STATEMENT
by Dr. Gro Harlem Brundtland
Director-General, World Health Organization

Thank you for inviting me to speak today. I feel very much at home, having wanted to promote change and the rights of women as a doctor and a public health worker, as a cabinet minister, as a parliamentarian, as a Prime Minister and now on behalf of the World Health Organization.

"Health for all women in the 21st Century: How do we get there?" Certainly we all know: there is a long way to go!

Let us begin on a positive note. Broadly, the 20th century has been a century of remarkable progress for the rights of women. Progress in political rights. Progress in the right to take responsibility for our own lives. Progress in the right to lead a healthy life. We can remain profoundly grateful to those courageous women who led the fight a century ago. It paid off for many.

But the progress is so uneven. Millions of women are denied fundamental political rights and fundamental human rights. Millions and millions of women are denied the right to take responsibility for their own lives. And millions and millions lack the right to live a healthy life.

Too many women starve and go to bed hungry. Children are sick and do not have access to treatment. Too many women do not have the means to prevent an unwanted pregnancy. Too many women die in childbirth or suffer severe disability. Too many women are infected with HIV. Too many women die of AIDS.

Too many women do not control their own lives, do not have the means of empowerment and decision making in their lives and in those of their children.

Women are more vulnerable where poverty is endemic and human rights are violated every day. More than two out of three of the 1.3 billion people living in poverty are women. They live on insufficient food. Combined with child bearing and a staggering workload, this often leads to serious malnutrition. Globally, more than a third of all women suffer nutritional anemia. Malnutrition has a cumulative effect during an individual's lifetime with adverse effects on the health of the next generation.

Poverty still has a gender bias.

All this is a moral shame. But that alone, we know, will not make a change.

I believe we need to adopt an additional message, which is targeted right at the core of political decision-making: Poverty is bad economics. Investing in strategies that lead out of poverty is good economics. And it is not costly.

This message, underpinned with facts and evidence, is the message that WHO will send out in the years to come. My ambition is to place health at the core of the international development agenda. And in doing so I need to bring greater attention to women's health and the key role it plays.

For some years we have known that investing in education - particularly in the education of young women - is a solid investment in development. We are now discovering that the same goes for investments in health - especially the health of women and children.

This is a message which needs to be brought to decision-makers. We need to reach Presidents, Prime Ministers and Finance Ministers and remind them that they are truly health ministers themselves. Many are getting the point and expenditure for health is generally increasing. But there are major exceptions. And there are important questions that are not being sufficiently answered: How do we spend money on health in a way which reaches those who need it most? How can we adopt health policies and systems which combat the growing inequities?

Today we know that poverty leads to ill health. Poor people get ill - from malnutrition, from communicable diseases such as tuberculosis and malaria. We know that the equation works the other way around - ill-health breeds poverty.

It is simple. People who are ill are not productive. Children who are under-nourished suffer damage to their brains and will never be able to make a real contribution. Areas which are haunted by poverty will not attract investment.

We also know that investing in health can contribute efficiently to the way out of poverty. The message of Health for All is a message of optimism. It pays to make basic investments in primary health care, and a lot can be saved in the long run if basic health services are delivered in an equitable fashion.

Investing in women's health leads directly to women making personal choices they could not otherwise make and it helps them to be more effective, whatever the roles they choose to play, whatever the tasks they undertake.

Today there are trends that create real obstacles. The health gap between rich and poor is widening and that creates severe health risks for women. They are more vulnerable. Their children are more vulnerable. National economic growth is not a guarantee for better health or higher status for women, as long as the benefits are not equally distributed. In three words what we need is redistribution of resources!

We need to turn our attention to the collapse or stagnation of health systems in many countries. This is an area that WHO has taken on as a challenge. I have said that unless what we do helps strengthen the health systems in all countries, we should consider not engaging.

For example - by providing tuberculosis treatment we help strengthen the district health system - and people will benefit long after TB is gone. When we embark on our Roll Back Malaria project we will focus on the home as a major center for treatment and care. Families and communities will benefit.

As we move into the new millennium, we need to be aware of the new patterns of mortality and morbidity for both women and men, related to demographic and socio-economic factors. Depression amongst women is no longer isolated to the industrialized world but it is recognized also as a key health issue for women in developing countries. TB is on the rise. There is also an alarming increase in the prevalence of tobacco smoking among women. This will inevitably lead to a large increase in female morbidity and premature death. The WHO Tobacco Free Initiative has a special focus on tobacco and women. The partnership which has developed between the health sector and women's organizations will help us get the health messages across to our young people.

When I spoke at The Hague last month at the ICPD + 5 forum, I committed WHO to work for sexual and reproductive health and rights in the new century.

I will say more this afternoon at the Commission on the Status of Women about broadening the focus to view the different needs of women in the entire life span.

We need to reach out to our partners. Partners within the health sector. Partners outside it.

Without girls' education, we cannot hope to improve communication and shared responsibility between men and women on responsible parenthood, sexual and reproductive behaviors and the whole range of day-to-day health problems.

An intensified, intersectoral effort can yield good results.

We must talk to each other about best practices and learn from them. In Benin, the Ministry of Public Health now supports 200 small economic projects initiated by women and unemployed young people to earn money for financing community health facilities, a collaborative effort by WHO, ILO, the World Bank, UNDP, and several NGOs, including the Association des Femmes Beninoises pour le Development.

Another example is provided by the Indian Ministry of Health and Family Welfare, which introduced a project in rural areas of the country, working in partnership with non-governmental and voluntary organizations. Local women known as sahelis or "friends" are selected from among day care or nursery school workers as well as from primary school teachers. This network of "friends" is used to create awareness in the community of health issues facing families from the moment that new families are formed. Sahelis are trained by their group leaders and keep in touch.

As the scheme produces more and more trained mothers who can help other newly-weds in their neighborhood, the need for sahelis disappears.

We - governments, the UN community, financial institutions, the private sector, and the non-governmental institutions - must learn from each other what works. Those present here today are an impressive example of this cooperation.

Four years ago in Beijing in my closing address, I talked about the empowerment of women through increased information and redirecting resources.

Those are the messages also today for health.

I am committed to ensuring the introduction of a gender perspective in WHO's work.I am committed to obtaining the information to make it work.

We also need constantly to reaffirm that the right to health and the goal of health for all apply equally to women. Indeed, health for all in the next century, or for that matter in the century after that is not an achievable goal until millions more women are empowered to promote and safeguard their own health, and consequently their own development. I thank you for your commitment and contribution, and I look forward to working with you to take new and decisive steps toward our common goals.

Thank you.