1 February 2018

Distinguished Guests, PAHO Staff Members, Ladies and Gentlemen:

It is the first of February, 2018 and I find myself at the mid-point of my tenure as the Director of the PanAmerican Sanitary Bureau. Five years have gone by and five years remain. I presented an account of the achievements of the past five years to the 160th Session of the Executive Committee in June, and in the Quinquennial Report to the 29th Pan American Sanitary Conference in September 2017. Today, I ask you to look forward with me. To imagine what we can achieve, together.

In this Region, most, although not all, of our countries have reached the stage where many of the easy public health gains have already been achieved. The low hanging fruit have been picked. Which means that each incremental improvement in the health of our peoples requires a redoubling of our efforts, in order to reach those most vulnerable and marginalized individuals that still lack health care. Increased overall investment in health in and of itself is not sufficient. Targeted interventions that make a tangible difference in the lives of underserved populations will be the key to our success; this targeted approach will figure throughout the Pan American Health Organization’s (PAHO) strategies and interventions in the coming years. And by reaching those most in need, by changing individual lives one at a time, we can also shift the national health indicators for morbidity and mortality. Simultaneously, we will contribute to the virtuous circle of social development and economic prosperity that improves all of our societies.

I would like to focus for a moment on this link between the micro and the macro. I believe that as good
health strategists, we must always focus on both perspectives. We must keep in mind our strategic
direction (which I will talk more about in a moment). At the same time, each small action we take to
improve the life of each person is not only of immense moral importance, it also takes us one step
further along the road towards our goals. And when thousands of health workers across dozens of countries work daily to reach all those in need, when those of us in public and private health systems do our jobs even though we are tired and often under-resourced, and when our leaders keep their focus on
social justice, human rights and development, we can all contribute to achieve the greatest impact.

At the end of the day, the success of our joint efforts must be judged by the health and social development of the poorest in our societies; “Verily I say unto you, inasmuch as ye have done it unto one of the least of these my brethren, ye have done it to me”.

I continue to feel blessed as I start this second term, as our strategic direction is clear. We have the Sustainable Development Agenda and the SDGs, which give us an inter-sectoral framework for socialand economic development across all countries. Of course we focus on SDG3, but we have several health-related targets in the other SDGs. This panorama reminds us of the importance of reaching beyond the health sector, of engaging with our partners inside and outside of government in a common, coordinated approach. We must engage communities and individuals, and work together with civil society organizations. We do not simply ask what can you do for us in health? but what can health do for you?

This year marks 40 years since Alma Ata, where the historic movement of health for all began. In December I launched a Regional Forum on Universal Health in the 21st Century. This Forum will review the achievements since Alma Ata, and examine remaining challenges and gaps in progress towards universal health coverage and universal access in the Americas. I am pleased to inform you that I have designated a high-level Commission to work with the Forum to prepare actionable recommendations for PAHO; this Commission will be headed by President Michelle Bachelet of Chile.
At the global level we have the new WHO General Programme of Work, or GPW13. This document, which all Member States have had a chance to contribute to, sets out WHO’s vision and objectives through 2023. It is firmly in line with the SDGs, and will inform PAHO’s own Strategic Plan 2020 to 2025. PAHO’s Strategic Plan will of course be developed as one of the key means to implement the Sustain- able Health Agenda for the Americas 2018-2030. This seminal document, approved by the Pan American Sanitary Conference last year, provides a vision for health development in the Region for the next 13 years, and constitutes the highest level of strategic planning and policy framework for health in the Americas. The Agenda also defines measurable targets for health impact that will help us focus our efforts to ensure that we meet and even exceed the challenging targets set out in the SDGs.

I take this opportunity to call for the active participation of Member States and PAHO staff in the preparation of the next Strategic Plan, which will begin following the March meeting of the Subcommittee on Program, Budget, and Administration. In PAHO’s results-based planning and budgeting model, the Strategic Plan is not a document that sits on a shelf, but it guides every element of the PAHO universe, from programmatic results to funding allocations. The Strategic Plan and the accompanying biennial Program and Budgets are the main instruments for corporate accountability of this Organization, and I encourage all of us to devote the necessary time and energy to ensure that they are the best they can be.

A crucial objective for all of our countries is to ensure adequate financing for health. This includes both public funding for the health sector, as well as other financing mechanisms to help pay for health care in each Member State. The Pan American Sanitary Bureau plays a key role in advocating for increased (and well spent) financing for health.We are partners; we are here to support the PAHO Ministries of Health as they seek to ensure sustainable, adequate, and efficiently utilized health financing.

Investment in health does not mean merely new hospitals, but targeted investments in the first level of care, to reach many of our most vulnerable peoples. It has been well established that for maximum benefit such investments must be made in line with the primary health care approach.
Another important area is health information. We cannot develop evidence-based policies and plans without strong health information systems. From individual patients up to national level and on to regional level, we need robust, inter-operable systems that capture necessary information efficiently and effectively.

We must be able to disaggregate data in order to identify inequities and vulnerabilities. Sometimes develop- ment partners pay too much attention to GDP as an indicator of development, when truly it is the indicators of social development that matter most. I am determined to ensure PAHO is the go-to source for health statistics and health development data in this hemisphere. We will also perform trend analyses of health data in order to help forecast health needs and resource requirements for the future. We have recently created a new department in PAHO to lead these efforts, the Evidence and Intelligence for Action in Health department.

Climate change is a major threat globally and in our Region, with clear and significant consequences for public health. Despite overwhelming scientific evidence, political action and commensurate funding has been inadequate. The Paris Agreement provides a strong overall framework, including specific reference to the right to health, and PAHO will work to implement and support all health–related aspects of the agreement.

Related to the topic of climate change, I cannot neglect to mention the major impact of hurricanes on our Region last year, especially in the Caribbean subregion. My own homeland Dominica was among the hardest hit. I am glad to say that the planning process for building a resilient country has begun. I have no doubt that the combination of external assistance with local determination will make for rapid progress. A key part of ensuring the health sector responds adequately to natural disasters is developing resilient health systems, and PAHO is at the forefront of this work in the Caribbean and elsewhere.

Five years may seem like a long time, but when shaping public health outcomes it can be all too short. I feel a deep sense of urgency. Our shared vision will guide us on this journey, but make no mistake it is a long and hard road, with many challenges. So, like Moses I pray God go with us. And I pledge today to our Member States, and to my own staff, that I stand with you as we face these challenges together. I have full faith and confidence that we will not only achieve our objectives, but that we will touch the lives of every man, woman and child in this great Region of the Americas.

I will close by thanking all of you who join me on this important occasion, both here in this room and remotely. I thank you for your support today, but even more so I thank you in advance for all the hard work I know you will deliver over the next five years!

On a personal note, I would like to thank my family, many of whom are in this room. Each of you has helped me to be where I am today, and I remain deeply grateful.

Thank you and God bless you all.