Mr. President, Director-General, ministers, ambassadors, other distinguished guests.
U.S. First Lady Hillary Rodham Clinton
of the United Arab Emirates Health Foundation Prize
at the World Health Assembly
Geneva - 14 May 1998
It is indeed a great honor to receive this award and to join all of you here today celebrating the World Health Organization's 50 years of leadership. I want to thank United Arab Emirates Health Foundation for this award, and for this generous gift to the Safe Motherhood Initiative, which will save the lives of countless women and children.
Let me congratulate the distinguished recipients of the Sasakawa health prize, for the work you do every day to put quality health care within the grasp of all people.
I also want to pay special tribute for his decades of service to WHO, and his lifetime of dedication to improving health throughout our world, to Dr. Nakajima. Thank you, Dr. Nakajima, for your service and leadership.
And to the incoming Director-General, Dr. Gro Brundtland, let me congratulate you on your election. Your expertise and leadership will help make WHO's vision a reality in the 21st century.
As we speak, at this very moment, children are being born in Africa, in Asia, in Australia, in the Americas, in Europe. What will their lives be like in the 21st century? Will they live with dignity and health -- or be degraded by poverty, war, injustice, and premature death? Will there be health for all?
The answers to these questions depend upon all of us. Heads of state, ministers, parliamentarians, experts, physicians, nurses, researchers, village health workers, and citizens all. Many of you in this room are the authors of the success stories of the 21st century. But the answers for tomorrow depend not just on what we say today as individuals, but on what we do tomorrow as a community of nations.
When public health leaders first started meeting internationally more than 100 years ago, they had seen firsthand the devastation left in the wake of the yellow-fever epidemic that swept across the Southern Cone in the late 1800s. They had experienced cholera overrunning Europe, malaria, terrible sanitation conditions, unsafe food and water, infectious diseases and diarrhea that robbed babies of any chance at life. No nation was safe from the epidemics that traveled across national boundaries. Yet no one really knew about the causes of infant mortality. There were no immunizations or antibiotics. No oral rehydration therapies or adequate prenatal care.
But now, thanks to the World Health Organization and many other public-health pioneers, researchers, scientists, and so many, a dramatically different world welcomes the 365,000 children born each day. It is far less likely that we will have to look into the eyes of children dying of infectious diseases, and know that their lives could have been saved had they only received a simple vaccination. Because smallpox is now only found in the history books, children today will not have to endure the blindness, the disfigurement or death that once plagued 15 million people a year. And if we refuse to give up, polio will soon be eradicated.
Children today are far more likely to live past their fifth birthday, and some born today will even be around to see the 22nd century dawn. But standing as we are at the border between one century and the next, we have the opportunity for the first time in history to alleviate and end much of human suffering and prevent millions of premature deaths.
We have every reason to reject the doom-sayers who paint a picture of a 21st century with environmental degradation, rampant poverty, and untold suffering from new diseases. As your new World Health Report makes clear, we can choose an optimistic vision of the future and work to make it a reality, so that at the end of the next century our successors will look back at what we did for the children born this very day. They will, I hope, see public health hazards overcome and diseases like cancer conquered, and see children living not only longer but better-quality lives.
Whether we see that vision or not is really the question we face today. We certainly have the means within our reach. Just as immunizations, antibiotics, and clean water revolutionized lives in this century, children are being born today into a world in which telemedicine on the Internet provides life-saving information in a matter of seconds. A world of biology where research is allowing us to map the human genome and unlock the mysteries behind chronic diseases and our greatest killers.
But we know that this promise of progress will only be possible if our ethics and self-interest compel us to act. If we apply ancient values and morality to new frontiers of discovery. If we master the political will and summon the economic resources to ensure that all citizens reap the benefits of advances in health care. If we heed yesterday's lessons to meet new challenges tomorrow.
Now some of what we need to do is not complicated. It is, so far, the best practices that are proven to work in every place that needs them. As I have been privileged to travel around the world I've seen what people can accomplish when they use simple public health techniques and community action to improve health and save lives.
In Bolivia, I visited with expectant mothers at a primary health center run by an NGO with support from the government. They had created a safe place for very poor women to come and get health care. The women -- with their ruddy faces and bowler hats -- were receiving prenatal checkups and having their infant immunized on the day that I visited. They were also learning about family planning and how to space births so they could more likely have their children survive, and themselves.
Some of what we need to do is provide better information and education so that people can make better health decisions for themselves and their children. On a recent trip my husband and I took to Africa, I met with women and two men from Malicounda Bambara village in Senegal. These people have accomplished something extraordinary. Although female genital mutilation affects less than 20 percent of women in Senegal, in villages like theirs it is considered a rite of passage for all girls. The women decided that FGM had for far too long harmed their daughters' bodies and spirits. They decided it was time to end the hemorrhaging, the AIDS, the childbirth complications caused by this tradition. During our discussion they showed me the skit they had used to educate their religious leaders, their neighbors and husbands.
As a result of their efforts, this village voted to ban this long-standing cultural ritual. Not only that, they are inspiring others to do the same. A 66-year-old man told me how he walks from village to village spreading the word about the dangers of FGM. Recently 13 other surrounding villages representing 8,000 people joined together to end FGM in their communities. They petitioned their government, and now the president is working to enact a new law to abolish it throughout the country.
When I asked one woman: "What drove these people to change such a long-standing tradition?" She simply replied: "We studied human rights and particularly the right to health."
What better time than now, here at the Palace of Nations on the 50th anniversary, not only of WHO but of the United Nations Declaration of Human Rights, to make clear that health care is a basic right, a basic human right that all men and women are entitled to. As Dr. Martin Luther King Jr. once said, "Of all the forms of inequality, injustice in health is the most shocking and the most inhumane."
For the children being born today, let us all declare, their basic health should not depend on where they live or how much money their parents have.
Some of what we have to do is to attack the inequities that deprive children in one area from enjoying the health care that is available to their neighbors. We know that child malnutrition varies greatly from continent to continent. The number of physicians and nurses varies greatly, depending on the wealth of a country. And even in rich countries there are pockets of despair.
To improve health for all, we must make progress in the fight against poverty. To fight poverty, we must ensure health care for all. That is part of the unfinished business of this century. And when we talk about health equity, we must talk about equity between countries and within countries. Men, women, and children come from all over the globe to be treated in the great medical centers of the United States, and yet we have more than 41 million Americans who are uninsured. But to be sure, their emergeny needs are usually taken care of, but often well after they should have received primary care, and frequently at a greater cost.
A country such as mine can have the most cutting-edge technology in the world. A country that is poor can have cutting-edge technology for the rich of that poor country. But it will not matter to the people who still die and suffer because they do not have access to the services they need.
Some of what we have to do is to face up to the difficult issues posed in every country about how we finance and deliver health care. As populations age, thanks to the wonderful progress we've made in health care, then every country, whether or not it currently has a universal system, will face greater cost pressures to meet overall needs.
Many countries with universal systems are now unable to afford the facilities they have, or the technology they need, and will have to face hard choices about how to restructure their systems. Other countries are in danger of having their existing health structures collapse under the huge weight of caseloads from HIV/AIDS or tuberculosis. And we find many parts of many countries cutting back on necessary basic services just to make ends meet.
Some of what we have to do is to join together to combat a new array of global health threats. Increases in food-borne illnesses mean families have more reason to worry about whether the dinner they just served their children will make them sick or worse. Parents are worried about tobacco addicting their children, stealing their health and often their lives. My husband is working hard to save children in our country from the death grip of big tobacco. But none of us can rest until we save all children from the advertising and other enticements that seduce them, and I applaud Dr. Brundtland for her strong statement yesterday.
Across the globe people are worrying about infectious diseases and with good reason. They remain the leading cause of death. In the last 20 years we have witnessed the birth of at least 30 new infectious diseases like ebola. The HIV/AIDS pandemic continues to strike at citizens without regard to sex or station in life, and increasingly women and children are the targets.
We also see old scourges like tuberculosis reemerging with new force. We have treatments that work for TB, but more people will die from tuberculosis this year -- 2 million -- than in any other year in history.
We also have anti-malarial drugs, but resistance to them, and other factors, have led to alarming increases in malaria, which is now moving into previously unaffected regions. Infant and child mortality could be decreased by 20 to 30 percent if malaria were eradicated. And I want to thank Dr. Brundtland for her commitment to roll back malaria once and for all.
We know there are no magic bullets, no solutions that we can take from the sky. We need to share information, share responses, share surveillance. What would happen if we had an excellent surveillance in Africa, for example, when the AIDS outbreak first occurred? I hope we never have to ask that question about any other disease in any part of the world again.
Some of what we have to do is end discrimination against girls and women. The health of children must never again depend on whether they are boys or girls. The last WHO event I attended was a forum at the Beijing Conference about women and health security. There were people from all over the world sending the message that the health of women and girls could no longer be divorced from progress on other economic or social issues.
For how can we have progress when half the population of any country is underfed, undervalued, or denied care when they are sick. How can we have progress when women live in fear of violence at the hands of strangers or relatives, when they are trafficked across state lines like drugs and sold into modern-day slavery? How can we have progress when women don't have access to the family planning they need to protect their health and make fundamental choices about when and if to have children? How can we have progress when every single minute that goes by, somewhere on this globe a woman is dying of complications from pregnancy and childbirth.
At a small clinic in Nepal I saw a safe home-delivery kit that is given to expectant mother. Inside is a bar of soap, twine, wax, a plastic sheet, and a razor blade. Its purpose is to reduce the two major causes of maternal and neonatal death -- tetanus and sepsis -- by promoting the "three cleans" priniciple -- clean hands, clean surfaces, clean umbilical care.
These kits are made locally by a microenterprise owned by women. And these kits, as well as the entire Safe Motherhood Initiative, teach us about the importance of investing in prevention. We will reap great human dividends if we give people the power to protect their with prenatal care, nutrition, and family planning. Most maternal deaths can be prevented by spending less than $2 a year per person. These safe motherhood kits are emblematic; they remind us that women's health, like all health, issues are not soft or marginal issues but are very important issues and moral obligations as well as practical necessities that every society must face.
Our political leaders must understand that unless we address the health care needs of our citizens we will not have the quality of life, the economic growth, the justice and equity that make democracies and economies thrive. Our leaders should be just as worried about reducing infant morality as increasing trade. They should be just as concerned about maternal mortality as military might. They must see women's health as part of the overall development of every nation. Because good health is linked to every other tool of opportunity -- jobs, loans to start microenterprises, legal protection and, above all else, education. When a woman can read and write, she is more likely to live through childbirth, her child is more likely to live, and her family is more likely to be healthy.
Above all, what we must do is to call upon the private, public, and non-profit sectors represented here to join together to meet all of the challenges of the 21st century. Just as concerned people have done in this great city before -- when they have banded together to ensure peace, or work towards universal human rights; just as nations and public and private institutions did during the 20th century when they invested in the research and training that gave birth to the advances we celebrate today.
We must put our hearts, our minds, and our resources in action, to meet the needs -- whether it's finding a vaccine for diseases like AIDS or malaria, closing the equity gaps that plague our health care systems, or making it clear that issues like maternal mortality or tobacco are not peripheral concerns, but central ones.
I would hope that on the occasion of WHO's 100th anniversary in 2048, our successors would look back at what has been accomplished. Instead of an apocalyptic 21st century, as predicted by some, of overpopulation, pollution, disease, and poverty, I hope they would see that for the first time in human history all people had access to the tools they needed to live longer and better lives in peace.
We don't have a minute, or a child, to waste. We have only one World Health Assembly left in this century. The children of the next century being born today in Africa, in Asia and Australia, in the Americas, and in Europe, come into our world with every reason to expect they will be wanted and loved by their families, and valued by the societies they join. We should not, we dare not, disappoint them. Yes, there will be obstacles and setbacks, but we cannot be discouraged. We have the technology, we have the know-how, we have the resources. We only need the will to act.
With the World Health Organization continuing to lead the way, I know that we all will turn the vision of "health for all" into a reality in the 21st century. And those children born today will thank all of you.
Thank you very much.