U.S. First Lady Hillary Rodham Clinton
of the United Arab Emirates Health Foundation Prize
at the World Health Assembly
Geneva - 14 May 1998
Mr. President, Director-General, ministers, ambassadors, otherdistinguished guests.
It is indeed a great honor to receive this award and to join all of youhere today celebrating the World Health Organization's 50 years ofleadership. I want to thank United Arab Emirates Health Foundation forthis 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 healthprize, for the work you do every day to put quality health care withinthe grasp of all people.
I also want to pay special tribute for his decades of service to WHO, andhis lifetime of dedication to improving health throughout our world, toDr. Nakajima. Thank you, Dr. Nakajima, for your service and leadership.
And to the incoming Director-General, Dr. Gro Brundtland, let mecongratulate you on your election. Your expertise and leadership willhelp make WHO's vision a reality in the 21st century.
As we speak, at this very moment, children are being born in Africa, inAsia, in Australia, in the Americas, in Europe. What will their lives belike in the 21st century? Will they live with dignity and health -- or bedegraded by poverty, war, injustice, and premature death? Will there behealth 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 arethe authors of the success stories of the 21st century. But the answersfor tomorrow depend not just on what we say today as individuals, but onwhat we do tomorrow as a community of nations.
When public health leaders first started meeting internationally morethan 100 years ago, they had seen firsthand the devastation left in thewake of the yellow-fever epidemic that swept across the Southern Cone inthe late 1800s. They had experienced cholera overrunning Europe, malaria,terrible sanitation conditions, unsafe food and water, infectiousdiseases and diarrhea that robbed babies of any chance at life. No nationwas safe from the epidemics that traveled across national boundaries. Yetno one really knew about the causes of infant mortality. There were noimmunizations or antibiotics. No oral rehydration therapies or adequateprenatal care.
But now, thanks to the World Health Organization and many otherpublic-health pioneers, researchers, scientists, and so many, adramatically 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 childrendying of infectious diseases, and know that their lives could have beensaved had they only received a simple vaccination. Because smallpox isnow only found in the history books, children today will not have toendure the blindness, the disfigurement or death that once plagued 15million people a year. And if we refuse to give up, polio will soon beeradicated.
Children today are far more likely to live past their fifth birthday, andsome born today will even be around to see the 22nd century dawn. Butstanding as we are at the border between one century and the next, wehave the opportunity for the first time in history to alleviate and endmuch of human suffering and prevent millions of premature deaths.
We have every reason to reject the doom-sayers who paint a picture of a21st century with environmental degradation, rampant poverty, and untoldsuffering 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 areality, so that at the end of the next century our successors will lookback at what we did for the children born this very day. They will, Ihope, see public health hazards overcome and diseases like cancerconquered, and see children living not only longer but better-qualitylives.
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 theInternet provides life-saving information in a matter of seconds. A worldof biology where research is allowing us to map the human genome andunlock the mysteries behind chronic diseases and our greatest killers.
But we know that this promise of progress will only be possible if ourethics and self-interest compel us to act. If we apply ancient values andmorality to new frontiers of discovery. If we master the political willand summon the economic resources to ensure that all citizens reap thebenefits of advances in health care. If we heed yesterday's lessons tomeet new challenges tomorrow.
Now some of what we need to do is not complicated. It is, so far, thebest practices that are proven to work in every place that needs them. AsI have been privileged to travel around the world I've seen what peoplecan accomplish when they use simple public health techniques andcommunity action to improve health and save lives.
In Bolivia, I visited with expectant mothers at a primary health centerrun by an NGO with support from the government. They had created a safeplace for very poor women to come and get health care. The women -- withtheir ruddy faces and bowler hats -- were receiving prenatal checkups andhaving their infant immunized on the day that I visited. They were alsolearning about family planning and how to space births so they could morelikely have their children survive, and themselves.
Some of what we need to do is provide better information and education sothat people can make better health decisions for themselves and theirchildren. On a recent trip my husband and I took to Africa, I met withwomen and two men from Malicounda Bambara village in Senegal. Thesepeople have accomplished something extraordinary. Although female genitalmutilation affects less than 20 percent of women in Senegal, in villageslike theirs it is considered a rite of passage for all girls. The womendecided that FGM had for far too long harmed their daughters' bodies andspirits. They decided it was time to end the hemorrhaging, the AIDS, thechildbirth complications caused by this tradition. During our discussionthey 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 thislong-standing cultural ritual. Not only that, they are inspiring othersto do the same. A 66-year-old man told me how he walks from village tovillage spreading the word about the dangers of FGM. Recently 13 othersurrounding villages representing 8,000 people joined together to end FGMin their communities. They petitioned their government, and now thepresident is working to enact a new law to abolish it throughout thecountry.
When I asked one woman: "What drove these people to change such along-standing tradition?" She simply replied: "We studied human rightsand particularly the right to health."
What better time than now, here at the Palace of Nations on the 50thanniversary, not only of WHO but of the United Nations Declaration ofHuman Rights, to make clear that health care is a basic right, a basichuman right that all men and women are entitled to. As Dr. Martin LutherKing Jr. once said, "Of all the forms of inequality, injustice in healthis the most shocking and the most inhumane."
For the children being born today, let us all declare, their basic healthshould not depend on where they live or how much money their parentshave.
Some of what we have to do is to attack the inequities that deprivechildren in one area from enjoying the health care that is available totheir neighbors. We know that child malnutrition varies greatly fromcontinent to continent. The number of physicians and nurses variesgreatly, depending on the wealth of a country. And even in rich countriesthere are pockets of despair.
To improve health for all, we must make progress in the fight againstpoverty. To fight poverty, we must ensure health care for all. That ispart of the unfinished business of this century. And when we talk abouthealth equity, we must talk about equity between countries and withincountries. Men, women, and children come from all over the globe to betreated in the great medical centers of the United States, and yet wehave more than 41 million Americans who are uninsured. But to be sure,their emergeny needs are usually taken care of, but often well after theyshould have received primary care, and frequently at a greater cost.
A country such as mine can have the most cutting-edge technology in theworld. A country that is poor can have cutting-edge technology for therich of that poor country. But it will not matter to the people who stilldie 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 inevery country about how we finance and deliver health care. Aspopulations age, thanks to the wonderful progress we've made in healthcare, then every country, whether or not it currently has a universalsystem, will face greater cost pressures to meet overall needs.
Many countries with universal systems are now unable to afford thefacilities they have, or the technology they need, and will have to facehard choices about how to restructure their systems.Other countries are in danger of having their existing health structurescollapse under the huge weight of caseloads from HIV/AIDS ortuberculosis. And we find many parts of many countries cutting back onnecessary basic services just to make ends meet.
Some of what we have to do is to join together to combat a new array ofglobal health threats. Increases in food-borne illnesses mean familieshave more reason to worry about whether the dinner they just served theirchildren will make them sick or worse. Parents are worried about tobaccoaddicting their children, stealing their health and often their lives. Myhusband is working hard to save children in our country from the deathgrip of big tobacco. But none of us can rest until we save all childrenfrom the advertising and other enticements that seduce them, and Iapplaud Dr. Brundtland for her strong statement yesterday.
Across the globe people are worrying about infectious diseases and withgood reason. They remain the leading cause of death. In the last 20 yearswe have witnessed the birth of at least 30 new infectious diseases likeebola. The HIV/AIDS pandemic continues to strike at citizens withoutregard to sex or station in life, and increasingly women and children arethe targets.
We also see old scourges like tuberculosis reemerging with new force. Wehave treatments that work for TB, but more people will die fromtuberculosis this year -- 2 million -- than in any other year in history.
We also have anti-malarial drugs, but resistance to them, and otherfactors, have led to alarming increases in malaria, which is now movinginto previously unaffected regions. Infant and child mortality could bedecreased by 20 to 30 percent if malaria were eradicated. And I want tothank Dr. Brundtland for her commitment to roll back malaria once and forall.
We know there are no magic bullets, no solutions that we can take fromthe sky. We need to share information, share responses, sharesurveillance. What would happen if we had an excellent surveillance inAfrica, for example, when the AIDS outbreak first occurred? I hope wenever have to ask that question about any other disease in any part ofthe 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 boysor girls. The last WHO event I attended was a forum at the BeijingConference about women and health security. There were people from allover the world sending the message that the health of women and girlscould no longer be divorced from progress on other economic or socialissues.
For how can we have progress when half the population of any country isunderfed, undervalued, or denied care when they are sick. How can we haveprogress when women live in fear of violence at the hands of strangers orrelatives, when they are trafficked across state lines like drugs andsold into modern-day slavery? How can we have progress when women don'thave access to the family planning they need to protect their health andmake fundamental choices about when and if to have children? How can wehave progress when every single minute that goes by, somewhere on thisglobe 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 givento expectant mother. Inside is a bar of soap, twine, wax, a plasticsheet, and a razor blade. Its purpose is to reduce the two major causesof maternal and neonatal death -- tetanus and sepsis -- by promoting the"three cleans" priniciple -- clean hands, clean surfaces, clean umbilicalcare.
These kits are made locally by a microenterprise owned by women. Andthese kits, as well as the entire Safe Motherhood Initiative, teach usabout the importance of investing in prevention. We will reap great humandividends if we give people the power to protect their with prenatalcare, nutrition, and family planning. Most maternal deaths can beprevented by spending less than $2 a year per person. These safemotherhood kits are emblematic; they remind us that women's health, likeall health, issues are not soft or marginal issues but are very importantissues and moral obligations as well as practical necessities that everysociety must face.
Our political leaders must understand that unless we address the healthcare needs of our citizens we will not have the quality of life, theeconomic growth, the justice and equity that make democracies andeconomies thrive. Our leaders should be just as worried about reducinginfant morality as increasing trade. They should be just as concernedabout maternal mortality as military might. They must see women's healthas part of the overall development of every nation. Because good healthis linked to every other tool of opportunity -- jobs, loans to startmicroenterprises, legal protection and, above all else, education. When awoman 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 behealthy.
Above all, what we must do is to call upon the private, public, andnon-profit sectors represented here to join together to meet all of thechallenges of the 21st century. Just as concerned people have done inthis great city before -- when they have banded together to ensure peace,or work towards universal human rights; just as nations and public andprivate institutions did during the 20th century when they invested inthe research and training that gave birth to the advances we celebratetoday.
We must put our hearts, our minds, and our resources in action, to meetthe needs -- whether it's finding a vaccine for diseases like AIDS ormalaria, closing the equity gaps that plague our health care systems, ormaking it clear that issues like maternal mortality or tobacco are notperipheral concerns, but central ones.
I would hope that on the occasion of WHO's 100th anniversary in 2048, oursuccessors would look back at what has been accomplished. Instead of anapocalyptic 21st century, as predicted by some, of overpopulation,pollution, disease, and poverty, I hope they would see that for the firsttime in human history all people had access to the tools they needed tolive longer and better lives in peace.
We don't have a minute, or a child, to waste. We have only one WorldHealth Assembly left in this century. The children of the next centurybeing born today in Africa, in Asia and Australia, in the Americas, andin Europe, come into our world with every reason to expect they will bewanted and loved by their families, and valued by the societies theyjoin. We should not, we dare not, disappoint them. Yes, there will beobstacles and setbacks, but we cannot be discouraged. We have thetechnology, we have the know-how, we have the resources. We only need thewill to act.
With the World Health Organization continuing to lead the way, I knowthat we all will turn the vision of "health for all" into a reality inthe 21st century. And those children born today will thank all of you.
Thank you very much.