateral organizations and other bodies in achieving this necessary and very worthwhile goal. Le PRESIDENT : Je remercie le délégué de la Bosnie-Herzégovine. Je donne la parole au délégué de la Gambie, qui s'exprimera au nom de la Communauté sanitaire d'afrique de l'ouest (Ghana, Libéria, Nigéria, Sierra Leone) et au nom de son propre pays. Je demande au délégué des Seychelles de venir prendre place à la tribune.

130 page 118 Mrs NJIE-SAIDY (Gambia): Mr President, Vice-Presidents, Director-General, distinguished delegates, on behalf of the Assembly of Health Ministers of the West African Health Community, made up of the republics of Gambia, Ghana, Liberia, Nigeria and Sierra Leone, I wish to congratulate the President and Vice-Presidents on their election to office and to express to the President our full confidence in his distinguished leadership of the Fiftieth Assembly. We also wish to congratulate the Director-General and his staff for a comprehensive report and for steering this great Organization successfully in the past year. We in the West African subregion face similar challenges in the health sector. Our policies continue to focus on community participation, social mobilization, intersectoral collaboration and the Bamako Initiative, among other areas. Essential limited expansion and consolidation of existing services in our secondary and tertiary structures are also being undertaken. The report subtitled Conquering suffering, enriching humanity emphasizes the chronic conditions which are now increasing in importance as a result of lengthening life expectancy and changes in lifestyles in our subregion. Controlling major noncommunicable diseases such as diabetes, coronary heart disease, hypertension, strokes and mental disorders continue to receive adequate attention. We will therefore continue to express our concern about the preventable nature of most of the diseases, prevention which,in most cases, can be achieved by instituting a change in lifestyle. Steps are therefore being taken to increase the level of awareness in the community of the preventable nature of these diseases, using appropriate health education and social mobilization strategies. In our implementation of the essential drugs policy, appropriate steps are being taken to ensure that fake and substandard drugs do not circulate in our communities. In the recent past,our subregion has seen the resurgence of endemic diseases and the emergence of new ones. We have had to battle with such diseases as cerebrospinal meningitis, cholera, Lassa fever and yellow fever. We were able to mobilize sufficient human and material resources to contain the epidemics. Our appreciation therefore goes to the international donor community for complementing our efforts to keep the epidemics under control. Control of vaccine-preventable diseases continues to be our concern, with the ultimate aim of eradicating such diseases as neonatal tetanus, poliomyelitis, diphtheria, measles,tuberculosis and whooping cough. We therefore support the WHO strategies for achieving the decade goals for child survival. We are also implementing other strategies for the control of major endemic diseases such as malaria, onchocerciasis and dracunculiasis. Programmes designed to contain the emergence of new diseases such as HIV/AIDS and Ebola fever are also being implemented, using of course an intersectoral and multidisciplinary approach. Increasing public awareness of health problems demands the reorganization of the health sector to respond adequately to the aspirations of our people. Member countries of the West African Health Community have therefore undertaken the necessary health sector reforms and formulated national plans of action to meet the challenges we are faced with currently and those ahead. We have, in collaboration with development partners and other sectors, developed a national consensus on the way forward for the health sector. We are therefore responding to the need for infrastructural development, improved managerial capacity in the health sector, adequate financial allocation to health, and improvement of the quality of health services offered generally. We are also sensitive to the danger of over-dependence on donors for implementing health programmes, with its attendant risk of the unsustainability of such programmes. We would, however, insist that donor agencies engaged in the provision of vaccines to Member States adequately compensate those States that are sites for the trial of new vaccines. We would also appeal for the phasing out of such assistance to be extended for at least five years,to allow Member States to build the resource base to meet the required expenditure. We are also worried about attempts to rapidly cut off donor support for critical programmes like the Expanded Programme on Immunization and disease control. Whilst we welcome initiatives like the Independent Vaccine Initiative for example, we wish to recommend a rapid phasing out process on account of the unfavourable financial situation most of our countries in the subregion are faced with. It is gratifying to note in all our countries the increased community participation in the improvement of health services and embracing of the health-for-all strategy. Reproductive health, family planning and female genital mutilation continue to be important public health concerns in our subregion and are being addressed appropriately. The economic crisis in our subregion has resulted in the deterioration of some aspects of our health situation. It is envisaged that the poverty alleviation programmes currently being embarked upon by our Member countries would result in the improved health status of our people. Health is now being positioned at the centre of development programmes. We are now fully aware of the health hazards posed by a deteriorating environment. Strategies for multisectoral participation in the management of the environment

131 page 119 have been developed and are being implemented with the full participation of the private sector. Also, the health of our cities continues to be our concern, and we fully endorse the resolutions from the Habitat II Conference with regard to strategies for the management of healthy cities generally. Political upheavals, conflicts and wars ш many countries in the West African subregion have had a negative impact on the health sector, and the problem of refugees and displaced persons continues to place an enormous burden on the health services. We welcome the new era of peace now evolving in the subregion, and hope that a lasting peace will make a positive contribution to the health care delivery services in our communities. It is also in an atmosphere of peace that we would be able to implement the costeffective intervention strategies for addressing the problems of malnutrition, micronutrient deficiency and food security. Adolescent health and the health of children under difficult circumstances also need to be focused upon. We are aware that these areas have received very little attention in the past, with a resulting negative effect on health indicators. We expect therefore to address these issues as a matter of urgency, as they affect the lives of the coming generation. Women in the developing world still continue to be underprivileged, with low socioeconomic status and low health status. Women in our part of the world carry the burden of the family and are the key health care partners. The problems of women are peculiar and need a special focus, and deserve more attention than we have given them in the past. The advancement of women's health for development is a vital component of any global health strategy. It is in the light of this therefore that we wish to congratulate the Director- General for establishing the Global Commission on Women's Health to serve as a global forum for advocating women's health issues,particularly in developing countries. We are encouraged by the work of the Commission, but are concerned by attempts to terminate its work. This is a time when we need increased global awareness of women's issues, and we wish to urge the Director-General to reconsider the decision to terminate the work of the Commission at this very crucial time. Mr President, the health systems in our countries are undergoing restructuring to meet the new challenges ahead. Poverty, unhealthy environment, low allocation of resources for health, and lack of managerial capacity result in minimal improvements in the health indicators of our various countries. To meet the challenges of the next millennium therefore, our subregion must address the need for multisectoral participation in solving health problems; decentralization of the health system; increased mobilization of resources, particularly national resources; training of health personnel; active involvement of the private sector in the health sector; and research and social mobilization of our communities. Collaboration amongst countries in the subregion is vital. We therefore believe that efforts by the Economic Community of West African States to merge the two existing subregional health organizations, one of which is our organization, to form a single health organization, the West African health organization is a step in the right direction and should be encouraged. Diseases know no boundaries,as we are always told. Mr President, we in the West African Health Community continue to have confidence in WHO and wish the Organization every success in the years ahead. Mr DUGASSE (Seychelles): Mr President, distinguished delegates, ladies and gentlemen, first of all, I would like to offer the President and the Vice-Presidents my heartiest congratulations on their election, and to offer them my best wishes and support in the demanding tasks of steering the work of this Assembly. I would also like to convey to the Director-General the appreciation and thanks of my delegation for the excellent The world health report The quality and usefulness of the annual report, now in its third year,has grown with each new edition. The report is,for us, not only a collection of statistics and an account of WHO's work, but also a rich source of information, ideas and inspiration for the development of health in the world and indeed in my own country. The main theme of the report, noncommunicable diseases,is particularly relevant to Seychelles, as these are now the leading causes of mortality and morbidity. Cardiovascular diseases, for example, account for more than one-third of all deaths. The chronic nature of these conditions and the fact that they are often the results of changing lifestyles, as noted in the report, present major challenges to the health services, both in terms of meeting the health needs of today and in preparing for the increasing burden in the future. In Seychelles, we address these challenges through strategies that are very much consistent with those presented in The world health report. We place a lot of emphasis on prevention, and I am pleased to note that one of the films exhibited at this Assembly is based on our efforts for the prevention of cardiovascular diseases.

132 A50/VR/5 page 120 Prevention necessarily implies working with the community and other sectors, governmental, nongovernmental and private, and we have made much progress in this area in the past few years. We also recognize the importance of the Government's continuing to play a key role in the development of health services. We believe that the control of diseases must be seen in the wider perspective of health for all. Health for all implies placing health at the centre of development, and ensuring that all our citizens have access to health care services and the opportunities to enjoy good health. Promoting this philosophy has been a cornerstone of my Government, and I believe that it requires strong government commitment to ensure that more resources are mobilized for health, and that the necessary partnerships are created and pursued. I commend the Director-General for promoting, in the report, the concept of health expectancy and not just life expectancy. The quality of life is more important than the mere quantity of life, and I believe that this outlook should stimulate us to redefine our health programmes and health indicators. We should not be satisfied that the average life expectancy is rising in nearly all countries; we should also be concerned about the quality of life of people and the often widening gap between countries and within countries. The world health report 1997 tells us that "the poor die young while the rich die old". The health needs of both the rich and the poor must be our concern, but it surely would be a tragedy and a shame on humanity if we failed to address the needs of the world's more vulnerable and disadvantaged as we near the end of this century. Mr President, I believe that this should be the focus of WHO's work in a renewed strategy for health for all. In this work, the Director-General, our Regional Director and the entire Organization can count on our fullest support. Mr GEITONAS (Greece): Mr President, Mr Director-General, fellow delegates, ladies and gentlemen, I am particularly happy and honoured that I have the opportunity to address this World Health Assembly. In the wider historical spectrum of philosophical thought about health, it is interesting to recall that in ancient Greece the principle of "a healthy mind in a healthy body" constituted the basis for promoting good health for people and societies. This concept, which reflects the need for a balanced coexistence of body and mind, continues to be the central issue for our well-being. Especially today, on the eve of the twenty-first century, when our societies, particularly in the developed countries, are characterized by urbanization, rapid and uncontrolled technological progress and serious environmental problems, creating stress and even anguish among people. In this context, speaking of chronic diseases, the Hippocratic concepts continue to play a major role and their contribution in combating chronic diseases is still quoted. Today the state of health in our societies, as is described in the report, shows considerable improvements. However, many problems still exist and have to be solved. The current situation is characterized by the following: people live longer; infant death rates are generally declining; inequalities in health still exist within and between countries; premature deaths of middle-aged people are mainly due to heart diseases, strokes, cancer and accidents; more than 41 million deaths annually are caused by chronic and infectious diseases. Although significant improvements have been made during the past decades in the state of health worldwide, the chronic and infectious diseases continue to be a major threat to our societies. The changes in the world epidemiological profile, in conjunction with current major political economic and social developments, emphasize the important role of WHO. I would now like to make a brief reference to the policy of the Greek Government in the health sector. We continue our efforts for further improvement of our health system and especially in the areas of accident prevention, tobacco and alcohol consumption, and environmental protection. In this connection, we wish to strengthen further our cooperation with WHO. We are in the process of passing through Parliament new legislation on the reorganization and restructuring of public health, school health services, primary health and hospital and after-hospital care. In the area of chronic diseases our health strategy places much emphasis on early detection, prevention and control of cancer, diabetes, cardiovascular and other degenerative diseases, which constitute the major causes of death and disability. On the other hand, my country's policy is shaped so as to cope with social problems affecting chronically ill patients. As far as international cooperation is concerned, I would like to draw the Assembly's attention to a new Balkan and Mediterranean health plan, which should be designed and supported first by the countries themselves in cooperation with international organizations active in the field, primarily WHO, the Council of Europe and the European Union. Greece has always welcomed not only social dialogue between all

133 A50/VR/5 page 121 interested groups at national level, but further, a strong commitment to the necessity of maintaining and promoting regular international cooperation. In concluding my statement, may I congratulate the Director-General on his valuable contribution and once again express my warmest appreciation for the highly important mission of WHO. I should like to assure you that, as far as we are concerned, no effort will be spared to contribute to achieving its objectives and policies. The new health-for-all strategy must be the main core of our policies. The ancient Greek saying, "a healthy mind in a healthy body" should open the way for "healthy human beings in a healthy social and physical environment". El Dr. NARRO ROBLES (México): Señor Presidente: Reciba usted una sincera felicitación por su designación para conducir en esta etapa los trabajos de la Asamblea. Señor Director General, señoras y señores delegados: por mi conducto, México expresa su felicitación al Director General por el informe que nos ocupa, y a la vez destaca la urgente necesidad de establecer un compromiso en favor de la promoción de la salud. Un compromiso para fomentar los modos de vida sanos, aquellos que estimulan el desarrollo saludable de los individuos y las comunidades, aquellos que se oponen a las prácticas de riesgo como pueden ser la alimentación inadecuada, la falta de ejercicio físico,el hábito del tabaquismo o el hábito del alcoholismo. Asisto a este foro también para expresar a ustedes que, como muchos otros delegados, considero que la Organización Mundial de la Salud transita por una etapa en la que habrá de transformarse para lograr que, tras 50 años de existencia, pueda seguir impulsando las grandes iniciativas que permitan a nuestras naciones continuar mejorando la salud de nuestra gente. Lo que hagamos o dejemos de hacer tendrá efectos sobre nuestro futuro. Las decisiones que habrá que tomar determinarán el rumbo y el destino de la Organización y tendrán también un efecto en nuestras sociedades. En el campo de la salud, como en el de la educación, lo que se hace hoy repercute en el futuro. Deseo aprovechar esta oportunidad para comunicar a este pleno algunos de los avances en materia de salud y también algunos de los desafíos que en este campo se presentan para la población de México. Apenas el año pasado, el Fondo de las Naciones Unidas para la Infancia ubicó a México como uno de los 10 países que más rápidamente están progresando en la lucha en favor de la niñez. La evaluación efectuada permitió identificar, por ejemplo, algunas de las metas programadas para cumplirse en el año 2000 y que ya han sido superadas; entre ellas, pueden mencionarse la reducción de 65% en las defunciones debidas a enfermedades diarreicas, la erradicación de la poliomielitis, la eliminación de la difteria o la desaparición del sarampión como causa de muerte en nuestra población. Lo realizado en los últimos seis años,conjuntamente por el pueblo y el Gobierno de México, permitió evitar más de muertes en los niños menores de cinco años, además de que se propició un mejor desarrollo para este grupo de población. En mi país sentimos que ésta es una de las mejores maneras de invertir en el futuro y de contribuir a la construcción de una sociedad más justa. Reconocemos que sin salud no puede haber desarrollo y que una población sana es condición inescapable para el progreso de cualquier colectividad y junto a los avances también identificamos los desafíos que se nos presentan. Así por ejemplo, los asuntos de población, particularmente su crecimiento, siguen teniendo la más alta prioridad: sin un crecimiento poblacional equilibrado no habrá crecimiento económico o desarrollo social que alcance. La emergencia de nuevas patologías, o la reaparición de aquellas que se consideraban controladas, ocupa parte de las acciones de las autoridades sanitarias. Aun cuando todavía vivimos en México parte de nuestra transición epidemiológica, cada vez es más importante la presencia de las enfermedades cronicodegenerativas en la estructura de la mortalidad, incluso en las zonas rurales del país. Señoras y señores delegados: En este foro de la más alta importancia, expreso a ustedes el compromiso del Gobierno de México de seguir otorgando la condición de prioridad a las acciones en favor de la salud. Por articular debidamente los programas de salud con aquellos de educación y de alimentación que generan efectos sinérgicos en los primeros, por continuar promoviendo la movilización social y el involucramiento de las autoridades locales de gobierno a través del Programa de Municipios Saludables, así como por reforzar los programas que promueven la adopción de estilos de vida saludables. «Vencer el sufrimiento y enriquecer a la humanidad» es el lema del informe de 1997, frase hermosa que recupera un humanismo que tanta falta hace hoy en día, enunciado que expresa convicción y compromiso, además de nobilísima aspiración. Sin más años de vida para nuestras poblaciones, no estaremos cumpliendo con una obligación fundamental; sin más calidad de vida en los años que se ganen, tampoco estaremos alcanzando nuestra meta.

134 page 122 Aquí está planteado el desafío, aquí está planteada la gran posibilidad de contribuir a la construcción de una sociedad más justa y equilibrada, de una sociedad más sana. Muchas gracias. El Sr. RODAS (Ecuador): Señor Presidente: Pronuncio este discurso en nombre del Dr. Guillermo Wagner Cevallos, Ministro de Salud Pública del Ecuador, quien no ha podido concurrir a esta 50 a Asamblea Mundial de la Salud. Señor Presidente: permítame empezar expresándole nuestras felicitaciones por su elección a la presidencia de esta Asamblea. Hago extensiva esta felicitación a los demás Miembros de la Mesa. Señores delegados, en el contexto mundial estamos experimentando profundos cambios en los modos de vida de los diversos grupos poblacionales. Estos cambios han tenido un impacto global, pero con expresiones particulares en la salud de las diferentes regiones. Se puede decir entonces que los países en desarrollo no han seguido el modelo de transición epidemiológica experimentado ya hace décadas por los industrializados, sino que el perfil epidemiológico de la infección y el contagio coexiste con aquel de la cronicidad y el deterioro. Por lo tanto, toda acción en salud deberá tener este enfoque integrador y considerar la brecha entre pobres y ricos para lograr la equidad en salud. En la Región de las Américas existe una gran variabilidad en cuanto al nivel de desarrollo en las condiciones de vida y de salud de su población. Algunos países se encuentran en una clara transición epidemiológica. Sin embargo, la mayoría está experimentando más bien un traslape epidemiológico caracterizado por la persistencia de problemas de salud típicos de las poblaciones pobres, tales como las enfermedades carenciales y las infecciones, pero simultáneamente las enfermedades crónicas representan ya problemas significativos de salud pública. Lo que resulta más preocupante en este aspecto es que muchos de estos problemas de salud son más prevalentes en los grupos poblacionales pobres. Otro aspecto a considerar dentro del contexto mundial es la influencia negativa que están teniendo los procesos de globalización de los mercados, el consumo de cigarrillos, alcohol y otros productos dañinos a la salud, mientras decrecen en los países industrializados, se incrementan en los países pobres. Por otro lado, los daños al ambiente cada vez son más severos y frecuentes en los países subdesarrollados. Los procesos de urbanización y otros cambios demográficos están condicionando cambios nocivos a la salud en los patrones de vida de grandes grupos de población. Adicionalmente, enfermedades que serían ya cosas del pasado están reemergiendo con mayor fuerza y actuando sinérgicamente con enfermedades emergentes en deterioro de grandes grupos de población. Ello representa enormes retos a la salud pública en nuestro continente, en medio de una situación social y económica que nos impone graves restricciones en cuanto a recursos y a la necesidad de desarrollar formas innovadoras y creadoras para abordar la situación. Es pertinente hablar entonces de «aliviar el sufrimiento de los más vulnerables para enriquecer a la humanidad», propendiendo a crear las condiciones favorables para una adecuada calidad de vida del ser humano y en especial de nuestras mujeres, nuestros adolescentes y nuestros niños dentro de su ámbito familiar. Los indicadores de mortalidad muestran avances en la situación de la población infantil, pero por otro lado un estancamiento en la situación de las mujeres. Las intervenciones de la Organización Mundial de la Salud en este contexto estarían orientadas al logro de grandes metas, que contribuirán a mejorar la calidad de vida de los grupos más desfavorecidos de nuestras sociedades. Estas metas incluyen, entre otras: reducir la mortalidad materna; erradicar las deficiencias nutricionales específicas; reducir las muertes infantiles por causas prevenibles; erradicar enfermedades inmunoprevenibles como el sarampión y consolidar la erradicación de la poliomielitis en nuestro continente; controlar las enfermedades emergentes y reemergentes; prevenir las enfermedades crónicas asociadas a patrones de vida poco saludables; garantizar el suministro racional y adecuado de medicamentos básicos; fortalecer los sistemas regionales de vigilancia y control epidemiológico y mejorar y preservar el medio ambiente. Las grandes líneas estratégicas que se están abordando en nuestra región para hacer frente a la situación descrita anteriormente incluyen esfuerzos para reformar los sistemas de salud bajo los principios de equidad, eficiencia y efectividad; fortalecer la participación ciudadana en las diferentes formas de hacer salud; promover el reforzamiento del poder y capacidad de gestión de los gobiernos locales y contribuir al alivio de la pobreza y las inequidades étnicas, de género y económicas. Dentro de este contexto, en la Región de las Américas estamos empeñados en llegar al nuevo siglo con un visión renovada de nuestras aspiraciones por lograr el pleno desarrollo del potencial humano de nuestras poblaciones, consecuente con el espíritu de solidaridad entre países que nuestra organización promueve. Quisiera terminar agradeciendo al Dr. Hiroshi Nakajima su trabajo de tantos años en favor de la mejora de la salud en el mundo.

135 A50/VR/5 page 123 Mr S.I. Shervani (India), President, resumed the presidential chair. M. S.I. Shervani (Inde), Président de l'assemblée, reprend la présidence. I thank the distinguished delegate of Ecuador for his statement and for the kind words addressed to the chair. I wish to express my warmest thanks to the fifth Vice-President for replacing me this morning and to all the Vice-Presidents who have replaced me on various occasions, all of whom have carried out their duties most efficiently and eloquently. We shall now continue and complete the debate on items 9 and 10 of the agenda. I give the floor to the honourable delegate of Sudan and invite to the rostrum the delegate of Norway. Mrs. AL GABSHAWI (Sudan): J^^tJl ^y^jl çlsapîj çl-jj j dj^-^i Cj^uji ^ JUJl JLaJI L^J^JJ\ (^JL^ \ 4 OUJJi J J ^SOl ^UaÍI Âil^iL ЛлJ JP 丨 I 二 j cfuil jíjcj IуЫ jijlij í OÍ ^j.cjusi vc^ji olj^laj ol^rу у.^iilb ^U- UJ b.ijiíl лг^з OÍ Jb^j.VkuJlj Jp^dJ N ç,y>r ÛÎ Â ^ I 户 ( / J L ^ blplj ^UflJi О ^r JT о I JiJJ OL^I J f^ ^ bwiil 01J 4<L.LiJi ji^ii Libj ^xjl ^jl^ji JLS^-j c c j j ^ j!>u IAJ^P ^ LuS ÜS^I " ti.- 二产 JJ!>LJJ L 5 í i * S / ) Ы 丨 J UJ^ JS- ^jyui' ^ijliij!>ülj f^ljl V^* Ьj^r lj i^b^l ^j^jl OU 逃 JT ^ ^ Ь L_üí US'.^jJl LJl rljl? ^ f!>ljl JI ^ 沪 C.áilJ ^jjlj ÂLTJI ÙbJ-X 'jj-^' Ч^ 1 Ul IJl-л Jj^Í /OL-J ^ jo^lj - Л J> vii;! ^ o L i U i i b jijjús JjLp ^-ijy y ixls ùb l J^îj 4 jljii ^ ÂxUc^Jl Â^^wail 4flbuil jü^i ^ ^JJ) \.4j>r «.«-al Jlp CJ\^-ijSi J ÂJlâil óys JUj filial J^Lp Jijl Ui'.^Ui;! j 4 ÂjjUu^I ôwijl êljj j^ot.-r ÂJLàj^l влл OÍ U^ïj )i c^^pjji\ ij-x^ L-L^ liili 01.ijywsJl oujbjl ^ 广 v^^jlj Ó Íj j^jdl SJLPIJ ÁÍl NI ÁJ-^-C- JLP ^Ux. ÁJ^ 1 ^ ^úí ) à \ ^ l - U ^J.1^-1 产 J jjud UU^i J*i(j ^M^Jl Д^чло d IJ JUipSll JUi^M V I U^Ñ VwJi ^IjJl jblo. Jl JU^Jl ys. ^Ji; ^Js- js^jl l^i Li_«J j^jíjj5jt)li«j 二 j^ill ^jjl^ij ^jjjjlu ^«лyl OLí L Jb^l dlji ùsl cí^sll J^liJlj I 4л-j ^Js- 丨 j ^jjjjjl ÁjU-) cul^jb:" ij^wijl CJUjlaJL ^ ^ j» / Л y» cjtl V^o /OL^J ^ 广 U ^-U^j S^-S/l l^iu^ c^i jla*j J-xiJaJl O J L i x J L5_Jl LjjMJÍ L^ j^-ft ^ 01 J L j ^ J ^^Lx jjj ^ oùji^jl 广 O^oj olj-j^^jj J f i J js^jj^jjsol LüLu^iJ U 广 J L i ü c^ujl IJLA ^ clülj aplj^ilj oll-p ^ ^ ^ tobj^illt 气气 V 广 bj bjtajl bôlsuj oujl VI^JÏ jltl ^ju ^^l^jji L^-lru jytjüi bujl ^JuJl j-jjl*j 一 ^uji (j 一 ^C^Jj CJL-Jíío 4 4 j l J L Ü l ja\ (Jул

136 A50/VR/5 page 124 J^oj Sj^r^Jl ojl^; J} 5>Ji J ^-PJJI IJj^ J^l )í 产 j 气 Я V rujl ^лл 广二 一 J-^J ^ijl^sll cjlt JJÜj.^Jb A JbrJ js ^Ui^b Já^o J^-^lj c^jjjü )jl>ujl ùl Lrip jjoji ijigj ^Lill i^ijjis J 户 -J V ^ I Л "JOJJ j ^UoNi atju^ji ^ Ajb á^a^ajl Яло!^L-U-^I d\ ÔjS'^ jj^xj j (Jy-w^Ji (^LP ajujji Ô(iU^ JlílJIJ^pL j ^S/lj onuo ^^j^i^ji J jy J ^ y luáiji oí v ^ í Mj.^^J 丨 J isr^ JLP ^UjNi ^ aipuii atjlí^jij ^iji 一.^UJl j^jl ijüb ^ óí^jl UL^ 如 J 4JJi JLJj as"y 丄 Jl L ijuhí jj^j Jx^ ^ ôonjlx. ijuh j^jí t^j\ (^wx^ c^b^jl ^j jij JJ ^JlP J íjj Mr HERNES (Norway): Mr President, Director-General, distinguished delegates,when in 1960 The New Cambridge Modern History published its volume on the twentieth century, the editors sought a title to encapsulate the essence of our time. The title finally chosen was "The era of violence". For never before in the course of human history had so many perished in wars, never had so many vanished in concentration camps,never had so many died in man-made catastrophes. But the history of our century could also be compressed in another caption - it could have been called "The era of public health". For never before in human history have so many survived infancy, never have so many lived long, never have so many had healthy years. Enormous strides have been made throughout the world in reduced infant mortality and enhanced life expectancy. Much of the progress has been achieved outside the health sector proper: by economic progress,by nutritional advances,by sanitary improvements,by educational gains - but also by breakthroughs in medicine and health technologies. Yet we, the peoples of the world, are facing not just one,but two widening gaps: first, between the potential that science and technology offers and policies we as nations individually and collectively pursue; and second, between the haves and the have-nots. On the one hand, the growth in knowledge is more rapid than the growth in resources; on the other, the gulf between rich and poor widens. We can do more than we can afford - yet we cannot afford not to fight poverty in order to better the living conditions of those that are worst off throughout the world. My Government welcomes the readiness of WHO to contribute in implementing the 20/20 initiative launched at the World Summit on Social Development. The objective of the 20/20 initiative is to achieve universal access to basic social services,including primary health care, through mutual commitment by developing and donor countries. Norway is firmly attached to this principle. I commend the initiative by the Director-General,Dr Nakajima,to establish the Task Force on Health in Development. It will be crucial in setting the future mission of WHO. Norway's commitment to health for all is underscored by the fact that the health and social sectors jointly constitute a priority area in Norway's international development cooperation. Hence my country has for many years been among the major voluntary donors supporting the activities of this Organization. Some years ago this Assembly called for measures on budgetary reform. Today I express with great pleasure my sincere appreciation of the improvements in structure and transparency of the proposed programme budget which the Director-General has submitted to us. We also endorse the changes the Director-General is proposing in the original draft budget. Like the rest of the United Nations system, WHO is undergoing comprehensive reforms. Norway has taken an active part in the reform process, including that of WHO. Recently,a timetable with specific steps has been set for addressing the crucial and delicate issues on the reform agenda of WHO. We are pleased to note the wide consultations with Member States initiated for this purpose. Fifty years' experience in international health and its unparalleled association with the scientific community puts WHO in a unique position to provide essential leadership for a healthier world. Member States expect WHO to provide such leadership. My government would like to strengthen WHO so that it will live up to these expectations. This is why my Government has decided to put forward the candidacy of our former Prime Minister, Dr Gro Harlem Bruntland, for the position of Director-General of WHO. For there is no doubt about the importance of its mission and the impact of its operations. More than any international organization, WHO can serve as a great unifier of peoples and nations against the entrenched enemies of mankind and the common scourges of humanity: germs and diseases, poverty and misery.

137 A50/VR/5 page 125 In no area other than health is the potential for human creativity and innovation greater, the impact of practical genius and political efforts more promising,the need for solidarity among men and cooperation among nations more urgent. WHO is and must be a repository of hope precisely because it can enable us to wrest from destiny the control of history to forge our common future. Dato Dr JOHAR NOORDIN (Brunei Darussalam): Mr President, Director-General, Vice-Presidents, excellencies, distinguished delegates, ladies and gentlemen, allow me, first of all, on behalf of the delegation of Brunei Darussalam, to align ourselves with the previous distinguished speakers to congratulate His Excellency, Minister Saleem I. Shervani, most sincerely on his election as President of the Fiftieth Health Assembly, and also the five Vice-Presidents and other office bearers. May I also take this opportunity to offer our sincere thanks and felicitations to Dr Hiroshi Nakajima and members of the Executive Board for their untiring work over the past year and for preparing the comprehensive and excellent The world health report In the developed and developing world alike, the past several decades have witnessed improvements in health, which have led globally to the increase in the life expectancy of its population. However, rapid "greying" or ageing of the population and changing lifestyles have led to an increase in the incidence of noncommunicable diseases. Particularly cardiovascular disease, cancer, diabetes and many other diseases. These chronic conditions in many countries, including Brunei Darussalam, are major causes of death, illhealth and disability. It is thus most apt and very timely that this year the central theme chosen for discussion at this World Health Assembly is "conquering suffering, enriching humanity". The theme focuses our attention on these chronic conditions which have increasingly become very important in the global health situation, contributing to suffering and the social and economic burden on families, societies and individuals. The developing countries, in particular, are experiencing an epidemiological transition and face the "double burden" of continuing the fight against endemic infectious diseases,in addition to the challenges created by noncommunicable diseases and chronic conditions. The world can no longer afford to ignore the realities of the demographic trends, greater longevity, economic progress and behavioural changes we see everywhere around us. These changes are accompanied, unfortunately, by the increasing burden of chronic diseases and social and behavioural health problems. These challenges of the 1990s,their implications and solutions, will require interdependent action and solidarity at local, national, regional and global levels. Already, efforts are being made by governments, organizations, communities and individuals to develop and implement more innovative and lasting solutions to these problems. In the Western Pacific Region,for example, under the wise guidance and initiative of our Regional Director, a principal influence is the initiative arising from his vision articulated in the document "New horizons in health". National and regional strategies for health are now redirected within the themes of "New horizons in health". These themes, namely, "preparing for life","protection for life" and "quality of life in later years", recognize that whatever happens in earlier life has an important influence on health status in old age. The multisectoral and multidisciplinary approaches proposed in the document are aligned appropriately with WHO's priorities for action in having an integrated, coordinated approach to the prevention of these noncommunicable diseases and chronic conditions throughout the entire life cycle of an individual. They also point to ways for collaborative work for health promotion and protection in the countries of the Region, working towards people making behaviour and lifestyle changes that will support longer healthier lives or health expectancy. Speaking of health expectancy or life expectancy in good health, our attention must now be focused on the needs of the elderly. Policies need to be reviewed and formulated and the most appropriate strategies need to be developed to improve the health and quality of life in this fast-growing section of the population. This will be achieved through approaches aimed at promoting healthy lifestyles throughout life, and preventing or delaying the occurrence of noncommunicable diseases, so as to maximize disability-free and productive lives in older age. The elderly must be helped to maintain their independence and dignity to enable them to play and continue to play their role as productive members of the community. One of the policies that needs to be reviewed is the mandatory retirement age of the working population at 55, which is still the practice in many countries. Needless to say, with increased longevity to the age of 75 and above, 55 is still too young for many to retire when they can still make a valuable contribution to the socioeconomic development of their countries. As we enter the new millennium, my country, Brunei Darussalam, remains firmly committed to health for all through the primary health care approach. We believe the principal themes of "New horizons in

138 page 126 health" are in line with the primary health care approach, as well as with the six priority areas for international action in health, to improve humanity's ability to prevent, treat, rehabilitate and, where possible, cure major noncommunicable diseases and to reduce the enormous suffering and disability that they cause. Finally,Mr President, Brunei Darussalam has enjoyed a fruitful and excellent cooperative relationship with WHO. I would like to put on record our sincere thanks and appreciation to Dr Hiroshi Nakajima and Dr S.T. Han for their continued support to my country, Brunei Darussalam, and for their successful leadership and management of world and Western Pacific regional health affairs. Dr. MUBARAK (Iraq): ÍjLa C^-Xû Juajî jjstjüí JUo ) JLAAJI ^ji^jl ÇUapÎJ ÇLXJJ ô^ljlij JJijí l)î c^^lw ^JÍJL^ C^J-^J)JUAAJI a^jjuil Â-A^îJ L-^Jj ^SiLp^^l ÍS^LJ OJj V^í oí ^J^jj с J l ^ J cilutj A-^JUl! Д fbjl ^jlji 价一 w Jl ^JÜl ^JJLA; NJ w d l yjl Jyj ^JlSNi 乂 i(jylj^sjl Jlj^l JLP ухлл^- j^tjji ji-w^jb ^LijMl J-^í dijbj ujl Jy ^ r A^JUil i^wajl 广 UJ^I Д11 JjJl ^ U^NJ UjlîT JbJlJ L^L**^J ^! 力 I JLP f^uoji ^P OL^^Ü ^wajl ^ V 汕 JJ lу и J )ir JloL I Á^JUJI Vwail Jb Я^Ы! JjjJl ^ jlyjl OIS'J.Sj^ki. J Cjli^l^j Uij ÁJU^Jlj 似 C - > l J J ^ L i J l jla^jl J j^lisl^jtj btj^yj oujbüij tl^-l^u J^e. j^j^jijl 4_J -ij L. ijiaj. Jlyjl ^ ^JlJ ol.jbül ^ «rly ^jjb^ Jl gjüij 气气 V /-bli YV ^ UiiiJl ^ )Ul <_bu y. iiçjujl a^wjl y.jljl y^i (jul VwJl ruá; ^ LJiJ jl^ji J l 少 Jlyjl J, JuJi ^jjl ^ Vy^1 s-j 丨 ^ 0Î Jl jlií ja íliji^j ôr^ij.jliil kij Â^uVl Âjjjl olj^^jlj ÁjjjS/I ^ OL.^Jl t.^ c-^; Jü tjlijl ^J.frljjJlj frijol t\'j>r a^ibtjl oby^jl J^i ULL'jl oliv-j (--«. 'jl j ^ Ь У* Л 气.Г" 气气.^ ojlt UÍÜ tsuj оч 气气 V 气气飞 JUisSll olij S^J o^bjlj П f>lp ^ ЛГ YAÍ ^ 气气. ^ 04 y Á^bül ^ 0jLi^Sll olij V^ Jüij. 气 <\ 4 / Y Y Jl "/.i, i^il: ÙljjL JÜI^Jl ^bljl Jl^l j ^ ^L Ljj^LJI CJLJU.^1 JLP C-Jjb 丄.;> J_J LJJLP ;. с ^ Jo^ b? Jl JLb tobl^i >f 气 Л.Г" JbSOl v'l^l j \o ТГЛ с^ы ГТ fjlâjl 0y,yû ^ tsjl^xijl j^sü fuil Aij. u>l r<\ Ml ^yjlj íájusi Toa (jbülj ÁjU'I y. o^ltj ÛÎ Jl - 八 Y í 声 ^s» (i/o / i^v 1 ) î-b^jl S^bJl Â^ju^SJS о ;jjjjl Á_<tjjL) jj_l _<J 二 ÂjjJLiillj J l j l t i l y «J l ^j-»*) 3*jlJ.AjJiJtlili. ум л jçlâxjl j jj : ^ja^íj Dji jláissll i g - _L ^ji eilj jl "^oj^jl i^ilic-lii^jl JsjIJJ] 5 ^ _ < J ^ ^ 01 ) ^ Чр a^uj ^Ub^Jl ouiiuwjl? JUjj^ t^l^sll il^i^jl Jj ts^ujl Я; Jb j-s- OUJbi- ÍJ15C.I j'-l*] liiji j t Jl с J 2 二 Ol.á.^T...oil Jl j tój-л^».üu SL^JI 奶 tijjjjajl 4JIÜI (_ r Jj -dl-j tájxjujl ^UJl jj-ujl U^t-LTU jj^ j^tjüi ^J^PÍ JÍJ tcrj^jl с/ ^ ÎJu*L Jl VwJl ólj ^ IUílJI (jií ^ И ^^V ^L. /jl T V J ^íl 1_ r Jb!t J a^uil ix^lijl ibrj ej_ü oí ^ d b J J 丨 J ^bxji j\j\ ^i 一 ^ J Ijl^p oo. ÓJ Д5 Jlyjl oíj Aj^AJ yy 夕 Y.& (^Uiil l/l, ^ ^ J jl5j L^il SliuJl hj^ J 尸 J 如 ^ ^ Jj) >Г V 尸 ^ SJJU^JI ju^sh JLp UJ j ^ 'bjmjl Á^l^ ^ f ^ ^ 1» # ^ > ^i: c ^ уь ^JJlj Jlyjl J P 夕 ^ ^ d ^ ^ 广 te Jj, ÍULJI l^üjj^h) 一 I fb-í V^l 恤 J > ; 4 j 爿 J ) 脚 fu^ j UJI.1 JZíj j cuji ^juii a^jl v^j ⑷ 丨 bj^1 ^ 1

139 A50/VR/5 page 127 I thank the distinguished delegate of Iraq for his statement and for the kind words addressed to the chair. I give the floor to the delegate of Fiji. The delegate of Fiji will speak on behalf of the Pacific Island countries: Cook Islands, Kiribati, Marshall Islands, Niue,Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu and on behalf of his own country. I invite to the rostrum the delegate of Barbados. Mr SMITH (Fiji): Mr President, Vice-Presidents, Director-General,distinguished delegates, ladies and gentlemen; first of all,allow me, Mr President, to congratulate you and members of your bureau on your election to the prestigious positions of President and Vice-Presidents of this Health Assembly. I know that through your wise counsel and leadership this august Assembly will achieve its set objectives. I would also like to thank the Director-General for the presentation of the very comprehensive World health report 1997 centring on the control and management of major noncommunicable diseases in order to reduce the burden of suffering to mankind and consequently enrich humanity,and to thank him also for his contribution to the health of peoples and countries. May I take this opportunity to also thank the delegates of the Pacific Island countries for nominating me to present this address on their behalf. As we face the impending millennium the lifestyles, values, priorities and the health status of the people in the Pacific Island countries are undergoing very rapid transition. The world health report 1997, which very eloquently highlights these issues, is most warmly appreciated and unanimously endorsed by the Pacific Island countries. We in the Pacific Island countries live and exist in a very fragile ecosystem and are a group of communities most vulnerable to developments which are beyond our control because of the rich and powerful nature of some of the international industrial organizations. Our frailty has resulted in the destruction of our natural environments, our tradition and cultures, and the imposition of products such as cigarettes and high-fat and high-carbohydrate food products. Feeling is a normal part of the human anatomy and physiology, and what may be taken for granted by some societies may not be acceptable for others. This feeling measures the degree and level of suffering experienced which may be the result of intentional or nonintentional means. Intentional or induced suffering should be avoided at all costs and the effects of unavoidable suffering minimized. We consider it our duty to promote action that minimizes or prevents causes or effects of suffering. The level of tolerance to life's assaults and hardships should be such that we can endure them without suffering from it as a result. Psychological preparation and behaviour modification are an important prerequisite to increased tolerance and acceptance of whatever one faces in life. Healthy lifestyles are one of the surest ways of increasing tolerance to, as well as preventing, most health problems. The degree of tolerance is very much dependent also on the environment we find ourselves in and on the level of exposure. We may say that we are suffering because we do not have piped water to our homes, but in most of the islands fetching water from nearby wells is not regarded as suffering. It is accepted as a normal way of life. It is taken as a matter of course, to be put up with patiently. It is therefore very important fully to understand the cultural and social dimension of suffering so that we can better appreciate its significance for the community and direct our activities accordingly. The Pacific Island countries exist in fragile ecosystems, and the environment and environmental health are issues that have direct effects on our livelihood. We encourage appropriate governmental action and mandates to authorize activities in support of care for the environment and promotion of good environmental health. Since the advent of air travel we have learned that no longer do we exist in isolation; we are as close as the next flight to anywhere around the world. Technology has advanced to a point where we can contact our brothers on the other side of the world within seconds, transfer data via telephone lines and satellite, and carry out research on new drugs in the Earth's outer atmosphere. Yet we are still faced with some of the oldest diseases laiown to man: malaria, tuberculosis, and cholera, and the new emerging ones: heart and lung diseases, cancer, HIV infections,as well as multiple-drug-resistant strains of some of the old organisms. Six years ago, in 1991,at the Forty-fourth World Health Assembly in this very distinguished chamber, it was mentioned that Solomon Islands was a malarious country and that malaria, the number one public health problem, was resurgent in a big way. The following year, in 1992, the malaria incidence rate reached the record level of 440 cases per thousand population for the whole country. In the capital, Honiara, malaria reached crisis levels, with an incidence rate of 1072 cases per thousand population. Some people dubbed

140 A50/VR/11 page 128 Honiara "the malaria capital of the world" in In 1993 the Government launched an all-out war against malaria with the generous support and assistance of WHO, other external partners and local communities. A new policy and strategy to control malaria was formulated; 1994 was declared the malaria action year and the Government launched its five-year plan of operations to control the disease. The Pacific Island countries acknowledge that supply and management of pharmaceuticals, essential drugs and medical equipment are an integral part of the health delivery system. We are striving to work together to provide high-quality goods and pharmaceuticals in a timely, cost-efficient and effective manner, developing a central point among the island countries for delivery. And because many of the countries in the Pacific are small and lack extensive resources we are uniting to develop a model framework for drug legislation and regulatory controls which could be customized to the requirements of the respective countries. Standardization and quality assurance are also being strengthened among the islands. This ensures quality and the delivery of effective services in the most efficient manner. We are encouraging and supporting the development of national health plans with performance indicators, and the careful monitoring of outcomes. We recognize that if we are to have an effect on health we must ensure that each person has the chance to develop his or her full potential. The sharing of information, technology, and expertise is paramount for the betterment of the environment and health status of the people of these island nations. The responsibility of each of us as individuals and as countries is to work together. The six priority areas for international action in health identified in the report are endorsed; we believe that if implemented they should lead to the improvement of our ability to prevent, treat and rehabilitate, and to cure (where possible) major noncommunicable diseases and reduce the suffering and disability that they cause. There is much to be done,and we in the Pacific will be pleased, as ever,to continue in that vital task. Noncommunicable diseases are a common area of concern to us all in the Pacific Island countries, and we need actually to consider the following issues: 一 First, we must understand how these diseases affect the population, and the attitude and behaviour of those affected towards any associated intervention programmes. The profile of the problem in the country as well as its place in the national priority listing should be established prior to the commencement of any intervention programme. - Once the national "climate" of noncommunicable diseases has been established there should be genuine willingness among those giving relief to offer assistance that will promote long-term solutions to these problems. -Efforts to prevent or to curb problems associated with noncommunicable diseases should be concentrated in the most critical primary or primordial period. Healthy lifestyles and avoidance of risk right from the preconception period are the key to successful prevention programmes. At any period in life, cessation of risky or unhealthy habits and behaviour will attenuate problems of noncommunicable diseases; cessation of smoking and moderation in alcohol consumption are common examples. -In the Pacific Island countries, where development programmes are competing for limited resources, it is also important first to identify the magnitude of problems of noncommunicable diseases in relation to others so that resources can be distributed accordingly. The national capability to manage such problems should also be considered, as some developing countries do not have the economic means or the manpower capability effectively to deal with such problems. - The use of the community-wide mass approach to risk factors is probably the best line of approach. This should incorporate "enabling factors" such as political support and multisectoral collaboration with relevant sectors such as environment, agriculture, fisheries and education. -An integrated approach should also be made for all those with common risk factors; a primary health care approach should continue to be promoted, with integrated preventive and curative measures. -There should be clearly established and well-defined policy on the main issues related to noncommunicable diseases such as food and nutrition, smoking cessation and so on. -Development of guidelines for the prevention of ill-health and promotion of healthy lifestyles is to be made at the global,regional and national levels; the target should be the groups susceptible or vulnerable to noncommunicable diseases. -Strengthening of secondary prevention aimed at improving early diagnosis and treatment of priority noncommunicable diseases should be the next line of approach. May I now refer to the biennial finance allocation? The Pacific Island countries have benefited tremendously during the past years from the financial assistance which WHO has thus been providing. Our

141 A50/VR/10 page 129 countries are fully dependent on this assistance to ensure that needed health programmes are successfully implemented. The recent decision on this budget allocation has to some extent affected our individual countries; hence, we request that budgeting allocations to the developing countries be reviewed. Mr President, how will we enrich humanity if we say that it is very difficult to conquer suffering or stop it because it is part of life? Tennessee Williams, an American dramatist, once said in the London Observer that we should not look forward to the day when suffering stops, because when it comes we will know that we are dead. What is therefore important is to reduce suffering to the level that is acceptable to a particular society and at the same time promote economic and social productivity. This should be the aim of individual governments in seeking support from WHO and others in a position to do so. The principles embodied in the "New horizons in health" documents in the Western Pacific Region provide a holistic approach to health promotion and disease prevention. The Regional Director and his staff have worked hard to provide guidance and support to Member countries to assist them in their efforts to decrease the burden of suffering from noncommunicable diseases as well as to improve their social life and values. On behalf of the Pacific Island countries, I would like to take this opportunity to thank our Regional Director and his staff for the support and assistance that they have given to our part of the world. It is the aim of the Pacific Island countries to provide everyone with a level of health that will enable them to live within the means available to them, to fully enjoy their religious and cultural life and to contribute fully to the socioeconomic and political development of their country. This is by no means unattainable. All that is required is the hard work and commitment of everyone towards the theme of The world health report 1997, which is "Conquering suffering, enriching humanity". The maxim of eating wisely,exercising regularly, avoiding smoking, working hard during the week and resting during weekends is probably as good preventive advice as any for any noncommunicable diseases. In conclusion, the Pacific Island countries note with regret the wish of the Director-General, Dr Hiroshi Nakajima, not to seek re-election next year. We are fully aware of his dedication, hard work and perseverance during the years he has served in his high office and especially those years in which he served as Regional Director for the Western Pacific. The Pacific Island countries wish to express our sincere gratitude and appreciation for all that he has contributed to our part of the world. Mrs THOMPSON (Barbados): Mr President, Director-General, fellow delegates, this closing twentieth century has been characterized by natural disasters ranging from flood and hurricane to volcanic eruption, earthquake and tornado. Famine, poverty and war have created refugees of some of the world's people. Terrorists have bombed federal buildings in cities, killing ordinary citizens, civil servants and children. The limbs and lives of many have been claimed by senseless violence, armed conflict and war. We now fight emerging and re-emerging diseases. Yet, no greater wounds, no greater loss of life, no greater impacts have been felt than by the suffering, disability and death inflicted on people worldwide by the chronic noncommunicable diseases; and current projections are that by the year less than 20 years from today - there will be a fivefold increase in deaths from this cause. These diseases are a major constraint to the attainment of the goal of health for all. In Barbados and the wider Caribbean we are spending as much as 60% of our national health budget in the treatment of these diseases. This represents considerable sums of money to countries with limited resources, and such spiralling expenditure can only be controlled by disease reduction. The social burden imposed by chronic diseases is equally severe - financial loss, ravages of the body and the emotional devastation of the afflicted and his or her family. The reasons for the increase in chronic diseases in small island developing States such as our own, Barbados, are increased life expectancy for the elderly; lack of exercise as our existence becomes more sedentary and more sophisticated with every member of the family owning his or her own car; the move away from traditional carbohydrate-based diets towards diets of fast foods high in fat; together with the stress of living in today's culture, which is focused on the acquisition of material wealth. What strategy should we employ to conquer chronic disease-related suffering? May I suggest five approaches in the battle to reduce the incidence of these diseases: -that we target our young people, and in their formative and early school years encourage them in the practice of eating healthily and exercising. In this way we will raise a more health-conscious generation. Children are also powerful lobbyists, particularly of their parents;

142 A50/VR/11 page 130 -that we mobilize all sectors of society, the church, media, social clubs, nongovernmental organizations, the private sector and other government ministries which are not traditional partners of ministries of health; -that we embark on public education campaigns to effect attitudinal and behavioural change in our populations, persuading them that chronic noncommunicable diseases are preventable, empowering them to adopt healthy lifestyles and to take responsibility for their own health; 一 that as nations we ensure collaborative effort with each other, engaging in technical cooperation, cross-fertilizing our ideas, transcending our parochial interests, resisting the gravitational pull of racial and other prejudices and acknowledging that the suffering of any people in the world diminishes all the people of the world; 一 the final way in which we will conquer suffering and enrich humanity is by leadership - at the individual country level and globally. Strong and inspired leadership will be needed at the international level. Barbados salutes the outgoing Director-General, Dr Nakajima, for his contributions to WHO and notes that the Executive Board in resolution EB97.R10 has set criteria for the attributes its members wish to see in their new Director-General. The Board has indicated that the new Director-General should, amongst other things, have "a strong technical and public health background and extensive experience in international health; competency in organizational management; proven historical evidence for public health leadership". Barbados concurs with the Executive Board that the Director-General should possess these attributes if he or she is to give the quality leadership in health which WHO and the world so urgently need. It is for this reason that Barbados will nominate for the post of Director-General of WHO, Dr George Alleyne,Director of the Pan American Health Organization, the Regional Office of this Organization. Dr Alleyne is an outstanding doctor, scholar and administrator, who epitomizes the criteria set by the Executive Board for its Director-General. The world moves toward the coming century facing the formidable challenge of the chronic noncommunicable diseases. Let us make and implement decisions and strategies such that when others write the history of the twenty-first century they will record our legacy as that of conquest of suffering and enrichment of humanity. Dr METTERS (United Kingdom of Great Britain and Northern Ireland): Mr President, Director-General, fellow delegates. I would first like to congratulate you, Mr President, on your election to guide the deliberations of this Assembly. It is a great pleasure for me to address the Fiftieth World Health Assembly on behalf of Tessa Jowel, the United Kingdom Minister of State for Public Health. I wish to congratulate the Director-General on his speech to this Assembly; he listed an impressive range of WHO's achievements. Like others we recognize and applaud the Director-General's personal contribution to ensuring the delivery of these notable successes. The United Kingdom Government will give new priority to prevention, and to moving beyond an approach to health which is concerned purely with the treatment of illness, but also carries a commitment to improving health through public policy, community and local action, and personal responsibility. The new Government has immediately met its commitment to give this effect by the appointment of a minister for public health, with responsibility for attacking the root causes of ill-health. We will set new goals for improving the overall health of the British people by recognizing the impact that poverty, poor housing, unemployment, and a polluted environment can have on health. Our pledge to reduce unemployment, to drive up educational standards, and to improve transport: all will improve the nation's health. It is estimated that there is a difference of about five years in life expectancy at birth between those in the highest and those in the lowest social classes. That is a fact no government can rest easily with. The bovine spongiform encephalitis crisis and the Escherichia coli outbreak have taught us many important lessons. We will seek to strengthen surveillance and safety measures by establishing an independent food standards agency. Smoking is the greatest single cause of preventable illness and death in the United Kingdom. WHO has done much to focus world attention on this problem. Over the coming weeks, the Government will be looking at ways of introducing an effective ban on tobacco advertising as part of a concerted plan of action to reduce smoking. The successor policy to health for all will be an important signpost to the future. Challenging but realistic targets will be the key. Maximum flexibility at country level will allow for differing requirements and the varying pace of progress towards targets. We heard yesterday from the Dutch Presidency about the substantial and varied health programme undertaken by the European Union. This shows the value of

143 A50/VR/10 page 131 countries working in unison towards agreed objectives for the benefit of all. The United Kingdom looks forward to playing a constructive role at the forthcoming Council of Health Ministers of the European Union when it meets in early June. Over the last nine years, WHO has had to adapt to a changing world with significant health implications. Throughout this time Dr Nakajima's commitment to improving health standards, eradicating disease and promoting the work of WHO and the expertise of its staff has never wavered. The elimination of poliomyelitis from the western hemisphere and the substantial progress towards its eradication from the rest of the world is one notable success. Looking to the future we are grateful for the constructive way in which Dr Nakajima announced his plans to facilitate a smooth transition in the leadership of WHO. Over the next 12 months, WHO will be preparing to meet the important challenges of the next century. In taking this work forward the United Kingdom is committed to playing an active role and giving strong support to Dr Nakajima and his staff. To conclude, the United Kingdom welcomes The world health report We congratulate Dr Nakajima and his staff on producing such a useful and important report. In raising awareness of the problems within it they have done a significant service in line with the best traditions of WHO. Mr SAJJAD (Pakistan): Mr President, excellencies, distinguished delegates, on behalf of the Pakistan delegation I wish to congratulate you, Mr President, on assuming the presidency of the Fiftieth World Health Assembly. We are confident that under your able guidance the deliberations of the Assembly will be productive and lead to a positive outcome. My delegation would also like to extend its felicitations to Dr Hiroshi Nakajima for presenting The world health report 1997, which is a comprehensive document, eloquently highlighting the major chronic noncommunicable diseases, while taking full account of the new and emerging infectious diseases which pose a constant threat to mankind. I would like to take this opportunity to express the deep appreciation of the Government of Pakistan to Dr Nakajima for the valuable services he has rendered in promoting the important objectives of WHO. The reform process initiated by Dr Nakajima is a vital step in enabling WHO efficiently to realize its goals. Under Dr Nakajima's able guidance, WHO has made a valuable contribution to international cooperation in the context of achieving the objective of health for all. Dr Nakajima has informed this Assembly of his decision not to present himself for re-election next year. We wish to inform him that his contributions will be long remembered, especially in the developing countries. The Government of Pakistan extends its best wishes to Dr Nakajima in his future endeavours. As a demonstration of our commitment to WHO, the Government of Pakistan has nominated Dr Nafis Sadik, the present Executive Director of UNFPA, for the post of Director-General of WHO. The role of WHO, together with UNICEF, UNDP and other international organizations, has been commendable in moderating and redressing the disparity which exists in the quality of health care available to people all over the world. Most disease-related fatalities in the developing countries are from infections and parasitic diseases resulting from poor social and economic conditions. Globalization has been paradoxically accompanied by the phenomenon of marginalization of the poorest segments of the world's people. Today, there may be a greater number of healthy people in the world, but even more are those suffering from undernourishment and the deprivation of basic health facilities. Our struggle to fight disease, communicable and noncommunicable, must be continued relentlessly. The Director-General has rightly pointed out in his report that with the dramatic increase in life expectancy and profound changes in lifestyles, new threats of global epidemics of cancer and chronic noncommunicable diseases are imminent. An important theme in the Director-General's report relates to the provision of health care in a manner which results in a longer life span. This, of course,would be most worthwhile when there are positive links between longer life and healthier life. As a result of gains in life expectancy, the age structure of the population is undergoing a radical change even in the developing countries. This change has its impact upon worldwide disease patterns. Such epidemiological transition will lead to further strains on health care systems, because in addition to the burden of infectious diseases the ageing population will be more prone to noncommunicable diseases such as cardiovascular disorders, cancer and diabetes. Increased drug use and violence will further aggravate the problems. Environmental health problems arising from industrialization, increased use of chemicals and urbanization also need our attention. Therefore our efforts to combat infectious diseases need to be supplemented by effective measures against noncommunicable diseases.

144 A50/VR/10 page 132 Unfortunately, most of the chronic diseases are very costly to treat. Many developing countries are unable to afford modern curative procedures. In essence, our strategy in health care has to be developed around preventive measures. In Pakistan there has been a major shift in expenditure on health care: today, about 75% of the total public outlay on health is on primary health care. The range of initiatives in preventive care can cover a broad range of measures, all of which can have an impact on the quality of life of our citizens; we need to introduce pollution control mechanisms to protect the environment; we have to reduce the risk factors present in our lives such as smoking, heavy alcohol intake, obesity, inappropriate diet (which includes excessive consumption of saturated fat) and a sedentary lifestyle. Similar measures have to be adopted to promote reproductive health and child care and to reduce occupational hazards. The task before us is not easy. The risk factors can only be reduced through intensive health education, the benefits of which are marginal in communities which are plagued by illiteracy, unemployment and lack of awareness. Take for example a well-known problem, namely, tobacco-related diseases: it is now an established fact that the incidence of lung cancer can be directly attributed to the use of tobacco. However, multinational tobacco companies facing declining sales in the developed countries have started tapping new markets in the developing countries. Unfortunately, in these countries, resource constraints discourage governments from banning the import and manufacture of cigarettes. It needs to be emphasized that, given strong political commitment by governments, supported by a reasonable deployment of skilled manpower and resources, a major proportion of the human diseases can be prevented. Integrated approaches have to be developed for supply of fresh water,effective sanitation systems and promotion of literacy,coupled with effective and affordable health care strategies. The local community has also to play its role in supervising and implementing preventive measures at its own level. The role of the international community in terms of technical and financial assistance is crucial. Assistance, whether technical or financial, should aim to develop the capacities of the recipient countries to continue to effectively utilize the available facilities, making it a two-way process. In conclusion, I wish to thank the Director-General, as well as the Regional Director for the Eastern Mediterranean, for the vital cooperation extended to Pakistan by WHO. Dr KIYONGA (Uganda): Mr President, honourable ministers and heads of delegations, Director-General, ladies and gentlemen, I wish to start by congratulating you on your deserved election to the chairmanship of the Fiftieth World Health Assembly. I would also like, on behalf of my delegation, to express our gratitude to Dr Nakajima and his staff for the commendable efforts they continue to make in guiding health policy and management in the United Nations system. Uganda also wishes to acknowledge the fruitful efforts made by the Regional Director for Africa since he took over leadership of the Regional Office. The world health report 1997 is quite clear and comprehensive. The theme "conquering suffering, enriching humanity" is most appropriate. This report should be discussed in the context of the corresponding reports of the two preceding years and the message of the Director-General on the occasion of the Fiftieth World Health Day. In the 1995 report the theme was "bridging the gaps", while in 1996 the Health Assembly discussed "fighting disease, fostering development". We are all aware of the facts of the re-emergence of diseases that we thought were coming under control, and the accompanying antibiotic resistance. The emergence of new diseases is also clear to us. The world health report 1997 indicates that, by mid-1996,average global life expectancy had reached 65 years. We must however quickly realise that in poor countries like mine, Uganda, life expectancy is still below 50 years and infectious diseases are still raging. Uganda has, in addition, been badly hit by one of the most devastating new diseases, HIV/AIDS. The HIV/AIDS epidemic has so far killed a total of half a million people in my country over the last 10 years. Within the context of a constrained resource envelope, Uganda has tried to deal with its disease burden. In the last 10 years the infant mortality rate has fallen from 122 to 97 per 1000 births. Immunization coverage for the six killer diseases averages over 80%,and in the first two rounds of the national immunization days for the eradication of poliomyelitis, we achieved 96% coverage. The top 10 diseases in our overall burden of disease are: malaria, HIV/AIDS, diarrhoeal diseases, acute respiratory infections, measles, tuberculosis, meningitis, malnutrition, intestinal worms, and ear and eye diseases. In respect to the AIDS epidemic, Uganda has virtually adopted all WHO recommendations. We have mounted a strong public health campaign and made provision for protective materials and safe bloodtransfusion arrangements. An effective multisectoral approach mechanism has been adopted. Recent

145 A50/VR/6 page 133 assessment of Uganda's HIV/AIDS control and prevention programme indicates that over 90% of the population now have knowledge about HIV/AIDS. There are evident signs of behaviour change including: later age of first sexual relations, increased use of condoms, and reduced number of sex partners. Consequently we have now recorded reduced prevalence of HIV/AIDS infection. The negative development in this respect however is that international support for Uganda's HIV/AIDS programme has fallen drastically in the last two to three years. This is unfortunate and we do hope that the international donor community that supported us so strongly at the start will recommit itself and give Uganda more resources. In Uganda per capita income is below US$ 300 per year, while per capita health expenditure is below US$ 12. Poverty in my country (and in other poor States) is a big headline that calls for urgent attention if we are to solve the health problems of our globe. The world health report 1997 has made excellent policy recommendations and Uganda fully supports this direction. However, we must point out that the implementation of these and other appropriate policy frameworks will not be feasible unless more resources can be made available to the developing countries. The gap between rich and poor countries continues to widen. In health terms this is clearly demonstrated by the statistics that all of us know. Leading amongst these is the fact that in sub-saharan Africa expenditure per capita on health is below US$ 12, while in the developed countries of the North expenditure ranges from US$ 1500 to US$ 4000 per annum. Although The world health report 1997 has indicated that life expectancy has risen to 65, in many of our poor countries, it is still below 50 years. The poor countries of the world are now facing the double burden of disease - the infectious diseases are still biting quite hard and diseases we did not know are now adding to this problem. Antibiotic resistance is also making its contribution to the already high mortality and morbidity indices in countries which are ill-prepared to handle these problems. Medical technological advances in the North are unattainable by the poor South. In summary Mr President we all now know that while the northern countries have 10% of the world's burden of disease, they are spending 87% of the resources available to health. To conclude, therefore, the delegation of Uganda fully supports The world health report However, we see the way forward involving the following elements: (i) effective measures to address poverty in the developing countries which should involve infrastructure development and also support to economic investment programmes in our countries. Our countries are also calling for a strong initiative for debt relief; (ii) we are requesting increased direct resource flow to the health sector and other latent sectors like education through WHO and other multilateral agencies and through the bilateral aid programmes; (iii) we also call for continuing strong and effective management of WHO, and finally, a realistic renewal of the health-for-all strategy. The world has become small, as we all know. The poor health situation in the poor countries if it is allowed to continue will not only hurt the South but will also hurt the North. Let's move to a world where we shall be talking of "we" rather than "us" and "them". Dr RAFEEQ (Trinidad and Tobago): Mr President, Director-General, distinguished ladies and gentlemen, I bring greetings to you from the Government and people of the Republic of Trinidad and Tobago. May I take this opportunity to congratulate you, Mr President, on your appointment to this prestigious but onerous post and I am sure that under your guidance and leadership, this Fiftieth World Health Assembly will achieve its goals. I also wish to place on record our appreciation of the Director-General, Dr Nakajima, for his sterling contribution to WHO over the past nine years. This year, the report of the Director-General rightly places the focus on the suffering of humanity and the role that health can play in alleviating and even conquering this suffering, and enriching humanity. Trinidad and Tobago has made considerable progress in health. We are particularly proud of our success in the Expanded Programme on Immunization which has resulted in notable decreases in the targeted diseases. We are not however content to rest on our laurels and at present we are engaged in a social mobilization programme leading to the elimination of measles and congenital rubella syndrome. Like many other countries, Trinidad and Tobago is bearing the double burden of disability, ill-health and mortality caused by infectious as well as noncommunicable diseases. Thus, we are constantly striving to consolidate the gains already made, allocating resources to combat the threat of resurgent diseases such as tuberculosis, while grappling with the high incidence of chronic noncommunicable diseases such as diabetes and hypertension. This has necessitated the reorientation of our health services to adequately address the changing epidemiological profile and to improve health expectancy and the quality of life. This and other factors have led to Trinidad and Tobago undertaking a comprehensive reform of the health sector. A main feature of the reform is the focus on wellness and health promotion and our renewed commitment to the

146 A50/VR/6 page 134 principles of health for all as the main strategies for improving the health of the population. Our commitment is evidenced by: the deliberate increase in budgetary allocation to health promotion; the strengthening of health education programmes with emphasis on schoolchildren; the fostering of community involvement in health and collaboration with other sectors; and the development of innovative programmes on health. Mr President, as a small State, Trinidad and Tobago recognizes the importance of collaboration with others in this quest for health. We are working closely with РАНО and with other Member States of the Caribbean in the Caribbean Cooperation in Health Initiative, determining our priorities and devising common goals, targets and strategies. However, as we face the many challenges to good health in our respective countries, I should like to devote some attention to two very important issues which confront us on a daily basis: violence and the environment. Mr President, we are living in a very violent world. Every day images of violence are highlighted in print and in electronic media all over the world. The victims can be found in every class, creed and race, and no one seems to be immune. Domestic violence against women and child abuse are but just two examples of violence that we face in many parts of the world. As indicated in the report of the Director-General, there are risk factors which predispose persons to being the victims or perpetrators of violence - risk factors which are diverse and complex. For example, women are often at risk for domestic violence while alcohol and drug abuse may contribute to the perpetration of violence even within families. In addition, in my own country, many of the homicides appear to be linked to the insidious drug trade. We cannot achieve our goal of health for all if we do not individually and collectively make a spirited effort to address the problems of violence in the world. The other issue which I wish to raise, Mr President, is that of the impact of the environment on health. In Trinidad and Tobago we record with some pride our improvements in the almost universal access to safe water and sanitation. However, we recognize that other environmental issues such as air and noise pollution and the unintended negative effects of industrialization continue to pose serious challenges. These issues are not confined to Trinidad and Tobago but are now recognized the world over. If these environmental issues are not placed on the national and international agenda for health, then I am afraid that we will be faced with health problems of alarming proportions in the future. These two issues - violence and the effect on health of the environment - have been selected because they serve to illustrate several points. As causes of morbidity and mortality, their contribution to health costs is largely uncounted, pointing to the need for more sensitive health information systems. Their causative factors are usually complex and multifaceted and often outside the purview of the health sector. They highlight the need for comprehensive strategies to address them and for the health sector to take a leading role in sensitizing the population to their possible adverse effects. They call for the implementation of the strategies of health promotion as advocated in the Caribbean Charter for health promotion, including the formulation of healthy public policy. Most of all, Mr President, they underline most forcefully the need for building alliances with other sectors. It is in this context and against this background that I dare to propose that governments throughout the world need to put health higher on their national agenda and look at health care as an investment in the future rather than a drain on the national treasury. We commend WHO on the efforts it has made and is continuing to make in addressing these issues. We urge WHO to continue to play a leading role in advocacy for health so that such issues can be given global prominence. Mr. Ould DAHMANE (Mauritania): :(LJbjj^) ÙU^O ajj ^у^хл Ju^e Ju^Jl c^lli JJ^J {js' J Ó^IsaÍIj Ü1 to^j^ujl e^ljl c^ujl jjj^jl (J-^ t ( _ r ~ íij-x^ Á^^UMI Ájj^^Jl j^b о J US'. Ш ^ --^Jl ^ JUJl V^r J UJl v-luj SjbJl ^L^i Л л Л J-^ii Ц:^; jp jytajl fujl jjjujlj jj\ ÙÎ DLT DI J Í^-Ju^ cj U«^ ol^pr Sop ^ ojj^i JJl 01.o 丨 -c^lî c^s-ú Á^Jl*J ^jjlp Сj-ki L^u-Í 已 J T L i ^ J l il" ^ i^ ûlj. 5 v ^ 1 bx^l JpLi^JlJ JljL. jjjajl ^L^JlJ ^UaJl jlbmi ^ 丨 l^aij jy^ü f^sí objb^- L^i JjoJl Á^JlxJl.j^i j ^ ^ ó j ^ ^ J i j i jjbjl LJyJ M 力 I ûsi tâ^jujl ijájj. Abj (^JÜI cû»jiujl olmji ^LkJI ^ JLJI (^Ju^ С il-^lj J^y ^Jhi c^jul ^rsl 丨 с / Л Jl ^JUsj J^f jiî jjub. llîjl ^jâj (Jbiil Jjj S^uJl ^.juji J-A U^J J^JlJ iwa^jlj JUisSil JLlJ Jl^l jàj LjMJl Js-

147 A50/VR/6 page 135 Vt^JltoLwcJUiJl Д-JI^J JUL. 4-Jbj^Jl a^j^^tjl t 伪 j Jii IJLA AJ^JJ a^bjl J. ^!>uî ùv JU>J l^ibl. ^îbil 一 ^JlJj^Síij ^Uji b^lj Ol pru- ^^ X v A - x j a J u JJ (Jùl^L-} C iss-^j Ы1JU->-í 4 jijo* JUwJl (jy-w^jl ^^Ip ol^jbül x _ j otjuiji ;^j colp^lt d L «l j^l ^ ^ij^jl o^u^jl jli^sll JL ^ ^..Л j h ^ ^jljú (^ 外 ÛU С Â^lC JL^ jlpj ^lill C. JLij ^ ) y^ljl Лyi^l С л o l J l l. JT Jul^l ^ /, Â^J ^L-Ji!^ ^ ^ í /ûl-jj /jlit ^ U cujij i ^ (j4-.l kli j Ljj%J\ Jb^y y, l J c 3 f ^ j.jjjl^ji ^ ^.(Я 乂 J ^ijjjl 4_J 015" 外 ^ ÂJ^aJI ^ 二 ^kjl 01 cojjjoijl ï^ljl c^uil ^ JLJI o**ji Jl Jlâi? cô^iaji iiwjl ^a cíjliwwj.jaíu^vji Jl JjUij )j^jâ^ ij^s^í j JJl Luilj-J ^y^^ajl ^-чь^ji ^Js- ^Jb ÔJL^ïJl Â^jW ol*jbüij J^yi Ял-MaJi jj l^iljjbl ^ j JUt-o ejujbr fuijlj ^JM. ^.bj^bi^síl C^L^ fuâjl Upli ^ ^ J ^-il^jl ij^i 01 CO^JJJIUJÍ e^ljl c^ujl j JuJi JUwJl Cj^jî^Jl (JJuaa> ^ om^l^jl J^ ^ í Ù^Ji^ UT UJl дч CÂJJjJi ЯР^^Л yuj JLp I ^ J^J l^ji M! jjb^jl El Dr. SANDOVAL MORÓN (Bolivia): Distinguidas damas y caballeros. Bolivia presenta un cordial saludo y felicitación al señor Presidente de la Asamblea, al señor Director General y a los señores delegados de esta Asamblea Mundial de la Salud. Nuestro país resalta la importancia del Informe sobre la salud en el mundo 1997 y remarca la importancia de similar informe de 1996,porque ambos están estrechamente vinculados a los principales esfuerzos sanitarios de nuestro país. Es así como después de haber erradicado la poliomielitis nos encontramos en camino de erradicar el sarampión y el tétanos neonatal antes del año 2000; intensificamos nuestras acciones contra la malaria y la tuberculosis, enfermedades que en Bolivia no son reemergentes, porque nunca dejaron de tener una activa y dramática presencia en nuestra población. Actualmente Bolivia desarrolla a través de un nuevo modelo sanitario, descentralizado y participativo, esquemas creativos y novedosos de incremento en nuestras coberturas de salud, mejorando el acceso al sistema de salud y trabajando por la mejoría en la calidad de atención, sobre todo en lo relacionado con la maternidad sin riesgo y el estímulo al envejecimiento sano, evitando la compartimentación del ciudadano de la tercera edad. Estas políticas prioritarias en nuestro país se desarrollan en el marco del Seguro Nacional de Maternidad y de Niñez, que establece coberturas específicas de atención al embarazo, parto y puerperio, así como enfermedades diarreicas y respiratorias en los menores de cinco años, alcanzando a proteger a un total de 2,9 millones de personas, lo que corresponde al 41% de toda nuestra población. El Seguro Nacional de Vejez otorga prestaciones integrales de salud a otras personas mayores de 65 años a través del sistema de Seguridad Social boliviano. Bolivia desea dejar constancia de su agradecimiento a la gestión del Dr. Hiroshi Nakajima por su permanente apoyo a nuestro Programa Nacional contra el Chagas, a las tareas relativas al combate al cólera, al Programa Nacional de Medicamentos Esenciales y por su presencia en Bolivia en octubre de 1996,ocasión en la que nuestro país recibió la certificación internacional por haber erradicado los desórdenes por deficiencia de yodo. Hacia el futuro, Bolivia mira con optimismo la concreción de sus metas y convoca a los demás países a refrendar su confianza en nuestra capacidad para enfrentar nuestros problemas y los del resto de la comunidad internacional en materia de salud en un esfuerzo permanente y conjunto. Bolivia, fiel representante de los países en desarrollo, se encuentra decidida a asumir las responsabilidades que la comunidad internacional le asigne en nuestra ineludible batalla mundial en favor de la salud, y desde ahora agradece la comprensión y la confianza que en este sentido se le otorgue.

148 A50/VR/6 page 136 El Dr. MUÑOZ (Chile): 1 El Gobierno de Chile comparte plenamente con la Organización Mundial de la Salud el diagnóstico de la situación sanitaria mundial, las proyecciones posibles y las esferas prioritarias que plantea para la acción internacional en su Informe sobre la salud en el mundo Nuestro país no es ajeno a ese diagnóstico. Como en muchos otros países en vías de desarrollo, los perfiles demográfico y epidemiológico en Chile vienen presentado cambios importantes en lo que denominamos la carga de enfermedad que enfrenta la sociedad. Las patologías que hoy explican la demanda por atención en nuestros centros asistenciales se asemejan cada vez más a las propias de países de mayor desarrollo - enfermedades crónicas, mentales, ocupacionales, traumatismos y violencia - aun cuando subsisten enfermedades características del subdesarrollo asociadas a condiciones de pobreza que todavía afectan a un cuarto de la población chilena. Este cambio progresivo de la carga de enfermedad en Chile se explica principalmente por dos factores: primero, el cambio de la estructura demográfica, representado por un aumento relativo de la población adulta y de tercera edad, que se caracteriza por patologías más complejas y costosas de recuperar; y segundo, los cambios en los estilos de vida estrechamente asociados a prácticas nocivas para la salud. Por otra parte, localidades que alcanzan niveles elevados de contaminación y desregulación ambiental estrechamente asociados a los procesos productivos, surgen peligrosamente como factores propicios para la proliferación de enfermedades. Desde esta realidad, que en muchos aspectos compartimos con otros países hermanos, queremos aportar algunas reflexiones en el plano de las políticas de salud para enfrentar los desafíos sanitarios y humanitarios que muy bien anticipa la OMS en el informe que nos ocupa. En primer lugar, postulamos que la equidad debe ser el principio orientador de las políticas de salud en los países que - en democracia - luchamos por salir del subdesarrollo y fortalecer nuestras economías. El principio de la equidad debe expresarse en un compromiso de los Estados por garantizar el acceso igualitario a los servicios de salud, particularmente de quienes no pueden disponer de seguros privados y de quienes presentan mayor riesgo y vulnerabilidad. Especialmente en nuestros países, donde la escasez de recursos y la falta de modernidad de las instituciones públicas son condiciones omnipresentes, la eficiencia en la gestión de los recursos del Estado es un factor crítico para alcanzar la equidad. Inspirados en el principio de equidad y esforzándonos al máximo por ser eficientes y eficaces en la gestión de las instituciones públicas de salud, debemos prepararnos para enfrentar los desafíos emergentes para la salud de nuestros pueblos. A nuestro juicio, fundado en la experiencia del proceso de fortalecimiento y modernización del sector público de salud chileno, que iniciamos con la recuperación de la democracia en 1990, las respuestas a tales desafíos podrían ordenarse en torno a cinco ejes centrales, teniendo en cuenta, por cierto, que las particularidades de cada país determinarán énfasis distintos en cada uno de ellos: 1. Readecuar los modelos de atención a las nuevas realidades epidemiológicas, socioculturales y tecnológicas de los países. Esto implica no sólo la racionalización funcional y física, y el fortalecimiento de las redes sanitarias nacionales, sino también adoptar un estilo de gestión orientado a la calidad, y reconocer que ésta se expresa, en definitiva, en el juicio de satisfacción o insatisfacción de los usuarios con la atención recibida. 2. Promover cambios en los estilos de vida de nuestras poblaciones. Esto tiene una dimensión distinta, escapa a la lógica de las redes asistenciales y configura un espacio de trabajo más amplio, con otros sectores y con la comunidad, en un esfuerzo conjunto de fomento, protección y prevención para evitar sufrimientos y sumar años de vida saludable a nuestros pueblos. 3. Priorizar las acciones en salud. Este es un desafío que sólo recientemente hemos comenzado a asumir en los países en vías de desarrollo. Debemos tomar más conciencia de la importancia de diseñar intervenciones sanitarias que respondan efectivamente a las necesidades y problemas de salud de nuestras poblaciones, obteniendo, en beneficio de ellas, el mayor provecho de los recursos disponibles. La priorización de las necesidades y preferencias de las personas debe transformarse en una referencia clave para la readecuación de los modelos de atención y la organización de la oferta de prestaciones de salud en las redes asistenciales de nuestros países. 4. Fortalecer las funciones institucionales del sector público de salud. A partir de la experiencia chilena, nos parece pertinente distinguir los principales ámbitos de actividad del sector público de salud y las funciones que se deben potenciar para un mejor desempeño del sector salud como un todo. En lo técnico, el proceso se basa en la diferenciación y reforzamiento de tres grandes funciones: función rectora, normativa y reguladora; función financiera; y función ejecutora. A partir de allí es posible establecer misiones y tareas para las instituciones responsables y evaluar sus resultados. 5. Garantizar los derechos de los usuarios. 1 Texto facilitado por la delegación de Chile para su inclusión en las actas taquigráficas, conforme a lo dispuesto en la resolución WHA20.2.

149 A50/VR/6 page 137 Éste es, a nuestro entender, el cambio más sustantivo que debemos impulsar en nuestros países. Se trata en realidad, de un cambio paradigmático puesto que implica cambiar la mirada del sector salud desde los intereses de los prestadores a los intereses de los usuarios. Así, la satisfacción de los usuarios y la protección de sus derechos (atención oportuna, de calidad y al menor precio), se convierten en la gran misión del sector salud, misión que el Estado puede cumplir eligiendo libremente los prestadores que mejor cumplan las condiciones de satisfacción a las cuales se ha comprometido con los usuarios del sistema público de salud. Este nuevo paradigma es coherente con la revalorización de la persona, consustancial a la consolidación de la democracia en nuestros países. Las expectativas de los ciudadanos se han elevado respecto de la garantía y el respeto de sus derechos por parte del Estado, de los sistemas y de los mercados; y resulta indispensable que la política social responda efectivamente a dichas aspiraciones. De este modo, las reformas del sector salud en que la mayoría de los países estamos empeñados no representan fines en sí mismas, sino que pasan a ser instrumentos necesarios para cumplir más oportuna y eficientemente los compromisos con las personas, a las que debemos devolver el protagonismo y la decisión última respecto a lo que requieren de los servicios de salud. Muchas gracias. Mrs CODFRIED-KRANENBURG (Suriname): 1 Mr President of the World Health Assembly, distinguished elected officials to the Assembly, honourable delegates, colleagues and friends, I should like to join in congratulating you, Mr President and other officials of the Conference on your election. As you may know, our Government has only recently assumed responsibility. Ours is a third-world country, in a region of great biodiversity, facing particular difficulties in controlling old and re-emerging infectious diseases. Suriname is presently recuperating from a structural adjustment programme and in the process of achieving economic stability. We took the opportunity of World Health Day 1997 to raise awareness around the country of the re-emergence of infectious diseases, and plan to start addressing human suffering due to chronic conditions by the end of this year. We do so, in spite of the limited financial means available and the continuing drain on our human resources. During the aforementioned World Health Day celebrations in Suriname, it was stated that malaria was a disease of underdevelopment rather than a mere medical condition. The same underdevelopment that is largely responsible for a number of infectious ailments, conditions prevention management of chronic diseases. When reviewing our morbidity and mortality data, it should be noted that the leading causes are: cardiovascular diseases, cerebrovascular accidents, malignant neoplasms, trauma and intestinal infections. These health problems have their origins predominantly in environmental and behavioural conditions. We therefore agree wholeheartedly with efforts for health promotion and protection that involve the participation of others and not the health sector alone. But at the same time we are competing with media-generated demands for high-technology medical care. In reviewing our options, Mr President, we reaffirm our belief in the strategies outlined in The world health report 1997 and will make a special effort to integrate disease-specific interventions into comprehensive packages; encourage healthy lifestyles; and develop public policies that favour a sustainable health status for the population in Suriname. We are therefore very pleased with The world health report 1997, and in particular with the chapter on charting the future which raises the issue of the double burden of dealing with communicable disease and, at the same time, attending to chronic suffering. Le Dr CANDUCCI (Saint-Marin) : 1 Monsieur le Directeur général, Monsieur le Président, Mesdames et Messieurs les délégués, permettez-moi tout d'abord, Monsieur le Président, de vous féliciter pour votre élection. Je voudrais très brièvement me référer au Rapport sur la santé dans le monde, 1997, qui a été présenté par le Directeur général et qui met l'accent sur les maladies chroniques actuellement en augmentation et pour lesquelles il est nécessaire de mener une action conjointe et concertée dans les domaines de la prévention et de 1 The text that follows was submitted by the delegation of Suriname for inclusion in the verbatim records in accordance with resolution WHA Le texte qui suit a été remis par la délégation de Saint-Marin pour insertion dans le compte rendu, conformément à la résolution WHA20.2.

150 page 138 la recherche, même si l'accroissement des dépenses sociales dans nos pays nous amène à des réformes qui visent à comprimer les budgets et à appliquer des taxes de plus en plus lourdes pour la collectivité. Malgré cela, nous devons mobiliser nos efforts sur le plan bilatéral et multilatéral et concentrer nos ressources humaines et financières pour réduire les conséquences d'un futur fléau. L'OMS tout entière est appelée à mettre en place des programmes de prévention pour maîtriser, d'une part, les maladies infectieuses tant nouvelles que réémergentes, qui frappent des centaines de millions de personnes et dont aucun pays n'est à l'abri et, d'autre part, les maladies non transmissibles chroniques, dont le poids social et économique n'est guère moins lourd. Réduire les écarts, prévenir et maîtriser les problèmes de santé doivent être pour nous tous les principaux objectifs sociaux. La "transition épidémiologique" transforme de plus en plus le tableau global de la morbidité et la communauté internationale doit en relever le défi. Il est donc de notre devoir d'adopter des mesures propres à développer la recherche et la prévention, à promouvoir des politiques sociales visant à instaurer des modes de vie et des comportements sains. La République de Saint-Marin connaît cette transition épidémiologique et son tableau de morbidité suit la même tendance que celle des autres pays européens. Les données sur la taille de la population (actuellement habitants) et le taux d'accroissement de la population (les taux de natalité et de mortalité pour la période étant respectivement de 10,4 et 7,5 %) indiquent un taux de mortalité parmi les plus bas des pays d'europe et un allongement de l'espérance de vie (71 ans pour les hommes et 79 ans pour les femmes). Les causes principales de décès sont les maladies cardio-vasculaires et le cancer qui, ensemble, sont responsables de 82 % des décès, les affections cardio-vasculaires venant en tête. Conscients de la nécessité d'axer nos politiques d'intervention sur la prévention, nous avons fondé nos programmes de prévention sur l'éducation sanitaire, l'information et la vulgarisation, et l'éducation alimentaire dans les écoles primaires et secondaires, afin d'éviter les conséquences à long terme des maladies chroniques. L'information et la promulgation d'une loi interdisant de fumer dans les lieux publics pour protéger les gens de l'exposition involontaire au tabac s'inscrivent dans notre programme de lutte contre le tabagisme et l'abus de substances psychoactives visant à sensibiliser la communauté. De bons résultats ont été obtenus en ce qui concerne la réduction des cardiopathies ischémiques et des myocardiopathies et un programme ambitieux de création d'un registre des maladies cardio-vasculaires vient d'être lancé. La lutte contre les dyslipidémies a été intensifiée grâce à un vaste programme contre le cholestérol et l'hypertension mené sur notre territoire. Nous avons réalisé un programme de prévention secondaire, de surveillance et de traitement intensif ainsi qu'un programme de réadaptation après infarctus. Prévention signifie promotion de l'exercice physique et de modes de vie sains, préconisés par les médecins de famille et les comités sportifs nationaux dans le but de réduire les conséquences des maladies et d'exercer une influence sur les facteurs de risque. Dans le cadre du programme DIAB-CARE, des résultats satisfaisants ont été obtenus dans la prévention et le traitement du diabète : seulement 3 % de la population sont frappés par la maladie et les indicateurs n'ont relevé jusqu'à présent aucune des séquelles du diabète (cécité, lésions du membre inférieur, insuffisance rénale). Des programmes de prévention primaire ont été lancés depuis bien des années pour le diagnostic des cancers du sein et du col, au moyen d'examens et du test de Papanicolaou. En 1994,nous avons fondé un centre pour les maladies auto-immunes pour le diagnostic, le traitement et la surveillance du lupus érythémateux disséminé et des maladies rhumatismales chroniques. Depuis de nombreuses années, nos politiques sociales et sanitaires ont mis l'accent sur la notion de vieillissement en bonne santé et sur la qualité de vie des personnes âgées. Des mesures législatives portant sur trois volets ont été promulguées : la vie des personnes âgées à l'intérieur de la famille, un soutien économique aux familles pour que les aînés puissent continuer à vivre dans un milieu familial, et une assistance domiciliaire adéquate. Des lois et des règlements ont été promulgués pour veiller à la salubrité des villes et aux effets de la pollution sur la santé afin que les secteurs impliqués dans les établissements humains et le développement prennent en compte les aspects liés à la santé et à l'environnement et luttent contre la dégradation du milieu. Les contrôles de la salubrité des aliments, de la qualité des eaux et de l'hygiène du milieu de travail ont été intensifiés, et des activités de formation ont été entreprises dans les usines en matière de sécurité chimique et d'évaluation des risques que comporte l'exposition aux substances toxiques pour la santé humaine et l'environnement.

151 A50/VR/6 page 139 Il est certain que la situation sanitaire globale évoluera avec le vieillissement rapide de la population, les changements de comportement et la détérioration de l'environnement, et que les conséquences des coûts sociaux devront être supportées par une partie de la population. Il est donc de notre devoir d'envisager une stratégie intégrée de prévention pour que, moyennant les ressources et la technologie disponibles, on puisse réduire la somme des conséquences dues aux souffrances et aux incapacités. Mr UEDA (Palau): 1 Mr President, Director-General, Your Excellencies, ladies and gentlemen, on behalf of the delegation from the Republic of Palau, I would like to take this opportunity to congratulate you on your election to lead us during this Fiftieth World Health Assembly. Congratulations are also extended to all Vice-Presidents, the Chairpersons,Vice-Chairpersons and Rapporteurs of Committees A and B. My delegation assures you all of our cooperation as you lead us towards successful achievement of the goals of this Assembly. Secondly, I wish to extend my congratulations to Dr Nakajima on the preparation of this clear and concise report on conquering suffering and enriching humanity. Distinguished delegates, it is my honour to address you on the occasion of the Fiftieth World Health Assembly. That I,from such a small island nation can stand before this august body on this day attests to two facts: first, that diseases do not respect borders and sizes,and the human suffering they cause are felt to the same degree irrespective of geographical locations and political status in the world; secondly, that we are now bound to each other by the common goal of conquering that suffering and by sharing the desire to enrich humanity. In practically all the small island nations in the Pacific, major health concerns have shifted from infectious diseases to noncommunicable diseases. Indeed, cardio- and cerebrovascular diseases, diabetes, cancer and nonintentional injuries have become not only the leading causes of death but also the leading causes of morbidity and deficiency in quality of life. They have also become the leading causes of economic disabilities among many in the small island nations of the Pacific. It seems as if we, of the small islands, had become particularly vulnerable to these lifestyle diseases. It seems as if we have a certain propensity to succumb to the target marketing of tobacco makers, alcohol and other substance abuse pushers and retailers of fast, nutritiously deficient western foods. It seems that we too easily desired to be like westerners without understanding the price we all had to pay. Now I stand before you because I believe that we in the small islands need much assistance in our efforts to protect our national and local health. We understand that we must play our part in assisting our own people to understand the risks involved in certain lifestyles and behaviour. We must help them understand options for positive behaviour and assist them to effect the desired modification. But we try to carry out these tasks with people who often lack the required skills to market, advocate and communicate positive health, and with often less than meagre means. Indeed, we are no match for the US$ six billion efforts that tobacco-makers put in each year to attract the young people of the world, particularly those in the developing nations,and especially us in the small islands who are vulnerable because of our own desire to become western in style. This is why in considering renewal of the health-for-all strategy, the interregional meeting on health for all for the twenty-first century recommended that health effects should be dealt with through strengthened international action for health to prevent the international spread of unhealthy products and lifestyles. We need you to help us fight - against tobacco companies, against marketers of breastmilk substitutes, against those who wish to dump cheap health-risk foods such as turkey tails, against those who push drugs and other harmful substances across borders into our fragile island environments. Long ago, our ancestors had to work hard to live. As the Pacific Islands entered the twentieth century, our forefathers began to trade some of that harsh rural life for an easier and more modern urban life. At first, the balance tended towards the bonus side - but somewhere along the way, we lost our sense of balance and, as we continued in our quest to become more modern, to work harder so that we might enjoy life, the bonus began to weigh less than the burden of suffering from modern life - the quest for it and the consequence of it. Now, on the eve of the twenty-first century, it seems that collectively we are coming to our senses again. We owe much of this understanding to the sole leadership of Dr Hiroshi Nakajima, who has worked 1 Tbe text that follows was submitted by the delegation of Palau for inclusion in the verbatim records in accordance with resolution WHA20.2.

152 A50/VR/6 page 140 so hard and so successfully during his tenure as Director-General to implement the health-for-all strategy. We now desire to conquer suffering together and to work together to enrich humanity once more. We believe it can be done. In the Western Pacific Region, our renewed health efforts are guided by the strategy contained in "New horizons in health", which brings into focus again the need to establish mechanisms and strategies to prepare for life, to protect life throughout its full spectrum, and even into the later years when ensuring the quality of life for that period remains a major focus of health activities. In the Pacific islands, we have specifically endorsed these concepts in the Yanuca Island Declaration of the healthy islands initiative. In our minds our healthy islands are ones with the least interference from negative health so that they are places where children are nurtured in body and mind, environments invite learning and leisure, people work and age with dignity, and ecological balance is a source of pride. These are lofty goals for areas where economic and social changes do not always keep pace with health and social security systems. In his address to the East Asian Ministerial Meeting on Caring Societies in Okinawa on December 5,1996, the Director- General, Dr Nakajima, said that to ensure sustainability and accessibility of health and social security systems, we have to emphasize prevention, particularly with regard to noncommunicable diseases. It we do that in the spirit of renewed health for all, we can look forward to the twenty-first century with greater hope and optimism. Mr ABDULLAH (Maldives): 1 Mr President, let me join my colleagues in congratulating you on your election as President of this historic meeting. We are fortunate to meet here, to discuss and to renew our policies in line with the trends in the epidemiological situation of the whole world. Fifty years is a short time in the life of an organization, but since the inception of this august world body, remarkable changes and progress have been achieved in the global health situation. It is time to reflect on our achievements and to change our course to meet the challenges of the future - a future that is clouded with the threat of emerging and re-emerging diseases which are bringing our status back to the pre-antibiotic era. The Maldives, like many other nations, has been fortunate in receiving generous technical and financial assistance from WHO, which has brought about considerable achievements and progress in our health situation. We have eliminated malaria, poliomyelitis, diphtheria, whooping cough, neonatal tetanus and other communicable diseases. We have also achieved considerable success in controlling filariasis and leprosy: the latter will reach zero transmission level by the end of this year. However, we have not yet been able to bring about the same result in the case of tuberculosis; and now HIV/AIDS is making inroads into our society as a double burden. We have achieved these successes with immense hard work and the utilization of considerable resources. Since the adoption of the health-for-all strategy in 1978,we have come to a state now where this strategy needs to be reviewed and renewed in order to meet the changes in the local situation and the challenges of the new millennium. The cornerstone or the basis of the progress in the health status of our people has been the strategy of health for all by the year 2000, adopted in From the experience we have gained thus far, however, we realize that in order to go ahead from here to meet the new challenges we need additional partners. Collaboration between the nations, rich and poor, and cooperation among the sectors of the Member nations is equally important. Participation by nongovernmental organizations and the community would help to give the necessary impetus for our progress. Therefore, the new strategy to meet the new challenges of a new era should be health for all by all, in which everybody will have a share and a stake. The world is now on the threshold of a new global threat: the transition to chronic noncommunicable diseases. Our children are going to inherit an ailing world, burdened with cardiovascular, respiratory and other chronic diseases due to man's rapid behavioural changes, fast urbanization, pollution and congestion of cities. Modern drugs and technology will not find sustainable solutions. We alone have to change our behaviour, resolve and situations. A new and pragmatic public health approach to prevent chronic diseases through a global campaign is an imperative - a strategy to encourage and motivate healthy lifestyles through integration of an effective programme into our health system, with particular attention to healthy development of children and adolescents. We believe that WHO should formulate a vibrant plan and programme to monitor the status of the Member countries with a view to providing them with advice and assistance for adopting an effective and sustainable approach for dealing with noncommunicable diseases. In the Maldives 1 The text that follows was submitted by the delegation of the Maldives for inclusion in the verbatim records in accordance with resolution WHA20.2.

153 A50/VR/6 page 141 our school health programme has been expanded with an ambitious "every child swims" programme and other regular exercises and health promotion activities. As I mentioned earlier, the epidemiological pattern of my country and many other countries is changing from communicable diseases to noncommunicable diseases. In this kind of environment a major role has to be played by individuals themselves to bring about necessary changes in their lifestyles and moral values. Many of these diseases are preventable and many of them have one small black streak as a common factor: that is, smoking. From numerous studies worldwide we can safely say that smoking leads to many diseases - cardiovascular diseases and cancer,among many others. Yet this is not all; if we look around carefully we may find that smoking is linked to the beginning of the worldwide pandemic of drugs and substance abuse. Therefore, we all have a moral responsibility to make the world a tobacco-free place for the sake of health not only for ourselves but for generations to come. A major area of concern should be the environment. The relation between environment and good health has been established and WHO has been giving equal priority to healthy cities, healthy schools and healthy hospitals. The Maldives is especially vulnerable to environmental degradation, on account of the fragile nature of its ecosystem. The Government is therefore giving priority to the protection of the environment, safe water and sanitation. It is in this context that our President, His Excellency Maumoon Abdul Gayyoom, launched the "million trees" programme in the public support for the programme has been immense and the goals initially planned for three years were almost attained in a year. It is with this success that the "million trees" programme has now been upgraded to "two million trees". In the same context a new campaign, "Independent Maldives - clean Maldives" was started last November to promote cleanliness and safe disposal of waste matter. A clean environment is the most important thing for good health. In conclusion, I should like to thank WHO for its efforts to bring about an epidemiological change in many nations; and in this context I should like to request my colleagues to support and sustain the achievements and to safeguard the health of all States, especially the vulnerable and the small States. Mrs PAUL (Dominica): 1 Mr President, Director-General, distinguished delegates, ladies and gentlemen, the Dominica delegation, on behalf of the eastern Caribbean States of Antigua and Barbuda, Grenada, St Kitts and Nevis, St Lucia and St Vincent, welcomes the theme of The world health report 1997: Conquering suffering, enriching humanity, the details enclosed therein and the charting for the future that is provided in the document. In this regard, we recognize the invaluable contribution of WHO under the able and competent leadership of Dr Nakajima towards the promotion and development of health in the eastern Caribbean region and worldwide. Many developing countries are in an epidemiological transition, whereas we have sufficiently succeeded in controlling communicable diseases, but are now faced with the burden of alleviating chronic diseases. We are however conscious that our control of communicable diseases could be tenuous, as we grapple with the reality of re-emerging and new infectious diseases. Of particular concern to us is the emergence of multidrug resistant tuberculosis,which is already in our hemisphere. We have to be particularly vigilant, as cholera is present in the neighbouring countries. We continue to undertake measures to enhance our vector control programmes to limit and counteract the threat from dengue, yellow fever and malaria. Many developing countries continue to grapple with the personal, social and economic burden of chronic diseases. This is particularly so, when our young working population is affected by the scourge of diabetes, hypertension and obesity, to name but a few. Predictions are that within 13 years the number of diabetics in Latin America and the Caribbean will rise from 13 million to 20 million. In recognition of this, we recall the WHO/PAHO documentation and resolution on diabetes in the Americas at the last meeting of the Directing Council of РАНО, which is indeed timely and points the way forward for control of this pandemic. Mr President, we endorse all priority areas for international action in health as being critical. We particularly welcome priority number three of paragraph 122 of The world health report 1997, that is a major intensified but sustained global campaign to encourage healthy lifestyles, with an emphasis on the healthy development of children and adolescents in relation to risk factors such as diet, exercise and smoking. We wish to comment further on two other issues of concern to us. The first refers to the acceleration of research on new drugs and vaccines. We noted with concern that while reverse transcriptase inhibitors 1 The text that follows was submitted by the delegation of Dominica for inclusion in the verbatim records in accordance with resolution WHA20.2.

154 A50/VR/6 page 142 such as AZT have been on the market for more than six years, the number of AIDS sufferers and HIV carriers with access to these drugs in our country is depressingly low. Nevertheless, we welcome the development of new drugs to treat this condition. We will however hope that these drugs will in the near future be affordable and accessible to our region. Mr President, it would be remiss of me not to stress the need for a WHO Task Force to consider in its mandate the specific circumstances of small island States and their vulnerability to severe climatic conditions and structural difficulties. As we embark on creating healthy public policies, our efforts are increasingly coming under the threat of globalization and trade liberalization - more specifically, the loss of preferential treatment for our bananas in the context of the WTO panel ruling against the European Union banana regime. Our efforts to diversify away from mono-crop economies so as to improve upon our competitiveness in tourism and other service-driven sectors require a longer transitional period than that envisaged by the proponents of free trade. We also believe that these efforts have to be matched by an increase in resources if our aspirations of achieving sustainable public health policies are to be realized. Finally,Mr President, we implore our bigger partners in this august body to truly assist in setting in motion the mechanisms that will assist in conquering suffering and enriching humanity. Le Dr DY (Cambodge) : 1 Monsieur le Président, honorables délégués, c'est pour moi un privilège de participer à la Cinquantième Assemblée mondiale de la Santé. Au nom du Gouvernement du Royaume du Cambodge, je voudrais vous adresser, Monsieur le Président, mes sincères félicitations pour votre élection. Je tiens également à exprimer au Directeur général mes plus vives félicitations pour le travail accompli au cours de l'année écoulée. En tant que représentant d'un pays appartenant au groupe des pays en développement où le budget de la santé s'élève à peine à US $2,5 par habitant par an, je me sens bien placé pour parler des défis que ces pays ont à relever pour offrir des soins qui soient à même de satisfaire les besoins de santé élémentaires. La santé de l'individu est de plus en plus influencée par des circonstances socio-économiques. Et un pays comme le nôtre, qui vient de sortir d'une longue période de guerre et d'isolement, subit de plein fouet ces influences. La réalité actuelle d'un pays en développement est de pouvoir trouver au moins US $12 par habitant par an pour couvrir les besoins de santé de base tels qu'ils sont définis dans l'édition 1993 du rapport de la Banque mondiale sur le développement dans le monde. Donc, déjà, la question cruciale est de savoir où trouver ces ressources pour faire face à ces besoins. La résolution WHA48.16, adoptée par l'assemblée mondiale de la Santé et intitulée "Adaptation de l'oms aux changements mondiaux : pour une nouvelle stratégie de la santé pour tous", n'a-t-elle pas reconnu la nécessité de vouer une attention prioritaire aux plus démunis sur le plan de la santé ou des soins de santé, en raison de la pauvreté, de la marginalisation ou de l'exclusion, et la nécessité d'un appui accru de la communauté internationale? Nous devons donc faire de gros efforts en tenant compte du contexte national et en choisissant des approches propres à la situation socio-économique pour élaborer une politique sanitaire nationale et adapter également cette dernière à la politique sanitaire mondiale. Un système de santé promouvant des formes novatrices de partenariat entre le gouvernement, les donateurs, les organisations non gouvernementales, le secteur privé et - plus important encore - la communauté elle-même garantit l'accès des plus démunis aux services de santé, tout en assurant que les différentes composantes d'un ensemble minimum de services essentiels sont disponibles, abordables et d'un bon rapport coût/efficacité. Un tel système a permis d'améliorer la situation sanitaire de la population du pays, où l'espérance moyenne de vie reste encore faible (au-dessous de 55 ans), où la mortalité infantile est encore élevée et où les maladies infectieuses ne sont pas encore maîtrisées. Cependant, si la priorité sanitaire de notre pays va à la lutte contre les maladies infectieuses, nous ne devons pas négliger les problèmes posés par les maladies non transmissibles. Nous devons nous employer à combattre avec nos faibles moyens les deux types de maladies simultanément, car nous avons la ferme conviction qu'allonger l'espérance de vie sans allonger l'espérance de santé est une action incomplète, que toute amélioration de l'état de santé nécessite des mesures intégrées complètes portant sur tous les déterminants de la mauvaise santé. Dans notre pays, le génocide perpétré par les Khmers rouges a laissé des traces : troubles mentaux et neurologiques, troubles nutritionnels (malnutrition et sous-nutrition chronique) et violence sous toutes les 1 Le texte qui suit a été remis par la délégation du Cambodge pour insertion dans le compte rendu, conformément à la résolution WHA20.2.

155 A50/VR/6 page 143 formes. Par ailleurs, actuellement, un déséquilibre démographique, avec 56 % de femmes et un taux de natalité s'élevant à 3,8 %,nous préoccupe. Nous devons élaborer des projets qui doivent protéger la santé mentale, la santé de l'enfant, la santé des enfants d'âge scolaire et des adolescents, et la santé de la femme. Le développement industriel dans les pays en développement doit tenir compte des risques professionnels, tels que les accidents du travail et les maladies professionnelles, pour n'en citer que quelques-uns. Nous devons penser dès à présent à des moyens de prévention efficaces. Monsieur le Président, honorables délégués, tous ces défis, nous devons les relever ensemble car nous en avons la responsabilité. Si nous ne le faisons pas, il est à craindre que nous voyions se creuser dans les années à venir un fossé entre les riches et les pauvres, entre les jeunes et les vieux, entre les hommes et les femmes, entre ceux qui travaillent et ceux qui ne travaillent pas. Mesdames, Messieurs, vainquons la souffrance et enrichissons ensemble l'humanité. Dr. HAMADI (Morocco): ^^ > J, ^ ol^tjl câ-^x-vâji çijjj ^AJÍ c^lítil JJJlJI JLmaJI t^^-uu^rjl ал-^лз!д-ллл- ^i^jl.ô^l-jij oijla^ji jj^ís^- 二 js^ii ç.liap!j ôjl^j l^sjj ^jl^ljl ^p-b jji (^JLa^ ^JLûjI oí ^улл^до LÂ^JycJl Jij U» J Uidu^r JU- Í 其一 7 ^ Jjyllj ^-UJl ^ Li^ C^^îl C^lУ bljl LUT ^jj otj csjjjüi JL^PÍ UJl л JS' Jlj jojl -vjl Jl jijlijl oljlp JjL^i j.jul-1 ÙÎ J L*^ LJIJLASII y,y Ljjjiij j^ieál. o b ^ j U J tájjlxjl í^jai..x «««广 LP JjJb>b; A^SJlÍ i^^ajl» ij ír^u \ ^ i^juii ÓUJI ajus/ij t^uii y.-uji -vji >Ji «ó;» Í US'. 气气 V b jjujl ^ J У opí (jjü! Liil J.^JUJl oljjr OliiJiwJ ÂTwaJl ( J ^ j a r l ^ja Ójlpr obj^nj» cjjb Ллл (jj U.., ^ ^y, J toljlijl IJLT j îol^îji jt> ó J y lilib JljTîAj tjjji y ^ ^bj ijj^jj 4^1 ^ J \ U^PJU" цлкй usjyül Ja^jJlJ (J OLÍ л J > \ J tâjjljl Jp\ 力丨 ^ Ûûii; -L^îo (JbJl ol UT'lili cci^í 一.i: J ÂjjLJI ^P Jo\ja4\ IjLül JjC cjlj^ j^-jl JJ> ^ ^ Jj-iJl. o L T J ii> ^ ÂJl^ÛJI oljjcái I cjlt J^jJs ^ J^e J S^'LJl JjJÜI OU t^-oul ^LJl J\ Ijjiú!4-.jli. M LgJ l^kli^. J-^J is^y. tî-^plwajl J J-ÜI Jlp ij^cia ^UJl JjoU J 幻 ISC- J^J yülj j ùli^jl oii Hi^j LpL^'jI «Jut. J 产 'ti-jv-j ^ ^ ^j'j J>í Jaju. ^ ^ L. jaij.j^jl ^ ^ ^ ájíi^í^j Á^UiJr^l ol-l^^l ^ 丨 снл? ) ù 丨叫 «jí^l VwiJl JTLi^Jl Uuj 户 -4jJjdl ^l^îj tijcjl 山 ùl on^j^ni j ^/Sî^ldl JU^. ^ JUJl j > r ^ 广 j 5jiJ\ ^UJjl 01 j U j ÜL ц-lkí j 力 I ^ OU^LÀ^ akjjjl JbljiJ OLjUs>Ijj tâjjl Jl J y. ji-^ 3_ 5bj "üu 2^»ilL j.jj^il IÓA ájju^nij Á^PL^t^I oulkul Uib^. ijly-l Á^L^. jl L.1 j t l4^jl e-ftb^ (Jj^A Js- JJUJI ^jjdl yjijl jjlj^il j^jujl 0Î US'.ÁJbú ^ÍTÍ Яхл-^ j Jt^j ÍJJ^ y f^' ÍÁj^JI jl^ ^U^JI ^ A^Ijj^ ^jkj\ Mj ou í j j l

156 A50/VR/6 page 144 ^ y j )J Jl jbluji OlSL. ^ J ùu-sb Jl âjjsíl blju^i OU cjlip^i IJl^ HсД-лмЛ ^л.j; J-^-í c^l^. 广 L^JJM ^Lkpi cjijub^l L^LJ SjlojücJÍ OL^I.AIaluJI (jyill ^J jí ÔjlSJi ^jpwaii «J^L^J^Ji ^Üj olij ^ ^Jiiill j^í ^ 广 U^l UjTj câiiidi Ju^ ^ J>Jl ôjub Ji a u ^ j J^jjl Â^waii JL^ L ^ bui^lj yjl ^jlj-jj JLoJl JUxi^Ml Ji ^usíi ^ b-uui^ 01 广 L^b y: J^ull Â^jljJi J ^ J^l^JlJ a^^iilj oí UT.^S^. ojljb oí Jj^ ^Jl J^pi^yJ Ajl ce^ljij OIJLAJI olc^uii ^ JLJI JL^l t^^j^jl wuxjl J^i JL^Jl IJLft ^J C M 4J^ JLÍ ;IceUU^Jl ^з" i^t-s^jlj 4-uJUJl A;ciJJl 岔 J^jl ùî jl^ipi J^oj ; ^ dllbj t^-^jj jlul ^ bjl^ji ^ijljb^l J ^ jbui^l ^Ikpl lujil. JLP ^-^ло L^LA. lijub Ы OOJL^ ai) tbujlj oljlwwjl olj^ c^ujl JL^Jl c^^wj) o^l.j-s^î (jy^»'^j^i Jj-^ И JLpL-^. Uujâ^ ^ J*^ ^ U^^^ ^ O^Uü oí bu cj^jl fjlji ^ ^ J ^ ^ 一 \.çjuil ^ A^Jl ^LJI jr > Mrs ROSEIRA (Portugal): Mr President, Director-General,honourable delegates, first of all, I would like to congratulate you, Mr President, on your election, to greet very warmly Dr Nakajima, the Director-General and thank him for his report, and finally greet all delegates at this special occasion, the Fiftieth World Health Assembly. The speaker continued in Portuguese. L'orateur poursuit en portugais {interprétation du portugais) : 1 Le Rapport sur la santé dans le monde, 1997, intitulé "Vaincre la souffrance, enrichir l'humanité", souligne des aspects très importants de la santé mondiale de nos jours; il les présente de façon extrêmement claire et complète. Il insiste sur la nécessité d'élaborer des approches collectives pour les maladies chroniques et sur l'importance d'un mode de vie plus sain et d'interventions médicales efficaces et rentables fondées sur des connaissances approfondies et qui permettront d'assurer des soins palliatifs là où les soins curatifs ne réussissent pas. Il souligne la nécessité de soutenir ces efforts par des politiques publiques appropriées. Bien sûr, nous partageons les commentaires formulés par la présidence de l'union européenne. De plus, nous sommes heureux de signaler que notre pays adopte aujourd'hui une stratégie de santé pour tous à l'aube du prochain siècle. Dans ce contexte national, nous estimons que le rapport susmentionné aurait pu insister davantage sur les politiques publiques de santé. En fait, nous prônons un meilleur équilibre entre l'attention qui est prêtée à des maladies et affections spécifiques et le besoin d'élaborer des outils politiques qui permettraient vraiment d'aborder toute la gamme des conditions d'existence, par exemple, mettre les citoyens et les malades au centre même du processus de promotion des soins de santé, reconnaître qu'il y a plusieurs façons de le faire, consolider leurs droits, leur permettre de prendre une part active à leur santé, soutenir les organisations de malades, respecter le choix du patient, tenir compte des préférences des citoyens dans l'affectation des ressources, développer des systèmes d'information à l'intention des patients. La prestation des soins de santé doit être novatrice et fondée sur les besoins de la collectivité à long terme. Il s'agit d'un réseau de gestion extrêmement difficile à assurer dans divers secteurs, d'autant plus que les connaissances sont très limitées dans la plupart des pays. Il s'agit de développer des soins de santé qui soient humains, qui tiennent compte de l'état d'esprit des malades, mais qui soient également à la pointe de la technique. Il s'agit également d'adopter de nouvelles formes de responsabilisation, des contrats de confiance qui permettent aux patients d'exprimer leurs préférences et aux responsables d'affecter les ressources de façon efficace. Toutes ces idées, qui sont des 1 Conformément à l'article 89 du Règlement intérieur.

157 A50/VR/6 page 145 éléments importants de la santé pour tous, sont formulées dans la stratégie sanitaire portugaise pour le siècle prochain. C'est dans cet esprit, dans le souci de partager ces principes communs que j'ai eu l'honneur d'accepter ma nomination à la vice-présidence. Je saisis cette occasion pour vous remercier de votre confiance. Le Portugal traverse aujourd'hui une phase particulièrement passionnante de son développement et il est prêt à jouer un rôle complet dans le développement de la santé internationale. En presque vingt ans, notre pays a quasiment surmonté le retard dû à un demi-siècle de régime autoritaire antidémocratique. Aujourd'hui, le Portugal apprécie son rôle au sein de l'oms, au sein de l'europe, au sein de la collectivité mondiale. Il joue un rôle positif dans l'union européenne et accorde une importance capitale à sa participation à la communauté des pays lusophones qui vient de se créer. Cette collectivité de 200 millions de personnes partage une langue et une culture communes. C'est la raison pour laquelle j'ai voulu aujourd'hui parler notre langue, le portugais. A ce triple titre, j'estime que mon pays est bien placé pour jouer un rôle actif face aux défis mondiaux que l'oms entend relever et qui ont été exposés dans le rapport sur la santé dans le monde. I thank the distinguished delegate of Portugal for her statement and for the kind words addressed to the chair. I give the floor to the delegate of Gabon who will speak on behalf of a group of African countries. Benin, Burkina Faso, Cameroon, Cape Verde, Congo, Côte d'ivoire, Guinea, Guinea-Bissau, Madagascar, Niger, Senegal, Togo, Zaire and on behalf of his own country. A time limit of 10 minutes has been allocated to this speaker, as he will speak in the name of 14 countries. In order to save the Assembly's time, the delegates of these countries will not take the floor. I invite to the rostrum the Observer fur the Holy See. M. BOUKOUBI (Gabon): Monsieur le Président, Mesdames et Messieurs les Ministres, Monsieur le Directeur général de l'organisation mondiale de la Santé, honorables délégués, c'est pour moi un honneur de prendre la parole à l'occasion de la Cinquantième Assemblée mondiale de la Santé. Cet honneur est d'autant plus grand que je m'exprime ici au nom d'un groupe de pays africains, à savoir le Bénin, le Burkina Faso, le Cameroun, le Cap-Vert, le Congo, la Côte d'ivoire, la Guinée, la Guinée-Bissau, Madagascar, le Mali, le Niger, la République centrafricaine, le Sénégal, le Togo, le Zaïre et, bien entendu, le Gabon, dont je dirige la délégation. Monsieur le Président, permettez-moi tout d'abord de vous présenter mes vives félicitations pour votre brillante élection à la tête de cette Assemblée. Mes collègues et moi sommes certains que votre sagacité nous permettra de traiter avec efficacité des questions importantes qui constituent à ce jour les préoccupations de notre Organisation. Ces félicitations s'adressent également aux Vice-Présidents et à tous les membres du bureau. Le rapport présenté par le Directeur général sur le thème "Vaincre la souffrance, enrichir l'humanité" permet de mesurer le chemin parcouru et d'apprécier à leur juste valeur les victoires qui ont été remportées sur la maladie et la souffrance au cours de ces dernières années. Aussi suis-je heureux de souligner le renforcement de l'unité des Maladies émergentes et réémergentes au Bureau régional de l'afrique, l'accélération de la mise en oeuvre des programmes de lutte contre le paludisme soutenus par des fonds extrabudgétaires et l'initiative Afrique 2000 pour l'approvisionnement en eau potable et l'assainissement, tout comme l'exécution des programmes interpays de lutte contre la maladie. Ces programmes auront particulièrement permis une amélioration variable selon les pays du taux de couverture vaccinale, des progrès notables dans l'éradication de maladies comme la dracunculose et la poliomyélite. Globalement, ils auront débouché sur la réduction de la mortalité maternelle et infantile et l'allongement de l'espérance de vie. Monsieur le Président, honorables délégués, il me plaît, au nom des pays dont je suis le porte-parole, d'exprimer nos remerciements sincères à l'oms et à nos partenaires au développement, dont le soutien constant a rendu possibles ces progrès. Toutefois, le rapport montre également l'ampleur des défis qui continuent à nous interpeller et qui devront orienter nos actions à venir. Il nous révèle notamment que sur plus de 52 millions de décès dans le monde en 1996,40 millions environ 一 soit près de 80 % - ont été enregistrés dans les pays en développement. Les maladies infectieuses constituent, à n'en point douter, les préoccupations majeures autour desquelles se bâtit l'essentiel de nos politiques sanitaires. Le paludisme continue à entraver sérieusement le développement

158 A50/VR/6 page 146 socio-économique de nos pays. Nos populations payent par ailleurs un lourd tribut aux maladies épidémiques, comme la méningite qui a causé la mort de plus de personnes en Quant au SIDA, il frappe avec toute sa force dans un contexte où l'accessibilité aux médicaments reste problématique pour nos pays. Il faut également souligner l'importance des maladies réémergentes, comme la tuberculose et la trypanosomiase. En outre, les troubles nutritionnels, les changements de comportements alimentaires, l'accroissement de l'usage du tabac et de l'alcool contribuent à l'apparition et à l'extension des maladies chroniques, telles que le diabète, les maladies cardio-vasculaires et les cancers. L'impact grandissant de ces affections exige dès maintenant l'élaboration et l'application de stratégies de prévention et de lutte adaptées. En cette fin de siècle, dans beaucoup de régions de notre continent, des pays font face à la guerre et à des troubles sociaux et politiques d'une gravité sans précédent. Ces phénomènes, outre leur impact considérable sur la morbidité et la mortalité, constituent autant d'obstacles limitant les progrès réalisés par nos pays en matière de développement durable. Il en résulte l'accentuation de la pauvreté qui nous maintient dans un cercle vicieux pauvreté-mauvais état de santé. Ce cycle constitue un défi non seulement pour nos Etats mais également pour la communauté internationale. Monsieur le Président, honorables délégués, notre auguste Assemblée doit se pencher, entre autres sujets, sur le projet de budget programme pour ,qui ne connaîtra sans doute pas d'accroissement sensible dans le contexte économique actuel. Cependant, force est de reconnaître que nos pays africains méritent une attention toute particulière pour leur permettre de faire face aux grands défis de l'heure, mais aussi et surtout de maintenir et de consolider les acquis reconnus par tous. Je ne puis conclure mon propos sans féliciter chaleureusement le Directeur général de l'oms, le Dr Hiroshi Nakajima, pour les avancées notables enregistrées par notre Organisation au cours de ses deux mandats. Au nom de tous les pays que j'ai l'honneur de représenter, je souhaite vivement que la succession de l'actuel Directeur général se déroule sans fracture, dans un environnement propice aux mutations susceptibles de porter la santé de nos populations au niveau le plus élevé possible. Pour terminer, je forme le voeu qu'à l'aube du troisième millénaire, en même temps que s'améliore l'espérance de vie, le concept "espérance de santé" s'ancre, prenne tout son sens et devienne un objectif pour la communauté internationale. Monseñor LOZANO BARRAGÁN (Santa Sede): Señor Presidente, señor Director General, distinguidos delegados, señoras, señores: Es para mí un gran placer y un honor tomar la palabra en nombre de la delegación de la Santa Sede para expresar a los distinguidos delegados la gratitud de la Iglesia Católica por todos los esfuerzos que la OMS no cesa de desplegar para el mejoramiento de la salud de los pueblos, así como la atención y el interés de mi delegación y mío propia hacia los trabajos de la 50 a Asamblea Mundial de la Salud. Nuestro agradecimiento va dirigido en especial al Dr. Nakajima por todos sus esfuerzos en favor de la salud en el mundo durante toda su gestión. La delegación de la Santa Sede ve con buenos ojos una estrategia de la salud para todos que se basa en la persona humana y que se integra en una dinámica global y sostenible de desarrollo, en el que el hombre jamás podrá ser medio, pues es su forjador y su fin. A este respecto, quisiera ilustrar mi punto de vista con tres observaciones relativas a la consulta en curso de acuerdo a la actualización de la estrategia mundial de la salud para todos. La Iglesia Católica, con sus instituciones de salud, desea tomar parte activamente en la definición de la nueva política de la salud. Consultadas estas instituciones sobre los enunciados más importantes de tal política, un buen número de ellas estima que uno de los problemas sobresalientes está constituido por la accesibilidad a los cuidados médicos y particularmente a las medicinas. Este problema tocará al conjunto de países, no solamente a los más desprotegidos, sino también a los países llamados ricos. Está unido al envejecimiento de la población, a la discriminación siempre flagrante entre ricos y pobres y al retroceso de sistemas de seguridad social, que son privatizados cada vez más. En este sentido, la accesibilidad a los cuidados médicos es una problemática mundial. Si no se quiere hacer de la equidad «letra muerta», algo como un eslogan barato, parece importante: primero, reducir el costo de los cuidados médicos y de las medicinas, conduciéndolos a niveles relativamente bajos, gracias a una nueva política de cuidados primarios y de medicamentos esenciales, lo que concierne tanto a los países ricos como a los pobres. Segundo, basar una política del género en una solidaridad entre las generaciones, entre las diversas personas, entre los sanos y los enfermos, entre los diferentes grupos o categorías, entre los ricos y los pobres. En resumen: urge introducir en la nueva estrategia la noción de sociedades de solidaridad mutua en la accesibilidad a los cuidados médicos y en particular en la accesibilidad a los medicamentos esenciales.

159 A50/VR/6 page 147 Como se trata de reformas sanitarias en curso en la mayor parte de los países y la tendencia es definir la política y evaluar la eficacia sobre la base de los costos economicofínancieros motivados por la enfermedad y la incapacidad, mi delegación hace propia la justa y pertinente observación del Director General de la OMS en su discurso a la 99 a reunión del Consejo Ejecutivo, cuando declara que conviene «tomar en cuenta el costo social y político de la enfermedad, de los sufrimientos y de las desigualdades de acceso a la salud y al desarrollo con la desintegración social, la inestabilidad política y la violencia que ellas entrañan». En fin, respecto a la salud reproductiva, mi delegación quisiera subrayar que ese programa concierne directamente a la vida humana y que no puede limitarse a una fase de la existencia humana. El hombre es un todo con su dimensión física, psíquica, emocional y relacional. En consecuencia, la concepción, la venida al mundo, las relaciones sexuales, hacen parte de un conjunto que compromete a la persona en una dinámica de relación que concierne tanto a la familia cuanto a la sociedad. Una salud ligada únicamente con la función sexual y reproductiva sería reductora y en cierta forma en contradicción con la misma definición de la salud que ha sido dada por la OMS, esto es, un estado de bienestar físico, psíquico y social del individuo. Quisiera concluir, señor Presidente, diciendo que si el desarrollo humano integral se vuelve el cuadro estratégico de la nueva política de la OMS, esto querrá decir que la persona humana debe ser su fin y su medida; reafirmar el respeto de su dignidad, su derecho a la vida y a una salud de calidad; recordar el derecho y la obligación de las Naciones a una cooperación y a una solidaridad basada sobre este respeto y la responsabilidad de todos y de cada uno constituye la mejor garantía moral de una política sanitaria conforme con la misión original de la OMS, proyectada hacia el tercer milenio. I thank the Observer for the Holy See for his statement. That completes the list of speakers. I now give the floor to the Director-General. Dr Nakajima you have the floor. The DIRECTOR-GENERAL: Mr President, Vice-Presidents, distinguished delegates, ladies and gentlemen, at the conclusion of this debate, I wish, first of all, to thank all delegates for their positive comments regarding The world health report These compliments are a source of great encouragement to my staff and to me. I have taken due note of the comments regarding certain areas where Member States would have wished to see more emphasis, for example, policy tools that can influence reform at all levels. As underlined by several speakers, today we face a more complex and difficult environment in health than has occurred in the last 50 years, that is during the lifespan of our Organization. I note that most countries are very concerned at the rising incidence of noncommunicable diseases, caused to a great extent by changing lifestyles - tobacco, nutrition - and environment, and the associated medico-ethical issues. I was glad to learn of the innovative efforts they are making to cope with the changing patterns of disease and to adjust their health systems to deal with this double burden. In this regard I applaud the efforts being made by certain countries, particularly certain developing countries - which face the heaviest burden of ill health - to reform and strengthen the management of their health systems. I note with satisfaction that many countries are giving more attention to improving the quality of human life and the whole span of human life and family life, and have recognized the importance of tackling at an early age the conditions that can cause suffering and disability in later years. I hope that the strong partnerships in health that we in WHO seek to establish for the twenty-first century will open new avenues to diminishing the known risk factors of many of these chronic conditions. Such partnerships will, I trust, foster the collaboration and the solidarity we will need to help each other in meeting our common challenges. This collaboration is crucial if we are to succeed in making new approaches and new technology available where they are most needed and in closely harmonizing technology and approaches. I appreciate the interest and support expressed by many delegates for our collective effort to renew the health-for-all strategy, and I would like to thank Member States for their constructive participation in this task. The need for WHO's leadership is widely recognized. May I remind you that the continued strength and unity which are necessary to enable the Organization to fulfil its task lie in your hands. I thank all of you for your expressions of support, and my thanks to the President and Vice-Presidents for steering this most important debate.

160 A50/VR/6 page 148 Thank you, Dr Nakajima. Committees A and В will meet this afternoon. The next plenary meeting will be held tomorrow, Thursday 8 May, at 17:00, when we shall consider Item 13, Awards, and its subitems. The meeting is adjourned. The meeting rose at 13:05. La séance est levée à 13h05.

161 A50/VR/11 page 149 SEVENTH PLENARY MEETING Thursday, 8 May 1997,at 17:00 President: Mr Saleem I. SHERVANI (India) SEPTIEME SEANCE PLENIERE Jeudi 8 mai 1997, 17 heures Président: M. Saleem I. SHERVANI (Inde) AWARDS DISTINCTIONS The Assembly is called to order. We shall now take up item 13: Awards. Excellencies, distinguished delegates, ladies and gentlemen, we are assembled here today for the presentation of the prizes awarded by the Léon Bernard Foundation, the Dr A.T. Shousha Foundation, the Ihsan Dogramaci Family Health Foundation, the United Arab Emirates Health Foundation, as well as for the presentation of the Jacques Parisot Foundation Medal, the Sasakawa Health Prize, and the Dr Comían A.A. Quenum Prize for Public Health in Africa. I have much pleasure in welcoming among us the distinguished winners of these prestigious prizes, who are seated on the rostrum. I am also very pleased to greet Professor Ihsan Dogramaci, the founder of the Ihsan Dogramaci Family Health Prize, Professor Kenzo Kiikuni, representing the Sasakawa Memorial Health Foundation, and Mr H.A.R. Al-Madfaa, Minister of Health of the United Arab Emirates, representing the founder of the United Arab Emirates Health Foundation Prize. Presentation of the Léon Bernard Foundation Prize Remise du Prix de la Fondation Léon Bernard We shall start with the presentation of the Léon Bernard Foundation Prize, item 13.1 of the agenda. This prize is given every two years to a person having accomplished outstanding service in the field of social medicine. The Léon Bernard Foundation Prize is awarded this year to Academician Evgueni I. Cazov, of the Russian Federation. Academician Cazov is a prominent figure at both national and international level as a scientist, physician and public health administrator. A member and academician of the USSR Academy of Medical Sciences since 1971 and of the USSR Academy of Sciences since 1979, for more than 20 years Academician Cazov held several key positions in the Ministry of Health, culminating in that of Minister of Health, a post which he occupied until In these high-level positions, he was instrumental in the planning, organization and management of public health in the entire country, in developing primary health and promoting a system of integrated prevention. Academician Cazov is also a well-known cardiologist, one of the pioneers of thrombolytic therapy for myocardial infarction. He is currently Director of the Cardiology Research Complex of the Russian Ministry of Health. His work in this domain has received worldwide acknowledgement. He is an honorary doctor

162 A50/VR/10 page 150 of a number of foreign academies and universities and has received throughout his long career many prestigious awards. v For his outstanding achievements, I have great pleasure in presenting Academician Cazov, in the name of us all, with the Léon Bernard Foundation Medal and Prize. Amid applause, the President handed the Léon Bernard Foundation Prize to Academician E.I. Cazov. Le Président remet à l'académicien E.I. Cazov le Prix de la Fondation Léon Bernard. (Applaudissements) I invite Academician Çazov to address the Assembly. Academician CAZOV: Академик ЧАЗОВ (Российская Федерация) Уважаемый г-н Председатель, уважаемый г-н Генеральный директор, уважаемые министры, коллеги, дамы и господа, Прежде всего, разрешите мне выразить искреннюю признательность Всемирной организации здравоохранения за высокую честь присуждения мне Премии Леона Бернара. Я отношу эту Премию не только к себе, я отношу эту Премию к большой армии советских русских организаторов здравоохранения, создавших такую систему медицинской помощи, которая была предложена Всемирной организации здравоохранения на Алма-Атинской конференции как эталон для других стран. Мы все учимся друг у друга, пытаясь использовать в своей деятельности все лучшее, что создается в мире. Вспомним Горация, который говорил: "Если что знаешь получше - поделись, если нет - у меня поучись". Сорок пять лет я слушаю сердца людей. Их были десятки тысяч. Это были сердца президентов различных стран и простых рабочих, ученых и фермеров, врачей и банкиров, но все здоровые сердца звучали одинаково, независимо от того, какую идеологию и религию исповедовали эти люди и какой цвет кожи у них был. Мы все вместе с вами защищаем эти сердца от болезней, прекрасно понимая, что нет большей ценности для общества и государства, чем здоровье народа. Однако не все общественные, политические и государственные деятели, к сожалению, и в моей стране, понимают эту азбучную истину. Вероятно, был прав Платон, который говорил: "Истина прекрасна и незыблема, но, думается, внушить ее нелегко". Эту истину не просто внушает, а постоянно внедряет в жизнь человечества Всемирная организация здравоохранения, объединяя в борьбе за здоровье усилия организаторов здравоохранения, ученых и врачей многих стран мира. Мы единое целое вместе с вами, потому что у нас один враг - это болезни и все, что их вызывает, и в этой связи вспомним слова великого английского поэта Джона Дона, который говорил: "Смерть каждого человека умаляет и меня, ибо я един со всем человечеством, поэтому никогда не спрашивай, по ком звонит колокол. Колокол звонит по тебе". Мы живем и работаем ради того, чтобы колокол смерти звучал как можно реже на нашей планете. В этом счастье нашей жизни, счастье нашего труда. Еще раз большое спасибо за Премию и за ваше внимание. Thank you, Dr Cazov.

163 A50/VR/10 page 151 Presentation of the Dr A.T. Shousha Foundation Prize Remise du Prix de la Fondation Dr A.T. Shousha I shall now proceed to the presentation of the Dr A.T. Shousha Foundation Prize, item 13.2 of the agenda. The Dr A.T. Shousha Foundation Medal and Prize are presented at the World Health Assembly, each year, to a person who has rendered significant service in the field of health in the geographical area in which Dr A.T. Shousha served the World Health Organization. The Dr A.T. Shousha Foundation Medal and Prize are awarded this year to Professor Mamdouh Kamal Gabr,from Egypt. Professor Gabr is a prominent figure at national, regional and international level. As a member of the National Council for Childhood since 1974,he has been very active in promoting national strategies for child health and nutrition, school feeding, vaccination programmes against measles, and the banning of milk formula advertising. As an adviser to the Ministry of Health, then Minister of Health, he was instrumental in the planning and implementation of rural and urban projects on primary health care and in the establishment of training programmes for PHC workers. He also initiated, jointly with WHO/UNICEF/USAID, a successful programme on oral rehydration. At the international level, Professor Gabr has held a number of prominent positions, all concerned with child health and nutrition, such as the Presidency of the International Union of Nutritional Sciences, and that of the International Pediatric Association. He is extremely well known in international fora, and the African and Eastern Mediterranean regions have greatly benefited from his expertise and experience in the fields of child health, nutrition, and public health. Professor Gabr is currently Chairman of the International Nutrition Forum, Secretary-General of the Egyptian Red Crescent Society, and Chairman of the Consultative Committee of WHO's Eastern Mediterranean Region. For his outstanding contribution to improve the health situation in the Eastern Mediterranean Region, I now have great pleasure in presenting Professor Gabr with the Dr A.T. Shousha Foundation Medal and Prize. Amid applause, the President handed the Dr A.T. Shousha Foundation Prize to Professor M.IC Gabr. Le Président remet au Professeur M.1C Gabr le Prix de la Fondation Dr A.T. Shousha. (Applaudissements) I invite Professor Gabr to address the Assembly. Professor GABR: Honourable President of the World Health Assembly, honourable heads and members of delegations, honourable Director-General and Regional Directors of WHO, excellencies, ambassadors and visitors, ladies and gentlemen, it is a great honour for me and for Egypt to receive the Shousha Foundation Prize. It is a dual honour for Egypt, this year, since the fellowship awarded by the Shousha Foundation was also received by an Egyptian. Awarding me the prize reflects the trust of Minister Ismail Sallam who forwarded my nomination as well as the appreciation of the honourable members of the committee that proposed my name and the international recognition by members of the Executive Board who approved it. May they kindly accept my sincere thanks and deep gratitude. It is almost 50 years since I started medical practice. During this period I have participated in various national, regional, and international activities. I have had the unique experience of working in both academic and service careers; in Cairo University and as Minister of Health for Egypt. This dual experience, together with my affiliation to the International Pediatric Association and the International Union of Nutritional Sciences has allowed me to have a broader vision on ways of solving health problems through applying modern scientific knowledge cost-effectively. I have had the opportunity of working with many leaders and pioneers in health care at regional and international level. Together we introduced oral rehydration to Egypt and the region, with a marked decline in diarrhoea-related mortality. Spreading vaccination coverage and improving maternal and childhood nutrition were other challenges. Health care facilities reached the unreachable in remote areas. These and other achievements were the fruits of the efforts of these early pioneers many of whom have received the Shousha Foundation Prize. It is an honour to join them.

164 A50/VR/6 page 152 I have witnessed the great achievements and innovative approaches of the Eastern Mediterranean Region (EMRO) during the last 50 years, under the leadership of its late directors Dr Ali Tewfik Shousha and Dr A. Hussein Taba, achievements which are maintained with great zeal by the present Regional Director Dr Hussein Gezairy. EMRO had the quickest increase in vaccination coverage and decrease in infant mortality among all WHO regions in the early 1990s. EMRO successfully initiated cooperation between medical schools and health services in order to promote medical education and achieve the goals of health for all. Ladies and gentlemen, may I take this opportunity of thanking you for your kind attendance and wish you all success in your endeavours to promote better health and welfare for mankind. Thank you, Professor Gabr. Presentation of the Jacques Parisot Foundation Medal Remise de la médaille de la Fondation Jacques Parisot I shall now proceed to the presentation of the Jacques Parisot Foundation Medal, item 13.3 of the agenda. This foundation was established for the purpose of awarding, every two years, a fellowship for research in social medicine or public health. The fellowship was awarded last year to Professor Kumudu Wijewardene from Sri Lanka. Professor Wijewardene is Professor of Community and Family Medicine at the University of Kelaniya, Sri Lanka. She is a specialist in statistics, epidemiology, research methodology, occupational health and demography. She also trains health-care workers in health-services research. She has conducted national health surveys, as well as research work for UNICEF and the International Development Research Centre (IDRC). The subject of the research study which she has carried out last year, under the Jacques Parisot Fellowship, concerns the role of women's organizations in promoting and protecting specific aspects of reproductive health. Professor Wijewardene will give us in a few minutes a very brief outline of the results of her work. In the meantime, it is a privilege for me to present to Professor Wijewardene the Jacques Parisot Foundation Medal. Amid applause, the President handed the Jacques Parisot Foundation Medal to Professor Wijewardene. Le Président remet au Professeur Wijewardene la médaille de la Fondation Jacques Parisot. (Applaudissements) Professor Wijewardene, you have the floor. Professor WIJEWARDENE: Mr President, distinguished delegates, ladies and gentlemen, I consider it a great honour to receive the Jacques Parisot Medal at the Fiftieth World Health Assembly, which is a significant milestone in the life of the Organization. I would like to thank the Jacques Parisot Foundation for giving me an opportunity to carry out research on the "Role of women's organizations in promoting and protecting specific aspects of reproductive health". An unwanted pregnancy is a dilemma and a source of emotional stress for any woman. In Sri Lanka many unwanted pregnancies end in unsafe abortion, placing those women at high risk. About 11% of maternal deaths in Sri Lanka are from septic abortion. Although abortion is illegal (except when performed for the sole purpose of saving the life of the mother), a significant number of abortions are performed daily under unhygienic conditions by unskilled persons. About 90% of unwanted pregnancies result from failure to use contraceptives. Unprotected intercourse is an open invitation to sexually transmitted infection, including HIV. The estimated disease burden of HIV-positive patients for Sri Lanka for the year 1996 was 6800.

165 A50/VR/6 page 153 Even with an 83% female literacy rate and freely available family planning services by the State, only 16.5% of married women use modern contraceptive methods. Although the electronic and print media and other formal methods of communications are powerful tools for increasing awareness and acceptance of family planning, non-formal education by word of mouth is also a potent source, especially in schools. Moreover, women in a reproductive crisis nearly always contact another female friend or a relative for advice. The objective of the study was to determine the role of women's organizations in providing information regarding prevention of unwanted pregnancies, unsafe abortions and sexually transmitted diseases (STD) including AIDS. A community intervention study was carried out by selecting two areas with similar sociodemographic features. In one area, representatives of women's organizations were trained to provide knowledge, change attitudes and promote decision-making on contraceptives and STD, within the existing cultural framework. Baseline data were collected by trained data collectors through a questionnaire addressed to randomly selected women in each area and through a "self-administered" questionnaire completed by schoolgirls over the age of 14. The programme was evaluated after six months by applying the same questionnaire in the intervention area and a control area, adopting the same sampling procedure. The results showed that there was a statistically significant improvement in the intervention area of the knowledge of students and adult women on transmission of HIV and regarding preventive measures against HIV transmission, such as having sex with a mutually faithful partner, or using condoms if having sex with an unknown partner. There was a significant improvement in the knowledge of women regarding all modern contraceptive methods. Although none of the women in the area was aware of the post-coital contraceptive pill, after the intervention 8.2% became aware of it and over two-thirds of them were below the age of 19 years. Before the intervention programme, 40% of women thought the oral pill had adverse effects on health and at the end of the study there was a statistically significant fall. Younger women changed their attitude more readily than older ones. Given the short duration of the study, it was not possible to observe a significant role of peer education in changing the negative attitude towards condoms or in improving knowledge regarding sexually transmitted diseases such as syphilis or gonorrhoea. The outcome of the programme is yet to be evaluated, as six months is too short a period to assess the impact of unwanted pregnancies and termination. However, a slight decrease in termination of pregnancies was observed during the last few months in the study area as compared to the control area. The results of the study indicate that the reproductive health of the women can be promoted through peer education. The intervention provided an opportunity for women to discuss their health problems with others in the community. For cultural reasons, teachers are reluctant to provide accurate knowledge about sex and reproductive health and the study shows that students can be influenced by community women's organizations and peer education. It also indicates that the training of representatives of women's organizations to provide knowledge on reproductive health to the community is feasible and acceptable. The study has contributed significantly towards emphasizing the possible role of women's organizations in the community in improving knowledge about reproductive health issues. I once again thank the Jacques Parisot Foundation for helping me to carry out research in this important field. Thank you, Professor Wijewardene. Presentation of the Ihsan Dogramaci Family Health Foundation Prize Remise du Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille We now go on to the presentation of the Ihsan Dogramaci Family Health Foundation Prize, agenda item This prize is being awarded for the first time this year. It was established in January 1996, under the name of its founder, as an extension of the Child Health Foundation Prize already promoted by Professor Dogramaci in It is given every two years to a person who has accomplished service in the field of family health. I have pleasure in announcing that the Ihsan Dogramaci Family Health Foundation Prize has been awarded this year to Mrs Sara Nazarbayeva, the First Lady of Kazakstan.

166 A50/VR/6 page 154 Mrs Nazarbayeva is devoting much time and energy to improving the situation of women and children in her country. In 1992,she promoted the establishment of the children's charity fund called "Bobek" (meaning "young child" in Kazak), which aims to create optimal conditions for children's life and development, protect their rights and legal interests and promote family health in general. She has been President of this fund since its inception. Under Mrs Nazarbayeva's strong leadership, the Bobek fund has undertaken a wide range of activities all directed at improving the health and well-being of children and the family. It also promotes education programmes for children and plays an important role in promoting the implementation of the Convention on the Rights of the Child and in advocating legislative reforms aimed at protecting vulnerable population groups. In spite of its short existence, the Bobek fund has acquired wide international recognition, and Mrs Nazarbayeva's action for the protection of children and women's rights is also well loiown at the international level. I now invite Professor Ihsan Dogramaci, the distinguished founder of the Prize to address the Assembly. Professor DOGRAMACI: Mr President, distinguished delegates, first of all I thank you for allowing me to extend my congratulations to Mrs Sara Nazarbayeva in public. I also want to congratulate and thank the committee and the Executive Board of WHO for making such a selection. We just heard briefly about Mrs Sara Nazarbayeva's achievements, but I can add one or two things. She does not belong to the medical or health profession. She is an economist by training, but has done a lot more than many who belong to the medical or health profession in her country and elsewhere. Before establishing the Bobek Foundation - "Bobek" in Kazak means young child - she spent a great deal of her time working for children, women and families in public life soon after finishing her training. She has promoted child health throughout the country, and has been a forceful agent in promoting immunization and the fight against diarrhoea and respiratory infections which are the main hazards for children. She has represented not only her own country, but Central Asian countries at a number of international conventions. I could mention among them the Fourth World Conference on Women, held in 1995 in Beijing, and the November 1995 meeting on the rights of the child, held in Paris. I would also like to congratulate Mrs Sara Nazarbayeva on behalf of my country, Turkey, because we regard Kazakstan as a sister country. I therefore take pleasure in extending our congratulations to her in public. Thank you. Thank you, Professor Dogramaci. In recognition of her devotion to the cause of women and children, I have the great honour to present to Mrs Nazarbayeva the first Ihsan Dogramaci Family Health Foundation Prize. Amid applause, the President handed the Ihsan Dogramaci Family Health Foundation Prize to Mrs S. Nazarbayeva. Le Président remet à Mme S. Nazarbayeva le Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille. (Applaudissements) Mrs NAZARBAYEVA: Г-жа НАЗАРБАЕВА (Казахстан) Здравствуйте, Уважаемый г-н Председатель, уважаемый г-н Генеральный директор, дамы и господа, дорогие друзья, Позвольте мне искренне поблагодарить членов Комитета Фонда Ихсана Дограмачи для охраны здоровья семьи за присуждение мне столь высокой международной награды, за признание моего скромного вклада в это святое дело - охрану здоровья семьи, защиту

167 A50/VR/6 page 155 материнства и детства, за высокую честь, которая оказана вами в моем лице родному Казахстану. Сегодня наша страна, идя по пути коренных реформ, испытывает трудности. За пятилетнюю историю своей независимости сложно преодолеть экономический кризис. И без того непростую ситуацию осложняют последствия безумного вмешательства человека в природу. Многолетние атомные испытания на Семипалатинском ядерном полигоне, стремительное исчезновение с лица земли Аральского моря принесли много горя нашему народу. Влияние этих экологических бедствий ощущается далеко за пределами нашего государства и стран СНГ. Понятно, что эти трудности легли на всех казахстанцев, но особенно - на хрупкие плечи женщин и детей. Создав в 1992 г. Детский фонд, я хотела помочь самым беззащитным и обездоленным в это непростое время - детям. Название моего Фонда Бабек переводится с казахского как "маленький мой" и созвучно английскому слову baby. За прошедшее с тех пор время проведено множество благотворительных акций совместно с ЮНИСЕФ, и правительством Казахстана принята и начала действовать программа Аспера, программа помощи детям и женщинам Приаралья. В Алма-Ате открыт первый в Казахстане детский неврологический центр, отремонтированы и оснащены детские отделения институтов туберкулеза, онкологии, онкогематологические отделения. Детским больницам подарены автомашины и другое необходимое оборудование. В этом году завершается строительство первого в стране детского оздоровительного центра. Ежедневно сталкиваясь с горем, безысходностью и отчаянием матерей больных детей, я все больше думала, как людям найти новый путь к здоровью, как быть здоровыми не только физически, но и духовно-нравственно. Я убеждена, что в природе эти стороны человеческой жизни взаимосвязаны. Этот новый взгляд был предложен и обоснован русским самородком и философом Парфирием Ивановым в системе природного оздоровления "Детка". Нести людям здоровый образ жизни - правило системы 一 стало одной из главных задач моего Фонда, моей путеводной звездой. Сегодня в этой системе природного оздоровления многие люди не только в Казахстане находят настоящий спасательный круг, обретают надежду на улучшение здоровья, расширяется самосознание человека. Бывая во многих уголках земного шара, я замечала, что многие по-своему стремятся идти по пути единения с природой, находить нетрадиционные подходы к здоровью, духовнонравственному возрождению, и это очень важно. Я убеждена, что если бы все жители планеты придерживались этих принципов и понимали, что без нравственного здоровья не может быть здоровья физического, то в третье тысячелетие человечество вступило бы с наименьшими проблемами в духе взаимопонимания и согласия между людьми. Я считаю, что эта высокая аудитория несет божественную миссию. Всеми нами движет любовь к человеку. Мировая общественность сможет еще очень многое сделать для оздоровления человечества, развивая основные принципы Устава Всемирной организации здравоохранения и определив в новом тысячелетии новые пути защиты здоровья, объединив для этого наши усилия и средства. Прекрасным примером подобного объединения служит Алма- Атинская декларация, подписанная на Международной конференции ВОЗ в столице Казахстана 20 лет назад. Давайте же жить в полной гармонии с природой, с окружающим нас прекрасным миром. Как говорят, здоровый нищий счастливее больного короля, поэтому я желаю всем нам здоровья, счастья. Мир вашему дому, мир нашему общему дому - планете Земля. Благодарю за внимание. Thank you, Mrs Nazarbayeva.

168 A50/VR/6 page 156 Presentation of the Sasakawa Health Prize Remise du Prix Sasakawa pour la Santé Distinguished delegates, ladies and gentlemen, I shall now proceed to the presentation of the Sasakawa Health Prize, agenda item This prize rewards outstanding, innovative work in health development and aims to encourage further advancement of such work. It is a great pleasure for me to announce that the 1997 Sasakawa Health Prize has been awarded to the Mongar Health Services Development Project, Bhutan. The purpose of this project was to devise and test a system of effective, comprehensive, primary health care with functional referral support services through the promotion of community participation and intersectoral collaboration. The main activities included the development of coordinating bodies at various levels in the district, the setting-up of a village health-workers system, the establishment of outreach clinics of basic health units and the district hospital. Particular emphasis was placed on the promotion of awareness and overall organization of the communities, the strengthening of expanded programmes of immunization, the promotion of sanitation and hygiene, safe drinking-water supplies and nutritional development. Supportive activities comprised the strengthening of the health referral system, the logistic and information support system and the development of a women's health-workers system in the district. The Mongar Project has yielded very positive results. It has manifestly helped to improve primary health care approaches in Bhutan and continues to have a broad influence on the expansion of health services in the country. The prize money will be utilized to replicate in other districts the experiences of the Mongar Project. I now invite Professor Kiikuni to address the Assembly on behalf of the Sasakawa Memorial Health Foundation. Professor KIIKUNI: Mr President, Mr Shervani; distinguished winner of this year's Sasakawa Health Prize, the Mongar Health Services Development Project of the Kingdom of Bhutan; Mr Director-General, Dr Hiroshi Nakajima; excellencies, distinguished delegates and friends, first of all let me express my most sincere esteem and appreciation to all my colleagues gathered here today for your tireless effort for the advancement of health and welfare of the people of this world. On behalf of the Nippon Foundation and Sasakawa Memorial Health Foundation, I would like to congratulate the Mongar Health Services Development Project of the Kingdom of Bhutan, the recipient of this year's Sasakawa Health Prize, for your most innovative effort and leadership which has inspired all of us whose concern is the enhancement of health of the people of the world. The Sasakawa Health Prize originated in 1985 by a complete agreement between the two unique leaders in health: Dr Halfdan Mahler, the then Director-General of WHO, and the late Mr Ryoichi Sasakawa, the founder of the prize and the then chair of the Japan Shipbuilding Industry Foundation. The prize was established to demonstrate the strong commitment by the two leaders to the betterment of health of the people through individual and group efforts in primary health care. It was in the mid-1970s that Mr Ryoichi Sasakawa decided to support WHO's effort in leprosy elimination. Leprosy is a disease which had been generally forgotten, but Mr Ryoichi Sasakawa was different. He had a special concern and sympathy for the sufferers from the disease. In those days, it was a disease with grave social consequences; patients had to suffer not only physically but socially and psychologically. There was another person who had deep concern and interest in this disease. It was the late Professor Morizo Ishidate, a noted scientist and the first chair of the Sasakawa Memorial Health Foundation. Some of you may know that he was the pioneer of leprosy chemotherapy in Japan, who synthesized and applied the drug sulfone in the early 1940s. He had always felt that it was Japan's honourable responsibility to contribute to the elimination of leprosy. Mr Sasakawa asked me to personally convey this message to Dr Mahler when he made the first financial contribution to WHO in the mid-1970s. Dr Mahler was very gratified by these words. However, a week after our meeting, Dr Mahler called me at my house and asked me whether this particular contribution from Mr Sasakawa could be used for smallpox eradication, which was at a crucial stage of achievement, although he acknowledged leprosy as an important issue as well. To this request Mr Ryoichi replied "the contribution now belongs to WHO, and therefore it can be utilized in any way that WHO thinks is best and most effective". Dr Mahler was greatly impressed by these words and said "voluntary contributions made to WHO usually have various strings attached". It was the first time anyone had entrusted him entirely with the utilization of such considerable

169 A50/VR" page 157 contribution. This became the basis of their strong friendship thereafter, which led to the establishment of Sasakawa Health Prize to promote the goals of "Health for All" of WHO and "the World is One Big Family: All Mankind are Brothers and Sisters" of the Nippon Foundation (the Nippon Foundation known until last year as the Japan Shipbuilding Industry Foundation). I am sure that the earnest wishes of these leaders implanted in this prize will be realized by the efforts of the past, present and future laureates of the Prize. Many of the prizewinners of the past are people making tremendous efforts at a grass-roots level. We should not forget that it was by those people's effort that the eradication of smallpox was achieved. Presently the Nippon Foundation and Sasakawa Memorial Health Foundation are putting all their efforts into the elimination of leprosy as a public health problem - a goal proclaimed by the World Health Assembly in Leprosy is a disease with a long history of suffering over the centuries throughout the world. No other disease brings such agony and distress to those afflicted and to their families as does leprosy. WHO's definition of health being the physical, mental and social well-being of people, the elimination of leprosy will no doubt have a significant meaning in human history. Eliminating an age-old disease, however, requires a tremendous effort in every sector of the society. Maintaining political commitment, ensuring financial resources and planning and implementing the programme from top to grass-roots level is a formidable challenge. I must truly praise the determination and leadership of the Director-General, Dr Hiroshi Nakajima, who is in fact the godfather of leprosy control, starting multidrug therapy in the field of the Philippines when he was the Regional Director at the Western Pacific Regional Office. I sincerely hope that the colleagues gathered here will honour the decision of the Delhi Conference on Leprosy Elimination of last October, held in New Delhi, which agreed to a concerted effort to reach every patient in every village to deliver multidrug therapy to achieve the goal of elimination. The Nippon Foundation now has a new chair, Mrs Ayako Sono, an acclaimed writer of conscience, and Mr Yohei Sasakawa has become its President. The Foundation's firm perspective reflected in their work is already gaining recognition and respect along with their new name. Mrs Sono personally expressed her interest to visit Myanmar later this year to observe our united effort of extending leprosy multidrug therapy in remote and difficult areas of the country. I interpret this as an expression of their eagerness and sincerity and hope the Foundation will be satisfied to find that multidrug therapy is reaching the periphery by the effort of grass-roots workers. Mr Yohei Sasakawa was unfortunately unable to attend this ceremony today. But he has personally asked me to deliver his message that he would very much like to visit each Member State in future to strengthen ties of cooperation between your countries and the Nippon Foundation. I would like to close my speech with the wish that the efforts of all of you, especially the recipient of the health prize this year, may materialize to bring about the elimination of leprosy as a public health problem by the year 2000,under the leadership of the Director-General, Dr Hiroshi Nakajima, and the distinguished delegates of each Member State. This is a unique opportunity and a challenge to mankind. Let us reconfirm our commitment to unite our efforts to eliminate leprosy as a concrete and important element of the achievement of health for all. Thank you for your attention. Thank you, Professor Kiikuni. It is now my privilege and honour to present the Sasakawa Health Prize to His Excellency Dasho Jigme Yozer Thinley, Ambassador, Permanent Representative of the Kingdom of Bhutan to the United Nations Office in Geneva, on behalf of the health workers and people of the Mongar District. Amid applause, the President handed the Sasakawa Health Prize to Mr Thinley on behalf of the Mongar Health Services Development Project. Le Président remet le Prix Sasakawa pour la Santé à M. Thinley pour le compte du projet de développement des services de santé de Mongar. (Applaudissements) I now invite Ambassador Thinley to address the Assembly.

170 A50/VR/6 page 158 Mr THINLEY: Mr President, esteemed Director-General, distinguished delegates, ladies and gentlemen, on behalf of the Royal Government of Bhutan and the staff of the Mongar Health Services Development Project, I am most honoured to receive the prestigious Sasakawa Health Prize. As I was the administrative head of the region when the project was implemented, this privilege indeed gives me deep satisfaction. Under the personal guidance of His Majesty the King, a very elaborate health infrastructure has been established to promote public health among our rural people, who are often isolated in small groups and households by the awesome features of the great Himalayas. Convinced that a well structured and managed primary health care service must continue to be the backbone of our health system, the search for ways and means to enhance the efficiency and effectiveness of the service is continuous. It was for this reason that the Government decided to choose Mongar as the most representative district where a pilot project would be carried out to test the efficacy of several innovative approaches aimed at further improving the coverage, effectiveness and sustainability of primary health care as an integral part of community development efforts. It targeted every member of the district community with special emphasis on the mother and child while promoting active community participation. Remarkable achievements were made for all the stated objectives, both in quantitative and qualitative terms. Encouraged by the success of the pilot project which ended in 1990,the Royal Government has already replicated the project ideas on a nationwide basis. The project was funded by WHO and, throughout its life, valuable technical and material assistance was provided by the Regional Office of WHO. Indeed, this is yet another example of the encouragement and support that WHO has always given to new and innovative ideas to promote the well-being of the global community. Beyond the excellent quality of the project design and management, a key element, which was strikingly visible to me during field inspections was the deep sense of commitment and dedication of the project staff at all levels. I found that, living in spartan and harsh conditions and often separated from their loved ones, the basic health workers in particular had established a special bond of trust with their respective communities. They were people in whom the young and old alike could confide their very personal problems and seek advice with casual ease and frankness. It was such commitment and the resultant mutual trust which, above all else, contributed to the success of the project. I believe that the wisdom which emerged from the project is that there can be no greater tool for any agent of development than the trust which must be cultivated on the fertile ground of mutual respect and nourished through the sincerity of purpose. The members of the team did not seek reward or recognition. But even the most altruistic among us can benefit from the occasional stimulants for self-renewal and reinvigoration. Often, a pat on the back is all that is needed. Although the project staff are now scattered across the country replicating their commendable achievements, I am certain that the news of this most prestigious award, which I receive in their name, will inspire them and spur their silent but noble endeavours to achieve the Alma-Ata goal of health for all before the dawning of the next millennium. Thank you, Mr Ambassador. Presentation of the Dr Comían A.A. Quenum Prize for Public Health in Africa Remise du Prix Dr Comían A.A. Quenum pour la Santé publique en Afrique Ladies and gentlemen, I now come to the presentation of the Dr Comían A.A. Quenum Prize for Public Health in Africa, item 13.7 of our agenda. The prize is awarded every two years to the person who has made the most significant contribution with regard to any health problem in the geographical area in which Dr Comían A.A. Quenum served the World Health Organization. This year, the Prize is awarded to Dr Redda Tekle-Haimanot, from Ethiopia. Taking the results of an epidemiological research project conducted in rural Ethiopia as his basis, Professor Redda Tekle-Haimanot, Professor of Medicine at Addis Ababa University, initiated the establishment of a community-based rehabilitation centre in a rural district south of Addis Ababa. The centre provides services to rural people suffering from epilepsy, post-poliomyelitis paralysis, and care to persons

171 A50/VR/6 page 159 with impaired vision. The ultimate aim of the project is to help those patients to become more independent and useful members of the community. The centre is using mobile teams in order to reach the villagers in their own surroundings, thus preventing the hardship and expense of inconvenient transportation to unfamiliar and unfriendly urban health centres. Professor Redda Tekle-Haimanot has also developed training programmes for local health personnel, and created a workshop which makes aids and appliances for the physically disabled and also produces furniture and other items for sale, thus generating income for the project. Professor Redda Tekle-Haimanot, throughout his pioneering work, has succeeded in involving the community and he has therefore gained respect and recognition from the community at large. He hopes to be able to set up such centres in other parts of Ethiopia. It gives me great pleasure, as a reward for his devotion to the cause of the disabled, to present the Dr Comían A.A. Quenum Prize for Public Health in Africa to Professor Redda Tekle-Haimanot. Amid applause, the President handed the Dr Comían A.A. Quenum Prize for Public Health in Africa to Dr Redda Tekle-Haimanot. Le Président remet le Prix Dr Comían A.A. Quenum pour la Santé publique en Afrique au Dr Redda Tekle-Haimanot. (Applaudissements) I now invite Dr Redda Tekle-Haimanot to address the Assembly. Dr TEKLE-HAIMANOT: Mr President, Director-General, honourable ministers and heads of delegations, distinguished delegates, ladies and gentlemen, I am privileged and honoured to be part of the Ethiopian delegation at this august Assembly, in order to come and receive the Dr Comían A.A. Quenum Prize for Public Health in Africa. Please allow me to give a very brief account of the project you have so generously endorsed for this honourable award. The community project that I have been honoured to head in my capacity as a neurologist and ordinary Ethiopian citizen started as an epidemiological research project based in rural Ethiopia. The research project was financially supported by the Addis Ababa University and the Swedish Agency for Research Cooperation with Developing Countries (SAREC). The surveys conducted between 1983 and 1990 revealed that epilepsy, mental retardation and post-poliomyelitis paralysis were the most common neurological disorders in the district of people. Blindness due to cataract and trachoma was also found to be a serious problem in the district. The work of my team was partly inspired by Dr Quenum's own philosophy. In one of his addresses on rehabilitation in 1979,he observed that there was need for epidemiological studies on the problems of disablement and pointed out that research and manpower training had to be promoted to ensure effective services for the disabled. In view of the glaring evidence of unmet needs demonstrated by our studies, we decided to implement the WHO motto of "No survey without service". We established the rehabilitation project, called Grarbet Ledekuman, in collaboration with Swedish donors and with the approval of the Ministry of Health of the Government of Ethiopia. The aims of the project were: to provide service to persons affected by epilepsy and poliomyelitis; to provide care to persons with impaired vision, in the form of surgery for cataract and trachoma complications; and to collaborate with the local and national health authorities in mass vaccination programmes within the project area. The project has the full support of the rural community, where a committee of elders is constantly and actively involved in the project management and the establishment of a local association for the disabled. The centre we established, with its outreach mobile teams, is organized to look after neglected rural persons with disabilities. These patients are not normally well attended and cared for by the existing local health institutions. We are indeed privileged to have been able to heed Dr Quenum's highly cherished humanitarian plea to provide priority of service to the poorest and most deprived persons, such as those with disabilities. We have tried to implement his multidisciplinary and multisectoral approach while at the same time ensuring the active participation of the communities.

172 A50/VR/6 page 160 I would like to express my sincere gratitude to the Regional Director for Africa, Dr Ebrahim Samba and his subcommittee on nominations for the Comían Quenum Prize for their decision to single out our project as being worthy of this merit. The African Regional Committee's and indeed this Assembly's endorsement of the decision brings comfort and pride to me, my collaborators and my country. My success would not have been realized without the close collaboration and devoted assistance of my Ethiopian and Swedish colleagues. To all I express my deepest gratitude. I would like to thank the Ministry of Health of Ethiopia, the Rotary Club of Addis Ababa West, and the WHO representative in Ethiopia, Dr Wedson Mwambazi, for their encouragement and support. Last but not least, I am indebted to the rural people of Butajira for accepting and supporting me in the organization and implementation of our project, which we sincerely hope will be a model that may be duplicated in other parts of my country and possibly other African countries. I thank you most sincerely for your attention. Thank you, Dr Redda Tekle-Haimanot. Presentation of the United Arab Emirates Health Foundation Prize Remise du Prix de la Fondation des Emirats arabes unis pour la Santé Ladies and gentlemen, I now come to the presentation of the United Arab Emirates Health Foundation Prize,item This prize is awarded to a person or persons, institution or institutions, or a nongovernmental organization or organizations, which have made an outstanding contribution to health development. The prize is awarded this year jointly to Dr Abdul Rahman Al-Awadi of Kuwait, and Dr Roberto Salvatella Agrelo,of Uruguay. Dr Abdul Rahman Al-Awadi played a prominent role in the Government of Kuwait for over 20 years, during which time he was successively Director of the Department of Preventive Services in the Ministry of Public Health, Minister of Public Health, Minister of Planning and Minister of State for Cabinet Affairs. Here we can cite only a few of his numerous achievements in very different fields of health. As Minister of Health, Dr Al-Awadi built up Kuwaiti health services, both curative and preventive. He was instrumental in promoting the training of physicians in public health so that they could occupy high-level management positions in the Ministry of Health or in hospitals. He also played an important role in supporting research into health systems and promoting health planning. Dr Al-Awadi is also a prominent figure at regional level. For 11 years he chaired the Executive Office of the Arab Health Ministers Council. He participated in the establishment of the Arab Council for Medical Specialization and played a key role in promoting the training of physicians in the region, particularly in preventive medicine and public health. Dr Al-Awadi is currently Secretary of the Regional Organization for the Protection of the Marine Environment and Secretary-General of the Arab Centre for Medical Literature. Dr Al-Awadi is also very well known in international health fora and for all his outstanding achievements he has received many prestigious awards and honours. As Director of the Chagas Disease Control Programme in Uruguay for 11 years, Dr Roberto Salvatella Agrelo undertook to reform the programme and ensure wide municipal and community participation. He obtained the support of the Ministry of Public Health, which designated the programme a priority and integrated it into the Intergovernmental Initiative of the Southern Cone for the Elimination of Chagas Disease. Dr Salvatella's talent for leadership made it possible for him to mobilize and to motivate health professionals, local communities, the media and national and local authorities to work together in order to solve the problem of Chagas disease, which was affecting the poorest in suburban and rural areas. Under Dr Salvatella's guidance, the programme succeeded in eradicating the main Chagas vector, Triatoma infestans, thereby stopping the vectorial transmission of the disease. This achievement became an exemplary objective for the region. It is indeed an example of how an individual with dedication and leadership can overcome limitations in material, human and economic resources and motivate all the sectors involved in order to achieve success. Before presenting the prize to the distinguished laureates, I call on the representative of the founder of the United Arab Emirates Health Foundation Prize, Mr H.A.R. Al-Madfaa, Minister of Health of the United Arab Emirates, to address the Health Assembly.

173 A50/VR/6 page 161 Dr. AL-MADFAA : OijUV^) jiaji J\ JLP Л^ jjsfjjl 4-JJl ^ SsJLP j^ljl C->1 сj^jl 4^1x11 4j>waJl ^Jj j-> ç ^ J i J 4^ 幻 J^ u^j ^W 5 ûlkl» y. Jblj ^ Jl j^ljl c-^u? JA ri ^ ^ í"^ ^ s-^"^3 СУ J-^W^J jjj^ J u^j s ^ c J T ^ij yij^ y ^ ^ J >. os"jí UT. Ji? Л^р ^J olyt ] ajliji ^JU col^j JT a lj oj^j оь J J - ^ i joui jl.a^juîi bwji ^ 一 uji 如 ^ a^^ji s. :ii J-^r y^jjj j^tjjij ) JLp j^'jlií ^ JS" Ji (^JuÂdi ^^JL^-JÍ üil^jj ^llii ejîu- ^L* ô^jl-j Uj U-ftjUtjG广 Ûil Upbái JA 亡 U dib OU cu^ll. SjíUJl ÓJlü JJ L^J а^ь 广 d\j 一 Lijl*^ j jjaj ^ 1 ^S^ I^OU LgJ ^ olll>- L*J e j 己 > 二. > Лз L^jIjjZ^J ejbrjujl O Í Â ] ^ ЯлмЛ ol*jbxjl Oi 4_ í^waji ^Ji JL4j.H1 J ^lîît-jj 4>JLLÜ1 Ял-síaJi ol*jbül jj ^ ^Jt^ ^JJ^ djijj N J jl^bsl! ouj jiü.ujl 丄 l^iijí 4 jljí 力 I ^^ 尸乂 ^Ьч JUaii^l IJla /. 气 o ^ yu^ Д^-jJlJÍ ouliülj Á^kiill ojoj U^ ^jj^í.b^^jjij (^JlJjJi jl jsolj JU^Síi JLi. 4 jlji L^í s^lljmij ^j-^il jl UJb çik; Sjl^UJI y \ ajj 二心 oí llr J \ VwJl o U ^ J l J o l ^ HJÜI UNÍJ a^l ouidl Jt-Síi ^ijbxi^ni cbu.^ujl J Ol^Ni ou^xij ÚÍ JbjJl ^^JLP ^UbJlj ^Üi ct^ y> SjíUJl ôijb ^ ^Jjl^JÍ LLÎJ LÍ?Ljj1 y ^^woll»j l)í Ui^ objl>jl j l ^ ^LiJ.^tJü bwji J^I^J J \ ajjsli v^ji 4 ipj)i ^Ьи cjl5" J^JJÍ j^jl sjj^ ^ ÔJljJLP OUjy^ 丄 V r 4 ) J L5^ l^ Cr^" J ^ I^JÍLA ^l-^j ^Li^l C^iji\ JL^XJ oí 已 U 乂 í Cji^U» ^ J-^ijiJl Ji^-iyii ajlp ^I^-LT ^i^sli j^jkij a^ji ojbui^ni b^ji Vwüi ^LJI ^ ^SOi ^ aiuij 广 UJi olb ou^jl ^ SOJJlJI AJL^NI ^J^L^ c^ju Jl ÍJla colb^jlj 4 JbcJl Я]ykJi J b j L s ^ J l с!ajliju yy,jj L.Í J^j-J^ ^ o i J ^ S - J^A O A Î U o ^ ÔJJUJI OJL» JU JLÂ3 c^i^pjjjí ^ A^cJUii.ô^S^ ЪгjJb 4jJJL>- y ^JlJ AIOIJJ ^ (Sj-^- jt^ ^ (J^ J^JiU JUaíl^ij ^jása^í ^t-jui) ij3l_>- oj-ssj ^J-^jj IJy*^ j IJ^L* jljl 4 y^ji ÔJJUJI ejlfe ob J^L5 lüli 1 h^jü à^jjcj^j 4-j L«J^rj Jp 4JJI UÂ3J Thank you, Mr Al-Madfaa. It is now with much pleasure that I invite Dr Al-Awadi and Dr Salvatella Agrelo to receive their Prize. Amid applause, the President handed the United Arab Emirates Health Foundation Prize to Dr A.R.A. Al-Awadi and Dr R. Salvatella Agrelo. Le Président remet au Dr A.R.A. Al-Awadi et au Dr R. Salvatella Agrelo le Prix de la Fondation des Emirats arabes unis pour la Santé. (Applaudissements) I now invite Dr Al-Awadi to address the Assembly.

174 page 162 Dr. AL-AWADI: 4JÜI XS. J\ JLP jjstjjl ^ J l C^JlT^J <Jlil 4-^-jj ^ilip joljl C4-JJI J^J JlP joljlj ô^^jlj 4Ü.^L- y 夯 Uipío(,Ç.\jj^Ji o^ljcwjl Á-JáiJl JLa OÍ oljb^íl OJjU- ^^JUj ^Si 4^-LUJ çt^jlo oí j Jj^jl ^^J Ol 4-ç>waJl A Lpjl A-JúJl AJjJÜI íí-^ ^ ^ ^ yj ejíujl ejjb L5ÍP J^va^JJ jw^ «^jyлз oj^jl ÁJL-J^I J^ijl yjioljl^ni SjíL^r JiP 0^LM^O'^JJI OJTÍ oí С. : L.Î ^2^- j-^j c^jjjjl ^r-ííj OLx^J JT OUai-^ Ji ^JÜl O^Laj S^з jlji ^Jl; ^ Coryí- J ji-ujl Lbr l5 JLp J 丄 - 一 J J L-^ojU a^jub^- U j.jjyil JT g L^ij <1,1; oi>^0 L ^ ^ J j jxs'sl C^J JÜ yjjlui^ J-Jl \jjb ^ J ÁÍJ^ olji^ djjb c^wó^jljlaaji ^ l-isy^ ^yll J 一 J Oír JJIJajuj^l 一 ôjjb ^ C^Uj ídj íj 4-LL**Jl ejüil^«jl \ cj> Ll^ Jjju^í ^J^Juj J--JO oí 已 N j OLJl^JI 4JL* olj^ J ^ja ja Iij S 二 l^ji 丨 Li? Ib ÓJljü ^^-JLP 广 jjl ^ j ^IPÍ UJLÍP Ol-JNl tc-ojsol (^JÜb ^ jjas' oí jj ^ J I ^pli^jl OJL» У 0b j^j^t^w JÜ1^waijl сиэ^jl Ùl t^j-^j) JL^Jl OL-^JN!j IJ^ Ub^J c^jüb ^ ljyjl J OIS" on.l-^дыл Jj: ^jli^j IyJjj 一 ^ o ^ 1 J 1 > Ji ejlft onu^jl ^ J^lJ OJ^ji с^д 少 лйк^л c^jjl ^bu jí oí Ub^iTÍj 4-JlSl.l JjJÜI ^lií Aíl 产 í ^ ojlililj OlSjliJl UJbr^ bjlsf ) C^^il JL^Jl ojub jí LJUÎ 0jLxij ^-JlS^I IJL^3 OjUiiliJui» ^s-jj с^jb ajji í Jj^ AJJ côï-l>- Ijl^ AJ ^PÎ c^jjl cu^jsol /'JJL-Í ^^íj c^l-iii j ^IbJl ^-jj J^ ô ^ijl J joli lu uj AÍliJU^j ДдЬиП «ulllij ojlpl^j 0^P J^ ^ЛЭ ^ j^^jlj S^b) 4J cjls^ J ^ L^ JjJÜI j ^Jls^ÍÍ J д Ч ^^ Jl ^ OLT J^J c^^jl JuJl j^u^ji ojbdi ^jj DLT j сьлз! ^bsl a^^ji a lp) ^ J^j ^fism^iji o^íu-ji ^ ^u^uo. 0jbdl UJl L^U Û ^ VJ^^ 叫.⑷ 二 "V-L^Ji ^ JÛ^Jl Lb.AJl^J^i LUaiJl Ju^. ^ A^UJl oijbl^jl JS" Jixlj oí J^UJÍj c^^bjlsnij ^yjl lil-jh oí Mi JjjJl ^^JLpSI ^LJ^ 1^3 JaxS\ ûlj a^puxjl VwJl JTL^Jl ^ 幻 LU51 01 CJLS^ ijbr 乙 Ubjl ^ L^Jby^-^ (J-Mall jajj jwcj O^JJ lijjj ^ á^s c^l^í J A j oult^jij ^jjl 力丨 C^w^í ijcl^jlslo 4jJbljl.oli ^Jl J AJlp ^ jbjoijl y^jb VwJl A LP) Lu olíj ejub ojl^j ^lijjl 01 objí L. ЛНкиЛ ojm» jjljb" L^'líiJ elb y Áí'jllj a^b al-j JUOI Jjüjlsi-fe J^LJ ai j OÍ, íl_ Ü T ba^j JSL^J ÔJla ^Ub 厶 ^L'j U^iJl OLPIUJÍ Oli diib bjl ^ JJ-ÜI L^u^i" Liyí Jlioí ^ ÁijSll jli^l o^ui^lj ijbr IJ^ as (JUJl ùl t^-j^l JL-Jl jî U^l Jbr JLw^o Jl^Í (^JlJI Ù ü b cjjb^íl y b^tj ÛL^^I ijb Ji Ыyí ^^iiil Sjj^ ^^Jlp J-T OIjIJLJI L^JLT К ^ JU^Sílj d U b JLP ЬJ.^JlxJl ^ 4JUJI J JUtl^ ^jjüi )jbdj Я)U3 C-JLA»! ^pj JjLJÍ ^ Ô^jU^ o ^^JlA AJ4.,-^IJUj íoláií ;I jl^jj 产 y V^lk^- ^ji^il ^âiil

175 Jjj- 一 bjl ^Ji S0515 ^all U^jiaJ Jl U^PJb 力丨 ijlaj ^JâlLj JJl(JJbJl jjz^ o l U o y L ^ A 0jJ^j otj JL_ J^i)l ljub fui ^ÂA; o U î ^ J! ^ SJb'lo^J ùij csjujbîjl.oljvi bu;^ U^L^Jl ^ atju^j! JT ^ S 人上 ^Jbti! ^UJ^NI IsM^uJl djl^jl JLp O-TÎiii ùli coi-jni Jl \ ju il d y ajji çbî c^^i JL^Jl ^Jù ^Il^J j j^jl 乙 j-ftj NÍ ц^^л^ал JL^-Jl I Jlp ^Jj ^aip уь on^) ojüb L-tr ^ 一» OÍ Jl (jjüi 彡 L^)j OJLA 1 乂 - уг^т;; OÍ U^PJb L-ÜjU^ j^jtiwjj b5l]as.í JLP jy^j UijUJi 1^3 J>í Âx^jjl; 4Í3J Ь. ^li^tj objbjl JLA01 j^jnjüb ^ JT bw^ j l buxi^l J ;IkpJ 4JU3 J^JJ ^IaÍI O 4J J p u. j-^sb JJbJ Ô^iT Sil^ J^yd^ UiüiL- 01 c^-j^i JL^Jl Iva^a^úi Д^^иС ÚÍ V^J tl^-lp ^^bxlil ^jlpojj^sb ^уь (J^ù ^ A^LuJl eijb 1.C^bLSlíl j-iî j^jj-jl OJLriJI jlsçt^ ^ ^ pxil -la^^jl Jj^ ц-ль l)s/ jja^jjl^jljl^l oí v^îj.ùl^i JA ^y^wail JUt^Jl ^ ^JjJÜI 0jUlll (^ ^J L^^r UlJjJ^ уь jjjji Lift jl^kjl^i {JS' Ál 3l>c-Jij 4 Ju3i Jj 二.^UJl U^P J ùl^vi 4JI J^y oijujvi (^Ul ^jlíji LLAJ С^JuJl UJl IJLA ^ ^ ÙÎ : 知 / ou-j^jjl Jubj L ù w C^JL^Ji a^ru- j.ajj:» ^ LjlJl 二 bjlj ou^ujl O^I^I 1Ы j \ N JbJbj! ^Ul! 广 UáJl ajlp ji]aj os/ C^ foljq Mi J ys/l UJ.^l^JNI ^Jl ^í ^ JUJNI a^í Jl ÙL^NI JaL^l li-jb JLi^ ^j^-^j c e ^ P jxjji ^ ÔJ^llll Jjoil ^ JaL-Jj 一 : 一 I) U JT J IW2 N oí 0J>rj\ L. JTj J^ii^l «Tj û! Jà^ ÙUJNI 01 м Uj^I jj^j (^JJl ÙL^NI ijub ol JL>-f ôl-s^ja J-^j Jl ÍUJ \jjj elsby ^^kjl ^ V^S Jl^ l)î ^Lo OÍJ Jjytii.jJ jill j ^-Ut-Jl J5" ÂJL^J^l J Lujl. (j j ojjuji ^^JU <j J>-\ o y ^ ^f^ j Thank you, Dr Al-Awadi. I now invite Dr Salvatella to address the Assembly. El Dr. SALVATELLA: Señor Presidente, señor Director General, señores Directores Regionales, señores ministros, señores delegados y miembros de la Fundación de los Emiratos Árabes Unidos para la Salud: Es para nosotros un alto honor este reconocimiento que se nos ha brindado y deseamos expresar lo que ha sido el trabajo de nuestro Ministerio de Salud Pública de la República Oriental del Uruguay durante largos años, en conjunción con el esfuerzo de los gobiernos municipales y la comunidad misma, que se sumó al esfuerzo para lograr el corte de la transmisión de la enfermedad de Chagas en el territorio uruguayo. Este aporte fue un aporte conjunto de muchos uruguayos trabajando desde las tareas más delicadas hasta aquéllas de acción operativa con la aplicación de medidas de control antivectorial vivienda por vivienda de las áreas endémicas de nuestro país. Para mí es también un enorme orgullo que estén presentes en esta sala, por la delegación del Uruguay, el Dr. Raúl Bustos, actual Ministro de Salud Pública del Uruguay, quien, con la creación del esquema de atención primaria de salud, fue el verdadero soporte de gran parte de la tarea que el Programa de Chagas pudo llevar a cabo. También está presente nuestro Director General de la Salud, el Dr. Antonio Chieza, quien es un ejemplo de lo que fueron nuestros fuertes niveles departamentales para poder llevar a cabo esta tarea, y la Dra. Beatriz Rivas, desde el área de Cooperación Internacional, apoyando lo que pudo realizarse con mucho esfuerzo. También queremos expresar nuestro agradecimiento a la Organización Panamericana de la Salud, que fue el soporte de toda esta tarea durante largos años y en especial también al Programa Especial de Investigaciones y Enseñanzas sobre Enfermedades Tropicales (TDR) y a la División de Lucha contra las Enfermedades Tropicales (CTD) de la OMS, que hicieron posible muchos de los puntos más delicados, como fue la evaluación de los resultados que el Programa de Chagas del Uruguay iba logrando alcanzar. También esta tarea de nuestro país estuvo integrada a lo que es para nosotros el gran orgullo subregional, la Iniciativa del Cono Sur, en la cual

176 A50/VR/6 page 164 seis países del extremo sur de Sudamérica conjuntamos esfuerzos y cooperamos entre nosotros técnicamente para llevar a cabo esta tarea dirigida hacia la salud de los más humildes de nuestros pueblos y de alguna manera obtener un logro que se va a ir concretando sin lugar a dudas con la erradicación de Triatoma infestans y la eliminación de la enfermedad para el año Muchas gracias. Thank you, Dr Salvatella. Francesco Pocchiari Fellowship Bourse Francesco Pocchiari I now wish to make an announcement regarding the award of the Francesco Pocchiari Fellowship. The Francesco Pocchiari Fellowship was established to honour the memory of Professor Francesco Pocchiari, former Director-General of the Istituto Superiore di Sanità, Rome, and member of the Executive Board of WHO. Its purpose is to award, every two years, one or two travelling fellowships to enable young researchers to visit other countries in order to obtain new experience relevant to their own research and to their national priorities. Special emphasis is placed on subjects concerning the public health sciences and related methodological issues of special relevance to health development. I am pleased to announce that the Executive Board of the World Health Organization, having considered the report of the Francesco Pocchiari Fellowship Committee, has awarded the Francesco Pocchiari Fellowship for 1997 to Dr Meslin Kassaye, of Ethiopia. Born in 1959,Dr Kassaye graduated from Gondar College of Medical Sciences, Addis Ababa University, in In 1991,he obtained his diploma of Master of Public Health and pursued postgraduate training at the International Training Centre for Diarrhoeal Disease at Mahidol University in Bangkok, at the University of Amsterdam in health research and anthropology, and at Umea University, Sweden, in advanced epidemiology. Dr Kassaye is currently Assistant Professor and Acting Head of the Department of Community Health at Addis Ababa University. Dr Kassaye's proposed programme during the fellowship is to "gain research experience in HIV/AIDS and adolescent health" at Umea University, Sweden, which will support the training programme in accordance with an agreement with the Department of Community Health, Faculty of Medicine, Addis Ababa University. We have now completed item 13. Before adjourning the meeting, I would like to remind you that tomorrow, Friday, 9 May, there will be no plenary meeting. Committees A and В will meet in the morning and the afternoon. The Committee on Credentials will hold its second meeting tomorrow at 14:30 in Room VII,and the General Committee will meet at 17:10 also in Room VII. The next plenary meeting will be held on Monday, 12 May at 09:00. The meeting is adjourned. The meeting rose at 18:35. La séance est levée à 18h35.

177 A50/VR/10 page 165 EIGHTH PLENARY MEETING Monday, 12 May 1997,at 9:00 President: Mr Saleem I. SHERVANI (India) HUITIEME SEANCE PLENIERE Lundi 12 mai 1997,9 heures Président: M. Saleem I. SHERVANI (Inde) 1. EARTHQUAKE IN THE ISLAMIC REPUBLIC OF IRAN: EXPRESSION OF SYMPATHY TREMBLEMENT DE TERRE EN REPUBLIQUE ISLAMIQUE D'IRAN: TEMOIGNAGE DE SYMPATHIE The Assembly is called to order. Before we proceed with our work, I wish to address myself personally and on behalf of this Assembly to the delegation of the Islamic Republic of Iran and express our deep regret and sympathy for the disaster that has occurred in that country. I give the floor to the distinguished delegate of the Islamic Republic of Iran. Dr NICKNAM (Islamic Republic of Iran): Thank you, Mr President, for giving me the floor. On behalf of the delegation of the Islamic Republic of Iran, I would like to announce that we are deeply touched by your understanding of the suffering of our affected people in the Khorasan area and the border of Afghanistan, and we appreciate your sentiments and those of other delegations. The Iranian Government immediately started to provide facilities such as food and medical emergency services, but the extent of the earthquake is such that one country alone cannot provide urgent care to the affected people. We again would like to express our appreciation to those countries that have joined the Iranian Government in responding to this natural disaster. Thank you, Mr President. I thank the distinguished delegate of the Islamic Republic of Iran. 2. SECOND REPORT OF THE COMMITTEE ON CREDENTIALS 1 DEUXIEME RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS 1 Our first item of business is to consider the second report of the Committee on Credentials, which held its second meeting on Friday, 9 May 1997,under the chairmanship of Dr J.D. Otoo. The report is contained 1 See reports of committees in document WÏIA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

178 page 166 in document A50/34 which you have all received. I note that Greece is not included among the Member States mentioned in paragraph 2 of this report as having submitted formal credentials. Greece has, however, done so. It has not been possible to convene all members of the Bureau of the Committee on Credentials; nevertheless, along with part of the Bureau, I have examined the credentials of Greece and found them to be in conformity with the Rules of Procedure. I therefore recommend that the Assembly consider Greece, along with the Member States mentioned in paragraph 2 of the report of the Committee, as having submitted formal credentials. Are there any comments? Does the Assembly accept this report of the Committee on Credentials, with the inclusion of Greece in paragraph 2 of the report? I see no objection. The report is therefore adopted. I would like to report that,when the General Committee met for the last time, on Friday, 9 May 1997, it gave me the authority to schedule our programme of work according to the progress in the two main committees. Having reviewed the progress of work, the General Committee agreed to propose that the Assembly could close earlier than was originally foreseen, and suggested that the plenary could meet at 16:00 hours on Tuesday afternoon to approve the report of the main committees and then take item 15,closure of the Assembly, on the understanding that I will monitor the progress of work in conjunction with the chairmen of the two committees. Does the Assembly agree that we proceed in this manner? It is so decided. Immediately following this plenary meeting, Committee A will meet. It is foreseen that the appropriation resolution will be taken up this morning in Committee A. Committee В will not meet, to enable all delegates to follow the discussions in Committee A. I wish to remind you that it is essential to have a quorum for consideration of this resolution. 3. FIRST REPORT OF COMMITTEE A 1 PREMIER RAPPORT DE LA COMMISSION A 1 We shall start with the first report of Committee A, as contained in document A50/36. Please disregard the word "Draft", as this report was adopted by the Committee without amendment. The report contains four resolutions. Is the Assembly willing to adopt the first resolution entitled "Reimbursement of travelling expenses for attendance at the Health Assembly"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the second resolution entitled "WHO collaborating centres"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the third resolution entitled "Guidelines on the WHO Certification Scheme on the Quality of Pharmaceutical Products moving in International Commerce"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the fourth resolution entitled "Cross-border advertising, promotion and sale of medical products through the Internet"? In the absence of any objections, the resolution is adopted, and the Assembly has therefore approved the first report of Committee A. 4. FIRST REPORT OF COMMITTEE B 1 PREMIER RAPPORT DE LA COMMISSION B 1 We shall now consider the first report of Committee В as contained in document A50/29. Please disregard the word "Draft",as this report was adopted by the Committee without amendment. The report contains eight resolutions. Is the Assembly willing to adopt the first resolution entitled "Interim financial report for the year 1996"? In the absence of any objections, the resolution is adopted. 1 See reports of committees in document WHA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

179 page 167 Is the Assembly willing to adopt the second resolution entitled "Transfer of funds from the Executive Board Special Fund to the Special Account for Disasters and Natural Catastrophes in the Voluntary Fund for Health Promotion"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the third resolution entitled "Status of collection of assessed contributions"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the fourth resolution entitled "Members in arrears in the payment of their contributions to an extent which would justify invoking Article 7 of the Constitution"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the fifth resolution entitled "Assessment of Andorra for 1997"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the sixth resolution entitled "Real Estate Fund"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the seventh resolution entitled "Relocation of the Regional Office for the Eastern Mediterranean from Alexandria to Cairo"? I give the floor to the honourable delegate of the United States of America. Mr BOYER (United States of America): Mr President, in Committee В last week the delegation of the United States expressed its strong disapproval of the expenditure that is authorized in this resolution. The United States delegation continues to believe that it is unwise for WHO and for this Assembly to authorize construction of a new building, to cost almost US$ 10 million, and to embark on a major construction project in this time of financial difficulty for the Organization. This position is consistent with positions taken by the United States throughout the United Nations system in opposing new investments in capital infrastructure. The US$ 10 million authorized in this resolution is money that could be used to reduce the assessments of Member States and would be much better applied to the financing of the budget. For this reason we continue to oppose this resolution. We will not call for a vote on this issue, because we have been working hard to achieve consensus on a larger issue, the next budget for However, we want the record to be clear on this point and we thank the President for the opportunity to make this statement. I thank the distinguished delegate from the United States. Are there any more comments? We take this resolution as adopted. Is the Assembly willing to adopt the eighth resolution entitled "Establishment of the International Vaccine Institute"? In the absence of any objections, the resolution is adopted. The Assembly has therefore approved the first report of Committee B. 5. SECOND REPORT OF COMMITTEE B 1 DEUXIEME RAPPORT DE LA COMMISSION B 1 We shall now consider the second report of Committee В as contained in document A50/31. Please disregard the word "Draft", as this report was adopted by the Committee without amendment. This report contains six resolutions and one decision. We start with the resolutions, which I invite the Assembly to adopt one after the other. Is the Assembly willing to adopt the first resolution entitled "Promotion of chemical safety, with special attention to persistent organic pollutants"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the second resolution entitled "Protection of the marine environment"? In the absence of any objections, the resolution is adopted. 1 See reports of committees in document WHA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

180 A50/VR/9 page 168 Is the Assembly willing to adopt the third resolution entitled "Recruitment of international staff in WHO: geographical representation"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the fourth resolution entitled "Employment and participation of women in the work of WHO"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the fifth resolution entitled "Salaries for ungraded posts and the Director-General"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the sixth resolution entitled "Method of work of the Health Assembly and proposed amendments to its Rules of Procedure"? In the absence of any objections, the resolution is adopted. Finally, does the Assembly agree with the decision on "United Nations Joint Staff Pension Fund: appointment of representatives to the WHO Staff Pension Committee"? In the absence of any objections, it is so decided, and the Assembly has therefore approved the second report of Committee B. 6. ELECTION OF MEMBERS ENTITLED TO DESIGNATE A PERSON TO EXECUTIVE BOARD ELECTION DE MEMBRES HABILITES A DESIGNER UNE PARTIE DU CONSEIL EXECUTIF SERVE ON PERSONNE DEVANT FAIRE The next item on our agenda is item 12,Election of Members entitled to designate a person to serve on the Executive Board, document A50/35. I draw your attention to the list of 10 Members, drawn up by the General Committee in accordance with Rule 102 of the Rules of Procedure. 1 In the General Committee's opinion, these 10 Members will provide, if elected, a balanced distribution of the Board as a whole. These Members are, in the English alphabetical order, Burundi, Canada, Cook Islands, Cyprus, Germany, Netherlands, Norway, Oman, Peru, Sri Lanka. Are there any comments or any objections concerning the list of 10 Members as drawn up by the General Committee? In the absence of any objections, may I conclude that, in accordance with Rule 80 of the Rules of Procedure, the Assembly accepts the list of 10 Members as proposed by the General Committee? I see no objection; I therefore declare the 10 Members elected. This election will be duly recorded in the records of the Assembly. May I take this opportunity to invite Members to pay due regard to the provisions of Article 24 of the Constitution when appointing a person to serve on the Executive Board. Before adjourning, I should like to remind you that Committee A will meet immediately after adjournment of this meeting. Both Committees A and В will meet this afternoon at 14:30. The next plenary meeting will be held either tomorrow or Wednesday, depending on the progress of the work in the committees. The exact time will be announced in the committee meetings. The meeting is adjourned. THE The meeting rose at 9:35. La séance est levée à 9h35. 1 See reports of committees in document WHA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

181 A50/VR/10 page 169 NINTH PLENARY MEETING Tuesday, 13 May 1997,at 16:00 President: Dr A. M'HATEF (Algeria) NEUVIEME SEANCE PLENIERE Mardi 13 mai 1997,16 heures Président: Dr A. M'HATEF (Algérie) 1. SECOND REPORT OF COMMITTEE A 1 DEUXIEME RAPPORT DE LA COMMISSION A 1 Le PRESIDENT : La séance est ouverte. En l'absence du Président, j'ai le plaisir de présider cette séance plénière. Le Président, en consultation avec les Présidents des deux commissions principales, a estimé nécessaire que nous nous réunissions aujourd'hui en plénière, car de nombreuses délégations risquent de devoir quitter Genève d'ici demain et donc de ne pas pouvoir être présentes lors de l'examen de la résolution portant ouverture de crédits. Nous allons cependant commencer par examiner le deuxième rapport de la Commission A contenu dans le document A50/37. Ne tenez pas compte du mot "Projet" qui figure sur le document, puisque ce rapport a été adopté par la Commission sans modification. Il contient trois résolutions que j'inviterai l'assemblée à adopter l'une après l'autre. L'Assemblée est-elle disposée à adopter la première résolution intitulée "Prévention de la violence"? En l'absence d'objections, la résolution est adoptée. L'Assemblée est-elle disposée à adopter la deuxième résolution intitulée "Qualité des produits biologiques entrant dans le commerce international"? Je ne vois pas d'objections, la résolution est donc adoptée. L'Assemblée est-elle disposée à adopter la troisième résolution intitulée "Journée mondiale de la Tuberculose"? En l'absence d'objections, la résolution est adoptée. L'Assemblée a ainsi approuvé le deuxième rapport de la Commission A. 2. THIRD REPORT OF COMMITTEE В 1 TROISIEME RAPPORT DE LA COMMISSION B 1 Le PRESIDENT : Le rapport suivant est le troisième rapport de la Commission В contenu dans le document A50/33. Veuillez ne pas tenir compte du mot ' Projet,,qui figure sur le document, car ce rapport a été adopté par la Commission sans aucun amendement. Ce rapport contient deux résolutions et une décision. 1 See reports of committees in document WÏIA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

182 page 170 Prenons d'abord les résolutions une par une. La première résolution est intitulée "Arriérés de contributions : Bosnie-Herzégovine". La Commission a accepté la petite modification suivante : au paragraphe 3 du dispositif, supprimer les mots "et les services dont bénéficie l'etat Membre". L'Assemblée est-elle disposée à adopter cette résolution ainsi amendée? En l'absence d'objections, la résolution est adoptée. L'Assemblée est-elle disposée à adopter la deuxième résolution intitulée "Rapport du groupe spécial sur la santé dans le développement"? En l'absence d'objections, la résolution est adoptée. L'Assemblée approuve-t-elle la décision de la Commission intitulée "Elaboration du Rapport sur la santé dans le monde, 1998 et troisième évaluation des progrès accomplis dans la mise en oeuvre de la stratégie mondiale de la santé pour tous d'ici l'an 2000"? Je ne vois pas d'objections. Il en est ainsi décidé. L'Assemblée a donc approuvé le troisième rapport de la Commission B. 3. THIRD REPORT OF COMMITTEE A 1 TROISIEME RAPPORT DE LA COMMISSION A 1 Le PRESIDENT : Nous allons maintenant examiner le troisième rapport de la Commission A contenu dans le document A50/38. Veuillez ne pas tenir compte du mot "Projet" qui figure sur le document, étant donné que le rapport a été adopté par la Commission sans amendement. Le rapport contient six résolutions. L'Assemblée est-elle disposée à adopter la première résolution intitulée "Financement du système mondial OMS d'information pour la gestion au moyen des recettes occasionnelles"? En l'absence d'objections, la résolution est adoptée. L'Assemblée est-elle disposée à adopter la deuxième résolution intitulée "Projet de résolution portant ouverture de crédits pour l'exercice "? Je donne la parole au délégué des Etats-Unis d'amérique. Mr BOYER (United States of America): Thank you, Mr Chairman. Mr President, in Committees A and B,the delegation of the United States has expressed its concerns about the level of budget that was proposed to the Members by the Director- General. In particular, our concern has been that the level of the budget and the level of the assessments on Member States have exceeded the ability of many Members States to pay their assessments. This has caused serious cash-flow problems for the Organization. Our concern continues even though we have made significant progress in this Assembly: first, slightly lowering the level of the budget; second, obtaining agreement to apply additional casual income to the budget in 1999 in order to reduce the assessments on Member States; and third, reaching agreement on the text of the resolution on the scale of assessments will give the Assembly next year the opportunity to decide to apply any new United Nations scale to the full budget. We are pleased that we have reached these agreements. However, I would like to make clear that the concern of the United States about the level of the budget is very serious. We depend on the Director-General, both the current one and the next one, to restrain budgets and expenditures, to sharpen WHO emphasis on high-priority programmes, to better coordinate regular budget programmes and extrabudgetary programmes - an issue that the Executive Board will begin to address this week - and to recognize the financial circumstances that limit the capacity of Member States to pay WHO in full and on time. The United States will not call for a vote on the budget resolution that is before us here, but we want the record of this plenary meeting to reflect our concerns and our hopes for future financial management of WHO that can strengthen WHO's capacity to seriously address the major health problems that face all of us, as Member States and governors of WHO. Thank you, Mr President. 1 See reports of committees in document WHA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

183 A50/VR/9 page 171 Le PRESIDENT : Je remercie le délégué des Etats-Unis. La résolution est donc adoptée. L'Assemblée est-elle disposée à adopter la troisième résolution intitulée "Projet de budget programme pour l'exercice : réaffectation aux programmes de santé prioritaires des montants dégagés grâce aux mesures prises pour accroître l'efficience"? En l'absence d'objections, la résolution est adoptée. L'Assemblée est-elle disposée à adopter la quatrième résolution intitulée "Renforcement des systèmes de santé dans les pays en développement"? En l'absence d'objections, la résolution est adoptée. L'Assemblée est-elle disposée à adopter la cinquième résolution intitulée "Réformes à l'oms : relier la nouvelle stratégie de la santé pour tous au dixième programme général de travail, à l'élaboration du budget programme et à l'évaluation"? En l'absence d'objections, la résolution est adoptée. L'Assemblée souhaite-t-elle adopter la sixième résolution intitulée "Elimination de la filariose lymphatique en tant que problème de santé publique"? Il n'y a pas d'objections. La résolution est adoptée et l'assemblée a ainsi approuvé le troisième rapport de la Commission A. 4. FOURTH REPORT OF COMMITTEE В 1 QUATRIEME RAPPORT DE LA COMMISSION B 1 Le PRESIDENT : Nous pouvons maintenant passer à l'examen du quatrième rapport de la Commission В contenu dans le document A50/39. Veuillez ne pas tenir compte du mot "Projet" qui figure sur le document, car ce rapport a été adopté par la Commission sans amendement. Le rapport contient trois résolutions. L'Assemblée souhaite-t-elle adopter la première résolution intitulée "Arriérés de contributions : Cuba,,? En l'absence d'objections, la résolution est adoptée. L'Assemblée est-elle disposée à adopter la deuxième résolution intitulée "Décennie internationale des populations autochtones"? En l'absence d'objections, la résolution est adoptée. L'Assemblée souhaite-t-elle adopter la troisième résolution intitulée "Respect de l'égalité entre les langues officielles"? En l'absence d'objections, la résolution est adoptée et le quatrième rapport de la Commission В est donc approuvé. 5. FIFTH REPORT OF COMMITTEE В 1 CINQUIEME RAPPORT DE LA COMMISSION B 1 Le PRESIDENT : Vous avez tous reçu le cinquième rapport de la Commission В contenu dans le document A50/40. Veuillez ne pas tenir compte du mot "Projet", étant donné que la Commission a adopté le rapport sans amendement. L'Assemblée est-elle disposée à adopter la résolution intitulée "Barème des contributions pour l'exercice "?.. Je ne vois aucune objection. La résolution est donc adoptée et le cinquième rapport de la Commission В est approuvé. Je donne la parole au délégué du Japon. Mr KOEZUKA (Japan): Thank you, Mr President. I would like to give an explanation of vote. Japan joined the consensus on the resolution on the scale of assessments for the financial period Earlier, Japan joined the 1 See reports of committees in document WHA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

184 A50/VR/10 page 172 consensus on the budget. As our position on the scale of assessments is well known, I am not going to make a lengthy statement. My point is that an element of retroactivity ought not to be introduced in the WHO scale of assessments. In fact, a similar position was taken by a great many countries in the deliberations of the relevant committees. The sense of this house has already been made very clear. The present wording of the resolution on the scale of assessments clearly endorses such a position, and provides sufficient safeguards for it. I just wish to register the position of the Japanese Government on this occasion. Thank you very much. Le PRESIDENT : Je remercie le délégué du Japon et je donne la parole au délégué des Pays-Bas. Mr VAN REENEN (Netherlands): In accordance with Rule 77 of the Rules of Procedure, I would like to give the following explanation of vote on behalf of the Member States of the European Union. It is the interpretation of the European Union that the wording of the resolution just adopted is such that the resolution does not have any retroactive effect upon the establishment of the scale of assessments for the biennium. Thank you very much, Mr President. Le PRESIDENT : Merci, Monsieur le délégué des Pays-Bas. J'ai été informé par la délégation du Belize qu'il y avait eu une erreur dans l'enregistrement de la position de son pays lors du vote par appel nominal qui a eu lieu le jour de l'ouverture de l'assemblée. Le Belize a été enregistré comme ayant voté "oui" alors que le délégué avait dit "abstention". Je voulais porter ce point à l'attention de l'assemblée afin que l'enregistrement du vote puisse être corrigé. Nous avons ainsi terminé nos travaux pour aujourd'hui. Demain, les Commissions A et В se réuniront à 9 heures pour examiner et approuver leurs rapports. La plénière se réunira à 10 heures pour approuver les rapports des commissions principales et passer ensuite au point 15 "Clôture de la Cinquantième Assemblée mondiale de la Santé". Excusez-moi, il y a une petite correction. La Commission A se réunira à 9 heures et la Commission В à 9 h 30,la plénière ayant lieu à 10 heures. La séance est levée. The meeting rose at 16:25. La séance est levée à 16h25.

185 A50/VR/10 page 173 TENTH PLENARY MEETING Wednesday, 14 May 1997,at 10:00 President: Mr Saleem I. SHERVANI (India) DIXIEME SEANCE PLENIERE Mercredi, 14 mai 1997,10 heures Président: M. Saleem I. SHERVANI (Inde) 1. COMMITTEE ON CREDENTIALS 1 COMMISSION DE VERIFICATION DES POUVOIRS 1 The Assembly is called to order. Let me first begin by thanking warmly Dr M'Hatef for replacing me yesterday at the plenary which I considered necessary, and which Г understand he presided over most efficiently. Thank you once again. The second report of the Committee on Credentials, which has already been approved by the plenary, noted that Burundi had submitted provisional credentials. Since that time, Burundi has submitted formal credentials. It has not been possible to convene all members of the Bureau of the Committee on Credentials. Nevertheless, along with part of the Bureau, I have examined the credentials of Burundi and found them to be in conformity with the Rules of Procedure. I therefore recommend that the Assembly consider Burundi as having submitted formal credentials. I see no objections. It is so decided. 2. FOURTH REPORT OF COMMITTEE A 1 QUATRIEME RAPPORT DE LA COMMISSION A 1 Let us now continue with approval of the reports of the main committees. We shall start with the fourth report of Committee A, which is contained in document A50/42. The report contains three resolutions which we shall proceed to review one by one. Is the Assembly willing to adopt the first resolution entitled "Malaria prevention and control"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the second resolution entitled "Eradication of dracunculiasis"? In the absence of any objections,the resolution is adopted. Is the Assembly willing to adopt the third resolution entitled "African trypanosomiasis"? In the absence of any objections, the resolution is adopted and the Assembly has therefore approved the fourth report of Committee A. 1 See reports of committees in document WÏIA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

186 A50/VR/10 page SIXTH REPORT OF COMMITTEE В 1 SIXIEME RAPPORT DE LA COMMISSION B 1 Let us continue with the sixth report of Committee В. It is contained in document A50/41 and deals with two resolutions. Is the Assembly willing to adopt the first resolution entitled "Cloning and human reproduction"? In the absence of any objections, the resolution is adopted. Is the Assembly willing to adopt the second resolution entitled "Health conditions of and assistance to the Arab population in the occupied Arab territories, including Palestine"? I give the floor to the distinguished delegate of Israel. Mrs HERZOG (Israel): Thank you Mr President. I just spoke with our embassy and our Ambassador is on his way. I would appreciate it very much if you would hold back for just a few seconds. Thank you very much, Mr President. I accept. In the meantime I give the floor to the distinguished delegate of the United States of America. Mr BOYER (United States of America): Mr President, the delegation of the United States of America strongly objects to the resolution that is before the plenary. After several years of forward progress in the peace process of the Middle East, this resolution marks a pronounced step backwards and is unbecoming of the World Health Organization. We hope that we can put this process of general agreement back on track at next year's Assembly. Thank you, Mr President. I thank the distinguished delegate of the United States of America, and I would like to give the floor to the distinguished delegate of Israel. Mr LAMDAN (Israel): Thank you Mr President. As Israel indicated in the committee yesterday, we are opposed to the draft resolution contained in the committee report under agenda item 28. Delegations will recall that in the last years,a compromise text on this resolution has been reached through direct negotiations between the Palestinian and the Israeli delegations and was adopted without a vote. That is not to say that Israel was satisfied with the compromise text, which remained political, starting with its title and including several aspects in both the preambular and operative parts; but taking a wider view of things and in a spirit of cooperation between ourselves and the PLO, for the sake of health assistance to the Palestinians, Israel went along with the language. Very much to our regret, this year the Palestinian delegation showed no interest whatsoever in compromise. Indeed, they showed no real interest in the health of the Palestinians. We reminded them of what our Minister said before this Assembly, and I quote: "The Palestinians cannot have it both ways. They cannot cooperate in the field of health with Israel, and look for our support at the bilateral and international levels,while at the same time using this Organization and other United Nations fora to conduct political battles against Israel. Health cooperation and political warfare do not go together.". This statement was not made lightly, but in our contacts with the Palestinians, the Palestinians chose to brush it aside. The Palestinians and their supporters have taken a risky path. They have chosen politics over health,rhetoric over reality. They might have done well to recall where they get their real health 1 See reports of committees in document WÏIA50/1997/REC/3. 1 Voir les rapports des commissions dans le document WHA50/1997/REC/3.

187 A50/VR/10 page 175 assistance from. From WHO? A pittance! From the vast majority of countries represented at the World Health Assembly? Not a penny. Real health assistance to the Palestinians on a day-to-day basis comes from Israel because we are there for them,and they know it. It is Israeli hospitals which are open to them; Israeli specialists, Israeli medical facilities, Israeli health courses which are extended to them unstintingly. As a simple matter of fact, they should bear in mind that if this resolution carries, as it probably will, Ministers and health officials in Israel will inevitably question the wisdom of our position and our openness towards the Palestinians in health matters. Look what the Palestinians have done with this resolution. They have thoroughly politicized it. They have introduced new terminology, clearly designed as presupposition with regard to Jerusalem, the capital of Israel - and I would add the eternal capital of Israel. They have introduced crude elements relevant perhaps to the peace process, but totally extraneous to anything to do with health assistance to the Palestinians. It is pure politics. Israel sees this resolution in a wider context, where the United Nations as a whole is once again being used by the Palestinians and their supporters as a political battlefield against Israel. In the last few months, we have seen similarly politicized resolutions submitted in the Security Council, the General Assembly, the Commission on Human Rights, the Inter-parliamentary Union, Habitat and now the World Health Assembly. No one has any illusions about what is going on, and if the Palestinians think that they are making anything but a negative impression on public opinion and the Government of Israel, they simply do not know how to read the political map. It is not just the Palestinians; there are delegations here representing countries eager to play an active part in the Middle East peace process. Israel has every reason to look at their positions and to wonder about their bona fides and their even-handedness. With some hesitation I must also point out that there are many delegations also in this hall, who in the last few days have approached us at very high levels and sought Israel's assistance in health matters. Let me respectfully remind Members that there is not a government in the world which would not think twice about the logic of offering assistance to countries supporting political moves against it. Let me conclude where I began. Israel would have preferred cooperation and compromise with the Palestinians. Israel is still open to such cooperation for the health of both our peoples, and for the better good of the peace process. It is more than time for all of us to get serious. Thank you, Mr President. I thank the distinguished delegate of Israel and give the floor to the observer for Palestine. Dr. ARAFAT (Palestine): : (jjaulà) Olà^P ^ ^ 1 ^ 扎 4 J^V 1 VJ^ AJI u, l5iut ÍJUÍ )í í ijií > > U3Í 一 otji oí.basu oíj UJb^í L^. ^ áj ^ i^u oí ^ o- ^ У J ^ ^ ^ 9 ^ ^ J Jljb 4 L. ^ J ^ y ^ <^ 1 úí cu^;^ L^ L-^ UJi düb JT J^Íp ^p Lup cli^ bw, ^ S Jf L J Lüí c ^ b ^isut c^atjí^ij.g U T я^р ^ 一 Ы ^^Ji í^jki) í b3ij ^ ûjudj 碎 ; 二 ojixij ouj^i ^ ^ ïju. ou ь. jruui ^ ^Jy^ 匕 ^Jl Lx^ IjX^j 二 j-^uji ^LJi I 二 Jl 一 UJI J ^ ^ ^ ÛjUiii IJl^ ^ O I thank the observer for Palestine and I give the floor to the distinguished delegate of Egypt. Dr. SALLAM (Egypt): ^lui jjstjjl ^ ^ J 丨丨 丨丨 ^ AU^LL- 乙 jj I 0Í ^li JL Ü ijií j^- 51 二 1 Г "^ ^ OÍ LT Lüí c j l ^ c u v Jj^Ji ^ f- j^jl IJla

188 A50/VR/10 page 176 ^ 2-îl.JbJbr j L J ci-b Л «Jl».a^lJl oly^jl Ldi* LJb jilуъ t^-lilj З-Ь-Jl jsll ^ UJI^NI oujl^ji Jlp -y- (/ijl ^illj oubyu^ 已 y US' jjl l-ь. ^IjSll ^ V-sJl Jl 广 Slt jy^aj Sibj Jl ^ r^ Ji> r^ p. Nj ^Uiil ^ ^jloil j > ^ dlli ^ Llj 丨力丨 ùlsljj 一 oupl^jij 丨 J 丨广 i ^ 一 U 丨 o^í oli*il Jl JJ^í 已 jj^ y>j ^jy^jl j\ jl 己 J i \ 乂 I ;JuJLp oljjls^ Jbu Lüí tilinj 已 j J l IJÜO -Lj^ OÍ j-^í C5-ÜIC^Sj!>\ ^j^jù ouxil OJL» ajljb s-jlkij А^Л J l j y u ; JbjJ-. ^ JL^ S^S/I d í - u JLJl ^L^Jl jü^l lift ^ J (JÜI ^LJl Jl is^'y US' ^Ij ÁJliil U^^Jl oljlij^lj 3y^liJlj ^Ij ^ ^ y j çt-ч oí l_ 5 _3 t 已 j^jl 1ДА j^j-u; ^ JÁ; f^j ijüy J J A J J J J I J j»jlpj Ь i iü^j JjJÜI 二 j»!>ljj JjjJl Ojbcil "hjí^ Líx^IJ J-V2J )jju üb Lh ^ijsli" s^waii Jij-^-^'i í^oji a...;> Uii ÁkLJi ^ ùj JiV-i 沙 albujl ^CJl J^Li." OÍ Jl JJU j jux^j j^j. \ inv L^b^l v^jl ^aül 丨 Jj» ÍUIPI ^ J^L c^jl^ JJJJ.oljL^Jl ^Js- jllgjtjlij JbjJo. ^ l^jl SibcL^Ij íl^jlj 0jLjdlj j.">lcjl Ij^^w ^JLr^lj jji 户 J f, j l ^ l 已 j^xj yj^jl ^Jl I thank the distinguished delegate of Egypt. Is the Assembly now prepared to adopt this resolution? I give the floor to the distinguished delegate of Israel. Mr LAMDAN (Israel): Mr Chairman, I should just like to observe yet again, and for the sake of removing any doubt: there is no consensus on this resolution. Is the Assembly now prepared to adopt this resolution? It is so decided. We have now approved the sixth report of Committee B. 4. REVIEW AND APPROVAL OF THE REPORTS OF THE EXECUTIVE BOARD ON ITS NINETY-EIGHTH AND NINETY-NINTH SESSIONS EXAMEN ET APPROBATION DES RAPPORTS DU CONSEIL EXECUTIF SUR SES QUATRE-VINGT-DIX-HUITIEME ET QUATRE-VINGT-DIX-NEUVIEME SESSIONS We now corne to the conclusion of item 9: "Review and approval of the reports of the Executive Board on its ninety-eighth and ninety-ninth sessions". Now that the main committees have finished their consideration of the Executive Board's reports, we are in a position to formally take note of these reports. From the comments which have been made, I take it that the Assembly wishes to commend the Board on the work performed and express its appreciation of the dedication with which the Board has carried out the task entrusted to it. In the absence of any comments, it is so decided.

189 A50/VR/10 page SELECTION OF THE COUNTRY IN WHICH THE FIFTY-FIRST WORLD HEALTH ASSEMBLY WILL BE HELD CHOIX DU PAYS OU SE TIENDRA LA CINQUANTE ET UNIEME ASSEMBLEE MONDIALE DE LA SANTE I should like to draw the Assembly's attention to the fact that under the provisions of Article 14 of the Constitution, the Health Assembly, at each annual session, shall select the country or region in which the next annual session shall be held, the Executive Board subsequently fixing the place. I shall also recall that the Thirty-eighth World Health Assembly concluded that it was in the interests of all Member States to maintain the practice of holding Health Assemblies at the site of the headquarters of the Organization. I therefore take it that the Assembly decides that the Fifty-first World Health Assembly will be held in Switzerland. In the absence of any objections, it is therefore so decided. 6. ANNOUNCEMENT COMMUNICATION Before adjourning the meeting, I have a brief announcement concerning the Executive Board. I understand that the hundredth session of the Executive Board will open at 9:30 on Thursday, 15 May in the Executive Board room at WHO headquarters. Documents for Executive Board members are available in their special pigeon-holes which are located next to the documents distribution counter near doors 13 and 15, here at the Palais des Nations. Members are requested to pick up their documents before 15:00 today. I shall now adjourn the meeting for a few minutes. Please remain in your seats. The closing plenary will be held in a few minutes. The meeting rose at 10:30. La séance est levée à 10h30.

190 A50/VR/11 page 178 ELEVENTH PLENARY MEETING Wednesday, 14 May 1997,at 10:35 President: Mr Saleem I. SHERVANI (India) ONZIEME SEANCE PLENIERE Mercredi 14 mai 1997,10h35 Président: M. Saleem I. SHERVANI (Inde) CLOSURE OF THE SESSION CLOTURE DE LA SESSION The meeting is called to order. I invite Dr Campos, Chairman of Committee A, to come to the podium and address the Assembly, to give us an overview of the work of Committee A. Dr CAMPOS (Belize) (Chairman, Committee A): Mr Director-General, fellow delegates, ladies and gentlemen, I have pleasure in presenting my perception of the debates in Committee A, where we dealt with a heavy agenda which included the review and approval of the Organization's proposed programme budget for the financial period The meeting was conducted in a good spirit of collaboration and cooperation among the delegates, who throughout the deliberations looked for ways to continue the delivery of priority programmes, recognizing WHO's comparative advantage and those activities it is uniquely best suited to perform. We began our debate with a general discussion of the proposed programme budget. Appreciation was expressed for the Organization's continuing improvement of the presentation of the strategic budget. In view of the need for increased efficiencies, a large number of delegations expressed their desire to reduce administrative and overhead costs and redirect the savings towards priority programmes. This was subsequently reflected in the adoption of a resolution on this issue, together with a resolution for the financing of WHO's worldwide management information system. The debate on the budget then turned to a detailed consideration of each appropriation section. Core functions and priority programmes for funding were discussed with a view to seeking a consensus while reconfirming our commitment to primary health care and health for all. In this context a resolution on the strengthening of health services in developing and least developed countries was adopted. We also considered such priority issues as adequate nutrition, essential drugs, reproductive health, and the impact that environmental factors have on human health in developed and developing countries alike. Perhaps predictably for this technical committee, the appropriation section dealing with the integrated control of diseases provoked the most extensive debate, during which 54 delegations took the floor. Throughout our deliberations we sought innovative ways to respond to growing health needs despite the universal shortage of funds. A resolution calling for better use of WHO collaborating centres was a step in this direction. Our discussion of the proposed programme budget concluded with amendment of the appropriation resolution and its subsequent adoption by consensus. The discussion of the Tenth General Programme of Work reflected the need to streamline further the Organization's managerial and policy instruments in order to ensure that WHO has the flexibility to respond quickly to rapidly changing health needs. The draft resolution on this topic was amended to reflect the need

191 A50/VR/10 page 179 for a more dynamic planning process, which would link the health-for-all strategy with the Tenth General Programme of Work and the strategic budgeting process. The amended resolution was adopted by consensus. Following this debate our discussion turned to consideration of resolutions proposed by the Executive Board in relation to the implementation of resolutions and decisions. Seventeen speakers addressed the need to prevent violence and the proposed resolution on this issue was substantially amended to reflect the problems of domestic violence, especially that directed at women and children, as well as child trafficking and sexual abuse, and bullying in schools and institutions. Other resolutions adopted by consensus or with minor amendments included those on guidelines on the WHO Certification Scheme on the Quality of Pharmaceutical Products moving in International Commerce, the quality of biological products moving in international commerce and World Tuberculosis Day. A new draft resolution was adopted in response to the problem created by the advertising, promotion and sale of medical products on Internet, which in some cases might circumvent national legislation designed to protect the health of consumers. Many delegates expressed satisfaction that WHO provided a mechanism for a rapid international response in such a largely uncharted area. In considering the various progress reports we expressed particular satisfaction with the newly restructured programme on reproductive health, which adopts a comprehensive approach to priority issues on family planning, maternal and newborn health, and reproductive tract infections including sexually transmitted diseases. We then turned to the Director-General's report on tobacco or health, when 28 delegations took the floor. While some countries reported progress, deep concern was expressed that health-education campaigns alone have not succeeded in preventing adolescents from starting to smoke and that stronger measures were needed. In this context, WHO was urged to accelerate its work on the international framework convention for tobacco control. We then considered the Director-General's report on HIV/AIDS and sexually transmitted diseases, which likewise, stimulated a large number of interventions. Many delegates expressed strong appreciation for WHO's policy and strategic orientations on HIV/AIDS and sexually transmitted diseases. We also heard concern that UNAIDS was not providing sufficient support, at the country level and that financial support, particularly in some of the most affected countries, had waned. Finally, the Committee considered and adopted four resolutions dealing with the control of tropical diseases. These included a call for greater action to combat malaria, a resolution to eliminate lymphatic filariasis, another on the eradication of dracunculiasis, and a fourth dealing with African trypanosomiasis. In concluding, Mr President, I would like to thank the distinguished delegates for their fine spirit of collaboration and consensus. Although opinions differed on several issues, not a single vote was needed to resolve these differences. I would also like to thank the Vice-Chairmen and Rapporteur and the Secretariat of this committee for its constant support. Finally, I should like to say that it has been an honour both for me and for my country to have chaired this committee. Thank you, Dr Campos. I should like to congratulate you very warmly for your excellent presentation and also for the outstanding way in which you have presided over the Committee. The next speaker will be the Chairman of Committee B, Dr Taitai, whom I invite to the podium to report on the work of Committee B. Dr TAITAI (Kiribati) (Chairman, Committee B): Mr President, Director-General, fellow delegates, ladies and gentlemen. It is a pleasure for me to present to you an overview of the work of Committee В during this year's World Health Assembly. I shall try to be brief and concentrate my remarks on the highlights of the Committee's work as the full details can be found in the reports. The work of Committee В was dominated by concern with financial matters including the interim financial report, the report of the External Auditor and the use of casual income. After repeated postponements and numerous attempts by concerned delegations to find a formulation acceptable to all, the resolution on the scale of assessments was finally adopted by consensus. Resolutions were adopted to facilitate the modalities of payment of arrears for Bosnia and Herzegovina and for Cuba. Two resolutions were adopted on the use of casual income to finance the Real Estate Fund, one of them being for the financing of the relocation of the Eastern Mediterranean Regional Office from Alexandria to Cairo. Our Committee considered what is arguably the most contentious scientific, legal and ethical issue confronting the international community at the end of the twentieth century: cloning in human reproduction.

192 A50/VR/10 page 180 Thirty-five delegations participated in the debate, demonstrating by the record number of interventions the significance of the matter. Careful work was done on the text of an amended resolution which was adopted by consensus. Collaboration within the United Nations system and with other intergovernmental organizations encompasses a number of matters of global concern. The main focus this year was on environmental matters. Two resolutions on the subject were adopted. One on persistent organic pollutants and the other on protection of the marine environment. Also under this item, a resolution was adopted to approve the agreement on the establishment of an international vaccine institute to promote the development of new vaccines in the spirit of the Children's Vaccine Initiative; another reiterated the need to develop health programmes for indigenous people. Unfortunately, it proved impossible to obtain consensus for the resolution on health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine. The resolution was put to a roll call vote and was adopted with 93 in favour, 4 against and 4 abstentions. On the subject of reform at WHO a comprehensive presentation was made to the Committee. The discussion on renewing the health-for-all strategy focused mainly on the report of the task force on health in development. A resolution was adopted requesting the Director-General inter alia to take into account the recommendations of the task force in the preparatory discussion for the Tenth General Programme of Work and in the renewal of the health-for-all strategy. Another step on the path of reform and rationalization was the decision that the global report on the third evaluation and the ninth report on the world health situation should be incorporated in The World Health Report 1998 and that there should no longer be separate reports on the world health situation. Improving the method of work of the Health Assembly is also a component of the reform process in WHO. The changes adopted in the resolution on the subject are designed to streamline procedures and thus avoid any waste of time. Delegations felt strongly, however, that this should not be to the detriment of equality among the official languages. A resolution was adopted requesting the Director-General inter alia to ensure that documents for the Health Assembly are not distributed until they are available in all the official languages. During the discussion on personnel matters, most interventions were concerned with the employment and participation of women in the work of WHO and the usefulness of establishing numerical targets in that respect. The resolution which was adopted raised the target to 50% for representation of women in the professional categories. Two other resolutions were adopted concerning personnel matters; recruitment of international staff in WHO, geographical representation, and salaries for ungraded posts and the Director-General. The report of the United Nations Joint Staff Pension Board was noted and Professor Beat Andreas Roos from Switzerland was appointed member of the WHO Staff Pension Committee with Dr Suleiman of Oman as alternate member. Dr Malolo from Tonga was appointed to replace Dr Тара. Mr President, distinguished delegates, Director-General and staff of WHO, it has been an honour and a privilege for me to serve as Chairman of Committee B. Vitally important financial matters were settled in a spirit of conciliation and consensus, boding well for the future of the Organization. I should like to thank warmly all the delegations who spared no efforts to achieve this admirable result, thanks to whom these difficult questions were resolved. Smooth deliberations were made possible thanks to the unfailing support and cooperation of the Secretariat of Committee B. Finally,I extend my thanks to you, Mr President, and to the Vice-Presidents and the Director-General for taking such assiduous interest in our work. As I said at the end of our work in Committee B, as we leave soon for our respective homes, may I wish you, Sir, and all other officers and delegates, your families and indeed your countries continued good health during the coming year. Have a good journey. Bon voyage! Thank you, Dr Taitai. Please accept my congratulations on your comprehensive report and for conducting so well the work of Committee B. Your excellencies, honourable ministers, Dr Nakajima, distinguished delegates and colleagues, it will soon be my duty to bring to a close this Fiftieth World Health Assembly, before I do so I would like to share with you a few reflections. Over the past two weeks we have demonstrated a true spirit of cooperation and tolerance. A spirit which has enabled us successfully to conclude our work. I have closely followed your deliberations and listened to the concerns expressed by various delegations and to the hopes and aspirations that have been renewed. The world health report 1997 that has been before us has identified the challenges that lie ahead. It has underlined the fact that the quality of life is at least as important as its quantity and that