|Dr. Mirta Roses Inaugural Address as Director of the Pan American Health Organization|
"This is above all a day of commitment. Today I renew my oath to devote myself tirelessly, day by day, hour by hour, to keeping PAHO at the forefront of the response to the regional and global challenges in public health and, particularly, to serve as an instrument for bringing good health to the most neglected, vulnerable, marginalized, and excluded populations."
This is a day of deep personal emotions as well as a very significant day in the institutional life of the Pan American Health Organization.
The renewal of my mandate for another term is both an honor and a privilege, since it allows me to continue serving the people of the Americas and working to ensure that international public health contributes to well-being, development, and peaceful coexistence among all the countries and territories of the Region.
First, I must express my thanks for the unwavering support of my country, the Republic of Argentina, and the firm backing of the Member States, as well as of our sister organizations in the Inter-American and United Nations systems, our partners, and the extraordinary staff of PAHO, as well as my colleagues, friends, and family, evidenced once again by their presence in this hall and by the many expressions of good will and joy that I have received since my reelection.
This is above all a day of commitment. Today I renew my oath to devote myself tirelessly, day by day, hour by hour, to keeping PAHO at the forefront of the response to the regional and global challenges in public health and, particularly, to serve as an instrument for bringing good health to the most neglected, vulnerable, marginalized, and excluded populations.
Proud heir to an invaluable tradition, now spanning over a century, of promoting health in the New World, PAHO in the 21st century looks inward searchingly from day to day as it renews its mission of solidarity and joint Pan American action. At the same time, it is doggedly moving forward in its efforts to complete the unfinished agenda, protect health achievements, and respond to the challenges in public health and socioeconomic development faced by its members.
This triple dimension reflects the diversity and complexity of political and structural processes in this Region, which unfortunately continues to be known as the most unequal in wealth distribution, while simultaneously bearing the burden of cumulative social debt, despite the abundance of its natural resources and the rich products of its human talent.
Health is a public and instrumental good for individuals, families, and communities. Thus, it should be within the reach of all. This has been the abiding theme of PAHO since its establishment and the axiological foundation of the World Health Organization, which this year celebrates its 60th anniversary. I congratulate Dr. Margaret Chan, the Regional Directors, and all our WHO colleagues on this anniversary, and I especially thank them for their personal support and affection.
At the same time, I wish to draw attention to the synergy between our regional priorities and global priorities and to the growing programmatic alignment and coordination that we have achieved. I am very proud to note PAHO's alignment with the six global objectives of the WHO agenda and the close cooperation we have attained as a single team under Dr. Chan's strong and worthy leadership as Director-General.
Quite symbolically, my second mandate is beginning the same year that we celebrate the 30th anniversary of the International Conference of Alma-Ata, which endorsed the primary health care strategy as the means for achieving the generous and ambitious goal of health for all. This year we also celebrate the 30th anniversary of the United Nations Conference on Technical Cooperation among Developing Countries. The Buenos Aires Plan of Action was a milestone in recognizing the unique creative capacity of every country to devise development solutions consistent with its own particular values, needs, and aspirations. I have been--and will continue to be--an enthusiastic promoter of cooperation among countries, steeped in the belief that human creativity and inventiveness are not geographically predetermined and that we are all fellow donors and recipients in this cosmogony of life.
In our Region, this network of relationships among countries, in which everyone generously shares experiences and resources based on mutual respect, finds expression in the integration processes and in the pan American sense of equality and solidarity among nations, which extends to collaboration with other countries in different regions of the world.
Putting health within the reach of all is a noble goal that calls for the convergence of a great many efforts. The recognized interdependency that marks this new century has overcome the distance between the local and the global, the individual and the collective, the micro and the macro, the biological and the environmental, making the global nature of threats and the global capacity to respond to them increasingly evident. In this regard, we have the ability to coordinate our activities, increase our connectivity, create networks for collaboration, and enlist new actors and institutions to confront the risks and specifically protect the most vulnerable among us. This is manifested every day in the regional preparations and response to natural disasters.
The Health Agenda for the Americas 2008-2017 and the Strategic Plan 2008-2013 provide the basic framework for the Region's efforts to improve public health and promote well-being, reducing inequalities and social exclusion and their pernicious effects on the social fabric and the full potential of individuals, families, and countries.
Worth noting in this connection is the approval of the Declaration on Rights of Indigenous Peoples, which after a quarter of a century of debate and unceasing calls for redress was approved by the United Nations General Assembly in its last session and will no doubt be a historic milestone in humanity's fight against all forms of discrimination and exclusion.
In the work to promote equity and social inclusion and to meet the objectives spelled out in the Strategic Plan and Health Agenda, we must redouble our efforts to ensure that the targets set in the Millennium Development Goals are met for all people. Health plays a key role in these targets, which presents us with three simultaneous challenges.
First, we must strengthen the national responsibility and the institutional capacity of governments, as well as international support provided to the priority countries of Bolivia, Guyana, Haiti, Honduras, and Nicaragua, in order to protect and intensify actions that will rapidly improve the living conditions and health status of their peoples. We must also ensure that the unique situation of the Region's middle-income countries remains visibly present on the international agenda to avoid the risk of setbacks and to guarantee that their achievements are consolidated. At the same time, we must prepare in advance to address the situation of island nations and small countries that must deal with the impact of climate change and with the consequences of the globalization of trade and labor and of its resulting migratory patterns.
For all of our members, moreover, we must deal NOW with the burden imposed on public health by urbanization, population growth, aging, violence, mental health problems, substance abuse, smoking, obesity, and chronic diseases, while also striving to eliminate the cumulative debt that the MDGs seek to address.
And in all of these cases, we must beware of the tyranny of averages, since poverty is often concealed by global figures. While in some countries national figures may show that MDG targets have been met, such statistics do not properly reflect the unacceptable inequalities stemming from the differing realities faced by their rural, border, indigenous, and Afro-descendant populations, women and children working in the informal economy, and populations not accounted for through official statistics.
Our aim is to facilitate equitable access to better-quality health services and to help reduce disparities, while trying to avoid reproducing in the sphere of health the same inequalities that are seen in other sectors. This requires the virtuous convergence of health promotion, with an emphasis on the social and environmental determinants of health, intersectoral policies, and local development; primary health care as the cornerstone for transforming health systems and services; and social protection--especially models for financing, for providing family and community care throughout the life cycle, and for a sustainable provision of critical and essential supplies, including well-trained human resources.
Beyond that convergence, and always with a human rights approach, we must strengthen the stewardship capacity of the State by fostering debate and exchange of views within the society so that growing demands can be met and they can be better prepared to respond to future scenarios. In this connection, I would like to underscore the need for dialogue between educators, employers, and decision makers on ways to provide and retain human resources for health, ensure their appropriate mix and capacities, and their geographical distribution to cover the needs of the most neglected groups in our societies.
It is also one of my priorities to promote interventions that have proven effective, to incorporate scientific knowledge and ethical considerations in policy-making and public information, and to promote information exchange and collaborative, transparent research that is accessible for public scrutiny by facilitating the capture and documentation of traditional knowledge and good practices and the dissemination of the lessons learned. To these ends, during this new term I will seek to strengthen information systems, health surveillance, the measurement of inequalities and of the burden of disease, and the analysis and use of information for decision-making. I will do so in partnership with other international agencies and through PAHO publications such as Core Health Data and Health in the Americas, as well as the Virtual Health Library and the Virtual Campus of Public Health.
To accomplish all this, the Organization must strengthen its role as a catalyst and facilitator of national, subregional, regional, and inter-country actions, mobilizing institutions of excellence, reference institutions, collaborating centers, scientific societies, professional associations, religious institutions, NGOs interested in health, the private and corporate sectors with social responsibility, and the communities, their leaders, and the public at large.
To meet these ambitious goals, we rely on the enormous energy and good will of our Member States. Their own teams produced the basic orientations and strategic documents that we now proudly display as part of our institutional strengthening and long-term programming. The Secretariat is no longer an occasional intermediary or presumed interpreter, but a channel for action and a bridge for ongoing exchange among the countries.
We will therefore give special emphasis to enhancing PAHO's image as a reliable partner for the countries, our strategic allies, and the public. I will increase the speed and flexibility of the Secretariat's operations, basing them on the modern standards set for the international public organizations, strengthening the instruments for transparency, accountability, and results-based management, which will result in tangible improvements in the health of our peoples.
Progressive application of PAHO's Program Budget Policy will further decentralize decisions and resources, bringing them ever closer to the countries to encourage greater flexibility and specificity in the response, greater and better-informed participation in decision-making and greater capacity for mobilization to ensure the synchronized, synergistic joint action that public health problems call for.
During this term, we hope to ensure a strategic presence in every country through ongoing dialogue and the search for innovative mechanisms with national authorities and the international community.
Ladies and Gentlemen:
A look at PAHO's historic achievements is a source of pride because of the magnitude of what has been accomplished at different stages. As we envision the future, we can dare to dream about events that will become a part of the long history of successes achieved by those who came before us.
In addition to meeting the MDG targets for all, one of my achievable dreams is to eliminate those health conditions or diseases that still afflict our peoples despite the fact that we possess the knowledge and the tools with which to make them virtually disappear. This is feasible. We are therefore ethically bound to make a determined effort to implement them without further delay.
We are already reviewing the data so as to determine which health problems (e.g., leprosy, trachoma, onchocerciasis, vector-borne Chagas' disease, lymphatic filariasis, and congenital syphilis) we can eliminate or significantly reduce in the Region by 2015. Others can be eliminated in certain subregions or in a particular country, as in the case of the plague in Peru and Ecuador, malaria in the Caribbean, cysticercosis in the Southern Cone, and hemorrhagic fever in Argentina and Bolivia. We are making headway in the scientific and political debate that will guide this proposal and make it possible to subsequently mobilize the necessary will and resources. This will be the greatest legacy of our 20th century generation to the children of the 21st century. We cannot fail them!
As an expression of regional solidarity in the fight against poverty, inequity, and exclusion, we intend to place even greater emphasis on cooperation with Haiti and other priority countries, as well as with other countries in the world that are facing critical conditions and lagging behind and that countries of this Region can work with, as is beginning to happen now with efforts to eradicate wild poliovirus from the face of the Earth.
Recognizing the dangerous and unjust illusion resulting from averages in health statistics, I have launched the Faces, Voices, and Places Initiative to make the most neglected communities seen and heard as we attempt to meet the targets of the MDGs. Working with the ministries of health and national and local governments, we are calling for intersectoral action for participatory local development. We are bringing to these communities the experiences and instruments that can help them speed up their progress, with the assistance of their partners and allies, through an approach designed to improve their quality of life and build a future for communities and their young adults and children.
We are now considering a new challenge: taking the Faces, Voices, and Places Initiative to areas that transcend borders and riddle geographical limits, paradoxically marked by biodiversity and poverty, cultural wealth and neglect, and an indigenous world vision and wisdom, but plagued by marginalization and isolation. These are ecological approaches where public health can make a difference: La Mosquitia in Central America, the Andean plateau (altiplano) around Lake Titicaca, South America's Chaco, and the Amazon region. In these areas, indigenous communities have lived for thousands of years, health has been slow to arrive and life expectancy is unfairly shorter. However, these groups have been clamoring for social justice with bold new collective approaches. We must redouble our efforts in these places, make the faces of these peoples visible and their voices audible, and support their efforts at community self-management.
This strong commitment to equity and to attaining the best possible health for all and with all is what keeps me at the helm of PAHO.
Thanks to the support and sacrifice of my family, the positive energy of my friends, the good will and call to service of my colleagues, especially the members of Executive Management, and the trust of the Member States, today I can optimistically begin my second and last term with the great staff of this Organization.
With humility, emotion, and gratitude I make this commitment to continue contributing to the achievement of health with equity, well-being, and prosperity in peace for all the peoples of the Americas.
Regional Office for the Americas of the World Health Organization