Dr. Jim Yong Kim, President, World Bank Group
Ban Ki-moon, Secretary-General of the United Nations
Lawrence H. Summers, Professor and President Emeritus, Harvard University
Michael Bloomberg, Entrepreneur, Philanthropist and Three-Term Mayor of New York City
Ngozi Okonjo-Iweala, Minister of Finance, Federal Republic of Nigeria
Margaret Chan,Director-General,World Health Organization
DIRECTOR‑GENERAL CHAN: Let me begin by thanking all of you for a wonderful, wonderful morning, and, of course, I want to thank Jim working with WHO to promote universal health coverage as an important mechanism to end poverty. The panel four‑‑I tell you, I'm shaking. Did you see it? I have an awesome panel.
Don't laugh like that.
Let me begin by introducing His Excellency, of course, Mr. Secretary‑General. He is the eighth Secretary‑General of the United Nations. He needs no introduction. We see him on TV all the time, right? He's a busy person, but he lends his support to this very important issue. And I have to tell you, in the last how many years we worked together, I'm truly impressed by his commitment and conviction to MDGs, especially MDGs 4 and 5, for women and children's health, for climate change, for energy, for nutrition. The list is so long. Sometimes I said, you are also the DG of the big show, aren't you, now this is a Secretary‑General who sees the importance of the interconnection of different sectors in order to put people in the center.
Mr. Secretary‑General, without further ado, the floor is yours.
SECRETARY‑GENERAL BAN KI‑MOON: Thank you, Dr. Margaret Chan of WHO.
Ladies and gentlemen, it is a great pleasure to meet you to discuss these very important universal health coverage issues. I'm immensely grateful to the President of the World Bank, Dr. Jim Yong Kim. And we have been working very closely on many development issues, and thank you for initiating this one. In fact, we traveled a lot together, at least twice the last year. We are also planning to do the same joint visit to Africa, which country I'm not going to disclose at this time.
And I'm also very pleased to see Minister Ngozi, who has been a strong supporter. I think she is familiar with the institute here. As you know, she was a Vice‑President of this. She also worked as one of the high level panel of eminent persons to define sustainable development.
I'm also very pleased to be here with Harvard President Emeritus, Dr. Lawrence Summers. We have both a connection to Harvard University. Thirty years ago I was just a student when he was one of the youngest faculty members, youngest ever in the history of Harvard. And I have a deep admiration for him.
And I'm also very happy to be here with Mayor Michael Bloomberg, who is now working as U.N. Special Envoy for Climate and Cities. And he's a strong champion since he was the mayor of New York City, and I'm very glad.
Ladies and gentlemen, countries around the world have achieved great advances on health through MDG. Billions of women and children have been spared preventable death. The spread of HIV/AIDS has been slowed, and malaria is being contained, and there is progress against tuberculosis and other infectious diseases. For now we have to go farther, and that means reaching the most vulnerable people. I have seen that success is possible. In rural parts of Africa, Asia and beyond, I have visited small health posts that deliver big results. In fact, I have traveled together with Dr. Margaret Chan in Asia and somewhere else to raise the awareness on the importance of women's health and children's health. That was quite effective, and I have witnessed immense relief on the faces of women, pregnant women, when they find skilled attendants to help them during delivery.
You may know that this health post is the unit, I think minimum unit, then you go health clinic, then from health clinic then you go to hospital. But going to hospital, that means you see almost the same facilities. But when you visit health post, I was very much humbled about the level of the facilities. But when I saw the women and children lying in a room, they were thinking that they were fine with the help of this health post. That really made me very much humbled that we have to do even this minimum facilities we should establish more. I have spoken to adolescents and young adults who need sexual and reproductive health services, and I have underscored the importance of helping members of the older generations who may require special care.
The Lancet Commission on Investing in Health Report points to an opportunity to close the gap by 2035. In this crucial period, we can bring maternal and child death and preventable infections to similar low levels in all countries, rich and poor. Today, we can celebrate the fact that, for example, virtually all mothers in Sweden will survive childbirth, but we cannot forget that in South Sudan, one in seven pregnant women will not live to see her baby.
Addressing these inequalities is a matter of health and human rights. The Commission also pointed out that non-communicable diseases, mental health problems, and injuries are becoming more deadly, even in low‑income countries. This is an important trend to consider as we shape the post‑2015 development agenda, a transformative and universal agenda, which builds and expands on the MDGs.
To secure health, we need to take all preventive actions. We have to think in terms of reducing exposure to pollution, improving nutrition, and promoting overall well‑being. The concept of universal health coverage can be an important catalyst. Right now, an estimated 100 million people fall into poverty because health costs break their family budget. Universal coverage would protect them and build resilience across society.
Our vision is an aspirational approach that allows countries to realize their goals on their own terms. Interest is growing. In 2012, Member States adopted a general assembly resolution on the need to move towards universal health coverage. Today, more than 70 governments have asked the United Nations for technical and policy support to achieve this goal.
Measuring progress is essential. I'm pleased that WHO and the World Bank are developing monitoring framework. This will help countries measure progress in a standardized manner. Ladies and gentlemen, universal health coverage is a big concept, and you are all big thinkers, but I would have framed this ambitious goal in plain terms. This is about relatively small investments that pay off huge dividends. It may cost a lot of money on the government's side, and you may think that only rich countries can do it, but I was very much surprised and encouraged to see that in Thailand, when their per capita GDP was just $400, they started national universal health coverage. So it's not a matter of GDP, the size of GDP. When there is political will, it can be done, even with the little and less GDP.
We should remember the power of simple solutions. A trained midwife can help a pregnant woman survive birth. An inexpensive vaccine can spare a child from disease. A bed net that costs just a few dollars can protect a family from malarian mosquitoes for years. Universal health care can be the model for the 21st century. It provides access to services, prevents against exclusion, and protects people from financial risk.
This will bring more than health. It will bring equity and contribute to a life of dignity for all.
Thank you very much.
DIRECTOR‑GENERAL CHAN: Thank you, Mr. Secretary‑General.
Now, Jim, come on up.
The 12th President of the World Bank Group.
PRESIDENT KIM: Thank you, Margaret. Thanks, everybody, for being here.
I'm so grateful to our panelists, and I'll say a word about‑‑maybe more than a few words about each of them because each of them represents something so important in our effort to scale up universal health care.
We have just 629 days until the deadline for the Millennium Development Goals. The World Bank Group remains deeply committed to helping countries push as far and as fast as possible toward all the goals. We cannot take our eye off the current goals as we think about the future goals. There will, though, be a lot of unfinished business at the end of 2015. Too many people will be dying from preventable causes because they lack access to a central, quality care or because they can't afford to pay for the care they need.
So, as you and Member States come together to forge the post‑2015 development framework, we must keep a few things in mind. The development landscape is changing. Between now and 2030, about half of today's low‑income countries will graduate to middle‑income status. Not only that, but the burden of disease is evolving, including the alarming spread of chronic conditions such as heart disease and diabetes. We must build on the progress made through the health MDGs and work together to set goals that are universal and based on the principle of health equity for all.
We need a bold health goal for 2030 that encompasses both the health outcomes we want and the path to get us there. We now have the evidence that we can end preventable maternal and child deaths. Let's have the courage to set a goal to do it. We have the evidence showing us that we can significantly reduce deaths and disability resulting from chronic disease. So let's set a goal that will help us scale up those interventions. And we also have a growing body of evidence that the most equitable and sustainable way to achieve the health outcomes we all want is through universal health coverage. So, let's set a goal that will make that happen by 2030.
Countries like Japan, Thailand, and Turkey have shown the promise of universal health coverage for their people, and a growing number of countries like Myanmar, Nigeria, Peru, Senegal, Kenya, South Africa, and the Philippines have made universal health coverage a top priority. They're mobilizing resources and pursuing reforms to turn universal health coverage from a slogan to a reality.
Thanks for a collaboration with WHO and for Margaret's great leadership. For the first time we now have two time‑bound targets for universal health coverage. These targets will allow us to chart progress, both in scaling up equitable access to essential services and in preventing poverty due to catastrophic out‑of‑pocket payments for health.
These targets can be applied to all countries, rich and poor, and as envisioned under the sustainable development goals. Time‑bound targets for universal coverage in the post‑2015 framework will drive policy and program choices that lead to better health such as investing in strong, front‑line primary care that is accessible to the poorest and most marginalized communities.
Good primary care delivers the essentials like antenatal care, skilled birth attendants, child vaccines, blood pressure and diabetes monitoring, and other interventions that prevent health crises and keep health care costs from escalating. We also know from the Lancet Commission on Investing in Health chaired by Professor Summers that investments in health deliver great economic returns. And let me just take a step back.
I think if you were to ask who are some of the most influential people in global health, not very many people would say Professor Larry Summers. He authored the report in 1993, "Investing in Health," that started everything going. We could then‑‑we began to make the argument that health care expenditures are an investment, and it also happened to be the most influential book that Bill Gates ever read. So Larry Summers brought Bill Gates into global health.
But now, I have to say, this report is even more profound. I find myself quoting you, Professor Summers, all the time from this report. This report showed that from 2000 to 2011, some 24 percent of economic growth was due to better health outcomes. That is a profound number, and I think Professor Summers will talk a little bit more about the return on investments in health that really make it a no‑brainer.
In meetings with Finance Ministers, we're having a different discussion today on health to a great extent because of the work that Professor Summers did 20 years ago and the work he that he did just very recently. Universal health coverage is our aspiration. A progressive pathway that will save lives, increase economic growth, and help millions of people lift themselves out of poverty. But some ask whether universal health coverage by 2030 is possible.
A decade ago, no one thought it would be possible to get 3 million people on antiretroviral treatment. And today, there are 10 million and counting, and I have to tell you, when we really‑‑when we first trotted that idea out‑‑and Margaret was there‑‑people were saying "you are absolutely crazy. It's not possible." The reasons for this being not possible, you would‑‑you know, I just want to remind you one very top official said, "How you can ask Africans to take antiretrovirals when they have no concept of time? They know morning. They know midday. They know the dark of night, but they have no concept of time. How you can ask them to take a drug five times a day?"
Well, one, the drugs were not five times a day, and two, this particular official had just visited Africa and the Africans' remark was that the only one who was late for every appointment was that official.
But that's the world that we lived in, and what we learned from the 3-by-5 movement was that unwavering political commitment, clear progressive goals, and measurable targets can drive achievements that most people would think are impossible.
This afternoon’s session is built on terrific morning panels, but this panel is very special. First, Minister Ngozi is leading a charge toward universal health coverage that leaves us all breathless. To think that a country as large and complex as Nigeria could reach the goal of universal health coverage is just awe inspiring, and we applaud her leadership for taking us in that direction.
And I think that, as we look back in the years and decades to come, we will remember Mayor Michael Bloomberg as one of the greatest leaders we've ever had. What he was able to do in health was just astounding. He was courageous enough to take measures to change the fundamental rules about everything from the use of trans fats to calorie counts, and he did it. He experimented with it, he kept going with the things that really worked, and the world will look like New York City soon enough. But even more‑‑well, gosh. Is that funny?
The world will look like New York City in terms of the way it deals with public health very soon.
But, here's the other thing. It's not just public health. Mayor Bloomberg said that they were going reduce the carbon footprint in New York by 2030‑‑wasn't it originally‑‑by 30 percent. They're going to get the job done by 2017. Once again, I hope, that from the perspective of sustainability, the world will look a lot like New York very soon. So, we're extremely lucky to have this particular panel.
These are absolutely brilliant leaders in so many other areas. We're so lucky we have them here with us talking about health, and they're going illustrate to us why it's time to take on universal health coverage.
Thank you very much.
DIRECTOR-GENERAL CHAN: Thank you very much, Jim. You make my life easier. You did part of my job.
Now, it is my great honor and great pleasure to invite the panels up on stage. What an awesome panel. Please join me in welcoming them.
Of course, we have with us today Professor Larry Summers, Charles Eliot University Professor and President Emeritus of Harvard University; Minister Ngozi, my sister from Nigeria; last, but not the least, a great leader, a great mayor, and a great supporter of some difficult issues, his name is Mike Bloomberg. For those of you who don't know him‑‑
I have the easy job. You guys have the difficult task. I'm going to ask questions, and you have to answer. And I was instructed the instruction to be given to all of you is "crisp, sharp, focused answer." That's not too difficult with this panel, is it? Never.
And also to remind you, we are also connected with the outside space by Twitter, by Chirp and whatever.
And for those of you who are online, please remember the hashtag is UHC2030. And, of course, feel free to submit your questions to this illustrious panel.
Let me start with you, Larry. We promise to be informal. You don't mind me calling you Larry, do you? You just chaired the Lancet Commission on Investing in Health, and the Commission reports make a compelling economic case for investing in health. Why should you think Minister of Finance should take heed of the Commission's finding? What are you going to say to them to convince them?
PROFESSOR SUMMERS: Ministers of Finance should take heed because the case can be rooted strongly in economics. I would say to Ministers of Finance that health care is an issue that should matter to you profoundly if you care, and it is an issue that should matter to you profoundly if you count, that the case can be made in the most concrete terms, and I would highlight three points.
First, and‑‑and I'll think of this as speaking to the typical finance minister of a typical lower‑, middle‑income country. First, a once‑in‑human‑history transition is possible in this generation. Until 200 years ago life expectancy was about the same everywhere. Life was nasty, brutish and short.