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In the 1990's, two important documents

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in global health emerged.
The first one is the Global Burden of

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Disease study that was released in the 1990.

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This is the first every comprehensive
global and regional assessment of

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mortality and morbidity from major
diseases, injuries, and risk factors.

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This is an important document because it
helped

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shape global health prioritization in the
years to come.

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It was updated twice, first in 2004 and
most recently

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in 2010.

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The other document was released in 1993 by
the World Bank.

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It is the first world development report
focused on health matters.

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Entitled investing in health, this report
signalled World Bank's commitment

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to addressing global health issues.
This document examined the inter-play

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between human health, health policy and
economic development.

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It contain many policy prescription.
But one of the,

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the, the suggestions,recommondations, was
the use

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of the Disability-Adjusted Life Year, or
DALY, as new metric for

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morbidity and mortality.
Again, this DALY, among other

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metrics will be discussed in a future
session in this course.

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The impact of the World Development Report
1993, as well as the different structural

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adjustment programs that were imposed by
the World Bank on many countries was huge.

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There were a cuts in public funding for

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health, privatization of health care
services, promotion of private

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health insurance, introduction of user
fee's, and

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rising cost in health care services
overall.

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The following year in 1994, in Cairo, there

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was held the International Conference on
Population on Development.

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This is also a very important conference,
because it recognized the importance of

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addressing reproductive health and rights
as well as the role of women

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and gender equality as

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corner stones of population and
development programs.

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This conference has been the basis of many

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efforts by different UN agencies, such as
the UN

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population fund, and many countries that
have been supporting

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efforts in reproductive health and gender
and women empowerment.

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Another important milestone

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in the 1990s is the emergence of the World
Trade organization in 1995.

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The WTO is the successor to the general
agreement on tariffs and trade,

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which is the mechanism that has governed
international trade for many decades.

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But WTO expanded their reach of global
trade to include internationally

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traded services such as Health Care and
Health Work Force.

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And also intellectual property, and of
course, this made a

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huge impact on access to medicines,
especially in the developing world.

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With all the developments in the 1990s,
and with the

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fact that the vision of health for all was
never achieved in the year 2000.

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Civil Society organizations decided to
come up with a

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collective response and gathered in
Bangladesh at the first People's Health

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Assembly which led to the founding of the
Peoples Health

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Movement and the drafting of the People's
Charter for Health.

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This charter lay down a comprehensive
analysis

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of the political economy of health

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and at the same time listed key
recommendations and demands for

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economic transformation, the protection of
the environment, the provision of

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publicly funded health care services among
all others.

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On the other hand, inside the holes of the

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United Nations,governments were
negotiating what we now call the

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Millennium Development Goals.
These goals are meant to

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be achieved by countries, by the year
2015, in a 15 year period.

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And while all the eight
goals are related to health,

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three are specifically addressing health
issues, such

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as the reduction of child mortality, the
improving of

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maternal health, and the combating of
HIV/AIDS, malaria, and other diseases.

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These goals have shaped national policies
as well as programs of UN agencies.

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And now we are in the process of reviewing
the gains as

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well as the lessons that we can learn for
the future development agenda.

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After the crafting

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of the Millennium Development Goals, the
United Nations was

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in 2001 called for a meeting to discuss
HIV/AIDS.

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It is important to remember that HIV/AIDS
is the first

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health issue to be discussed by the United
Nations General Assembly.

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The summit laid down firm commitments on a
wide range of issues,

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including the prevention and treatment of
HIV/AIDS, as well as addressing the needs

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of vulnerable groups that are often
afflicted by HIV/AIDS and

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who, and who also suffer the stigma
associated with the disease.

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[INAUDIBLE].

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In addition, in 2001, WHO, under the
leadership of then Director General,

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Dr Gro Harlem Brundtland, created the commission on
macroeconomics and health.

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This commission emphasized that health

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is a creator and prerequisite of
development.

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It also recommended the extension of
coverage of health services,

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as well as of a small number of critical
interventions to the world's poor.

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And these interventions are actually
proven to

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have the potential to save millions of
lives.

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Since the release of the report of the
commission

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there has been so many developments,

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especially in the financing of such
interventions,

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for example, the G8 played a more
prominent role in global health from

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creating the global fund to fight AIDS,
tuberculosis and malaria in 2001

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to making pledges on a wide range,

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such as health system
strengthening.

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Moreover, the Bill and

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Melinda Gates Foundation became a key
global health player, and a source

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of Global health funding. For example it
stimulated the creation of

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the Global Alliance for Vaccines and
Immunization (GAVI).

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Since then more Global health initiatives
and partnerships from the

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governance, the private sector foundations
and civil society

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along side governments.

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Despite the growing attention and
increased

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flow of financing and resources for global

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health, health inequalities remain a huge

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problem between countries and within
countries.

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Therefore in 2008, the World Health
Organization released the

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report of the Commission on Social
Determinants of Health.

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And the commission attempted to answer the
basic question,

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what good does it do to treat people's
illnesses

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only to send them back to the conditions
that made them sick?

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Social determinants of health pertain to
the conditions in which people are born,

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grow, live, work and age.
And the report clearly stated that

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an equal distribution of health damaging
experiences,

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is not in any sense a natural phenomenon

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but the result of the toxic combination
of poor social policies and programs,

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unfair economic arrangements, and bad
politics.

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Therefore, the Commission crafted three

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over-arching recommendations to address
this problem.

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First, through improving

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daily living conditions such as sanitation
and housing.

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The second is to tackle the

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inequitable, distribution of power, money,
and resources

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through reforms in international financing
institutions and in global trade.

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And the third one pertains to measuring
and understanding

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the problem in assessing the impact of
actions.

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how we can enhance monitoring

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progress in acting on the social
determinants of health.

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Also, in 2008, the Director General of

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the World Health Organization, Dr Margaret
Chan, made a call to return

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to Alma-Ata.
This is in part of the 30th anniversary

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celebration of the Alma-Ata declaration.
And during this

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year WHO released a world health report

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entitled, primary health care now more
than ever

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which laid down reform, priority areas in

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delivery, in leadership of health care
systems, in financing

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to achieve universal health coverage and
addressing public

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policies that impact on health systems and
health outcomes.

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This was supported by the development of a
frame work for health

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system, the so called six building
blocks of a health care system.

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Which included governance, human resources
for a health, health information systems,

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service delivery, health financing and
medicine technologies and devices.

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This is a very important framework for
action,

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for governments, for civil society and any
actor

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that wants to contribute to strenghtening
of health systems worldwide.

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In 2010 WHO again released an important
report,

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this time focusing on health financing,
and this serve as the basis

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of our reform of priorities toward
achievement of universal

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health coverage that is now growing
momentum, in fact, nearly a 100

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countries are now racing towards the
finish line of universal health coverage

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in order to ensure that their people, the
populations have access to

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essential healthcare without the risk of

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impoverishment due to catastrophic, health
spending.

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Even the Director General herself
emphasized

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during the 65th World Health Assembly in 2012

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that universal health coverage is
the ultimate expression of fairness.

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And universal coverage is the single most
powerful concept

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that public health has to offer.

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Universal health coverage is now gaining 
traction

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even in the ongoing discussions on the post 
2015th agenda.

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We know that the millennium development goals 
are nearing their end and therefore, the world,

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the United Nations, the Global community is
discussing what's next after

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2015 and universal coverage is about
definitely at the center of the table

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of, global discussion.

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And I would like to encourage you by
closing with a quotation, by a German

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philosopher named Arthur Schopenhauer, he
said that, health is not everything.

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But without health everything is nothing.

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Thank you very much and I look forward to
working with you in the future, Bye bye.

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