57th world health assembly
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Infact
Challenging corporate abuse
Building grassroots power
Infact Intervention to the 57th Session of the World Health Assembly
Agenda Item 21: Policy for Relations with Nongovernmental Organizations
Thank you for the opportunity to speak on behalf of Infact. Infact and the Network for Accountability of
Tobacco Transnationals (NATT) strongly support the intent to enhance NGO participation that underlies the
proposed new policy for NGO accreditation and collaboration. The acceleration and expansion of NGO access to
the Framework Convention on Tobacco Control (FCTC) negotiations contributed positively to the development
of the treaty'.
With the adoption of the FCTC a year ago, the World Health Assembly established the first multilateral
convention of a global scope that protects public health policy from the commercial interests of an industry
^aose products or practices cause harm. Part of this victory can be attributed to the positive role played by civil
"iety organizations including NGOs—a fact recognized by many delegations in their statements at last year's
WHA.
However, the success of the FCTC is also rooted in measures taken to insulate the treaty negotiations and public
health policies included in it from interference by the tobacco industry. With the FCTC and WHA resolution
54.18, the WHO and member states have set the precedent that not all industries are entitled to have a voice in
the development of health policy. When profits and health come into conflict, corporations cannot be counted on
to protect consumers.
Infact therefore urges WHO Member States to reject the inclusion of groups with industry affiliation or
commercial interests in the proposed definition of NGOs. The proposed policy confuses the definition of NGOs
by including: “not-for-profit organizations that represent or are closely linked with commercial interests.” This
move goes against established norms and marks a complete reversal in policy. The current Principles Governing
Relations Between the WHO and NGOs restrict admission into official relations to those NGOs which are: “free
from concerns which are primarily of a commercial or profit-making nature.”
Corporations have long tried to advance their interests by forming pseudo NGOs. This trend has reached
dangerous new levels as the Confederation of Food and Drink Industries of the EU (CIAA), and the International
^uncil of Grocery Manufacturers Associations (ICGMA), two influential food industry trade associations
whose expressed intent is to promote their products—many of which are junk food—are currently applying for
official relations status. The proposal to recognize these so-called “NGOs” clearly illustrates the pitfalls of
reversing the current NGO policy, and demonstrates why WHO must, at a minimum, distinguish between NGOs
and organizations representing commercial interests.
The proposed new definition of NGO and the inclusion of trade associations such as the CIAA and the
ICGMA would make it more difficult for Member State delegates to the EB or the WHA to distinguish
between organizations representing the public interest and those representing business interests. If WHO
member states choose to include organizations that represent or are closely linked with commercial interests in
debate on health issues, their participation should be subject to the WHO’s guidelines for interaction with the
private sector—and their affiliations must be displayed in a transparent manner to all participants, for example
through the use of different color badges for the private sector.
We urge WHO either to keep the old definition of NGOs or to delete the phrase “not-for-profit organizations that
represent or are closely linked with commercial interests.” The avoidance of conflicts of interest, including in
WHO's relations with NGOs, is vital to the organization's integrity and capacity to achieve future breakthroughs
in public health. Thank you.
46 Plympton Street ’ Boston. MA 02118-2425
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G O wi H ' S
International Federation of Red Cross and Red Crescent Societies
Federation Internationale des Societes de la Croix-Rouge et du Croissant-Rouge
Federacidn Internacional de Sociedades de la Cruz Roja y de la Media Luna Roja
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WORLD HEALTH ASSEMBLY
57 session
Al
Geneva, 17-22 May 2004
Committee A
Agenda item 12.9
“Family and Health”
Reducing the Impact of Malaria and Measles on Families
Statement by
Bernard Moriniere
Medical Epidemiologist
INTERNATIONAL FEDERATION
OF RED CROSS AND RED CRESCENT SOCIETIES
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Telephone +41 22 730 4222 - Telex 412 133 FRO CH - Telefax +41 22 733 0395
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12.9 Family and Health (malaria and measles)
Statement by
the International Federation of Red Cross and Red Crescent Societies
at the 57th World Health Assembly
Geneva, 17-22 May 2004
Mr. Chairman,
Ladies and gentlemen,
The International Federation of Red Cross and Red Crescent Societies welcomes the
opportunity to address this Assembly, and to pledge its support in observance of the tenth
anniversary of the International Year of the Family.
Children under 5 years of age and
pregnant women in malaria endemic areas are at especially high risk of dying.
We are
committed to join with other partners in efforts to enhance family health and to generate new
activities aimed at reducing global mortality from malaria, in combination with immunization
activities and other health interventions.
The International Federation, and its more than 45 member National Societies in Africa,
recognize the severe burden of disease and death imposed by malaria on children and
mothers; the impact of malaria on economic and social development; the availability of cost-
effective interventions for treatment and prevention; and the commitment of the Roll Back
Malaria partners to mobilize resources and to scale-up control efforts towards achieving the
Millennium Development Goals and the targets set for 2005 by the Abuja Malaria Summit.
These objectives are consistent with the Red Cross and Red Crescent Societies’ mission to
improve the life and health of the most vulnerable individuals and families, and with their
capacity to mobilize thousands of community volunteers, to extend the reach of health
services towards their intended beneficiaries.
The International Federation at global level, and National Societies at country level, are
playing an increasing role as partners in global health alliances against major public health
problems, working with national governments and Ministries of Health, and with WHO,
UNICEF, the Centers for Disease Control and Prevention, the UN Foundation and other
global, regional and local partners. In addition to their traditional role in disaster and outbreak
response activities, Red Cross and Red Crescent volunteers have been increasingly engaged in
ongoing disease control programs, including HIV/AIDS, Tuberculosis, Polio Eradication and
others. Since 2001, Red Cross and Red Crescent Societies have taken an active part in mass
vaccination campaigns against measles, as part of the Africa measles partnership, spearheaded
by the American Red Cross. By the end of 2005, more than 200 million African children will
have been vaccinated, preventing several hundred thousand measles deaths annually. These
renewed efforts in measles control have offered opportunities to accelerate other important
interventions, including the mass distribution of insecticide-treated mosquito nets for malaria
prevention among children under 5 years and pregnant women. Demonstration projects were
conducted with success in selected districts in Ghana in 2002 and in Zambia in 2003. A
nationwide campaign is under preparation in Togo for December 2004, combining measles
vaccination with nationwide distribution of mosquito nets to eligible households, with
participation of Red Cross volunteers for community mobilization before and during the
campaign. In partnership with the Togo Ministry of Health, local WHO and UNICEF staff,
other NGOs, and with a number of other partners, we look forward to a substantial impact on
malaria morbidity as a result of this nationwide partnership effort.
Mr. Chairman,
In January 2004, WHO and UNICEF issued a joint statement calling for combining malaria
control activities with immunization activities, when possible, either during Supplementary
Immunization Activities (such as measles vaccination campaigns), or on a regular basis
through routine immunization services
The International Federation welcomes and supports this policy development.
We look
forward to working with WHO, governments and other partners to implement the
WHO/UNICEF comprehensive strategies for measles mortality reduction and for scaling-up
malaria control activities. National Societies of Red Cross and Red Crescent and their
volunteers will work with you towards increasing demand for these interventions.
We support the call for strengthening partnerships at the global, regional and national levels.
As an international organization with a bridging role, we believe that a broader involvement
of NGOs as partners to their respective national governments is crucial to achieving better
health for all families. The successful mobilization of civil society and the involvement of
communities and families in their own health issues are the very core of our Red Cross and
Red Crescent National Societies.
Communities can thus sustain essential public health
interventions which will result in improved health for the most vulnerable populations. In this
way we can together achieve the desired progress towards the fulfillment of the Millennium
Development Goals.
Thank you, Mr. Chairman.
C O H H ' 3W- ■
WHA57.17
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
Agenda item 12.6
22 May 2004
Global strategy on diet, physical activity and health
The Fifty-seventh World Health Assembly,
Recalling resolutions WHA5I.I8 and WHA53.17 on prevention
noncommunicable diseases, and WHA55.23 on diet, physical activity and health;
and
control
of
Recalling The world health report 2002,' which indicates that mortality, morbidity and
disability attributed to the major noncommunicable diseases currently account for about 60% of all
deaths and 47% of the global burden of disease, which figures are expected to rise to 73% and 60%,
respectively, by 2020;
Noting that 66% of the deaths attributed to noncommunicable diseases occur in developing
countries where those affected are on average younger than in developed countries;
Alarmed by these rising figures that are a consequence of evolving trends in demography and
lifestyles, including those related to diet and physical activity;
Recognizing the existing, vast body of knowledge and public health potential, the need to
reduce the level of exposure to the major risks resulting from unhealthy diet and physical inactivity,
and the largely preventable nature of the consequent diseases;
Mindful also that these major behavioural and environmental risk factors are amenable to
modification through implementation of concerted essential public-health action, as has been
demonstrated in several Member States;
Acknowledging that malnutrition, including undemutrition and nutritional deficiencies, is still a
major cause of death and disease in many parts of the world, especially in developing countries, and
that this strategy complements the important work of WHO and its Member States in the overall area
of nutrition;
Recognizing the interdependence of nations, communities and individuals and that governments
have a central role, in cooperation with other stakeholders, to create an environment that empowers
and encourages individuals, families and communities to make positive, life-enhancing decisions on
healthy diet and physical activity;
1 The world health report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.
WHA57.17
Recognizing the importance of a global strategy for diet, physical activity and health within the
integrated prevention and control of noncommunicable diseases, including support of healthy
lifestyles, facilitation of healthier environments, provision of public information and health services,
and the major involvement in improving the lifestyles and health of individuals and communities of
the health and relevant professions and of all concerned stakeholders and sectors committed to
reducing the risks of noncommunicable diseases;
Recognizing that for the implementation of this global strategy, capacity building, financial and
technical support should be promoted through international cooperation in support of national efforts
in developing countries;
Recognizing the socioeconomic importance and the potential health benefits of traditional
dietary' and physical activity practices, including those of indigenous peoples;
Reaffirming that nothing in this strategy shall be construed as a justification for the adoption of
trade-restrictive measures or trade-distorting practices;
Reaffirming that appropriate levels of intakes for energy, nutrients and foods, including free
sugars, salt, fats, fruits, vegetables, legumes, whole grains, and nuts shall be determined in accordance
with national dietary and physical activity guidelines based on the best available scientific evidence
and as part of Member States’ policies and programmes taking into account cultural traditions, and
national dietary habits and practices;
Convinced that it is time for governments, civil society and the international community,
including the private sector, to renew their commitment to encouraging healthy patterns of diet and
physical activity;
Noting that resolution WHA56.23 urged Member States to make full use of Codex Alimentarius
Commission standards for the protection of human health throughout the food chain, including
assistance with making healthy choices regarding nutrition and diet,
1.
ENDORSES the Global Strategy on Diet, Physical Activity and Health annexed herewith;
2.
URGES Member States:
(1)
to develop, implement and evaluate actions recommended in the strategy, as appropriate
to national circumstances and as part of their overall policies and programmes, that promote
individual and community health through healthy diet and physical activity, and reduce the risks
and incidence of noncommunicable diseases;
(2)
to promote lifestyles that include a healthy diet and physical activity and foster energy
balance;
(3)
to strengthen existing, or establish new, structures for implementing the strategy through
the health and other concerned sectors, for monitoring and evaluating its effectiveness and for
guiding resource investment and management to reduce the prevalence of noncommunicable
diseases and the risks related to unhealthy diet and physical inactivity;
WHA57.17
(4)
to define for this purpose, consistent with national circumstances:
(a)
national goals and objectives,
(b)
a realistic timetable for their achievement,
(c)
national dietary and physical activity guidelines,
(d)
measurable process and output indicators that will permit accurate monitoring and
evaluation of action taken and a rapid response to identified needs,
(e)
measures to preserve and promote traditional foods and physical activity;
(5)
to encourage mobilization of all concerned social and economic groups, including
scientific, professional, nongovernmental, voluntary, private-sector, civil society, and industry
associations, and to engage them actively and appropriately in implementing the strategy and
achieving its aims and objectives;
(6)
to encourage and foster a favourable environment for the exercise of individual
responsibility for health through the adoption of lifestyles that include a healthy diet and
physical activity;
(7)
to ensure that public policies adopted in the context of the implementation of this strategy
are in accordance with their individual commitments in international and multilateral
agreements, including trade and other related agreements, so as to avoid trade-restrictive or
trade-distorting impact;
(8)
to consider, when implementing the strategy, the risks of unintentional effects on
vulnerable populations and specific products;
3.
CALLS UPON other international organizations and bodies to give high priority within their
respective mandates and programmes to, and invites public and private stakeholders including the
donor community to cooperate with governments in, the promotion of healthy diets and physical
activity to improve health outcomes;
4.
REQUESTS the Codex Alimentarius Commission to continue to give full consideration, within
the framework of its operational mandate, to evidence-based action it might take to improve the health
standards of foods consistent with the aims and objectives of the strategy;
5.
REQUESTS the Director-General:
(1)
to continue and strengthen the work dedicated to undemutrition and micronutrient
deficiencies, in cooperation with Member States, and to continue to report to Member States on
developments made in the field of nutrition (resolutions WHA46.7, WHA52.24, WHA54.2 and
WHA55.25);
(2)
to provide technical advice and mobilize support at both global and regional levels to
Member States, when requested, in implementing the strategy and in monitoring and evaluating
implementation;
3
II HA57. I'
(3)
to monitor on an ongoing basis international scientific developments and research relative
to diet, physical activity and health, including claims on the dietary benefits of agricultural
products which constitute a significant or important part of the diet of individual countries, so as
to enable Member States to adapt their programmes to the most up-to-date knowledge;
(4)
to continue to prepare and disseminate technical information, guidelines, studies,
evaluations, advocacy and training materials so that Member States are better aware of the
cost/benefits and contributions of healthy diet and physical activity as they address the growing
global burden of noncommunicable diseases;
(5)
to strengthen international cooperation with other organizations of the United Nations
system and bilateral agencies in promoting healthy diet and physical activity throughout life;
(6)
to cooperate with civil society and with public and private stakeholders committed to
reducing the risks of noncommunicable diseases in implementing the strategy and promoting
healthy diet and physical activity, while ensuring avoidance of potential conflicts of interest;
(7)
to work with other specialized United Nations and intergovernmental agencies on
assessing and monitoring the health aspects, socioeconomic impact and gender aspects of this
strategy and its implementation and to brief the Fifty-ninth World Health Assembly on the
progress of this activity;
(8)
to report on the implementation of the global strategy at the Fifty-ninth World Health
Assembly.
4
WHA57.I7
ANNEX
GLOBAL STRATEGY ON DIET,
PHYSICAL ACTIVITY AND HEALTH
(endorsed by resolution WHA57.17)
1.
Recognizing the heavy and growing burden of noncommunicable diseases, Member States
requested the Director-General to develop a global strategy on diet, physical activity and health
through a broad consultation process.1 To establish the content of the draft global strategy, six regional
consultations were held with Member States, and organizations of the United Nations system, other
intergovernmental bodies, and representatives of civil society and the private sector were consulted. A
reference group of independent international experts on diet and physical activity from WHO’s six
regions also provided advice.
2.
The strategy addresses two of the main risk factors for noncommunicable diseases, namely, diet
and physical activity, while complementing the long-established and ongoing work carried out by
WHO and nationally on other nutrition-related areas, including undemutrition, micronutrient
deficiencies and infant- and young-child feeding.
THE CHALLENGE
3.
A profound shift in the balance of the major causes of death and disease has already occurred in
developed countries and is under way in many developing countries. Globally, the burden of
noncommunicable diseases has rapidly increased. In 2001 noncommunicable diseases accounted for
almost 60% of the 56 million deaths annually and 47% of the global burden of disease. In view of
these figures and the predicted future growth in this disease burden, the prevention of
noncommunicable diseases presents a major challenge to global public health.
4.
The world health report 20021
2 describes in detail how, in most countries, a few major risk
factors account for much of the morbidity and mortality. For noncommunicable diseases, the most
important risks included high blood pressure, high concentrations of cholesterol in the blood,
inadequate intake of fruit and vegetables, overweight or obesity, physical inactivity and tobacco use.
Five of these risk factors are closely related to diet and physical activity.
5.
Unhealthy diets and physical inactivity are thus among the leading causes of the major
noncommunicable diseases, including cardiovascular disease, type 2 diabetes and certain types of
cancer, and contribute substantially to the global burden of disease, death and disability. Other
diseases related to diet and physical inactivity, such as dental caries and osteoporosis, are widespread
causes of morbidity.
6.
The burden of mortality, morbidity and disability attributable to noncommunicable diseases is
currently greatest and continuing to grow in the developing countries, where those affected are on
average younger than in developed countries, and where 66% of these deaths occur. Rapid changes in
1 Resolution WHA55.23.
2 The world health report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.
5
H'HA57.1~
Annex
diets and patterns of physical activity are further causing rates to rise. Smoking also increases the risk
for these diseases, although largely through independent mechanisms.
7.
In some developed countries where noncommunicable diseases have dominated the national
burden of disease, age-specific death and disease rates have been slowly declining. Progress is being
made in reducing premature death rates from coronary artery disease, cerebrovascular disease and
some tobacco-related cancers. However, the overall burden and number of patients remain high, and
the numbers of overweight and obese adults and children, and of cases, closely linked, of type 2
diabetes are growing in many developed countries.
8.
Noncommunicable diseases and their risk factors are initially mostly limited to economically
successful groups in low- and middle-income countries. However, recent evidence shows that, over
time, patterns of unhealthy behaviour and the noncommunicable diseases associated with them cluster
among poor communities and contribute to social and economic inequalities.
9.
In the poorest countries, even though infectious diseases and undemutrition dominate their
current disease burden, the major risk factors for chronic diseases are spreading. The prevalence of
overweight and obesity is increasing in developing countries, and even in low-income groups in richer
countries. An integrated approach to the causes of unhealthy diet and decreasing levels of physical
activity would contribute to reducing the future burden of noncommunicable diseases.
10.
For all countries for which data are available, the underlying determinants of noncommunicable
diseases are largely the same. Factors that increase the risks of noncommunicable disease include
elevated consumption of energy-dense, nutrient-poor foods that are high in fat, sugar and salt; reduced
levels of physical activity at home, at school, at work and for recreation and transport; and use of
tobacco. Variations in risk levels and related health outcomes among the population are attributed, in
part, to the variability in timing and intensity of economic, demographic and social changes at national
and global levels. Of particular concern are unhealthy diets, inadequate physical activity and energy
imbalances in children and adolescents.
11. Maternal health and nutrition before and during pregnancy, and early infant nutrition may be
important in the prevention of noncommunicable diseases throughout the life course. Exclusive
breastfeeding for six months and appropriate complementary feeding contribute to optimal physical
growth and mental development. Infants who suffer prenatal and possibly, postnatal growth
restrictions appear to be at higher risk for noncommunicable diseases in adulthood.
12.
Most elderly people live in developing countries, and the ageing of populations has a strong
impact on morbidity and mortality patterns. Many developing countries will therefore be faced with an
increased burden of noncommunicable diseases at the same time as a persisting burden of infectious
diseases. In addition to the human dimension, maintaining the health and functional capacity of the
increasing elderly population will be a crucial factor in reducing the demand for, and cost of, health
services.
13.
Diet and physical activity influence health both together and separately. Although the effects of
diet and physical activity on health often interact, particularly in relation to obesity, there are
additional health benefits to be gained from physical activity that arc independent of nutrition and diet,
and there are significant nutritional risks that are unrelated to obesity. Physical activity is a
fundamental means of improving the physical and mental health of individuals.
6
Annex
WHA 57.17
14. Governments have a central role, in cooperation with other stakeholders, to create an
environment that empowers and encourages behaviour changes by individuals, families and
communities, to make positive, life-enhancing decisions on healthy diets and patterns of physical
activity.
15. Noncommunicable diseases impose a significant economic burden on already strained health
systems, and inflict great costs on society. Health is a key detcnninant of development and a precursor
of economic growth. The WHO Commission on Macroeconomics and Health has demonstrated the
disruptive effect of disease on development, and the importance for economic development of
investments in health.1 Programmes aimed at promoting healthy diets and physical activity for the
prevention of diseases are key instruments in policies to achieve development goals.
THE OPPORTUNITY
16. A unique opportunity exists to formulate and implement an effective strategy for substantially
reducing deaths and disease worldwide by improving diet and promoting physical activity. Evidence
for the links between these health behaviours and later disease and ill-health is strong. Effective
interventions to enable people to live longer and healthier lives, reduce inequalities, and enhance
development can be designed and implemented. By mobilizing the full potential of the major
stakeholders, this vision could become a reality for all populations in all countries.
GOAL AND OBJECTIVES
17. The overall goal of the global strategy on diet, physical activity and health is to promote and
protect health by guiding the development of an enabling environment for sustainable actions at
individual, community, national and global levels that, when taken together, will lead to reduced
disease and death rates related to unhealthy diet and physical inactivity. These actions support the
United Nations Millennium Development Goals and have immense potential for public health gains
worldwide.
18.
The global strategy has four main objectives:
(1)
to reduce the risk factors for noncommunicable diseases that stem from unhealthy diets
and physical inactivity by means of essential public health action and health-promoting and
disease-preventive measures;
(2)
to increase the overall awareness and understanding of the influences of diet and physical
activity on health and of the positive impact of preventive interventions;
(3)
to encourage the development, strengthening and implementation of global, regional,
national and community policies and action plans to improve diets and increase physical activity
that are sustainable, comprehensive, and actively engage all sectors, including civil society, the
private sector and the media;
1 Macroeconomics and health: investing in health for economic development. Geneva, World Health Organization,
2001.
7
II /IA57. r
Annex
(4) to monitor scientific data and key influences on diet and physical activity; to support
research in a broad spectrum of relevant areas, including evaluation of interventions; and to
strengthen the human resources needed in this domain to enhance and sustain health.
EVIDENCE FOR ACTION
19.
Evidence shows that, when other threats to health are addressed, people can remain healthy into
their seventh, eighth and ninth decades, through a range of health-promoting behaviours, including
healthy diets, regular and adequate physical activity, and avoidance of tobacco use. Recent research
has contributed to understanding of the benefits of healthy diets, physical activity, individual action
and population-based public health interventions. Although more research is needed, cunent
knowledge warrants urgent public health action.
20. Risk factors for noncommunicable disease frequently coexist and interact. As the general level
of risk factors rises, more people are put at risk. Preventive strategies should therefore aim at reducing
risk throughout the population. Such risk reduction, even if modest, cumulatively yields sustainable
benefits, which exceeds the impact of interventions restricted to high-risk individuals. Healthy diets
and physical activity, together with tobacco control, constitute an effective strategy to contain the
mounting threat of noncommunicable diseases.
21. Reports of international and national experts and reviews of the current scientific evidence
recommend goals for nutrient intake and physical activity in order to prevent major noncommunicable
diseases. These recommendations need to be considered when preparing national policies and dietary
guidelines, taking into account the local situation.
22.
For diet, recommendations for populations and individuals should include the following:
• achieve energy balance and a healthy weight
• limit energy intake from total fats and shift fat consumption away from saturated fats to
unsaturated fats and towards the elimination of trans-fatty acids
• increase consumption of fruits and vegetables, and legumes, whole grains and nuts
• limit the intake of free sugars
• limit salt (sodium) consumption from all sources and ensure that salt is iodized.
23. Physical activity is a key determinant of energy expenditure, and thus is fundamental to energy
balance and weight control. Physical activity reduces risk for cardiovascular diseases and diabetes and
has substantial benefits for many conditions, not only those associated with obesity. The beneficial
effects of physical activity on the metabolic syndrome are mediated by mechanisms beyond
controlling excess body weight. For example, physical activity reduces blood pressure, improves the
level of high density lipoprotein cholesterol, improves control of blood glucose in overweight people,
even without significant weight loss, and reduces the risk for colon cancer and breast cancer among
women.
24. For physical activity, it is recommended that individuals engage in adequate levels throughout
their lives. Different types and amounts of physical activity are required for different health outcomes:
8
WHA57.17
Annex
at least 30 minutes of regular, moderate-intensity physical activity on most days reduces the risk of
cardiovascular disease and diabetes, colon cancer and breast cancer. Muscle strengthening and balance
training can reduce falls and increase functional status among older adults. More activity may be
required for weight control.
25.
The translation of these recommendations, together with effective measures to prevent and
control tobacco use, into a global strategy that leads to regional and national action plans, will require
sustained political commitment and the collaboration of many stakeholders. This strategy will
contribute to the effective prevention of noncommunicable diseases.
PRINCIPLES FOR ACTION
26. The world health report 2002 highlights the potential for improving public health through
measures that reduce the prevalence of risk factors (most notably the combination of unhealthy diets
and physical inactivity) of noncommunicable diseases. The principles set out below guided the
drafting of WHO’s global strategy on diet, physical activity and health and are recommended for the
development of national and regional strategies and action plans.
27.
Strategies need to be based on the best available scientific research and evidence;
comprehensive, incorporating both policies and action and addressing all major causes of
noncommunicable diseases together; multisectoral, taking a long-term perspective and involving all
sectors of society; and multidisciplinary and participatory, consistent with the principles contained in
the Ottawa Charter for Health Promotion and confirmed in subsequent conferences on health,
promotion,1 and recognizing the complex interactions between personal choices, social norms and
economic and environmental factors.
28.
A life-course perspective is essential for the prevention and control of noncommunicable
diseases. This approach starts with maternal health and prenatal nutrition, pregnancy outcomes,
exclusive breastfeeding for six months, and child and adolescent health; reaches children at schools,
adults at worksites and other settings, and the elderly; and encourages a healthy diet and regular
physical activity from youth into old age.
29.
Strategies to reduce noncommunicable diseases should be part of broader, comprehensive and
coordinated public health efforts. All partners, especially governments, need to address simultaneously
a number of issues. In relation to diet, these include all aspects of nutrition (for example, both
ovemutrition and undemutrition, micronutrient deficiency and excess consumption of certain
nutrients); food security (accessibility, availability and affordability of healthy food); food safety; and
support for and promotion of six months of exclusive breastfeeding. Regarding physical activity,
issues include requirements for physical activity in working, home and school life, increasing
urbanization, and various aspects of city planning, transportation, safety and access to physical activity
during leisure.
30.
Priority should be given to activities that have a positive impact on the poorest population
groups and communities. Such activities will generally require community-based action with strong
government intervention and oversight.
1 See resolution WHA51.12 (1998).
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Annex
31. All partners need to be accountable for framing policies and implementing programmes that will
effectively reduce preventable risks to health. Evaluation, monitoring and surveillance are essential
components of such actions.
32. The prevalence of noncommunicable diseases related to diet and physical activity may vary
greatly between men and women. Patterns of physical activity and diets differ according to sex, culture
and age. Decisions about food and nutrition are often made by women and are based on culture and
traditional diets. National strategies and action plans should therefore be sensitive to such differences.
33. Dietary habits and patterns of physical activity are often rooted in local and regional traditions.
National strategies should therefore be culturally appropriate and able to challenge cultural influences
and to respond to changes over time.
RESPONSIBILITIES FOR ACTION
34. Bringing about changes in dietary habits and patterns of physical activity will require the
combined efforts of many stakeholders, public and private, over several decades. A combination of
sound and effective actions is needed at global, regional, national and local levels, with close
monitoring and evaluation of their impact. The following paragraphs describe the responsibilities of
those involved and provide recommendations deriving from the consultation process.
WHO
35. WHO, in cooperation with other organizations of the United Nations system, will provide the
leadership, evidence-based recommendations and advocacy for international action to improve dietary
practices and increase physical activity, in keeping with the guiding principles and specific
recommendations contained in this strategy.
36. It will hold discussions with the transnational food industry and other parts of the private sector
in support of the aims of this global strategy, and of implementing the recommendations in countries.
37. WHO will provide support for implementation of programmes as requested by Member States,
and will focus on the following broad, interrelated areas:
• facilitating the framing, strengthening and updating of regional and national policies on
diet and physical activity for integrated noncommunicable disease prevention
• facilitating the drafting, updating and implementation of national food-based dietary
and physical activity guidelines, in collaboration with national agencies and drawing upon
global knowledge and experience
• providing guidance to Member States on the formulation of guidelines, norms,
standards and other policy-related measures that are consistent with the objectives of the
global strategy
• identifying and disseminating information on evidence-based interventions, policies and
structures that are effective in promoting healthy diets and optimizing the level of physical
activity in countries and communities
10
Annex
WHA57.17
• providing appropriate technical support to build national capacity in planning and
implementing a national strategy and in tailoring it to local circumstances
• providing models and methods so that interventions on diet and physical activity constitute
an integral component of health care
• promoting and providing support for training of health professionals in healthy diets
and an active life, cither within existing programmes or in special workshops, as an essential
part of their curricula
• providing advice and support to Member States, using standardized surveillance
methods and rapid assessment tools (such as WHO’s STEPwise approach to surveillance of
risk factors for noncommunicable diseases), in order to measure changes in distribution of
risk - including patterns in diet, nutrition and physical activity - and to assess the current
situation, trends, and the impact of interventions. WHO, in collaboration with FAO, will
provide support to Member States in establishing national nutrition surveillance systems,
linked with data on the content of food items
• advising Member States on ways of engaging constructively with appropriate industries.
3S. WHO, in close collaboration with organizations of the United Nations system and other
intergovernmental bodies (FAO, UNESCO, UNICEF, United Nations University and others), research
institutes and other partners, will promote and support research tn priority areas to facilitate
programme implementation and evaluation. This could include commissioning scientific papers,
conducting analyses, and holding technical meetings on practical research topics that are essential for
effective country action. The decision-making process should be informed by better use of evidence,
including health-impact assessment, cost-benefit analysis, national burden-of-disease studies,
evidence-based intervention models, scientific advice and dissemination of good practices.
39.
It will work with FAO and other organizations of the United Nations system, the World Bank,
and research institutes on their evaluation of implications of the strategy for other sectors.
40. The Organization will continue to work with WHO collaborating centres to establish networks
for building up capacity in research and training, mobilizing contributions from nongovernmental
organizations and civil society, and facilitating coordinated, collaborative research as it pertains to the
needs of developing countries in the implementation of this strategy.
Member States
41. The global strategy should foster the formulation and promotion of national policies, strategies
and action plans to improve diet and encourage physical activity. National circumstances will
determine priorities in the development of such instruments. Because of the great variations in and
between different countries, regional bodies should collaborate in formulating regional strategies,
which can provide considerable support to countries in implementing their national plans. For
maximum effectiveness, countries should adopt the most comprehensive action plans possible.
42. The role of government is crucial in achieving lasting change in public health.
Governments have a primary steering and stewardship role in initiating and developing the strategy,
ensuring that it is implemented and monitoring its impact in the long term.
11
II H. 15 '. I -
Annex
43. Governments are encouraged to build on existing structures and processes that already
address aspects of diet, nutrition and physical activity. In many countries, existing national
strategies and action plans can be used in implementing this strategy; in others they can form the basis
for advancing control of noncommunicable diseases. Governments are encouraged to set up a national
coordinating mechanism that addresses diet and physical activity within the context of a
comprehensive plan for noncommunicable-disease prevention and health promotion. Local authorities
should be closely involved. Multisectoral and multidisciplinary expert advisory boards should also be
established. They should include technical experts and representatives of government agencies, and
have an independent chair to ensure that scientific evidence is interpreted without any conflict of
interest.
44. Health ministries have an essential responsibility for coordinating and facilitating the
contributions of other ministries and government agencies. Bodies whose contributions should be
coordinated include ministries and government institutions responsible for policies on food,
agriculture, youth, recreation, sports, education, commerce and industry, finance, transportation, media
and communication, social affairs and environmental and urban planning.
45. National strategies, policies and action plans need broad support. Support should be
provided by effective legislation, appropriate infrastructure, implementation programmes, adequate
funding, monitoring and evaluation, and continuing research.
(1)
National strategies on diet and physical activity. National strategies describe the
measures to promote healthy diets and physical activity that are essential to prevent disease and
promote health, including those that tackle all aspects of unbalanced diets, including
undemutrition and overnutrition. National strategies should include specific goals, objectives,
and actions, similar to those outlined in the global strategy. Of particular importance are the
elements needed to implement the plan of action, including identification of necessary resources
and national focal points (key national institutes); collaboration between the health sector and
other key sectors such as agriculture, education, urban planning, transportation and
communication; and monitoring and follow-up.
(2) National dietary guidelines. Governments are encouraged to draw up national dietary
guidelines, taking account of evidence from national and international sources. Such guidelines
advise national nutrition policy, nutrition education, other public health interventions and
intersectoral collaboration. They may be updated periodically in the light of changes in dietary
and disease patterns and evolving scientific knowledge.
(3) National physical activity guidelines. National guidelines for health-enhancing physical
activity should be prepared in accordance with the goals and objectives of the global strategy
and expert recommendations.
46. Governments should provide accurate and balanced information. Governments need to
consider actions that will result in provision of balanced information for consumers to enable them
easily to make healthy choices, and to ensure the availability of appropriate health promotion and
education programmes. In particular, information for consumers should be sensitive to literacy levels,
communication barriers and local culture, and understood by all segments of the population. In some
countries, health-promoting programmes have been designed as a function of such considerations and
should be used for disseminating information about diet and physical activity. Some governments
already have a legal obligation to ensure that factual information available to consumers enables them
to make fully informed choices on matters that may affect their health. In other cases, actions may be
specific to government policies. Governments should select the optimal mix of actions in accordance
12
Annex
WHA57.1 7
with their national capabilities and epidemiological profile, which will vary from one country to
another.
(1)
Education, communication and public awareness. A sound basis for action is provided
by public knowledge and understanding of the relationship between diet, physical activity and
health, of energy intake and output, and healthy choice of food items. Consistent, coherent,
simple and clear messages should be prepared and conveyed by government experts,
nongovernmental and grass-roots organizations, and the appropriate industries. They should be
communicated through several channels and in forms appropriate to local culture, age and
gender. Behaviour can be influenced especially in schools, workplaces, and educational and
religious institutions, and by nongovernmental organizations, community leaders, and mass
media. Member States should form alliances for the broad dissemination of appropriate and
effective messages about healthy diet and physical activity. Nutrition and physical activity
education and acquisition of media literacy, starting in primary school, are important to promote
healthier diets, and to counter food fads and misleading dietary advice. Support should also be
provided for action that improves the level of health literacy, while taking account of local
cultural and socioeconomic circumstances. Communication campaigns should be regularly
evaluated.
(2)
Adult literacy and education programmes. Health literacy should be incorporated into
adult education programmes. Such programmes provide an opportunity for health professionals
and service providers to enhance knowledge about diet, physical activity and prevention of
noncommunicable diseases and to reach marginalized populations.
(3)
Marketing, advertising, sponsorship and promotion. Food advertising affects food
choices and influences dietary habits. Food and beverage advertisements should not exploit
children’s inexperience or credulity. Messages that encourage unhealthy dietary practices or
physical inactivity should be discouraged, and positive, healthy messages encouraged.
Governments should work with consumer groups and the private sector (including advertising)
to develop appropriate multisectoral approaches to deal with the marketing of food to children,
and to deal with such issues as sponsorship, promotion and advertising.
(4)
Labelling. Consumers require accurate, standardized and comprehensible information on
the content of food items in order to make healthy choices. Governments may require
information to be provided on key nutritional aspects, as proposed in the Codex Guidelines on
Nutrition Labelling.1
(5)
Health claims. As consumers’ interest in health grows, and increasing attention is paid to
the health aspects of food products, producers increasingly use health-related messages. Such
messages must not mislead the public about nutritional benefits or risks.
47. National food and agricultural policies should be consistent with the protection and
promotion of public health. Where needed, governments should consider policies that facilitate the
adoption of healthy diet. Food and nutrition policy should also cover food safety and sustainable food
security. Governments should be encouraged to examine food and agricultural policies for potential
health effects on the food supply.
' Codex Alimcmanus Commission, document CAC/GL 2-1985, Rev 1-1993.
13
Annex
(1)
Promotion of food products consistent with a healthy diet. As a result of consumers’
increasing interest in health and governments’ awareness of the benefits of healthy nutrition,
some governments have taken measures, including market incentives, to promote the
development, production and marketing of food products that contribute to a healthy diet and
are consistent with national or international dietary recommendations. Governments could
consider additional measures to encourage the reduction of the salt content of processed foods,
the use of hydrogenated oils, and the sugar content of beverages and snacks.
(2)
Fiscal policies. Prices influence consumption choices. Public policies can influence
prices through taxation, subsidies or direct pricing in ways that encourage healthy eating and
lifelong physical activity. Several countries use fiscal measures, including taxes, to influence
availability of, access to, and consumption of, various foods; and some use public funds and
subsidies to promote access among poor communities to recreational and sporting facilities.
Evaluation of such measures should include the risk of unintentional effects on vulnerable
populations.
(3)
Food programmes. Many countries have programmes to provide food to population
groups with special needs or cash transfers to families for them to improve their food purchases.
Such programmes often concern children, families with children, poor people, and people with
HIV/AIDS and other diseases. Special attention should be given to the quality of the food items
and to nutrition education as a main component of these programmes, so that food distributed
to. or purchased by, the families not only provides energy, but also contributes to a healthy diet.
Food and cash distribution programmes should emphasize empowerment and development,
local production and sustainability.
(4)
Agricultural policies. Agricultural policy and production often have a great effect on
national diets. Governments can influence agricultural production through many policy
measures. As emphasis on health increases and consumption patterns change, Member States
need to take healthy nutrition into account in their agricultural policies.
4S. Multisectoral policies are needed to promote physical activity. National policies to promote
physical activity should be framed, targeting change in a number of sectors. Governments should
review existing policies to ensure that they are consistent with best practice in population-wide
approaches to increasing physical activity.
(1)
Framing and review of public policies. National and local governments should frame
policies and provide incentives to ensure that walking, cycling and other forms of physical
activity are accessible and safe; transport policies include nonmotorized modes of
transportation; labour and workplace policies encourage physical activity; and sport and
recreation facilities embody the concept of sports for all. Public policies and legislation have an
impact on opportunities for physical activity, such as those concerning transport, urban
planning, education, labour, social inclusion, and health-care funding related to physical
activity.
(2)
Community involvement and enabling environments. Strategies should be geared to
changing social norms and improving community understanding and acceptance of the need to
integrate physical activity into everyday life. Environments should be promoted that facilitate
physical activity, and supportive infrastructure should be set up to increase access to, and use of,
suitable facilities.
14
Annex
lVfIA57.17
(3) Partnerships. Ministries of health should take the lead in forming partnerships with key
agencies, and public and private stakeholders in order to draw up jointly a common agenda and
workplan aimed at promoting physical activity.
(4)
Clear public messages. Simple, direct messages need to be communicated on the
quantity and quality of physical activity sufficient to provide substantial health benefits.
49. School policies and programmes should support the adoption of healthy diets and physical
activity. Schools influence the lives of most children in all countries. They should protect their health
by providing health information, improving health literacy, and promoting healthy diets, physical
activity, and other healthy behaviours. Schools are encouraged to provide students with daily physical
education and should be equipped with appropriate facilities and equipment. Governments are
encouraged to adopt policies that support healthy diets at school and limit the availability of products
high in salt, sugar and fats. Schools should consider, together with parents and responsible authorities,
issuing contracts for school lunches to local food growers in order to ensure a local market for healthy
foods.
50. Governments are encouraged to consult with stakeholders on policy. Broad public
discussion and involvement in the framing of policy can facilitate its acceptance and effectiveness.
Member States should establish mechanisms to promote participation of nongovernmental
organizations, civil society, communities, the private sector and the media in activities related to diet,
physical activity and health. Ministries of health should be responsible, in collaboration with other
related ministries and agencies, for establishing these mechanisms, which should aim at strengthening
intersectoral cooperation at the national, provincial and local levels. They should encourage
community participation, and should be part of planning processes at community level.
51.
Prevention is a critical element of health services. Routine contacts with health-service staff
should include practical advice to patients and families on the benefits of healthy diets and increased
levels of physical activity, combined with support to help patients initiate and maintain healthy
behaviours. Governments should consider incentives to encourage such preventive services and
identify opportunities for prevention within existing clinical services, including an improved financing
structure to encourage and enable health professionals to dedicate more time to prevention.
(1)
Health and other services. Health-care providers, especially for primary health care, but
also other services (such as social services) can play an important part in prevention. Routine
enquiries as to key dietary habits and physical activity, combined with simple information and
skill-building to change behaviour, taking a life-course approach, can reach a large part of the
population and be a cost-effective intervention. Attention should be given to WHO’s growth
standards for infants and preschool children which expand the definition of health beyond the
absence of overt disease, to include the adoption of healthy practices and behaviours. The
measurement of key biological risk factors, such as blood pressure, serum cholesterol and body
weight, combined with education of the population and support for patients, helps to promote
the necessary changes. The identification of specific high-risk groups and measures to respond
to their needs, including possible pharmacological interventions, are important components.
Training of health personnel, dissemination of appropriate guidelines, and availability of
incentives are key underlying factors in implementing these interventions.
(2)
Involvement with health professional bodies and consumer groups. Enlisting the
strong support of professionals, consumers and communities is a cost-effective way to raise
public awareness of government policies, and enhance their effectiveness.
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WHA57.I7
Annex
52. Governments should invest in surveillance, research and evaluation. Long-term and
continuous monitoring of major risk factors is essential. Over time, such data also provide the basis for
analyses of changes in risk factors, which could be attributable to changes in polices and strategies.
Governments may be able to build on systems already in place, at either national or regional levels.
Emphasis should initially be given to standard indicators recognized by the general scientific
community as valid measures of physical activity, to selected dietary components, and to body weight
in order to compile comparative data at global level. Data that provide insight into within-countiy
patterns and variations are usefill in guiding community action. Where possible, other sources of data
should be used, for example, from the education, transport, agriculture, and other sectors.
(1) Monitoring and surveillance. Monitoring and surveillance are essential tools in the
implementation of national strategies for healthy diet and physical activity. Monitoring of
dietary habits, patterns of physical activity and interactions between them; nutrition-related
biological risk factors and contents of food products; and communication to the public of the
information obtained, are important components of implementation. Of particular importance is
the development of methods and procedures using standardized data-collection procedures and a
common minimum set of valid, measurable and usable indicators.
(2)
Research and evaluation. Applied research, especially in community-based
demonstration projects and in evaluating different policies and interventions, should be
promoted. Such research (e.g., into the reasons for physical inactivity and poor diet, and on key
determinants of effective intervention programmes), combined with the increased involvement
of behavioural scientists, will lead to better informed policies and ensure that a cadre of
expertise is created at national and local levels. Equally important is the need to put in place
effective mechanisms for evaluating the efficacy and cost-effectiveness of national disease
prevention programmes, and the health impact of policies in other sectors. More information is
needed, especially on the situation in developing countries, where programmes to promote
healthy diets and physical activity need to be evaluated and integrated into broader development
and poverty-alleviation programmes.
53. Institutional capacity. Under the ministry of health, national institutions for public health,
nutrition and physical activity play an important role in the implementation of national diet and
physical activity programmes. They can provide the necessary expertise, monitor developments, help
to coordinate activities, participate in collaboration at international level, and provide advice to
decision-makers.
54. Financing national programmes. Various sources of funding, in addition to the national
budget, should be identified to assist in implementation of the strategy. The United Nations
Millennium Declaration (September 2000) recognizes that economic growth is limited unless people
are healthy. The most cost-effective interventions to contain the epidemic of noncommunicable
diseases are prevention and a focus on the risk factors associated with these diseases. Programmes
aimed at promoting healthy diets and physical activity should therefore be viewed as a developmental
need and should draw policy and financial support from national development plans.
International partners
55. The role of international partners is of paramount importance in achieving the goals and
objectives of the global strategy, particularly with regard to issues of a transnational nature, or where
the actions of a single country are insufficient. Coordinated work is needed among the organizations of
16
Annex
WHA57.17
the United Nations system, intergovernmental bodies, nongovernmental organizations, professional
associations, research institutions and private sector entities.
56. The process of preparing the strategy has led to closer interaction with other organizations of the
United Nations system, such as FAO and UNICEF, and other partners, including the World Bank.
WHO will build on its long-standing collaboration with FAO in implementing the strategy. The
contribution of FAO in the framing of agricultural policies can play a crucial part in this regard. More
research into appropriate agriculture policies, and the supply, availability, processing and consumption
of food will be necessary.
57. Cooperation is also planned with bodies such as the United Nations Economic and Social
Council, ILO, UNESCO, WTO, the regional development banks and the United Nations University.
Consistent with the goal and objectives of the strategy, WHO will develop and strengthen
partnerships, including through the establishment and coordination of global and regional networks, in
order to disseminate information, exchange experiences, and provide support to regional and national
initiatives. WHO proposes to set up an ad hoc committee of partners within the United Nations system
in order to ensure continuing policy coherence and to draw upon each organization’s unique strengths.
Partners can play an important role in a global network that targets such areas as advocacy, resource
mobilization, capacity building and collaborative research.
58.
International partners could be involved in implementing the global strategy by:
• contributing to comprehensive intersectoral strategies to improve diet and physical activity,
including, for instance, the promotion of healthy diets in poverty-alleviation programmes
• drawing up guidelines for prevention of nutritional deficiencies in order to harmonize future
dietary and policy recommendations designed to prevent and control noncommunicable
diseases
• facilitating the drafting of national guidelines on diet and physical activity, in collaboration
with national agencies
• cooperating in the development, testing and dissemination of models for community
involvement, including local food production, nutrition and physical activity education, and
raising of consumer awareness
• promoting the inclusion of noncommunicable disease prevention and health promotion
policies relating to diet and physical activity in development policies and programmes
• promoting incentive-based approaches to encourage prevention and control of chronic
diseases.
59. International standards. Public health efforts may be strengthened by the use of international
norms and standards, particularly those drawn up by the Codex Alimentarius Commission.1 Areas for
further development could include: labelling to allow consumers to be better informed about the
benefits and content of foods; measures to minimize the impact of marketing on unhealthy dietary
patterns; fuller information about healthy consumption patterns, including steps to increase the
consumption of fruit and vegetables; and production and processing standards regarding the nutritional
1 See resolution WHA56.23.
17
H'H.457.17
Annex
quality and safety of products. Involvement of governments and nongovernmental organizations as
provided for in the Codex should be encouraged.
Civil society and nongovernmental organizations
60. Civil society and nongovernmental organizations have an important role to play in influencing
individual behaviour and the organizations and institutions that are involved in healthy diet and
physical activity. They can help to ensure that consumers ask governments to provide support for
healthy lifestyles, and the food industry to provide healthy products. Nongovernmental organizations
can support the strategy effectively if they collaborate with national and international partners. Civil
society and nongovernmental organizations can particularly:
• lead grass-roots mobilization and advocate that healthy diets and physical activity should be
placed on the public agenda
• support the wide dissemination of information on prevention of noncommunicable diseases
through balanced, healthy diets and physical activity
• form networks and action groups to promote the availability of healthy foods and possibilities
for physical activity, and advocate and support health-promoting programmes and health
education campaigns
• organize campaigns and events that will stimulate action
• emphasize the role of governments in promoting public health, healthy diets and physical
activity; monitor progress in achieving objectives; and monitor and work with other
stakeholders such as private sector entities
• play an active role in fostering implementation of the global strategy
• contribute to putting knowledge and evidence into practice.
Private sector
61. The private sector can be a significant player in promoting healthy diets and physical activity.
The food industry, retailers, catering companies, sporting-goods manufacturers, advertising and
recreation businesses, insurance and banking groups, pharmaceutical companies and the media all
have important parts to play as responsible employers and as advocates for healthy lifestyles. All could
become partners with governments and nongovernmental organizations in implementing measures
aimed at sending positive and consistent messages to facilitate and enable integrated efforts to
encourage healthy eating and physical activity. Because many companies operate globally,
international collaboration is crucial. Cooperative relationships with industry have already led to many
favourable outcomes related to diet and physical activity. Initiatives by the food industry to reduce the
fat, sugar and salt content of processed foods and portion sizes, to increase introduction of innovative,
healthy, and nutritious choices; and review of current marketing practices, could accelerate health
gains worldwide. Specific recommendations to the food industry and sporting-goods manufacturers
include the following:
• promote healthy diets and physical activity in accordance with national guidelines and
international standards and the overall aims of the global strategy
18
Annex
W7//157.77
• limit the levels of saturated fats, trans-fatty acids, free sugars and salt in existing products
• continue to develop and provide affordable, healthy and nutritious choices to consumers
• consider introducing new products with better nutritional value
• provide consumers with adequate and understandable product and nutrition information
• practise responsible marketing that supports the strategy, particularly with regard to the
promotion and marketing of foods high in saturated fats, Zrans-fatty acids, free sugars, or salt,
especially to children
• issue simple, clear and consistent food labels and evidence-based health claims that will help
consumers to make informed and healthy choices with respect to the nutritional value of
foods
• provide information on food composition to national authorities
• assist in developing and implementing physical activity programmes.
62. Workplaces are important settings for health promotion and disease prevention. People need to
be given the opportunity to make healthy choices in the workplace in order to reduce their exposure to
risk. Further, the cost to employers of morbidity attributed to noncommunicable diseases is increasing
rapidly. Workplaces should make possible healthy food choices and support and encourage physical
activity.
FOLLOW-UP AND FUTURE DEVELOPMENTS
63. WHO will report on progress made in implementing the global strategy and in implementing
national strategies, including the following aspects:
• patterns and trends of dietary habits and physical activity and related risk factors for major
noncommunicable diseases
• evaluation of the effectiveness of policies and programmes to improve diet and increase
physical activity
• constraints or barriers encountered in implementation of the strategy and the measures taken
to overcome them
• legislative, executive, administrative, financial or other measures taken within the context of
this strategy.
64. WHO will work at global and regional levels to set up a monitoring system and to design
indicators for dietary habits and patterns of physical activity.
19
WHA57.17
Annex
CONCLUSIONS
65. Actions, based on the best available scientific evidence and the cultural context, need to be
designed, implemented and monitored with WHO’s support and leadership. Nonetheless, a truly
multisectoral approach that mobilizes the combined energy, resources and expertise of all global
stakeholders is essential for sustained progress.
66. Changes in patterns of diet and physical activity will be gradual, and national strategies will
need a clear plan for long-term and sustained disease-preventive measures. However, changes in risk
factors and in incidence of noncommunicable diseases can occur quite quickly when effective
interventions are made. National plans should therefore also have achievable short-term and
intermediate goals.
67. The implementation of this strategy by all those involved will contribute to major and sustained
improvements in people’s health.
Eighth plenary meeting, 22 May 2004
A57/VR/8
20
G®
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
H - 3 i-—
WHA57.10
22 May 2004
Agenda item 12.7
Road safety and health
The Fifty-seventh World Health Assembly,
Recalling resolution WHA27.59 (1974), which noted that road traffic accidents caused
extensive and serious public health problems, that coordinated international efforts were required, and
that WHO should provide leadership to Member States;
Having considered the report on road safety and health;1
Welcoming United Nations General Assembly resolution 58/9 on the global road-safety crisis;
Noting with appreciation the adoption of resolution 58/289 by the United Nations General
Assembly inviting WHO to act as a coordinator on road safety issues within the United Nations
system, drawing upon expertise from the United Nations regional commissions;
Recognizing the tremendous global burden of mortality resulting from road traffic crashes, 90%
of which occur in low- and middle-income countries;
Acknowledging that every road user must take the responsibility to travel safely and respect
traffic laws and regulations;
Recognizing that road traffic injuries constitute a major but neglected public health problem that
has significant consequences in terms of mortality and morbidity and considerable social and
economic costs, and that in the absence of urgent action this problem is expected to worsen;
Further recognizing that a multisectoral approach is required successfully to address this
problem, and that evidence-based interventions exist for reducing the impact of road traffic injuries;
Noting the large number of activities on the occasion of World Health Day 2004, in particular,
the launch of the first world report on traffic injury prevention,1
2
1.
CONSIDERS that the public health sector and other sectors - government and civil society
alike - should actively participate in programmes for the prevention of road traffic injury through
injury surveillance and data collection, research on risk factors of road traffic injuries, implementation
and evaluation of interventions for reducing road traffic injuries, provision of prehospital and trauma
1 Document A57/10.
2 World report on road traffic injury prevention. Geneva, World Health Organization, 2004.
£
II7/15’. 10
care and mental-health support for traffic-injury victims, and advocacy for prevention of road traffic
injuries;
2.
URGES Member States, particularly those which bear a large proportion of the burden of road
traffic injuries, to mobilize their public-health sectors by appointing focal points for prevention and
mitigation of the adverse consequences of road crashes who would coordinate the public-health
response in terms of epidemiology, prevention and advocacy, and liaise with other sectors;
3.
ACCEPTS the invitation by the United Nations General Assembly for WHO to act as a
coordinator on road safety issues within the United Nations system, working in close collaboration
with the United Nations regional commissions;
4.
RJECOMMENDS Member States:
(1)
to integrate traffic injuries prevention into public health programmes;
(2)
to assess the national situation concerning the burden of road traffic injury, and to assure
that the resources available are commensurate with the extent of the problem;
(3)
if they have not yet done so, to prepare and implement a national strategy on prevention
of road traffic injury and appropriate action plans;
(4) to establish government leadership in road safety, including designating a single agency
or focal point for road safety or through another effective mechanism according to the national
context;
(5)
to facilitate multisectoral collaboration between different ministries and sectors, including
private transportation companies, communities and civil society;
(6)
to strengthen emergency and rehabilitation services;
(7)
to raise awareness about risk factors in particular the effects of alcohol abuse,
psychoactive drugs and the use of mobile phones while driving;
(8)
to take specific measures to prevent and control mortality and morbidity due to road
traffic crashes, and to evaluate the impact of such measures;
(9)
to enforce existing traffic laws and regulations, and to work with schools, employers and
other organizations to promote road-safety education to drivers and pedestrians alike;
(10) to use the forthcoming world report on traffic injury prevention as a tool to plan and
implement appropriate strategies for prevention of road traffic injury;
(11) to ensure that ministries of health are involved in the framing of policy on the prevention
of road traffic injuries;
(12) especially developing countries, to legislate and strictly enforce wearing of crash helmets
by motorcyclists and pillion riders, and to make mandatory both provision of seat belts by
automobile manufacturers and wearing of seat belts by drivers;
2
WHA57.1O
(13) explore the possibilities to increase funding for road safety, including through the creation
of a fund,
5.
REQUESTS the Director-General:
(1)
to collaborate with Member States in establishing science-based public health policies
and programmes for implementation of measures to prevent road traffic injuries and mitigate
their consequences;
(2)
to encourage research to support evidence-based approaches for prevention of road traffic
injuries and mitigation of their consequences;
(3)
to facilitate the adaptation of effective measures to prevent traffic injury that can be
applied in local communities;
(4) to provide technical support for strengthening systems of prehospital and trauma care for
victims of road traffic crashes;
(5) to collaborate with Member States, organizations of the United Nations system, and
nongovernmental organizations in order to develop capacity for injury prevention;
(6)
to maintain and strengthen efforts to raise awareness of the magnitude and prevention of
road traffic injuries;
(7)
to organize regular meetings of experts to exchange information and build capacity;
(8)
to report progress made on the promotion of road safety and traffic injury prevention in
Member States to the Sixtieth World Health Assembly in May 2007.
Eighth plenary meeting, 22 May 2004
A57/VR/8
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57th World Health Assembly
Medecins Sans Frontieres (MSF) would like to share with you some of our concerns
regarding the WHO prequalification project, an issue that is relevant for agenda
items 12.1. (HIV/AIDS) and 12.12 (Quality and safety of medicines) of the 57th
World Health Assembly.
Achieving the goal of access to essential medicines for all requires globally
accepted mechanisms for ensuring that these medicines - generic and originator
products - are of quality.
What is the WHO prequalification project?
It is one of WHO’s key functions to improve access to quality and affordable
medicines. The WHO prequalification pilot project was set up in 2001 by the United
Nations (WHO, UNICEF, UNFPA and UNAIDS, supported by the World Bank) to fulfill
this mandate.
The specific tasks of the prequalification project include:
a) to assess the quality of essential drugs, produced by generic and brand
name companies, through the evaluation of product dossiers submitted by
companies, and
b) to assess manufacturing sites to comply with Good Manufacturing Practices.
These evaluations are performed by international teams consisting of drug
regulatory experts from 20 countries.
The prequalification project publishes and regularly updates a list of the drugs and
manufacturing sites it has validated.
What are the achievements to date?
Three years after being set up, the WHO prequalification project has dramatically
improved access to quality essential medicines, particularly AIDS drugs. More than
90 products - 50 of them generics - have been prequalified to date. The project has
also contributed to improving standards of generic producers and helped enhance
countries’ capacity to produce quality medicines.
Why is the WHO prequalification project so important?
The final responsibility for drug evaluation and approval is in the hands of national
drug regulatory authorities, but the existence of a reliable, international reference
facilitates the task of national drug authorities and procurers. The WHO
evaluations inform countries’ drug approval processes thus reducing the burden of
product evaluations and facilitating fast track registration of essential medicines.
This is particularly important for countries that lack regulatory capacity and
resources for assessing drugs.
Not only governments but also other providers of medical care such as MSF and
other NGOs need assurance of the quality of the drugs they use. The example of
antiretroviral medicines illustrates the vital role prequalification plays in improving
access to affordable medicines: today, MSF is providing ARV treatment for over
13,000 people living HIV/AIDS in more than 20 countries. Our ability to increase the
number of patients on treatment has largely depended on the majority of our
programmes being able to make use of WHO prequalified fixed-dose combinations
of ARVs - that is, pills containing two or three AIDS drugs in one tablet.
Is the WHO prequalification project equipped to face the growing challenges of
AIDS, TB and malaria?
WHO’s prequalification work must be adequately supported. If this is not the case,
much-needed essential medicines will not be assessed in a prompt manner. This
will have the undesirable effect of limiting the sources of medicines rather than
expanding them - in particular when funding agencies require that drugs are WHO
prequalified. It could also lead to a discrepancy between internationally
recommended treatment guidelines and the availability of these particular
treatments. This has already been the case with artemisinin-based malaria
treatment. The prequalification project should therefore become more proactive
so that treatments that are recommended and needed are assessed as soon as
possible.
-> MSF urges the WHA to reinforce the WHO prequalification pilot
project by ensuring that it is a fully-fledged permanent function of the
WHO Essential Drugs and Medicines Policy Programme (EDM). In order to
face current health challenges, the WHO prequalification project needs
to be strengthened and expanded. We call upon the WHA to ensure that
additional technical, financial and human resources are made available.
Please do not hesitate to contact me or the relevant MSF representative in your
country for more details on any of the above.
Sincerely
Ellen't Hoen
Interim Director
Campaign for Access to Essential Medicines
Medecins Sans Frontieres
G0tv\ H -
X "1
WORLD HEALTH ORGANIZATION
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
Provisional agenda item 16.1
A57/24
15 April 2004
Regular budget allocations to regions
Report by the Secretariat
BACKGROUND
1.
At its 101st session (1998), the Executive Board considered a report of a special group it had
established to review the Constitution, including regional arrangements.1 Among the group’s
recommendations was a proposal to change the way in which regional budgets were determined. The
group noted that the then current practice was for the Director-General to propose to the Health
Assembly an allocation of the budget between regions based primarily on historical precedents. It
expressed concern that the amounts had changed little over time, and recommended instead the
introduction of a model which would guide the way in which the allocation should be made.
2.
The Board and subsequently the Health Assembly endorsed this recommendation.12 Resolution
WHA51.31 recommended that regional, intercountry and country allocations should for the most part
be guided by a model that:
• draws upon UNDP’s Human Development Index, possibly adjusted for immunization
coverage
• incorporates population statistics of countries calculated according to commonly accepted
methods, such as “logarithmic smoothing”
• can be implemented gradually so that the reduction for any region would not exceed 3% per
year and would be spread over a period of three bienniums.
3.
The Director-General was requested to present a thorough evaluation of the model to the
Fifty-seventh World Health Assembly for the purpose of continuing response to health needs and
equitable allocation of the resources of WHO. In preparation for the report, input was sought from the
six regional committee sessions held in September 2003 (see paragraphs 16 and 17). The matter was
also considered by the Board at its 113th session.3
1 See document EB101/1998/REC/1, Annex 3.
2 Resolution EB101.RIO, and resolution WHA51.31 (attached as Annex I).
3 See document EBII3/2004/REC/2, summary records of the ninth and tenth meetings.
A 5 7/2 4
EVALUATION
Financial outcome
4.
The programme for the model' was run, using the latest available data, during preparation of the
budget proposals for each of the three bienniums from 2000 to 2005. The results were percentage
shares of the regular budget (excluding headquarters) for each region based on the latest Human
Development Index. The actual budget proposals made by the Director-General to the Health
Assembly, however, modified this outcome related to the provisions and discretions set out in
resolution WHA51.31.
• For the biennium 2000-2001, the Director-General adjusted the model also to take account of
immunization coverage. However, in the light of fluctuations and uncertainties surrounding
some immunization-coverage statistics, that variable was not used in the bienniums
2002-2003 or 2004-2005.
• The maximum reduction foreseen in paragraph 3(c) of resolution WHA51.31 of 3% per
annum per region was implemented in the first biennium, 2000-2001. Thereafter, the
maximum reduction for any region was limited to 2% per year in the biennium 2002-2003,
and to 1.5% per year in the biennium 2004-2005. This decision was taken in part to reflect the
fact that regions had to absorb cost increases in these bienniums, in addition to the decreases
in regular budget allocations resulting from application of the model.
• Least developed countries were not subject to any decrease.
5.
The Health Assembly subsequently adopted appropriation resolutions on the basis of the regular
budget proposals for the six regions which were put forward by the Director-General in each of the
three bienniums concerned/
6.
The result in financial terms was an increase in the share of the African Region from about 28%
of regular budget allocations in 1998-1999 to around 34% in 2004-2005. The share of the European
Region increased from about 9% to 10% over the same period. The allocations of the other four
regions were reduced in order to pay for these increases.
7.
Table 1 below shows the cumulative impact of the model in financial terms, including a transfer
of USS 12 million from the headquarters regular budget to benefit the two regions concerned over the
six-year period, which was not required by the model.3 It also compares these regular budget transfers
with the total growth in regional allocations of extrabudgetary resources for which the model is not
used at all. Information on these latter resources is available only for the four-year period 2000 to 2003
inclusive.
' The model is detailed in document EBI02/4.
2 Resolutions WHA52.20, WHA54.20 and WHA56.32.
3 Full details are given in Annex 2.
2
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TABLE 1. REGULAR BUDGET AND EXTRABUDGETARY EXPENDITURE:
CUMULATIVE CHANGE
Office
Regular budget
Extrabudgetary expenditure
Cumulative change pursuant to
resolution WHA51.31
2000 to 2005
Cumulative change
USS million
USS million
2000 to 2003
Headquarters
(12)
439
Africa
84
286
The Americas3
(23)
-
South-East Asia
(18)
69
Europe
9
45
Eastern Mediterranean
(20)
143b
Western Pacific
(20)
34
3 In the Region of the Americas, extrabudgetary resources handled by WHO have declined slightly. Most
extrabudgetary resources are accounted for under the Pan American Health Organization; figures have been relatively
stable in recent years.
b Includes expenditure under the Iraq oil-for-food programme
Programme impact
8.
The model guided only the overall allocation to a region. It was not used to determine the
individual allocation to countries within a region (although such figures are generated by the model).
Those were based on judgements made by the Regional Director and Director-General, and debates in
the regional committees. The Western Pacific Region however applied the model in part to assist in
decisions on country allocation.
9.
The model did not apply to the headquarters regular budget. Indeed, it is not designed for such
an outcome since it relies on the grouping of countries into regions for apportioning the funding.
10.
The two regions receiving the additional regular budget funds used them mostly to strengthen
programmes in countries. The regions that had to make regular budget reductions did so both in
regional offices and in country programmes. Because extrabudgetary resources are generally less
flexible as to use than regular budget funds, regions whose regular budget allocations had been
reduced were sometimes obliged to make cuts in areas where no source of funding other than the
regular budget was available.
The model
11.
With respect to the key parameters of the model, the Human Development Index is a summary
measure of human development that is calculated using three basic dimensions, each one contributing
an equal weight: (1) a long and healthy life, as measured by life expectancy at birth; (2) knowledge, as
3
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measured by the adult literacy rate (with two thirds weight) and the combined primary, secondary and
tertiary gross enrolment ratio (with one third weight); and (3) a decent standard of living, as measured
by gross domestic product per capita (purchasing power party to USS).
12.
Table 2 below shows the evolution of the Human Development Index by region (adjusted to
reduce the effect of large populations) for the period 1997 to 2001 (the indices used for the actual
calculations). The index has a potential range from zero to one, one being the highest level of
development possible.
TABLE 2. HUMAN DEVELOPMENT INDEX: EVOLUTION BY REGION
1997
2001
Percentage
Europe
0.816
0.841
3.0
The Americas
0.763
0.778
2.0
Western Pacific
0.741
0.757
2.2
Eastern Mediterranean
0.644
0.688
3.8
South-East Asia
0.580
0.609
4.9
Africa
0.460
0.462
0.5
Region
13.
The model moved the pre-1998 distribution of the regular budget towards the inverse of the
above distribution, after allowing for various constraints. Europe remained the region with the smallest
regular budget, Africa with the largest. However, both these regions were shown by the model to be
relatively underfunded, hence the reallocations.
14.
With respect to population, the adjustment to reduce the effect of large populations (the
“adjusted log population squared” (ALPS)) method produces a dampening of the effect of raw
population size, with the equivalent point (the intersection between the two curves) being around a
population of 45 million. In other words, countries with a population greater than 45 million receive
proportionally less under the ALPS method, whereas countries with less than 45 million would receive
proportionally more.
15.
The population adjustment has a major impact on the model. The Western Pacific and SouthEast Asia regions' share of the total would more than double if raw population data were used,
whereas that of the African and European regions and of the Region of the Americas would halve.
VIEWS OF THE REGIONAL COMMITTEES
16.
The debates in the regional committees in September 2003 indicate that the four regions whose
allocations were reduced now favour discontinuing use of the model at the end of the six-ycar period.
The committees concerned passed resolutions to this effect.
17.
At the Regional Committee for Africa delegates expressed their appreciation of resolution
WHA51.31; the additional funds would have an impact on meeting the health needs of the populations
4
A57/24
in the Region. They suggested that the resolution should be Fully implemented in the shortest possible
time and supported an evaluation of the model. The Regional Committee for Europe discussed the
question of regional allocations under the regular budget and commented on the need for a fair and
equitable apportionment.
POINTS FOR CONSIDERATION
18.
The pattern of distribution of WHO resources after 2005 will need to evolve in accordance with
developments in global health requirements and priorities. At issue is whether the model set out in
resolution WHA51.31 should, for the most part, continue to guide the allocation process between
regions. It is clear from the debate in the regional committees and at the Executive Board that the four
regions which have experienced regular budget reductions under resolution WHA51.31 now wish to
end its use.
19.
Since 2000-2001 the Organization has adopted a results-based approach to budgeting. This calls
for a greater focus on priorities and expected results than the distribution of resources. An integrated
approach has also been pursued for the budget (regular budget and voluntary contributions). As an
example it may be noted that both the African and European regions received four times more in
extrabudgetary resources in the four years to 2003 than they will under the regular budget reallocation
in the six years to 2005.
20.
The Director-General reported to the Executive Board at its 113th session on adjustments he
intends to make to the extrabudgetary resources for 2004-2005 so as to allocate more funding to
regional and country levels.1 In the biennium 2002-2003, approximately 56% of total resources (67%
of regular budget and 50% of extrabudgetary resources) were allocated to regional and country offices.
The aim is to achieve an apportionment of 70% of total resources in the biennium 2004-2005 and 75%
in 2006-2007. Each 5% of movement in total resources represents approximately USS 125 million at
present budget levels.
21.
The Director-General would suggest therefore that the focus in the coming years be on real
needs and on implementation in countries. Resource allocation would no longer be guided by the
model contained in resolution WHA51.31, but would be based on clear results-based budgeting that
covers both regular budget and extrabudgetary resources.
ACTION BY THE HEALTH ASSEMBLY
22.
The Health Assembly is invited to consider the evaluation contained in the above report. In the
light of its conclusion, a decision or resolution could be prepared for adoption.
1 Document EBI13/2004/REC/2, summary record of the first meeting, section 1.
5
,157/24
ANNEX 1
WHA51.31
Regular budget allocations to regions
The Fifty-first World Health Assembly,
Recalling resolution EB99.R24 on regional arrangements within the context of WHO reform;
Noting that regular budget allocations to regions have not been based on objective criteria but
rather on the basis of history' and previous practice;
Concerned that, as a result, each region’s share of such allocations has remained largely
unchanged since the Organization's inception;
Recalling that two basic principles governing the work of WHO arc those of equity and support
to countries in greatest need, and stressing the need for the Organization to apply principles which
Member States have adopted collectively;
Noting that other organizations of the United Nations system, particularly UNICEF, have
already adopted models based on objective criteria to ensure a more equitable distribution of
programme resources to countries,
1.
THANKS the Executive Board and its special group for the review of the Constitution for the
comprehensive study of allocations from the regular budget to regions;1
2.
REAFFIRMS Article 55 of the Constitution which stipulates that it is the Director-General’s
prerogative to prepare and submit to the Board the budget estimates of the Organization, and requests
her or him to take into account the discussion on this matter during the Fifty-first World Health
Assembly when preparing future programme budgets;
3.
RECOMMENDS that, globally, the regional, intercountry and country allocation in future
programme budgets approved by the Health Assembly should for the most part be guided by a model
that:
(a)
draws upon UNDP’s Human Development Index, possibly adjusted for immunization
coverage;
(b)
incorporates population statistics of countries calculated according to commonly accepted
methods, such as "logarithmic smoothing”;
(c)
can be implemented gradually so that the reduction for any region would not exceed 3%
per year and would be spread over a period of three bienniums;
1 Document EB10l'1998/REC/I. Annex 3.
6
■Inn ex 1
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4.
REQUESTS the Director-General to present a thorough evaluation of that model to the
Fitty-seventh World Health Assembly for the purpose of continuing response to health needs and
equitable allocation of the resources of WHO;
5.
DECIDES that the model should be applied in a flexible, rather than a mechanical, manner so as
to minimize, to the extent possible, any adverse effects on countries whose budgetary allocations will
be reduced;
6.
REQUESTS the Director-General:
(1)
to ensure that during the 2000-2001 biennium all least developed countries will be
guaranteed that their regular budget allocation will not be less than that of the 1998-1999 budget
by use of the 2% transfer from global and interregional activities foreseen in resolution
WHA48.26 and by casual income if available; and to continue in subsequent bienniums to give
high priority to protect the situation of least developed countries;
(2)
while emphasizing that any additional funds resulting from the present process of
reallocation should flow to country level, to enable regions to determine for themselves within
the terms of the Constitution the partition between country, intercountry and regional office
budgets;
(3)
to monitor and evaluate closely the working and the impact of this new process in the
light, in particular, of changes in international social and economic conditions, and to report
annually to the Executive Board and the Health Assembly with a view to any further refinement,
development or modification in order to ensure response to health needs and the equitable
allocation of the resources of WHO;
(4)
to report to the Executive Board at its 103rd session and to the Fifty-second World Health
Assembly on the details of the model and the regional, intercountry and country allocations to
be applied to the 2000-2001 biennium;
(5)
further to report to the Executive Board at its 103rd session and to the Fifty-second World
Health Assembly within the context of the request in paragraph 4 above, on the use of
extrabudgetary allocations in regional, intercountry and country programmes in the previous
three bienniums.
(Tenth plenary meeting, 16 May 1998 Committee B, sixth report)
7
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ANNEX 2
REGULAR BUDGET ALLOCATIONS TO REGIONS
2000-2001 TO 2004-2005
(thousands of US dollars)
The Americas
Approved regular budget 1998-1999 = 82 686
Unchanged
budget
Theoretical
budget using
model
Reduction due
to model
Other budget
changes
Budget actually
adopted
2000-2001
82 686
77 725
(4 961)
0
77 725
2002-2003
82 686
74 682
(8 004)
0
74 682
2004-2005
82 686
72 491
(10 195)
736
73 227
Total resources
2000-2005
248 058
224 898
(23 160)
736
225 634
South-East Asia
Approved regular budget 1998-1999 = 99 251
Unchanged
budget
Theoretical
budget using
model
Reduction due
to model
Other budget
changes
Budget actually
adopted
2000-2001
99 251
95 595
(3 656)
0
95 595
2002-2003
99 251
93 022
(6 229)
0
93 022
2004-2005
99 251
91 169
(8 082)
2 285
93 454
Total resources
2000-2005
297 753
279 786
(17 967)
2 285
282 071
Eastern Mediterranean
Approved regular budget 1998-1999 = 90 249
Unchanged
budget
Theoretical
budget using
model
Reduction due
to model
Other budget
changes
Budget actually
adopted
2000-2001
90 249
85 869
(4 380)
0
85 869
2002-2003
90 249
83 390
(6 859)
0
83 390
2004-2005
90 249
81 584
(8 665)
765
82 349
Total resources
2000-2005
270 747
250 843
(19 904)
765
251 608
8
Annex 2
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Western Pacific
Approved regular budget 1998-1999 = 80 279
Unchanged
budget
Theoretical
budget using
model
Reduction due
to model
Other budget
changes
Budget actually
adopted
2000-2001
80 279
75 889
(4 390)
0
75 889
2002-2003
80 279
73 262
(7 017)
0
73 262
2004-2005
80 279
71 305
(8 974)
731
72 036
Total resources
2000-2005
240 837
220 456
(20 381)
731
221 187
Africa
Approved regular budget 1998-1999 = 157 413
Unchanged
budget
Theoretical
budget using
model
Increase due to
model
Other budget
changes
Budget actually
adopted
2000-2001
157413
176 822
19 409
0
176 822
2002-2003
157413
186 472
29 059
0
186 472
2004-2005
157 413
192 718
35 305
(983)
191 735
Total resources
2000-2005
472 239
556012
83 773
(983)
555 029
Europe
Approved regular budget 1998-1999 = 49 823
Unchanged
budget
Theoretical
budget using
model
Increase due to
model
Other budget
changes
Budget actually
adopted
2000-2001
49 823
51 699
1 876
0
51 699
2002-2003
49 823
52 771
2 948
0
52 771
2004-2005
49 823
54 332
4 509
450
54 782
Total resources
2000-2005
149 469
158 802
9 333
450
159 252
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Annex 2
Headquarters
Approved regular budget 1998-1999 = 282 953
Unchanged
budget
Theoretical
unchanged
budget"
Reduction'1
Other budget
changes
Budget actually
adopted
2000-2001
282 953
279 055
(3 898)
0
279 055
2002-2003
282 953
279 055
(3 898)
0
279 055
2004-2005
282 953
279 055
(3 898)
(527)
278 528'
Total resources
2000-2005
848 859
837 165
(11 694)
(527)
836 638
1 The model does not produce any change to the headquarters budget.
b The reduction resulted from a recommendation to the Health Assembly by the Director-General to contribute to the
transfer of resources.
c The total budget adopted for 2004-2005 also included USS 34 million for miscellaneous expenditure. This amount
was not apportioned by the Health Assembly between regions and headquarters.
10
Cjo nn H '• %
WORLD HEALTH ORGANIZATION
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
Provisional agenda item 19
A57/30
19 April 2004
Health conditions of, and assistance to,
the Arab population in the occupied
Arab territories, including Palestine
Report by the Director-General
1.
A number of studies on the health conditions of the Arab population in the occupied Palestinian
territories have suggested the increasing presence of mental health distress among the people of the
occupied Palestinian territories, higher malnutrition rates, decreased immunization coverage in
specific areas, increased prevalence of low birth-weight, and higher anaemia rates among pregnant
women in the past two years. Although prevalence of malnutrition among children between the ages of
six months and five years has been reduced since June 2002, partly because of increased and sustained
food assistance and physical access to health services, childhood malnutrition and micronutrient
deficiency are major concerns for some groups. The organizations responsible for the studies include
UNRWA, the nongovernmental organizations Save the Children and CARE, and the Ministry of
Health of the Palestinian Authority.
2.
A household survey on access to health services in the occupied Palestinian territories was
carried out at the end of 2002 by WHO, in collaboration with the Palestinian Ministry of Health and
Al-Quds University.1 Findings from the districts of Nablus, Ramallah, Hebron, Rafah and Gaza
indicated that more than 50% of the surveyed population changed their health-service provider
between March and December 2002. In almost 90% of instances the change was related to restrictions
on mobility. Of those seeking health-care services, 3% to 5% were not able to obtain them. Of
pregnant women, 22% could not access some antenatal services. Of the surveyed population,
13% reportedly suffered problems related to their mental and psychological health. The study group
cannot be considered as representative of the whole population of the occupied Palestinian territories,
but the findings indicate the health-related problems faced by people in the districts included in the
study.
3.
According to information provided by UNRWA, immunization coverage has deteriorated
somewhat since 2000. In some specific areas the percentage of children fully immunized has dropped
from 100% to between 84% and 67%.
4.
Following the 2003 review of the United Nations Humanitarian Action Plan, a United Nations
Consolidated Appeal for 2004 was drawn up in October 2003 with a proposed budget of
USS 305 million, including USS 26.6 million for health-sector activities. The analysis contained in the
1 Access to health services in the West Bank and Gaza Strip. Facts and figures. Ministry of Health of the Palestinian
Authority World Health Organization, Al-Quds University. 2003.
<J1M
-
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Consolidated Appeal shows that the severe restrictions on movement of Palestinian people and goods
is causing economic difficulties for much of the population. Military incursions, closures and curfews,
the withholding of Palestinian tax revenues, land confiscation and levelling, house demolition and the
construction of the “barrier" have disrupted economic life and generated unprecedented levels of
unemployment. As a result, poverty, food insecurity and nutritional vulnerability are widespread^
5.
The Palestinian health system is divided between Gaza and the West Bank and is severely short
of funds. UNRWA, which provides health care for the refugee population, the nongovernmental
organizations working in the area and even private health-service providers are, in general,
underfunded or facing a critical financial situation. In this context, assistance from the international
community and decentralization of health services in order to adapt to the constraints on the mobility
of health workers and patients, have made possible the provision of essential health services in
peripheral areas, thus avoiding a further deterioration of the health status of the Palestinian population.
6.
Resolution WHA56.5 requested the institution of a fact-finding committee on the deterioration
of the health situation in the occupied Palestinian territory. Under the current circumstances it has not
yet proved possible to enable such a committee to undertake its role.
7.
WHO, at both regional and global levels, has responded to the health needs of the Palestinian
population for over 50 years, in conjunction with UNRWA. Through the WHO Regional Office for
the Eastern Mediterranean the Organization assists the Palestinian Ministry of Health with a
programme which focuses on several specific health interventions. Further, it is working with
populations in the West Bank and Gaza Strip through the Special Technical Assistance Programme,
established in 1994 to support the health of Palestinian people by promoting a health system based on
equity, effectiveness and sustainability, and by addressing the broader social, economic,
environmental and cultural determinants of health, particularly those which are most affected by the
Israeli-Palestinian conflict. It maintains a direct link with, and provides support to, the Ministry of
HeaTtE"of the Palestinian Authority, and communicates and collaborates actively with the Ministry of
Health of Israel.
8.
During 2003, WHO continued to provide support to the Palestinian Ministry of Health for the
development of a strategic response to health needs. In collaboration with the governments of Italy and
of the United States of America, WHO leads the Health Inforum, a body which collects and
disseminates information about the health situation.1 Health Inforum aims to support the decision
making capacities of the Health Sector Working Group, and focuses on consolidating data on health
and health sector activities, on the status of health facilities and on the availability of medical supplies.
9.
With the Ministry of Health and other stakeholders, WHO has formulated a general plan for
mental health and is implementing a programme financed by the European Commission to improve
delivery of mental health services. The Organization is also participating in a review of the Palestinian
health sector together with the European Commission, the World Bank, and the Government of Italy
and of the United Kingdom of Great Britain and Northern Ireland.
10.
WHO maintains its coordination role in the Health Sector Working Group, as technical adviser,
where it represents the other organizations of the United Nations system. Within the same framework,
thematic subgroups on nutrition, mental health, health management information and reproductive
health have been established. WHO co-chairs, with the Ministry of Health of the Palestinian
1 www.healthinfonjm.orB .
2
A57/30
Authority, bi-monthly emergency-support coordination meetings in the West Bank and Gaza Strip,
and recently at district level. Participants at these coordination meetings have analysed the impact of
the separation “barrier" on the health of the Palestinian population. One challenge is to ensure that
United Nations personnel, including WHO staff, are able to enter and work in the occupied Palestinian
territories in a predictable and timely manner.
11.
WHO is taking steps to secure additional funding for health actions in the occupied Palestinian
territories, in particular to meet with the urgent health needs of the Palestinian people. WHO is
committed to supporting effective communication between Palestinian and Israeli health professionals,
nongovernmental organizations and health institutions. WHO seeks to create platforms for dialogue
an£l to take advantage of every opportunity to encourage open discussion and cooperation. A “cities
partnership” project is currently being implemented involving European, Palestinian and Israeli cities
that focuses on health and social action. WHO has also drawn up, together with the United Nations
Office for Humanitarian Affairs, UNICEF, UNDP, UNRWA, WFP and UNFPA, an advocacy strategy
for health in the occupied Palestinian territories, and is implementing specific initiatives which
promote health and human rights.
3
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WORLD HEALTH ORGANIZATION
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
Provisional agenda item 20
A57/31
19 April 2004
Collaboration within the United Nations system and
with other intergovernmental organizations
Report by the Secretariat
1.
WHO’s relations with the United Nations are a requirement based on Article 69 of the
Constitution as well as a formal agreement dating back to 1948. WHO also has formal framework
agreements with some specialized agencies and other intergovernmental organizations. This report
does not detail all cunent collaboration with the United Nations system and other intergovernmental
organizations. Rather, it concentrates on major events since the last report to the Health Assembly;1
other reports on specific collaboration are provided for relevant technical agenda items.
UNITED NATIONS GENERAL ASSEMBLY, FIFTY-EIGHTH SESSION
2.
An unprecedented number of health-related resolutions were adopted by the United Nations
General Assembly during its fifty-eighth session in 2003. In resolution 58/236, the United Nations
General Assembly welcomed the WHO/UNAIDS “3 by 5” initiative. In resolution 58/237, the General
Assembly called upon the international community to support the development of manufacturing
capacity of insecticide-treated nets in Africa and the transfer of technology required to make
insecticide-treated nets more effective and long-lasting. It also urged the pharmaceutical industry to
take note of the increasing need to provide effective combination treatment for malaria and to form
alliances and partnerships so that all people at risk can benefit from prompt, affordable, quality
treatment. Resolution 58/179 called on States to implement national strategies for access to
comprehensive treatment, care and support for all individuals infected and affected by pandemics such
as H1V/A1DS, tuberculosis and malaria. In resolution 58/173, the General Assembly requested that the
international community continue to assist developing countries in promoting the full realization of the
right to the enjoyment of the highest standard of physical and mental health. In addition, there were a
number of resolutions with significant health components.1
2
UNITED NATIONS ECONOMIC AND SOCIAL COUNCIL
3.
The substantive session of the United Nations Economic and Social Council was held in Geneva
from 30 June to 25 July 2003. During the high-level segment devoted to rural development in
developing countries, WHO provided input on the subject of inequities and inequalities in rural health
1 Document A56/46.
2 United Nations General Assembly resolutions 58/5, 58/9, 58/134, 58/156, 58/157, 58/217, 58/246.
—
A57/3I
care. WHO also hosted a Ministerial Roundtable Breakfast discussion on the Organization’s extensive
coordination efforts with the United Nations system and the public health community at large during
the outbreak of severe acute respiratory syndrome.
UNITED NATIONS FIELD SECURITY MANAGEMENT SYSTEM
4.
The fifty-eighth session of the United Nations General Assembly also discussed United Nations
field security, identifying interested parties and responsibilities within the field security management
system. WHO adheres strictly to the United Nations recommendations: the roles and responsibilities of
WHO Representatives, who are accountable for the safety and security of employed personnel and
their eligible dependants, arc outlined in the Organization’s security policy and are being reflected in
job descriptions, terms of reference and performance appraisals.
INTERAGENCY COORDINATION THROUGH THE UNITED NATIONS SYSTEM
CHIEF EXECUTIVES BOARD FOR COORDINATION AND THE UNITED
NATIONS DEVELOPMENT GROUP
5.
During its April 2003 session, the United Nations System Chief Executives Board for
Coordination' continued the follow up of the Millennium Summit, focusing on sustainable
development. The Board endorsed a note on HIV/AIDS, with particular attention to the issue of
reducing the cost of antiretroviral treatment. Other matters, deliberated during the October 2003
session, included emerging global issues relating to multilateralism, financing for development and
reporting on the United Nations Millennium Declaration together with more specific items, including
the triple threat posed by HIV/AIDS, food insecurity and weakened capacity for governance.
6.
In its capacity as a member agency of the United Nations Development Group, WHO
participated actively in more than 15 working groups concerned with improving the operational
aspects of the United Nations offices at country level in support of the Millennium Development
Goals; coordinated actions at country level have been shaped according to the guiding principles of
harmonization and simplification. In addition, policy development and guidance for country teams
have been improved in the following areas: human rights, countries in transition, HIV/AIDS, food
security and governance, joint programming, the Common Country Assessment and United Nations
Development Assistance Framework Guidelines, reporting on progress towards the Millennium
Development Goals at the country level and the role of United Nations agencies in support of national
poverty reduction strategies.
HIGHLIGHTS OF INTERAGENCY COLLABORATION
7.
Poliomyelitis eradication. In January 2004, United Nations Secretary-General Kofi Annan
addressed a ministerial meeting in Geneva, co-hosted by WHO and UNICEF together with the
ministers of health of the six countries of highest priority for stopping the transmission of poliovirus
globally. WHO has also worked with the World Bank, Rotary International, the Bill & Melinda Gates
Foundation and the United Nations Foundation in order to establish an innovative financing
1 Formerly ACC.
2
A57/31
mechanism ior procuring oral poliovirus vaccine for poliomyelitis eradication campaigns in Nigeria
and Pakistan. WHO is currently working with the United Nations Office for the Coordination of
Humanitarian Affairs to include poliomyelitis eradication in the Common Humanitarian Action Plan.
WHO also worked closely with the Organization of the Islamic Conference (OIC) in support of the
adoption by the Conference’s 57 Member States of a landmark resolution on poliomyelitis eradication
at the Tenth Islamic Summit Conference, held in Putrajaya, Malaysia, in October 2003.
8.
International outbreak response. The Global Outbreak Alert and Response Network
(GOARN) was set up by WHO to improve the coordination of international outbreak response. Since
its inception, GOARN has responded to 34 events in 26 countries and has grown to a partnership of
120 institutions and networks, including United Nations and intergovernmental organizations.
GOARN played a critical role in the rapid containment of the outbreak of severe acute respiratory
syndrome by immediately dispatching multinational teams to the field and developing virtual networks
of clinicians and epidemiologists to improve treatment and control of the virus. GOARN was also
mobilized rapidly in response to the avian influenza outbreak, providing Viet Nam and Thailand with
expertise in epidemiology, clinical diagnosis and management, virology and logistics.
9.
Communicable diseases. In its capacity as a lead agency of Partners for Parasite Control, WHO
has managed to involve new partners - the World Bank, UNICEF, WFP and the Schistosomiasis
Control Initiative, funded by the Bill & Melinda Gates Foundation - in order to reach the target of
regular deworming by 2010 of at least 75% of school-age children at risk of morbidity. Partners for
Parasite Control assisted more than one million children in 2003. WHO is also working with the
“anchor unit” of the World Bank’s Fluman Development Network to promote deworming activities in
the FRESH Start initiative (Focusing Resources on Effective School Health). WHO also collaborates
with the Office International des Epizooties and FAO, providing support on surveillance, prevention
and control in connection with zoonotic diseases, including severe acute respiratory syndrome, avian
influenza, rabies and brucellosis.
10.
Health in emergencies. During the launch of the 2004 interagency Consolidated Appeals
Process, WHO called on Member States to invest as a matter of urgency in health systems for
45 million children, women and men caught up in the world’s deadliest crises. WHO is committed
both to greater harmonization of policy procedures and collective competencies through interagency
coordination and to bringing health action to the forefront of humanitarian interventions.
11.
WHO is making progress on a systematic analysis of the health needs of children in emergency
settings. In connection with this work, WHO and UNICEF called a meeting on child health in complex
emergencies in 2003. WHO co-chairs the Inter-Agency Standing Committee Task Force on Gender
and Humanitarian Assistance. The Organization also helps to ensure a global culture of - and a
capacity for - crisis preparedness, especially in the health sector. To this end, WHO participates in the
Inter-Agency Standing Committee mechanisms dealing with contingency planning, preparedness and
natural disasters.
12.
United Nations Ad Hoc Interagency Task Force on Tobacco Control. Comprising 17 United
Nations bodies, the United Nations Ad Floc Interagency Task Force on Tobacco Control was
established in 1999 by the Secretary-General of the United Nations in order to galvanize a joint United
Nations response. Tobacco control can only be effective with the involvement of the different sectors
of society. This was emphasized in the WHO Framework Convention on Tobacco Control and is an
important aspect of the mission of the Tobacco Free Initiative. At the last meeting of the Task Force held at the World Bank’s headquarters in Washington, DC on 21 and 22 October 2003 - members
pledged to involve the United Nations Development Group system in order to improve intersectoral
3
157/31
cooperation between Task Force members at country level. They also stressed the importance of
linking tobacco with poverty, development and the Millennium Development Goals.
13.
Partnership for Safe Motherhood. WHO was invited to host the secretariat for the newly
established Partnership for Safe Motherhood and Newborn Health whose steering committee currently
comprises 21 members and includes the International Confederation of Midwives, the International
Federation of Gynecology and Obstetrics, WHO, the World Bank, UNICEF and UNFPA as permanent
members. Total membership of the Partnership exceeds 35 and is made up of international and
regional organizations, multilateral and bilateral agencies and nongovernmental organizations.
14.
Collaboration with UNAIDS for the HIV Vaccine Initiative. United Nations HIV vaccine
activities are managed within the joint WHO/UNAIDS HIV Vaccine Initiative, hosted in WHO, with
core budget and staff provided by UNAIDS. The Initiative’s mission, performed with a focus on
developing countries, consists of promoting the development and evaluation of HIV -preventive
vaccines, and addressing issues of future access.
15.
Health technology and pharmaceuticals. The AIDS Medicines and Diagnostics Service is the
operational arm of the “3 by 5” initiative. Established in November 2003, it ensures that developing
countries have access to quality antiretroviral medicines and diagnostic tools at the best prices. The
service aims to help countries to buy products for the treatment and monitoring of HIV/AIDS, and to
forecast and manage their supply and delivery. In addressing the AIDS treatment gap in developing
countries, the AIDS Medicines and Diagnostics Service builds on years of work by WHO, the World
Bank, UNICEF, UNAIDS and the global health community, as well as some more recent initiatives,
such as that by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
16.
Prequalification project. Since the beginning of 2001, WHO - together with partners including
UNICEF, UNFPA, UNAIDS, Roll Back Malaria and the Global Drug Facility, and with support from
the World Bank - has been managing the United Nations Pilot Procurement, Quality and Sourcing
Project, which aims to provide access to HIV/AIDS, tuberculosis and malaria products of acceptable
quality. To date, more than 444 products have either been received and assessed or are in the process
of assessment for HIV/AIDS, tuberculosis and malaria; very few products have passed assessment.
17.
Millennium Development Goals (MDGs). During the period 2003-2004, two meetings took
place with the MDG Task Force 5 (working group on access to medicines). A detailed set of
recommendations and a series of commissioned papers were agreed at an MDG Task Force meeting in
December 2003. WHO has actively worked as a member of the United Nations Development Group to
ensure consistency of messages and to provide input into policy discussions on the health-related
MDGs, in addition to being the focal point for initiatives such as the United Nations Millennium
Project and the Global Governance Initiative of the World Economic Forum. WHO, together with the
World Bank, is also acting as secretariat for the High Level Forum on Health, Nutrition and
Population-Related MDGs. The High Level Forum provides an opportunity for informal discussions
between donors, technical agencies and developing countries on progress towards achieving the
MDGs. At its first meeting in Geneva on 8 and 9 January 2004, the Forum concentrated on the need to
increase the flow of aid to developing countries over the next 10 to 15 years. The Forum will hold a
maximum of four meetings, the next being later in 2004, probably in Africa.
4
A57/31
EXAMPLES OF INTERAGENCY COLLABORATION
COUNTRY LEVELS
AT REGIONAL AND
18.
Africa. The Health Strategy of the New Partnership for Africa’s Development (NEPAD) calls
for a more coordinated effort by international partners, in collaboration with African governments, to
eradicate preventable diseases and promote good health on the continent. WHO is promoting the
NEPAD Health Strategy with a view to establishing health as an integral component of Africa’s
development programme. WHO is also involved in discussions on tackling critical issues relating to
staff shortages and migration. WHO’s proposal of establishing health and social affairs desks within
the regional economic communities has been adopted. WP10 is also collaborating with the
International Organization for Migration to establish a database on health professionals.
19.
Europe. Over the last year, WHO has been increasingly involved in collaborative activities with
the World Bank thematic group on health, nutrition, population and poverty. This collaboration is
particularly strong at country level: in Eastern Europe, for example, in 2003 WHO and the World
Bank worked very closely on a health transformation programme in several countries, including
Turkey. In the Russian Federation, collaboration involved both initiatives to combat tuberculosis and
HIV/AIDS and work in the area of pharmaceuticals. During the last year, the European Observatory
on Health Systems, in partnership with the World Bank and the European Investment Bank, has
collaborated on issues like health and European enlargement and social and voluntary health
insurance. In relation to the European Union, a series of high-level meetings have reaffirmed the
priority areas for cooperation, especially within the WHO/European Union strategic partnership. The
partnership focuses on the health-related Millennium Development Goals and diseases of poverty
(HIV/AIDS, tuberculosis and malaria) by means of the European and Developing Countries Clinical
Trials Partnership. The Council of European Union Health Ministers has continuously been updated
on the epidemics of severe acute respiratory syndrome and avian influenza. WHO will provide
technical input into the European centre for disease control and prevention, which will be formally
established in 2005. New perspectives for cooperation are being opened up in the areas of eHealth and
pharmaceuticals with the Directorates-General of InfoSociety and Enterprise. The Financial and
Administrative Framework Agreement between the European Commission and WHO has been signed
and will greatly facilitate future collaboration.
20.
South-East Asia. A cooperative Memorandum of Agreement was signed in July 2003 between
the WHO Regional Office for South-East Asia and the United Nations Office on Drugs and Crime for
an effective regional response to HIV vulnerability. WHO also signed a Memorandum of
Understanding with the International Federation of Red Cross and Red Crescent Societies in order to
encourage collaboration to ensure that Members States’ needs receive an effective health system
response in the following areas: prevention and control of communicable diseases (including
HIV/AIDS), promotion of voluntary non-remuncrated blood donations, and collaboration on
preparedness and response in relation to health emergencies and disasters.
21.
Western Pacific. WHO has further strengthened its collaboration and partnership with members
of the United Nations family and other intergovernmental organizations in the Western Pacific Region.
Significant events over the last year include collaboration with the Asian Development Bank on
control of severe acute respiratory syndrome and with FAO on control of highly pathogenic avian
influenza, and the joint WHO/UNICEF/UNFPA workshop on the progress of maternal mortality
reduction together with a consultation for the development of the adolescent sexual and reproductive
health regional strategy.
5
A 5 7/31
22.
The Americas. A high-level meeting with representatives of ILO, UNESCO, WHO, the World
Bank, UNICEF. UNDP. UNFPA, UNAIDS and the United Nations Office on Drugs and Crime was
held in Washington, DC in June 2003. The purpose of the meeting was to strengthen the policy
dialogue on H1V/A1DS with government leaders in order to counter discrimination against people
living with HIV/AIDS and strengthen HIV prevention among adolescents and vulnerable populations.
One outcome of this meeting was the establishment of a Regional Interagency Coordinating
Committee on HIV/AIDS for Latin America and the Caribbean. The Committee has coordinated
formulation and execution of projects backed by the Global Fund to Fight AIDS, Tuberculosis and
Malaria together with three rounds of subregional negotiations for the reduction of prices for
antiretroviral agents, laboratory supplies and diagnostic kits. In addition, a Regional Interagency
Coordinating Committee Task Force, focusing on maternal mortality and morbidity reduction in Latin
America and the Caribbean, was launched in February 2004. The Task Force, which involves WFIO,
the World Bank, UNICEF, UNFPA, Family Care International, the Population Council, the Inter
American Development Bank and USAID, signed a Joint Statement of Support for Maternal Mortality
and Morbidity Reduction. The Task Force has developed a consensus strategy for the next 10 years
and identified five priority areas for action.
23.
Eastern Mediterranean. Since the last World Health Assembly, the WHO Regional Office for
the Eastern Mediterranean has signed several Memoranda of Understanding with partners such as the
International Federation of Red Cross and Red Crescent Societies, the Economic Commission for
Africa, the Common Market for Eastern and Southern Africa, and the Arab Red Crescent societies.
WHO cooperated with the World Bank in accomplishing a joint United Nations/World Bank needs
assessment mission in Iraq following the recent war in that country. The assessment report was
prepared as a strategic document for the health sector, enabling it to identify the relevant needs,
priorities and financial requirements. WFIO has, in close coordination and cooperation with all other
United Nations bodies and other interested parties, established an effective coordination and resource
mobilization mechanism in the health sector to cope with the aftermath of the recent war. WHO
chaired the Health Sector Working Group and, jointly with other sister organizations, the Health
Sector Contingency Plan was developed; available resources of other agencies involved under the
health sector were pooled and additional resources thus mobilized. The effective coordination
mechanism established by WFIO with the assistance of other partners was a key factor in achieving
control of cholera and measles outbreaks during the crisis.
ACTION BY THE HEALTH ASSEMBLY
24.
6
The Health Assembly is invited to note the report.
WORLD HEALTH ORGANIZATION
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
Provisional agenda item 19
A57/30
19 April 2004
Health conditions of, and assistance to,
the Arab population in the occupied
Arab territories, including Palestine
Report by the Director-General
1.
A number of studies on the health conditions of the Arab population in the occupied Palestinian
territories have suggested the increasing presence of mental health distress among the people of the
occupied Palestinian territories, higher malnutrition rates, decreased immunization coverage in
specific areas, increased prevalence of low birth-weight, and higher anaemia rates among pregnant
women in the past two years. Although prevalence of malnutrition among children between the ages of
six months and five years has been reduced since June 2002, partly because of increased and sustained
food assistance and physical access to health services, childhood malnutrition and micronutrient
deficiency are major concerns for some groups. The organizations responsible for the studies include
UNRWA, the nongovernmental organizations Save the Children and CARE, and the Ministry of
Health of the Palestinian Authority.
2.
A household survey on access to health services in the occupied Palestinian territories was
carried out at the end of 2002 by WHO, in collaboration with the Palestinian Ministry of Health and
Al-Quds University.1 Findings from the districts of Nablus, Ramallah, Hebron, Rafah and Gaza
indicated that more than 50% of the surveyed population changed their health-service provider
between March and December 2002. In almost 90% of instances the change was related to restrictions
on mobility. Of those seeking health-care services, 3% to 5% were not able to obtain them. Of
pregnant women, 22% could not access some antenatal services. Of the surveyed population,
13% reportedly suffered problems related to their mental and psychological health. The study group
cannot be considered as representative of the whole population of the occupied Palestinian territories,
but the findings indicate the health-related problems faced by people in the districts included in the
study.
3.
According to information provided by UNRWA, immunization coverage has deteriorated
somewhat since 2000. In some specific areas the percentage of children fully immunized has dropped
from 100% to between 84% and 67%.
4.
Following the 2003 review of the United Nations Humanitarian Action Plan, a United Nations
Consolidated Appeal for 2004 was drawn up in October 2003 with a proposed budget of
USS 305 million, including USS 26.6 million for health-sector activities. The analysis contained in the
1 Access to health services in the West Bank and Gaza Strip. Facts and figures. Ministry of Health of the Palestinian
Authority, World Health Organization, Al-Quds University, 2003.
.157/30
Consolidated Appeal shows that the severe restrictions on movement of Palestinian people and goods
is causing economic difficulties for much of the population. Military incursions, closures and curfews,
the withholding of Palestinian tax revenues, land confiscation and levelling, house demolition and the
construction of the “barrier” have disrupted economic life and generated unprecedented levels of
unemployment. As a result, poverty, food insecurity and nutritional vulnerability are widespread.
5.
The Palestinian health system is divided between Gaza and the West Bank and is severely short
of funds. UNRWA, which provides health care for the refugee population, the nongovernmental
organizations working in the area and even private health-service providers are, in general,
underfunded or facing a critical financial situation. In this context, assistance from the international
community and decentralization of health services in order to adapt to the constraints on the mobility
of health workers and patients, have made possible the provision of essential health services in
peripheral areas, thus avoiding a further deterioration of the health status of the Palestinian population.
6.
Resolution WHA56.5 requested the institution of a fact-finding committee on the deterioration
of the health situation in the occupied Palestinian territory. Under the current circumstances it has not
yet proved possible to enable such a committee to undertake its role.
7.
WHO, at both regional and global levels, has responded to the health needs of the Palestinian
population for over 50 years, in conjunction with UNRWA. Through the WHO Regional Office for
the Eastern Mediterranean the Organization assists the Palestinian Ministry of Health with a
programme which focuses on several specific health interventions. Further, it is working with
populations in the West Bank and Gaza Strip through the Special Technical Assistance Programme,
established in 1994 to support the health of Palestinian people by promoting a health system based on
equity, effectiveness and sustainability, and by addressing the broader social, economic,
environmental and cultural determinants of health, particularly those which are most affected by the
Israeli-Palestinian conflict. It maintains a direct link with, and provides support to, the Ministry of
Health of the Palestinian Authority, and communicates and collaborates actively with the Ministry of
Health of Israel.
8.
During 2003, WFIO continued to provide support to the Palestinian Ministry of Health for the
development of a strategic response to health needs. In collaboration with the governments of Italy and
of the United States of America, WHO leads the Health Inforum, a body which collects and
disseminates information about the health situation.1 Health Inforum aims to support the decision
making capacities of the Health Sector Working Group, and focuses on consolidating data on health
and health sector activities, on the status of health facilities and on the availability of medical supplies.
9.
With the Ministry of Health and other stakeholders, WFIO has formulated a general plan for
mental health and is implementing a programme financed by the European Commission to improve
delivery of mental health services. The Organization is also participating in a review of the Palestinian
health sector together with the European Commission, the World Bank, and the Government of Italy
and of the United Kingdom of Great Britain and Northern Ireland.
10.
WHO maintains its coordination role in the Health Sector Working Group, as technical adviser,
where it represents the other organizations of the United Nations system. Within the same framework,
thematic subgroups on nutrition, mental health, health management information and reproductive
health have been established. WHO co-chairs, with the Ministry of Health of the Palestinian
u'u'w.healthinforum.org.
2
A 5 7/30
Authority, bi-monthly emergency-support coordination meetings in the West Bank and Gaza Strip,
and recently at district level. Participants at these coordination meetings have analysed the impact of
the separation “barrier” on the health of the Palestinian population. One challenge is to ensure that
United Nations personnel, including WHO staff, are able to enter and work in the occupied Palestinian
territories in a predictable and timely manner.
11.
WHO is taking steps to secure additional funding for health actions in the occupied Palestinian
territories, in particular to meet with the urgent health needs of the Palestinian people. WHO is
committed to supporting effective communication between Palestinian and Israeli health professionals,
nongovernmental organizations and health institutions. WHO seeks to create platforms for dialogue
and to take advantage of every opportunity to encourage open discussion and cooperation. A “cities
partnership” project is currently being implemented involving European, Palestinian and Israeli cities
that focuses on health and social action. WHO has also drawn up, together with the United Nations
Office for Humanitarian Affairs, UNICEF, UNDP, UNRWA, WFP and UNFPA, an advocacy strategy
for health in the occupied Palestinian territories, and is implementing specific initiatives which
promote health and human rights.
3
Corvq )5, f?,-
W WORLD HEALTH ORGANIZATION
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
Provisional agenda item 18.2
A57/29
25 March 2004
Rules of Procedure of the World Health Assembly:
amendment to Rule 72
Report by the Secretariat
1.
At its 112th session the Executive Board adopted resolution EB112.RI amending several of its
rules of procedure and recommending a resolution to the Health Assembly which proposes inter alia to
amend Rule 72 of the Health Assembly's Rules of Procedure, so as to change the majority required to
appoint the Director-General. The recommended resolution also deals with gender inequality in the
texts contained in the Basic Documents, following the approach taken in other international
organizations of the United Nations system.
2.
The resolution adopted by the Board was in response to resolution WHA54.22 in which the
Health Assembly requested the Board to review its working methods in order to ensure that they are
effective, efficient and transparent, and to ensure improved participation of Member States in its
proceedings. As requested by the Health Assembly, the Board established an open-ended working
group to consider the question in depth.
3.
The proposed change to Rule 72 arose from a review by the Ad hoc open-ended working group
to review the working methods of the Executive Board of the process for nomination of the DirectorGeneral. Article 31 of the WHO Constitution provides that the Director-General shall be appointed by
the Elealth Assembly on the nomination of the Board. Rule 52 of the Board’s Rules of Procedure sets
forth the nomination process in the Board1 and Rules 108 and 110 of the Health Assembly’s Rules of
Procedure set forth the appointment process for the Director-General in the Elealth Assembly upon
receiving the Board’s nomination. The majority required for nomination of a candidate as DirectorGeneral by the Board, and for the decision by the Health Assembly on whether to accept the Board’s
nomination, is currently dealt with in general terms in Rule 43 and Rule 73 of the Rules of Procedure
of the Board and of the Health Assembly, respectively. In each case the decision is to be taken by a
majority of those present and voting.
4.
However, the open-ended group considered that, although the nomination of a candidate as
Director-General could remain as a decision taken by a majority of the members present and voting in
the Board, the decision by the Health Assembly whether to accept the nomination should be subject to
more than just a majority of the Member States present and voting. The Board accepted the group’s
proposal to recommend to the Health Assembly that it amend Rule 72 of the Health Assembly’s Rules
of Procedure so as to include “the appointment of the Director-General” as one of the questions listed
in that rule requiring a two-thirds majority of the Members present and voting.i
i See also Rule 109 of the Rules ofProcedure of the World Health Assembly.
.457/29
ACTION BY THE HEALTH ASSEMBLY
5.
The Health Assembly is invited to consider the draft resolution contained in resolution
EB112.R1.
2
Co nn ¥•> '
C-
WORLD HEALTH ORGANIZATION
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
Provisional agenda item 18.1
A57/28
8 April 2004
Agreement with the Office International
des Epizooties
Report by the Secretariat
1.
The Office International des Epizootics (OIE) is an intergovernmental organization established
in 1924. OIE, which currently has 165 Member Countries, maintains relations with more than
20 international organizations, including WHO.
2.
A previous agreement establishing relations between OIE and WHO was approved by resolution
WHA14.50 (1961). The agreement was revised in 2003 to take into account a number of recent
developments of shared concern. Food safety became a formal area of OIE activity in 2001. The
emergence of such zoonotic diseases as bovine spongiform encephalopathy and the related variant
Creutzfeldt-Jakob disease, severe acute respiratory syndrome, and avian influenza, has drawn renewed
attention to the animal health component of consequential new diseases in humans. These
developments have underscored the need for closer collaboration between the two organizations in the
surveillance, prevention, and control of zoonotic diseases.
3.
A revised agreement reflecting these developments was endorsed by the OIE International
Committee at its 71st session in May 2003. By virtue of Article 6, its entry into force is subject to the
approval of the Health Assembly.
ACTION BY THE HEALTH ASSEMBLY
4.
The Health Assembly is invited to approve the revised agreement with OIE, attached as Annex.
A57/28
ANNEX
AGREEMENT
BETWEEN THE OFFICE INTERNATIONAL DES EPIZOOTIES (OIE) AND
THE WORLD HEALTH ORGANIZATION (WHO)
The World Health Organization (hereinafter referred to as WHO) and the Office International des
Epizooties (hereinafter referred to as the OIE) wishing to co-ordinate their efforts for the promotion
and improvement of veterinary public health (VPH) and food security and safety, and to collaborate
closely for this purpose
Have agreed to the following:
Article 1
1.1
WHO and the OIE agree to cooperate closely in matters of common interest pertaining to
their respective fields of competence as defined by their respective constitutional
instruments and by the decisions of their Governing Bodies.
Article 2
2.1
WHO shall transmit relevant resolutions of the World Health Assembly and the
recommendations of relevant WHO consultations, workshops and other official WHO
meetings to OIE for the purpose of circulating them to OIE Member Countries.
2.2
The OIE shall transmit the recommendations and resolutions of its International Committee
as well as the recommendations of relevant OIE consultations, workshops and other official
OIE meetings to WHO for the purpose of circulating them to WHO Member States.
2.3
These resolutions and recommendations sent for the consideration of the respective bodies
of the two Organizations (hereinafter referred to as the Parties) shall form the basis for
coordinated international action between the two Parties.
Article 3
3.1
Representatives of WHO shall be invited to attend the meetings of the International
Committee and Regional Conferences of OIE and to participate without vote in the
deliberations of these bodies with respect to items on their agenda in which WHO has an
interest.
3.2
Representatives of OIE shall be invited to attend the meetings of the Executive Board and of
the World Health Assembly and Regional Committees of WHO and to participate without
vote in the deliberations of these bodies with respect to items on their agenda in which OIE
has an interest.
3.3
Appropriate arrangements shall be made by agreement between the Director-General of
WHO and the Director-General of OIE for participation of WHO and OIE in other meetings
of a non-private character convened under their respective auspices which consider matters
in which the other party has an interest; this especially involves those meetings leading to
the definition of nouns and standards.
1
OIE/WHO Agreement - 13 November 2002 V4-348-3
3.4
The two Parties agree to avoid holding meetings and conferences dealing with matters of
mutual interest without prior consultation with the other party.
Article 4
WHO and OIE shall collaborate in areas of common interest particularly by the following means:
4.1.
Reciprocal exchange of reports, publications and other information, particularly the timely
exchange of information on zoonotic and foodbome disease outbreaks. Special
arrangements will be concluded between the two Parties to coordinate the response to
outbreaks of zoonotic or/and foodbome diseases of recognized or potential international
public health importance.
4.2
Organizing on both a regional and a world-wide basis meetings and conferences on
zoonoses, food-bome diseases and related issues such as animal feeding practices and anti
microbial resistance related to the prudent use of anti-microbials in animal husbandry and
their containment/control policies and programmes .
4.3
Joint elaboration, advocacy and technical support to national, regional or global programmes
for the control or elimination of major zoonotic and food-bome diseases or emerging/
re-emerging issues of common interest.
4.4
Promoting and strengthening, especially in developing countries, VPH education,
operationalization of VPH and effective co-operation between the public health and animal
health/veterinary sectors.
4.5
International promotion and coordination of research activities on zoonoses, VPH and food
safety.
4.6
Promoting and strengthening collaboration between the network of OIE Reference Centres
and Laboratories and that of WHO Collaborating Centres and Reference Laboratories to
consolidate their support to WHO Member States and OIE Member Countries on issues of
common interest.
Article 5
5.1
WHO and OIE will, in the course of the preparation of their respective programmes of work,
exchange their draft programmes for comment.
5.2
Each party will take into account the recommendations of the other in preparing its final
programme for submission to its governing body.
5.3
WHO and OIE will conduct one annual coordinating meeting of high level officials from
headquarters and/or regional representation.
5.4
The two Parties should devise administrative arrangements necessary to implement these
policies, such as the sharing of experts, common organization of joint scientific and
technical meetings, joint training of health and veterinary personnel.
2
OIE/WHO Agreement - 13 November 2002 V4-348-3
Article 6
6.1
The present Agreement shall enter into force on the date on which it is signed by the
Director-General of WHO and the Director-General of the DIE, subject to the approval of
the International Committee of the OIE and the World Health Assembly.
6.2
This Agreement may be modified by mutual consent expressed in writing. It may also be
terminated by either party by giving 6 months’ notice in writing to the other party.
Article 7
7.1
This Agreement supersedes the Agreement between the WHO and OIE adopted by WHO on
4 August 1960 and by the OIE on 8 August 1960.
Adopted by WHO on
18 December 2002
Dr D.L. Heymann,
Executive Director
Communicable Diseases
OIEAVHO Agreement - 13 November 2002 V4-348-3
v\ - / 2.
WORLD HEALTH ORGANIZATION
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
Provisional agenda item 16.2
A57/25
15 April 2004
Programme budget 2002-2003
Performance assessment report: summary of initial findings
Note by the Secretariat
1.
The assessment of 2002-2003 programme budget performance is part of a biennial monitoring
and evaluation cycle and focuses on the delivery of the programme budget. It assesses the contribution
of each WHO office to expected results, and overall achievement of the expected results by the whole
Organization. A full report will be submitted to the Executive Board at its 115th session.1 The present
document summarizes some of the findings.
2.
WHO first introduced results-based management in the Programme budget for the financial
period 2000-2001. Since then, application of results-based management has been furthered throughout
WHO with each subsequent programme-budget cycle. These efforts have met with considerable
success and are seen as a positive step in building a focus on results, improving the targeting of
resources and achieving greater accountability. At the same time, various challenges remain to be
addressed if results-based management practices arc to be applied consistently across organizational
levels and areas of work.
GREATER DIALOGUE AND COLLABORATION BETWEEN ORGANIZATIONAL
LEVELS
3.
Changes in preparation of the proposed programme budget, requiring a more collaborative
approach, have facilitated dialogue among the levels of the Organization. With greater input from the
country offices, regional offices have worked with headquarters in drafting the proposed programme
budget. Country input was based on national health strategies and priorities and the priorities for WHO
action as identified in WHO Country Cooperation Strategies or equivalent strategic planning
processes. The regional offices consolidated individual country inputs, identifying commonalities to
be included in the proposed programme budget. This iterative process has allowed for better
communication and coordination between the various levels, while respecting the differences among
regions and countries within agreed Organization-wide objectives and strategies.
An initial draft, in English, is available on request.
A 5 7/2 5
FOCUS ON ACCOUNTABILITY AND IMPROVED MANAGEMENT
4.
WHO’s governing bodies, including the regional committees, and WHO partners and donors
have commended the Organization’s move to establish results-based budgeting within a broader
framework of results-based management. For the first time, through performance monitoring,
evaluation and reporting on expected results, the governing bodies are able to “visualize” results to
which the Organization is committed. As a result of adopting results-based management, WHO is seen
as being a more transparent and accountable organization. Furthermore, senior staff are increasingly
gearing management to results, drawing on, and applying, lessons leamt during implementation.
ENSURING THAT ORGANIZATION-WIDE EXPECTED RESULTS INFORM THE
DEVELOPMENT
OF
OFFICE-SPECIFIC
EXPECTED
RESULTS
AND
WORKPLANS
5.
Implicit in the collaborative planning process is a shared responsibility for achieving the
Organization-wide expected results and the assumption that the different levels and offices will
undertake the activities necessary to ensure their achievement. This assumption has not held across all
areas of work. Although the expected results are adopted by the governing bodies for the Organization
as a whole, regional and country offices may give priority to locally defined needs, while at global
level Organization-wide commitments may be considered synonymous with achievements at
headquarters. This perspective may have an impact on joint planning among organizational levels in
support of Organization-wide expected results, and on resource allocation, programme
implementation, and reporting.
DEVELOPING MEANINGFUL ORGANIZATION-WIDE EXPECTED RESULTS
6.
WHO’s results-based management is reflected in the programme budget, which sets out what
the Organization collectively intends to accomplish over the biennium. The nature of the Organization
and geographical scope of its programmes require Organization-wide expected results that are
sufficiently broad to accommodate the unique needs of Member States while providing a level of
specificity that clearly expresses desired results and facilitates accountability. This balance is not easy
to achieve. Expected results may be formulated in an abstract way that makes measurement of their
achievement difficult and does not provide sufficient guidance for drawing up workplans.
ENSURING CONSISTENCY
PLANNING
BETWEEN
STRATEGIC
AND
OPERATIONAL
7.
The programme budget provides a strategic framework, and sets out common objectives, for
WHO’s work. However, the timeframe for preparation of the proposed programme budget at
headquarters may mean that regional and country offices draw up their operational plans before, or at
the same time as, the proposed programme budget is finalized. This conjuncture may affect the
consistency and linkage between strategic and operational planning and necessitate adjustments in the
planning cycles.
8.
The challenge of ensuring consistency between strategic and operational planning is further
illustrated during resource allocation. The Organization-wide expected results and the integrated
2
/15 7/25
budget tor areas of work are vertical in nature, cutting across the three levels of the Organization,
whereas budget allocations are horizontal: that is, they arc allotted by organizational level. It is
therefore important to ensure that actual allocations arc commensurate with the resources required to
achieve the contribution of regional and country offices to the collectively agreed upon Organizationwide expected results.
TACKLING CONSTRAINTS DERIVING FROM ORGANIZATIONAL CULTURE
9.
Results-bascd management as implemented in WHO implies a greater degree of
interdependence across organizational levels and among offices; an clement of uniformity of
processes; greater responsibility; and a greater acceptance and compliance with Organization-wide
business rules than previously had been the case. Similarly, there is a demand for greater
accountability, and a need to demonstrate results and to strengthen the focus within and across
programmes. Further, programmes arc expected to adopt a “planning, performance monitoring,
evaluation, and reporting culture” that does not favour ad hoc programming and ad hoc mobilization
of resources. The challenge of overcoming resistance to change is real and remains a significant factor
in the introduction and effective application ofresults-based management.
LESSONS LEARNT IN IMPLEMENTING THE PROGRAMME BUDGET 2002-2003
10.
An examination of the performance analysis by area of work highlights certain commonalities
across the 35 areas and are applicable to the Organization as a whole.
Cause-and-effect logic underpinning the programme budget
11.
WHO objectives, Organization-wide expected results and indicators arc sometimes drafted with
insufficient attention to their logical connection, by persons other than those charged with their
implementation. As a result, workplans do not necessarily support the achievement of the
Organization-wide expected results and WHO objectives. Greater attention should be given to these
linkages when preparing the proposed programme budget.
Improved use of indicators
12.
Similarly, indicators arc sometimes poorly chosen and drafted or require data that are
incomplete or unavailable, which affects reporting on the achievement of Organization-wide expected
results. In general, measurable targets and baseline data for the indicators were absent. Indicators,
targets and baseline data have therefore been refined in order to measure more accurately the
achievement of the Organization-wide expected results in the Programme budget 2004-2005.
13.
In order to avoid similar problems when preparing the proposed programme budget 2006-2007,
a practical, detailed guide for drafting expected results, indicators, targets, and baseline data has been
prepared and disseminated throughout the Organization, and training courses and seminars have been
held for regional and headquarters staff. Indicators arc being reviewed as part of the process to prepare
the proposed programme budget so as to ensure their technical quality and practicality.
A 5 7/2 5
Closer coordination between organizational levels
14.
WHO's results-bascd management, with its single programme budget, requires close
coordination among the three levels of the Organization. This coordination has been identified as a
crucial factor for success in many of the areas of work. Coordination is being strengthened through a
greater emphasis on joint planning, performance monitoring, and evaluation. Preparation of the
proposed programme budget 2006-2007 will maximize input from countries through greater reliance
on the Country Cooperation Strategy. The joint planning process will identify what is required from
countries, regions, and headquarters in order to achieve the Organization’s expected results, and will
ensure that collectively agreed upon contributions of each office are reflected in their workplans.
Programme budget as a basis for mobilization, prioritization and allocation of funds
15.
In order to function as a single instrument for the whole Organization the programme budget
should integrate different sources of funding. The breakdown for the regular budget and for
extrabudgetary resources needs to be the basis for mobilization, prioritization and allocation of funds
across areas of work and by organizational level.
16.
In conformity with WHO’s Financial Rules and appropriation resolution WHA56.32, the
allocation of the regular budget and of extrabudgetary resources across areas of work will be adjusted
and resources shifted as necessary throughout the biennium 2004-2005 in order to ensure that the total
amount planned by area of work is made available.
Monitoring and reporting for more effective programme management
17.
Results-based management also requires clearly defined roles and a robust monitoring and
reporting system. Specific responsibilities for the development and implementation of results-based
management instruments will be defined for each level of the Organization. The framework for
performance monitoring quality assurance, evaluation and reporting will be revised in order to provide
programme managers with the tools necessary for more effective management.
Capacity building to support results-bascd management
18.
In order to implement effectively results-based management, staff skills need to be improved.
Beyond the need for general orientation to results-based management for staff at all levels, including
senior management, extensive training is needed in the logical framework approach, with particular
reference to the formulation of results, indicators and targets. To supplement the training that is being
offered at country, regional and global levels, tools are being developed for quality control of
operational and strategic planning.
ACTION BY THE HEALTH ASSEMBLY
19.
4
The Health Assembly is invited to note the above report.
- Media
RF_COM_H_82_SUDHA.pdf
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