n ш) World Health Organization Organisation mondiale de la Santé PROVISIONAL VERBATIM RECORD OF THE THIRD PLENARY MEETING

Transcription

1 n ш) World Health Organization Organisation mondiale de la Santé FIFTIETH WORLD HEALTH ASSEMBLY A50/VR/3 CINQUANTIEME ASSEMBLEE MONDIALE DE LA SANTE 5 May mai 1997 PROVISIONAL VERBATIM RECORD OF THE THIRD PLENARY MEETING Monday, 5 May 1997, at 14:30 Palais des Nations, Geneva President: Mr S.l. SHERVANI (India) COMPTE RENDU IN EXTENSO PROVISOIRE DE LA TROISIEME SEANCE PLENIERE Lundi 5 mai 1997, à 14h30 Palais des Nations, Genève Président : M. S.l. SHERVANI (Inde) CONTENTS Page 1. Presidential address 3 2. Adoption of the agenda and allocation of items to the main committees 5 3. Announcements Review and approval of the reports of the Executive Board on its ninety-eighth and ninety-ninth sessions Review of The world health report SOMMAIRE Page Discours du Président de l'assemblée 3 Adoption de l'ordre du jour et répartition des points entre les commissions principales.. 5 Communications 24 Examen et approbation des rapports du Conseil exécutif sur ses quatre-vingt-dixhuitième et quatre-vingt-dix-neuvième sessions 25 Examen du Rapport sur la santé dans le monde,

2 A50/VR/10 Note: In this provisional verbatim record speeches delivered in Arabic, Chinese, English, French, Russian or Spanish are reproduced in the language used by the speaker; speeches delivered in other languages are given in the English or French interpretation. This record is regarded as provisional because the texts of speeches have not yet been approved by the speakers. Corrections for inclusion in the final version should be handed in to the Conference Officer or sent to the Records Service (Room 4113,WHO headquarters) in writing, before the end of the session. Alternatively, they may be forwarded to Chief, Office of Publications, World Health Organization, 1211 Geneva 27, Switzerland, before 1 July Note : Le présent compte rendu in extenso provisoire reproduit dans la langue utilisée par l'orateur les discours prononcés en anglais, arabe, chinois, espagnol, français ou russe, et dans leur interprétation anglaise ou française les discours prononcés dans d'autres langues. Ce compte rendu est considéré comme un document provisoire, le texte des interventions n'ayant pas encore été approuvé par les auteurs de celles-ci. Les rectifications à inclure dans la version définitive doivent, jusqu'à la fin de la session, soit être remises par écrit à l'administrateur du service des Conférences, soit être envoyées au service des Comptes rendus (bureau 4113,Siège de l'oms). Elles peuvent aussi être adressées au Chef du Bureau des Publications, Organisation mondiale de la Santé, 1211 Genève 27,cela avant le 1 er juillet Примечание: В настоящем предварительном стенографическом отчете о заседании выступления на английском, арабском, испанском, китайском, русском или французском языках воспроизводятся на языке оратора; выступления на других языках воспроизводятся в переводе на английский или французский языки. Настоящий протокол является предварительным так как тексты выступлений еще не были одобрены докладчиками. Поправки для включения в окончательный вариант протокола должны быть представлены в письменном виде сотруднику по обслуживанию конференций или направлены в Отдел документации (комната 4113, штаб-квартира ВОЗ) до окончании сессии. Они могут быть также вручены до 1 июля 1997 г. заведующему редакционно-издательскими службами, Всемирная организация здравоохранения, 1211 Женева 27, Швейцария. Nota: En la presente acta taquigráfica provisional, los discursos pronunciados en árabe, chino, español, francés, inglés o ruso se reproducen en el idioma utilizado por el orador. De los pronunciados en otros idiomas se reproduce la interpretación al francés o al inglés. La presente acta tiene carácter provisional porque los textos de los discursos no han sido aún aprobados por los oradores. Las correcciones que hayan de incluirse en la versión definitiva deberán entregarse, por escrito, al Oficial de Conferencias o enviarse al Servicio de Actas (despacho 4113,sede de la OMS) antes de que termine la reunión. A partir de ese momento, pueden enviarse al Jefe de la Oficina de Publicaciones, Organización Mundial de la Salud, 1211 Ginebra 27,Suiza, antes del 1 de julio de jí y \ jí a^jxj^íi jí s jí yjb oukjl J^j cjjji J i J u h j 二 J H ijub ÙU i S o U L ^ oukií L.Í. 厶 JbxJuJl ÂiiJl ^JJúj AJl^Vl jt J^íl ^ ji ÂijiSoNb O Lo ^alil JLM; J.^^Jb^ujl e^lwjl JA Jbu JUIÍU ousoi J^ú дч 1 ЬЗ ja ^^Jl ijm» j^ju j r U ^ b ^ l b l l ^! y ^ y jí ОЛ^ ^P J J \ V ^ UJU^I ^Jl 4_>w2Ji 4-^Já.U.: colj^-juljl 广 ; J^y OÍ Ua í ^J JJ (A^kuli ^Jb j J I j j ^ jiduij cyv câ.çjujl 说明 : 凡是阿拉伯文 中文 英文 法文 俄文或西班牙文的发言, 将以发言人所用 的语种在本临时逐字记录中刊印 ; 其他语种的发言, 将以其英文或法文的译文刊印 本记录屑临时性质, 因为发言稿的文本未经发言人审阅 需要列入最后文本的 修改, 应在本届会议结束以前书面提交会务官员或送记录办公室 ( 世界卫生组织总 部 4113 室 ), 或者在 1 卯 7 年 7 月 1 日以前寄给瑞士 1211 日内瓦 27, 世界卫生组织出版 办公室负责人

3 A50/VR/10 1. PRESIDENTIAL ADDRESS DISCOURS DU PRESIDENT DE L'ASSEMBLEE Excellencies, distinguished delegates, Dr Nakajima, colleagues and friends, it is indeed a great honour for the entire South-East Asia Region, my country, India, and for me personally to be elected President of the Fiftieth World Health Assembly. I express my sincere thanks for the honour and the trust bestowed on me, especially as this year coincides with the celebration of India's fiftieth year of independence. With your cooperation and the Secretariat's support, I am confident that we will be able to conclude our business successfully and on time. I take up my duties with a sense of humility, and have faith that this meeting of minds will lead to a new understanding, reinforcing our efforts to serve the world community better. As we avail ourselves of this unique opportunity, let us undertake to share our experiences and knowledge, and help each other in overcoming the obstacles that stand in the way of securing better access to health for our people. Better endowed and more progressive countries must be prepared to share the burden of countries which are poor. Whatever we may decide and undertake to do as a world community should also have a time-bound framework for action. It is a formidable task and, as the foremost international organization responsible for the health of people the world over, we, the members of WHO, must reinforce the Organization's leadership and reassert the Assembly's role in the most fruitful way. These sentiments take an added significance this year as the World Health Assembly holds its fiftieth session. As we rededicate ourselves to achieving the goal of health for all, I feel proud and- privileged to recollect that India has been associated with this Organization since its inception. In fact, India played a pioneering role in establishing the World Health Organization, as well as in drafting and approving its Constitution. The International Health Conference adopted the Constitution of the World Health Organization in 1946 in the wake of the devastation left by the world war. In the ensuing years, the nations of the world have come together to promote the cause of global health. Fifty years ago the world gave a mandate to direct and coordinate international health work and provide technical support to countries. We have witnessed the shining achievement of the eradication of smallpox from the world and the near-eradication of guinea-worm infection. We have also seen how, through the continuous mobilization of its technical know-how and other resources, the World Health Organization has succeeded in strengthening the capabilities of national governments in health planning, in effective management of communicable diseases, in developing human resources and in setting laboratory norms and standards for foods, drugs and nutrition. As we approach the next millennium, we observe a rapid transition on all fronts: political, social and economic. In endeavouring to enhance the well-being of our people, especially the less fortunate, we face formidable challenges. These include high population pressure, the changing age profile of much of the world's people, and the double burden of disease and the onset of emerging and re-emerging diseases, further compounded by microbial and parasitic resistance to therapeutic agents. These problems have been further aggravated by the degradation of the environment, rapid urbanization, malnutrition and high levels of illiteracy exacerbated by poverty, which remains the world's deadliest disease. In addition, not only in industrialized countries but also in the developing world, changes in lifestyle, cardiovascular diseases, high blood pressure, cancer, diabetes and mental health problems have become a major threat. They have led to the growth of complicated noncommunicable diseases, calling for heavy investment hardly envisaged even a decade ago. This situation will undoubtedly bring about a sharp rise ira the demand for in-patient care. Major rnvestmenis wift be needed in terms of staff, equipment and training and, in many countries, in setting up additional health facilities. While more efficient technologies and the development of new vaccines against bacterial and parasitic diseases give us greater hope and an opportunity to share expertise and the fruits of research, a new professional challenge - that of improving the management of referral systems - now confronts us. The poor must not be squeezed out of the health system by answering the demand for treatment of chronic disease amongst the better-off. We must help them to participate fully, and investments in hospital care should not crowd out essential investments in primary health infrastructure, including the provision of drugs in the urban slums and remote rural areas, where the poorest people live.

4 A50/VR/10 The time has come when we have to recognize that the private sector is also an important provider of primary health care, and we need to draw on it much more in order to improve our capacity for overall planning and quality improvement. Our challenges include the fact that one billion people, one-fifth of the world's population, live on less than a dollar a day, and many others remain far below what can be termed a decent quality of life. This ought to be unacceptable in a world which has so much. More progress has been achieved in raising standards during the last half-century than at any other time in human history. But still the challenge persists, and appears to grow. The private health sector, whether nongovernmental, community-based or based on private ventures, has been making major contributions for centuries. Until about a hundred years ago private providers were the only source of health care and even today they account for a larger share of spending than public sources. The government's role has expanded only in the current century. Currently, an estimated 50% of all global spending for health care comes from the private sector. Meanwhile the population in many of the countries has grown in the same 50 years with the near tripling, if not quadrupling, of the urban population. Millions of people now live in cities in abject poverty in unhygienic tenement houses, illegal squatter colonies, even on pavements with no shelter at all. A large number of these are women and children. We cannot but depend on the private sector to whom, in any case, people first turn for ambulatory care. But governments have a responsibility to regulate the sector and we must identify effective ways of doing so to protect the consumer and to contain costs while building meaningful partnerships founded on mutual trust and an understanding of each other's role. As a part of the health reforms being taken worldwide, we must call for a more efficient allocation of resources, greater individual freedom in demanding and securing a basic package of services, and help strengthen institutional capacity within the health system. We must encourage the devolution of responsibility and management. Health sector reforms necessarily carry with them special opportunities and also special risks. As policy-makers we have the opportunity to redesign the health services and introduce healthfinancing mechanisms aimed at avoiding escalation of costs, long waiting lists and excessive prescription of drugs. We must promote policies which are relevant, aimed at containing costs, expanding consumer choice and improving the quality of services. At the base of these policies lies the need to protect highly vulnerable populations of women, children and the elderly who are entitled to receive specially designed services. Secondly, we must secure an affordable access to a package of basic services for the whole population. I represent a region where one-fourth of the world's population lives. Although we have high population growth, ours is a society with strong cultural bonds and an inherent spirit of sharing and caring. We have been fortunate in achieving success in joint collaboration between the countries of the South-East Asia Region. We have successfully evolved common border strategies for malaria, synchronized immunization dates where feasible, and cooperated with each other in sharing technical know-how, expertise and training. We need to now move towards a similar interdependence amongst regions to foster the establishment and growth of a world health order where health becomes an essential plank for securing a better quality of life. We need to have a global mechanism for monitoring health status and forecasting the spread of contagious diseases. We need to continuously arrive at a consensus on the adoption of policies. We seek affirmative action in favour of health. Health must be seen as a responsibility which has to be shouldered by the whole society. To that end, we must strengthen a collaborative process which helps governments to secure a more meaningful place for health as it impinges so acutely on human life. In the past year, there has been a glimmer of hope in the treatment of HIV/AIDS through the use of multidrug regimens. Simultaneously, the remarkable scientific achievement of cloning a mammal from the cells of a sheep's udder has opened up scientific vistas of enormous potential. These achievements, however, stand tempered by the fact that the costs of multiple drugs needed for HIV treatment are today a prohibitively expensive option, and therefore still out of reach. The cloning technology has raised ethical questions which are being addressed in different forums. Suffice to say that as a world community we have to be alive to the comparative merits of each case and draw whatever is the best for mankind from new discoveries. In benefiting from new discoveries, we must also acknowledge the place of traditional systems of which many countries in the world are justly proud. We must not ignore these systems in our zeal to subscribe to modern science and technology alone. India alone has contributed three fully fledged systems of medicine known as Ayurveda, Siddha and Unani, which along with yoga and naturopathy contain a wealth of scientific knowledge and literature that has provided an effective response to diseases like arthritis, rheumatic disorders, asthma, neurological disorders, liver diseases and leukoderma. These are complete systems of medicine based

5 A50/VR/10 on authentic texts developed through centuries of research and experience. To keep pace with modern-day expectations, they have been given a legal framework and an organized structure. Standardization has been undertaken. Well-designed courses leading to registration of practitioners exist. It may be worthwhile to consider convening an international conference for discussing traditional systems of medicine to create awareness, to dispel misconceptions and to make positive recommendations for adopting them where feasible. In the next few days, as we address the items on the agenda, we will have the pleasure of rewarding outstanding achievements that have promoted the cause of world health. Committee A will look at what WHO plans to do during the period , the Tenth General Programme of Work and the first for a new century. It will also discuss, among others, where the world stands in reducing the menace of HIV/AIDS and sexually transmitted diseases, malaria and other tropical diseases, and tobacco use. Committee В will examine the Organization's financial and administrative health and reforms, its policy and strategies as well as our relations in the United Nations family. Issues of shared interest including the world's marine environment and chemical safety will also be addressed. We live in a world of interdependence. Advances in information technology have truly made our planet a global village. This provides an excellent opportunity for promoting health and creating public awareness aimed at changing people's behaviour and lifestyles to achieve better health for all. The transfer of technology and technical know-how on concessional and preferential terms from industrialized to developing countries is required in the true sense if we are to realize the fruits of cooperation. I would like to urge those who have already achieved the best health indices to assist and cooperate fully with the endeavours of those who are yet to attain the goal of health for all. Our combined efforts will surely provide the spirit of caring, sharing, solidarity, and service so vital for the success of our deliberations. 2. ADOPTION OF THE AGENDA AND ALLOCATION OF ITEMS TO COMMITTEES ADOPTION DE L'ORDRE DU JOUR ET REPARTITION DES POINTS COMMISSIONS PRINCIPALES THE MAIN ENTRE LES The first item to be considered this afternoon is item 8 of the provisional agenda, "Adoption of the agenda and allocation of items to the main committees", which was examined by the General Committee at its first meeting earlier today. The General Committee examined the provisional agenda for the Fiftieth World Health Assembly, document A50/1, as prepared by the Executive Board and sent to all Member States. The General Committee recommended the following changes to the provisional agenda contained in document A50/1 : deletion of item 11,"Admission of new Members and Associate Members (Article 6 and Rule 115) [if any]", since no new applications had been received; deletion of item 22.4, "Amendments to the Financial Regulations [if any]"; and deletion of item 23,"Supplementary budget for [if any]". Does the Assembly agree with these recommendations? Before we proceed to adopt the agenda, I wish to report to the Assembly that the General Committee also considered the addition of supplementary agenda items, for which two proposals had been received by the Director-General. The first proposal was to include a supplementary agenda item on "Cloning in human reproduction". The Committee agreed to include this item on the agenda. Are there any comments? I see none. The supplementary agenda item is accordingly included. The second proposal was to include a supplementary agenda item "to invite the Republic of China (Taiwan) to participate in the World Health Assembly as an Observer". The Committee recommended not to include this item on the agenda. Are there any comments? I would like to give the floor to the honourable delegate of Nicaragua.

6 A50/VR/10 El Dr. PRADO (Nicaragua): Muchas gracias, señor Presidente. Permítame felicitarlo por su elección y desearle todo éxito en el desempeño de sus nuevas funciones. Señor Presidente, el Gobierno de Nicaragua, a través de su Representación Permanente en Ginebra y de conformidad con el artículo 12 del Reglamento Interior, hizo llegar al Director General, Dr. Nakajima, una solicitud de adición de un punto en el orden del día de esta magna Asamblea. En esta oportunidad que se nos brinda queremos reiterar dicha petición, que rezaría como sigue: «Admisión con estatuto de Observador ante la Asamblea Mundial de la Salud a la República de China (Taiwán)». El Gobierno de Nicaragua, mediante esta petición, vela por el firme respeto de los propósitos constitutivos de la Organización Mundial de la Salud. En este caso preciso, el párrafo preambular 3 de la Constitución de la Organización dispone que «La salud de todos los pueblos es una condición fundamental para lograr la paz y la seguridad, y depende de la más amplia cooperación de las personas y de los Estados». En este sentido, dado el compromiso innegable del Gobierno de la República de China (Taiwán) de mejorar sustancialmente la salud mundial de los países pobres y subdesarrollados, siempre ha demostrado en la práctica su solidaridad efectiva. La República de China (Taiwán) ha practicado la ayuda con hechos y no con promesas en los países del Tercer Mundo. Hay que hacer notar que estamos por entrar en el siglo XXI, en el cual tenemos que luchar por que cambien las mentalidades, ya que el resto que hoy hay que tomar en esta tierra es como una sola patria, olvidando las fronteras. Dado que el mismo desarrollo de la humanidad está afectando nuestra civilización y a esto hay que agregarle las adversidades naturales que va a encontrar nuestro globo terráqueo, con todo respeto, estimados delegados de esta Asamblea, os expongo esta realidad para que superemos nuestro pensamiento aun de frontera o de países, y que un país amigo de todos como la República de China (Taiwán) sea introducida en esta ocasión como Miembro Observador. Muchas gracias, señor Presidente. Are there any other comments? I give the flour to the honourable delegate of Dominica. Mrs PAUL (Dominica): Mr President, let me on behalf of the Dominica delegation extend sincerest congratulations to you on the attainment of this high office and to wish you well as you seek to lead us throughout the deliberations. Mr President, we are in support of the proposal to grant observer status to the Republic of China (Taiwan). It is our belief that contagious diseases know no national boundaries and that to prevent contagious diseases from spreading requires the participation and cooperation of all countries in the world. The Republic of China (Taiwan) has a population of 21.4 million people. Indeed, it is important that we, as an Organization seeking to attain the highest level of health for all the peoples of our countries, recognize that any outbreak of disease in the Republic of China (Taiwan) can affect, in fact, many countries in that hemisphere and spread throughout the world. I would trust that as Members of this Organization we would, from a humanitarian point of view, and recognizing that the health of one country can suddenly have an impact not only on our social situation but also on trade relations with other countries, be able to give our support to this proposal. Thank you very much, Mr President. Thank you. I would now like to give the floor to the honourable delegate of Senegal. M. NGOM (Sénégal): Monsieur le Président, je voudrais tout d'abord vous féliciter pour votre élection à la tête de notre Assemblée et vous souhaiter un plein succès dans votre mission.

7 A50/VR/10 La délégation du Sénégal voudrait appuyer la requête qui a été faite par le Nicaragua, conformément à l'article 12 du Règlement intérieur de l'assemblée de la Santé, parce que cette demande d'inscription d'un point supplémentaire à l'ordre du jour concernant l'invitation de la République de Chine (Taiwan) à participer en qualité d'observateur aux travaux de l'assemblée nous semble venir à point nommé. La délégation sénégalaise est vivement préoccupée, en effet, par le sort des 21 millions d'habitants de la République de Chine (Taiwan) qui se trouve exclue des activités dans le domaine de la santé, et plus particulièrement celles de l'oms. Or, par vocation universelle, l'organisation mondiale de la Santé doit demeurer le creuset de toutes les aspirations de bien-être de l'humanité et offrir par là même une vision de solidarité entre les nations. Le monde d'aujourd'hui est certes caractérisé par des incertitudes, des angoisses en matière économique, sociale et sanitaire. La tentation de repli sur soi demeure, mais ce monde est également chargé de mutations porteuses que seules l'entente, la solidarité et la compréhension entre les peuples peuvent assurer. Il nous faut donc démarquer les problèmes de santé de toute considération politique car, dans ce domaine plus que dans tout autre, les défis qui se posent à la communauté internationale requièrent la contribution de tous les acteurs de la société internationale. Les problèmes de santé ne connaissent ni barrière idéologique, ni frontière nationale. Nous considérons donc que l'objectif de cette démarche n'est pas de demander ni l'adhésion de la République de Chine à notre Organisation, ni son admission en tant que Membre associé ni même en qualité d'observateur auprès de l'organisation; il s'agit simplement d'inviter ce pays à participer en qualité d'observateur aux travaux de la Cinquantième Assemblée mondiale de la Santé. Cette démarche ne devrait point être interprétée comme un signe d'hostilité ou de défiance à quelque pays que ce soit; au contraire, plus qu'une conviction, elle est la marque d'une volonté politique de dévouement pour ce grand dessein qu'est la nécessité de la coopération internationale dans le domaine de la santé. Je vous remercie. Thank you very much, honourable member from Senegal. I would like to give the floor to the delegate of Gambia. Ms ISATOU-NJIE SAIDY (Gambia): Mr President, like my previous colleagues, I wish also to congratulate you on your appointment to this position. Now, The Gambia also believes that we should look at this issue very seriously, and we support the previous speakers with regard to this request to allow the Republic of China (Taiwan) to observe this particular meeting, in conformity of course with the same Rule of Procedure, Rule 12, as highlighted by my previous colleagues. As you said in your speech, health for all is an intrinsic right deserved by everybody, and I think, that for reasons of justice and equity, the people in the Republic of China (Taiwan) also have a right to participate in enhancing global health. Since health, as we all agree in WHO, is seen and should be seen as a nonpolitical issue and nonconflicting at that, we feel that this request should be considered. It should also be noted, of course, that we have made this request to ensure that the People's Republic of China (Taiwan) is allowed to observe this meeting. Thank you very much. Thank you very much. I would like now to give the floor to the delegate of China.

8 A50/VR/10 Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 主席先生, 由子这是中国代表团第一次在大会上发言, 所以请允许我祝贺您当选第五十届世界卫生大会的主席和其他各位副主席以及主要委员会主席的当选, 我相信本届大会在你们的领导下一定会取得圆满成功 总管总务委员会巳经作出了决定, 极少数国家不顾国际法准则和联合国大会及卫生组织的有关决议, 仍公然提出所谓台湾申请作为世界卫生組织观察员的问题的提案, 这个提案明目张胆的企图在卫生组织制造 两个中国 或 一中一台, 不仅严重地侵犯了中国的主权, 粗暴地干涉了中国的内政, 同时, 也是对 联合国宪章 联大第 2758 咢决议和本组织 组织法 及 1972 年第二十五届卫生大会 WHA25. 1 号决议的肆意践踏, 中国代表团对此表示强烈的遣责和极大的愤慨 希望本組织会员主持正义, 捍卫联合国宪章和本组织 组织法 的宗旨和原则, 支持中国代表团的立场和总务委员会的决定 主席先生, 众所周知, 台湾自古以来就是中国的领土,1943 年的幵罗宣言和 1945 年的波茨坦公告再次确认了中国对台湾的主权 迄今为止巳经有 159 个国家与中国建立了外交关系, 他们都承认世界上只有一个中国, 中华人民共和国政府是代表全中国及其人民的唯一合法政府, 台湾是中国不可分割的一部分 25 年前, 联合国大会第 26 届会议以压倒多数通过了具有历史意义的第 2758 咢决议, 该决议以明确无误的语言承认中华人民共和国政府的代表是中国在联合国的唯一合法代表, 中华人民共和国是安理会 5 个常任理事国之一, 并恢复了中华人民共和国在联合国的一切合法权利 据此, 中国在联合国的代表权问题从政治上 法律上和程序上得到了公正彻底的解决 根据联大决议, 世界卫生组织于 1972 年第二十五届世界卫生大会通过了 WHA25. 1 号决议, 恢复了中华人民共和国在世界卫生组织的一切权利, 承认中国政府为世界卫生组织内代表中国的唯一合法政府 主席先生, 联合国和世界卫生组织都是由主权国家组成的政府间的国 际组织 根据联合国和世界卫生组锲的协定及本组织的 组织法, 世界

9 A50/VR/10 卫生组织是政府间协定建立的联合国专门机构之一, 组织法 第三章关子成员的条款明确规定, 只有国家才有资格提出申请加入本组织, 台湾作为中国的一个省, 没有资格申请加入世界卫生组织 根据卫生大会的议事规则, 如果要申请作为观察员也只有中国政府才有资格这么做 主席先生, 台湾问题纯属中国内政, 只能由中国人民自已来解决, 任何国家都无权插手和干涉, 以任何理由 任何方式提出台湾在本组织的代表权问题都是对中国主权和领土完整的严重侵害, 都是对中国内政的粗暴干涉, 中国人民对此决不能容忍 中华人民共和国政府一向关心台湾人民的健康事业, 并且也愿意将台湾省的卫生状况向世界卫生组织提供, 并将卫生组织的政策传达给台湾省 我们将会希望通过会谈寻求积极的有建设性的解决办法, 就此做出妥善安排 台湾是中国领土不可分割的一部分, 关于台湾 2100 万人口的健康间题是中国政府义不容辞的责任, 为了加强台湾卫生界同人对世界卫生组织的了解, 并最终服务子台湾人民的健康事业, 我们愿意釆取可行的措施 主席先生, 中国政府和人民维护国家主权和领土完整的坚定立场得到了绝大多数国家的支持 为维护 联合国宪章 和世界卫生组织 组织法 的权威性, 更严格的按照联合国大会和卫生大会的决议和它的 议事规则 办事, 我建议大会拒绝这一提案, 以便我们能有充分的时间就大家更关心的卫生健康问题进行讨论 谢谢主席先生 I thank the honourable delegate of China, and I would like to give the floor to the honourable delegate of the Solomon Islands. Mr SUPA (Solomon Islands): Mr President, may I first of all congratulate you on your election to the Office of President of the Fiftieth World Health Assembly. Mr President, we wish to dispute the General Committee's recommendation not to invite the Republic of China (Taiwan) to participate as an Observer. The Solomon Islands fully supports and endorses Taiwan's application to the World Health Organization for observer status. The Republic of China was one of the founding Members of the World Health Organization in Sadly, in the wake of the United Nations General Assembly's adoption of resolution 2758 in 1971, the Republic of China was forced to withdraw from

10 A50/VR/10 the Organization in This indeed deprives the right of 21.4 million people of the Republic of China (Taiwan). The Preamble to the Constitution of WHO states very clearly that WHO believes that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Accordingly, such fundamental human rights are inherent, inalienable and free of political connotations. This conviction has influenced the Solomon Islands to fully support the Republic of China (Taiwan)'s bid with WHO. The Republic of China (Taiwan), in our view, must be given observer status. Finally, Mr President, contagious diseases know no national boundaries. Thus to prevent contagious diseases from spreading requires the participation and cooperation of all countries throughout the world, including Taiwan. Mr President, thank you for giving me the floor. I thank the honourable delegate of the Solomon Islands, and now I give the floor to the honourable delegate of Pakistan. Mrs AZHAR (Pakistan): Mr President, first of all, the Pakistan delegation would like to express its disappointment that the Assembly, instead of focusing on the agenda items, is actually discussing a request which is aimed to challenge the sovereignty of a Member State of WHO. This issue was decided a very long time ago, 26 years ago by the United Nations General Assembly, and 25 years ago by the Health Assembly, that the People's Republic of China is the sole legitimate representative of the people of China. Therefore, instead of wasting our time in a discussion that will have no logical conclusion, we would like to suggest that we focus on the more important issues before us and discuss them. Thank you very much. Swaziland. I thank the honourable delegate of Pakistan. I would now like to invite the honourable delegate of Dr DLAMINI (Swaziland): Mr President, may I,like all the other delegations before me, congratulate you on your appointment to head this Assembly. The delegation of Swaziland believes that health is the right for all people of the world and the delegation also believes that the World Health Assembly is a nonpolitical assembly concerned with issues of health. It also believes that communicable diseases do not know any boundaries. It also believes that the 21 million people of the Republic of China (Taiwan) do deserve to be people that have all rights to all forms of health. We also believe that, if we really mean to attain health for all by 2000, this Assembly should not exclude any group of people in the world. My delegation hereby supports the move by Nicaragua to have on the agenda the application of the Republic of China (Taiwan) for observer status in this Assembly. It would be sad to watch the Health Assembly taking the partisan view to a nonpolitical problem and turn it into a political agenda. We hereby urge you, Mr President and the Assembly to have included in the agenda for consideration the application by the Republic of China (Taiwan) for observer status, because those people of China are indeed people who deserve all the rights to health. I thank you, Mr President. I thank the honourable delegate of Swaziland and I would now like to give the floor to the honourable delegate of Grenada. 10

11 A50/VR/10 Mrs DUNCAN (Grenada): I too would like to congratulate you on your recent post as President of the World Health Assembly. Mr President, I too would like to support the proposal concerning the granting of observer status to the Republic of China (Taiwan). Given the mandate of this august body, I think it is important for us to ensure that all people of the world are afforded the opportunity to participate in programmes of health. The World Health Organization continues to call for health for all. How can we achieve this if we continue to disallow some countries because of politics? Mr President, I have had the opportunity to visit the country of the Republic of China (Taiwan) and I have seen for myself how 21 million people of that nation work together to develop their country. A country which has developed itself from being independent - not only cultivating some basic agricultural crops to feed its people - to a known economically affluent country, more improved than some countries of the world who are Members of this very Organization and who are considered internationally as world powers. We have heard that despite the fact that the Republic of China (Taiwan) is no longer a Member of this Organization they have continued to maintain their public health system in accordance with standards stipulated by WHO, and have never ceased to extend aid to countries of the world with which they have friendly relations. They have also indicated their willingness to provide further assistance. With the difficulties faced by the world with the emergence of new deadly diseases and the re-emergence of old diseases, we who are involved in health care of our people must ensure that we maximize all available resources and work together in our fight to maintain the health and well-being of our people. It is clear, Mr President, that the Republic of China (Taiwan) is very serious about the health and well-being of people the world over, by virtue of their overall medical support and assistance to countries less fortunate than themselves. I therefore wish to join with my colleagues who have spoken before me on this issue and to recommend that the Republic of China (Taiwan) be granted observer status at this meeting. Finally, Mr President, my colleagues from Saint Lucia who are not able to be here with us at this meeting today have asked me to indicate to you, Sir, that they fully support the application by the Republic of China (Taiwan) for observer status. Thank you Mr President. Thank you very much. I thank the honourable delegate of Grenada, and now give the floor to the honourable delegate of the Central African Republic. Le Dr DJENGBOT (République centrafricaine): Monsieur le Président, la République centrafricaine voudrait joindre sa voix à celle de ceux qui vous ont félicité et vous souhaite plein succès. Les raisons qui incitent la République centrafricaine à appuyer la proposition du Nicaragua sont les suivantes : protéger le droit aux services de santé de 21,4 millions d'habitants, échanger les résultats des recherches médicales approfondies, aider les pays en développement à améliorer le niveau des soins médicaux à travers la coopération médicale. L'OMS étant une organisation humanitaire apolitique, nous souhaitons que tout le monde puisse bénéficier de son attention si nous voulons atteindre l'objectif qu'elle s'est fixé elle-même : la santé pour tous. Je vous remercie. I thank the honourable delegate of the Central African Republic, and now give the floor to the honourable delegate of El Salvador. 11

12 A50/VR/10 El Sr. ANGULO (El Salvador): Muchas gracias, señor Presidente. En nombre de la delegación de El Salvador, considerando que la salud debe ser para todos, nuestro país, de conformidad con el artículo 12 del Reglamento Interior, apoya la propuesta de la hermana República de Nicaragua para conceder el estatuto de Observador a la República de China (Taiwán). Muchas gracias. I thank the honourable delegate of El Salvador, and now I would like to give the floor to the honourable delegate of Côte d'ivoire. Le Professeur KAKOU GUIKAHUE (Côte d'ivoire): Je voudrais féliciter le Président de cette Cinquantième Assemblée mondiale de la Santé et lui souhaiter plein succès. J'estime qu'il faut être logique. Je ne pense pas que les conditions qui avaient amené l'assemblée générale de 1972 à prendre une décision aient changé. C'est la raison pour laquelle je voudrais que nous nous attelions aux problèmes de santé que nous avons décidé de discuter, sans créer des problèmes inutiles. J'appuie le Pakistan et également la Chine populaire qui n'acceptent pas que nous accordions un quelconque statut à la République de Taiwan, que l'on appelle aussi République de Chine (Taiwan). Allez-y comprendre quelque chose. Je vous remercie. I thank the honourable delegate of Côte d'ivoire, and I would now like to give the floor to the honourable delegate of Guinea. Le Dr DRAMÉ (Guinée): Monsieur le Président, à l'instar des délégués qui m'ont précédé, je voudrais tout d'abord vous féliciter pour votre élection à la tête de la Cinquantième Assemblée mondiale de la Santé. Je voudrais également féliciter les Vice-Présidents et les autres membres du bureau. Nous hésitons tous autant que possible à politiser les sessions de l'assemblée de la Santé. Cependant, pour en préserver la bonne atmosphère, nous devons prendre en compte l'environnement dans lequel nous évoluons. Et l'on sait bien que les grandes stratégies de santé sont aussi des choix politiques. C'est pourquoi notre délégation, afin d'éviter toute situation ambiguë, recommande que la requête demandant d'accorder le statut d'observateur à Taiwan ne soit pas acceptée, d'autant que l'onu a réglé ce problème sino-chinois il y a plusieurs années. I thank the honourable delegate of Guinea, and I would now like to give the floor to the honourable delegate of Saint Vincent and the Grenadines. Mr JACK (Saint Vincent and the Grenadines): Thank you Mr President and, like all the other speakers before me, I wish, on behalf of this delegation, to extend to you our sincerest congratulations. 12

13 A50/VR/10 Mr President, on the issue of the proposal put forward to include the Republic of China (Taiwan) as observer to this body, I have to communicate that my delegation, recognizing the contribution made by the Republic of China (Taiwan), and which it continues to make, must be recognized in our efforts to further develop health, and therefore in recognition of these efforts we believe that it would be most fitting if the Republic of China (Taiwan) were to be encouraged by being included in this body as an observer, and with that, Mr President, I should thank you. Thank you very much the honourable delegate of Saint Vincent and the Grenadines. I would now like to give the floor to the honourable delegate of Argentina. El Dr. MAZZA (Argentina): Señor Presidente: Nuestra delegación quiere reiterar lo manifestado en la Mesa de la Asamblea en cuanto a la inconveniencia de incluir este tema en el orden del día. Hemos manifestado allí expresamente que el tema es de carácter político, que ha sido definido por las Naciones Unidas y que en todo caso debería discutirse en ese ámbito, limitando a esta Organización a la discusión de aquellos temas que son de su interés particular en su condición de organismo especializado de las Naciones Unidas. Por tal razón, proponemos que no se incorpore ese punto al orden del día de la Asamblea. Thank you very much, the honourable delegate of Argentina. I wottld nom like to) give the floor to the honourable delegate of Cuba. El Dr. DOTRES (Cuba): Señor Presidente: La delegación cubana se opone a la propuesta ya que consideramos improcedente y fuera de lugar el aspecto que se plantea. Hay problemas de salud de millones de ciudadanos de los países que están representados en esta Asamblea que no estamos tratando. Estamos hablando de un aspecto eminentemente político, que no tiene a nuestro juicio espacio en este foro, como han manifestado otros colegas. Desde 1971, la Asamblea General de las Naciones Unidas tiene reconocido que la República Popular China es la única y verdadera representación del pueblo chino en las Naciones Unidas. El resto es un asunto interno de los chinos, tal y como ha manifestado el delegado de ese país. Mi delegación está convencida de que el problema de la salud de los 21 millones de chinos de Taiwán es un asunto interno del pueblo chino, y confía, según lo declarado por el delegado de la República Popular China, en que se buscará la solución más conveniente. Muchas gracias. I thank the honourable delegate of Cuba, and now would like to give the floor to the honourable delegate of the Dominican Republic. El Dr. VASQUEZ (República Dominicana): Señor Presidente, señores Miembros de la Mesa: Nuestra felicitación a usted, señor Presidente, y al resto de los elegidos en la mañana de hoy. La República Dominicana quiere dar testimonio de su posición con relación a este asunto que ocupa a esta 50 a Asamblea Mundial de la Salud. Creemos que la Organización Mundial de la Salud es una dependencia de las Naciones Unidas y que no puede contribuir a segregar a ningún 13

14 A50/VR/10 estamento territorial ni étnico del mundo. Tenemos entendido que Taiwán es un estamento territorial que, independientemente de la voluntad de los Estados aquí presentes, tiene sus propias leyes y, en consecuencia, tiene su Estado. Entendemos que la Organización Mundial de la Salud, y en consecuencia esta Asamblea, debe adherirse a la pluralidad, no puede adherirse a dictámenes de bloque alguno. Pensamos que permitir que Taiwán sea Observador en la 50 a Asamblea Mundial de la Salud y en futuras Asambleas significa que ese país tendrá acceso a tecnologías y políticas de salud a las que actualmente Taiwán no tiene acceso en el ámbito de la cooperación externa. La República Dominicana piensa que tal vez sea ésta la mejor forma, la mejor manera de acercar dos sistemas de atención de salud que han permanecido durante muchos años separados. Por consiguiente, la República Dominicana respalda la propuesta del hermano país de Nicaragua en el sentido de que Taiwán sea designado Observador en la Asamblea Mundial de la Salud. Muchas gracias, señor Presidente. I thank the honourable delegate of the Dominican Republic and would now like to give the floor to the honourable delegate of Nepal. Dr SIMKHADA (Nepal): Thank you, Mr President. As my delegation is taking the floor for the first time let me express our deep satisfaction and happiness in seeing you assume the office of President of the World Health Assembly. Your leadership makes all of us as South Asians proud, and my delegation will fully cooperate with you to make this Assembly address all the major problems of health in the world today. His Majesty's Government of Nepal fully recognizes the People's Republic of China as the sole and legitimate representative of the Chinese people. So my delegation, in conformity with the relevant United Nations resolutions, fully supports the position stated by the distirtguished representative of the People's Republic of China and endorses the tradition of the General Committee not to endorse this item on the agenda. Thank you very much, Mr President. I thank the honourable delegate of Nepal and now would like to give the floor again to the honourable delegate of China. Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 谢谢主席先生让我第二次发言 我觉得在上述的所有支持台湾作为观察员的发言当中都用了所谓 " 中华民国 " 这种称呼, 在世界丑生组织论坛上出现这样的两个中国的论调, 是多年以来所没有的 这一现象让人惊讶, 让人痛心 这样的一个问题难道是个技术间题吗? 我觉得, 有一些国家代表的发言, 他们在说, 卫生组织不是一个政治性组织, 是一个技术性组织 但是, 在这个论坛上挑起这个政治议题的又是谁呢, 我觉得讨论这一个议题, 不是一个简单的技术问题, 我们应当看 14

15 A50A/R/3 到它背后隐藏着的东西 我觉得, 关子吸收观察员, 世界卫生组织的议事规则是有规定的, 是卫生大会的议事规则第三条 只有三类情况可以申请作为观察员, 第一类是主权国家, 他们已经申请成为 WHO 成员但还没有得到批准 ; 第二类是一部分领土或若干领土, 代表他们国际关系和外交事务的主权国家已经代表他们申请成为卫生組织的准成员, 但还没有得到批准的 ; 第三类是与卫生组织有正式关系的政府间或非政府间的组织 台湾不属于其中的任何一类 由于世界上只有一个中国, 台湾是中国的领土, 是中国的一个省, 所以只有中国政府才有资格代表台湾申请作为观察员, 其它国家是不能这么做的, 这是一个原则性的问题 正像我刚才发言当中谈到的, 不是一个表面的技术性问题, 而是是不是要槁 两个中国 和 " 一中一台 " 的政治问题 如果这个问题耽误了卫生大会的日程, 这也是少数国家不顾历史事实, 不顾过去的重要决议, 也不尊重全中国人民感情 这样一个政治问题是少数国家挑起的, 正像我刚才所说, 中国政府在这个领土主权完整的相关的问题上是没有任何调和余地的 所以我希望, 绝大多数主持正义和社会公理的国家能够支持中国的立场, 并且也支持总务委员会作出的正确决定, 拒绝将这一议题列入议程 谢谢主席 Thank you very much, honourable delegate of China. I have three more speakers on my list. Is the Assembly agreeable to closing the list of speakers? I see that there is no objection. The list is closed. I would now like to give the floor to the honourable delegate of Myanmar. Mr AYE (Myanmar): I thank you Mr President. Mr President, on behalf of the Myanmar delegation may I first congratulate you on your assumption of the Presidency of this Assembly and wish you every success in your endeavours. Mr President, the Union of Myanmar established diplomatic relations with the People's Republic of China in Our country strictly adheres to the one-china policy. Moreover, United Nations resolution 2758 recognized the Government of the People's Republic of China as the sole legitimate representative of all the people of China. Taiwan is a province of China and is an inalienable part of the People's Republic of China. We cannot support any attempts to interfere in the internal affairs of China. Our delegation also cannot support Taiwan as a member of WHO nor can it be granted observer status. We do not support the inclusion of this subject in the agenda items of the Assembly. I thank you Mr President. Thank you very much the honourable delegate of Myanmar. Now I give the floor to the honourable delegate of Kiribati. 15

16 A50/VR/10 Dr TAITAI (Kiribati): Thank you, Mr President, and let me join the others to congratulate you also on your election to the post of President of this Assembly. The Kiribati delegation supports the General Committee recommendation not to include a supplementary item which is to invite the Republic of China (Taiwan) to participate in the World Health Assembly as an observer. Kiribati recognizes the one-china policy and would like to leave any necessary political discussions on this matter to other United Nations forums which are more competent and better equipped to deal with such issues. Thank you, Mr President. I thank the honourable delegate of Kiribati and now would like to give the floor to the honourable delegate of Egypt. Dr BADRAN (Egypt): I would also like to join my colleagues in congratulating you on the assumption of the presidency of this Assembly. My delegation finds that it supports the decision of the General Committee not to include the item on the inclusion of Taiwan as an observer. We think that, although WHO is of course a scientific community and a health community, yet it also has to take account of and abide by the decisions of the United Nations. Therefore, we support the decision of the General Committee not to include this item on the agenda. Thank you. Thank you very much, the honourable delegate of Egypt. I believe we have one more speaker, the delegate of Papua New Guinea, who had requested the floor before we closed the list, so I would like to give the floor to the honourable delegate of Papua New Guinea. Dr TEMU (Papua New Guinea): Mr President, the Papua New Guinea delegation also congratulates you on your appointment and will support you during the deliberations of this Assembly. The Papua New Guinea delegation concurs with the position of the delegation of the Republic of China and requests the Fiftieth World Health Assembly, through you Mr President, not to entertain this agenda item. The Papua New Guinea delegation recognizes this as a purely political matter which should therefore be appropriately handled as an internal affair by the sovereign independent State of the People's Republic of China. The Papua New Guinea delegation requests closure of the debate on this issue and seeks its referral to the People's Republic of China. Thank you, Mr President. Thank you very much, the honourable delegate of Papua New Guinea. I understand from the discussion that there are Members who wish to see this item included as a supplementary agenda item. We must therefore proceed to a vote. I give the floor to the Legal Counsel to explain the procedures. Mr TOPPPING (Legal Counsel): Thank you, Mr President. The situation is as follows. We have, on the one hand, a recommendation by the General Committee not to include this item as a supplementary agenda item. I repeat, this has been a proposal by the General Committee not to include this item on the agenda. On the other hand, several delegations are opposed to this proposal. The proposal of the General Committee is the proposal that is being voted on. In a few minutes the President will ask all of those in favour to raise your nameplates. This will be a vote in favour of the General Committee recommendation not to include this as a supplementary agenda item. 16

17 A50/VR/3 I think the honourable delegate of Nicaragua wishes to speak on a point of order, so I give the floor to the honourable delegate of Nicaragua. El Sr. ROSALES (Nicaragua): Muchas gracias, señor Presidente. La delegación de Nicaragua discrepa ligeramente del Reglamento Interior y de la forma en que lo está leyendo el Asesor Jurídico. El artículo 33 del Reglamento Interior dispone que: «... la Mesa de la Asamblea, previa consulta con el Director General y a reserva de lo que la Asamblea de la Salud pueda disponer:... establecerá el orden del día de todas las sesiones plenarias de la reunión». De la frase «a reserva de lo que la Asamblea de la Salud pueda disponer» se deduce que la Asamblea de la Salud tiene que pronunciarse sobre la propuesta formal hecha por la delegación de Nicaragua y apoyada por otras delegaciones. Muchas gracias, señor Presidente. Thank you very much the honourable delegate of Nicaragua. I will give the floor again to the Legal Counsel to make his comments. Mr TOPPING (Legal Counsel): Thank you, Mr President. My interpretation of the situation is on the basis of Rule 12,which says that a supplementary agenda item may be added if, upon the report of the General Committee, the Assembly so decides. It is on the report of the General Committee that the Assembly is so deciding. Rule 33 relates to the functions of the General Committee. I do not see that that alters the effect of Rule 12 on this point and therefore, Mr President, I advise you to maintain the position that the issue before the Assembly is the recommendation by the General Committee not to include this item on the agenda. Now continuing, if I could, to explain my position so that everyone will understand when you are asking everyone to raise their nameplates: when the President asks for those in favour to raise their nameplates, this is a vote in favour of the General Committee recommendation not to include this item on the agenda. Those against do not agree with the recommendation and they want to see this item placed on the agenda. Thank you, Mr President. I think the position has been explained by the Legal Council, so I would now call for the vote. The list of speakers is closed so only those who want to raise a point of order can be given the floor - is Nicaragua asking to speak on a point of order again? Yes? I give the floor to the honourable delegate of Nicaragua. El Sr. ROSALES (Nicaragua): Señor Presidente: La Delegación de Nicaragua siente mucho tener que seguir discrepando de la interpretación del Asesor Jurídico, pero es soberanía de la Asamblea de la Salud decidir sobre la propuesta formal hecha por la República de Nicaragua y apoyada por múltiples delegaciones. El artículo 12 en ningún momento condiciona una decisión de la Asamblea Mundial de la Salud a una aprobación de la Mesa. Lo que prevé el artículo 12 es que la Mesa informe sobre sus recomendaciones en relación con las solicitudes de los Estados Miembros, lo cual no significa que la Asamblea Mundial de la Salud no pueda pronunciarse sobre una propuesta formal de un Estado Miembro. La aprobación de la Mesa no es una condición para el pronunciamiento de la Asamblea; por lo tanto, señor Presidente, lo que se tiene que poner a votación nominal es la propuesta formal de Nicaragua de que los países que apoyen el otorgamiento del estatuto de Observador a Taiwán voten a favor, los que se oponen voten en contra y los que se abstienen, se abstengan. Así de sencillo, 17

18 A50/VR/3 y no a la inversa. Repito, no es de ninguna manera condición la aprobación de la Mesa. Esta Asamblea tiene que decidir. Muchas gracias. I thank the honourable delegate of Nicaragua and now would like to give the floor to the honourable delegate of China. Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 谢谢主席 我再一次发言 注意到这个问题它的题目是审议总务委员会的决定, 所以我觉得法律顾间作出的决定是对的 另外, 如果要对总务委员会的决定进行表决的话, 我建议以唱名方式进行表决 I believe Côte d'ivoire also has a point of order, so I will give the floor to the honourable delegate of Côte d'ivoire. Le Professeur KAKOU GUIKAHUE (Côte d'ivoire): Merci, Monsieur le Président. Excusez-moi, mais nous ne suivons plus la délégation du Nicaragua. Reprenons les faits comme ils se sont passés. Le Président de l'assemblée de la Santé a abordé la question de l'adoption de l'ordre du jour, puis le Nicaragua a pris la parole pour rappeler qu'il avait adressé une lettre à la Direction générale pour apporter un amendement à cet ordre du jour. Comme on n'en parlait pas, il l'a rappelé. Donc je pense que nous sommes en train de discuter de l'ordre du jour et que le Conseiller juridique a tout à fait raison de poser la question comme il la pose. Je ne vois pas pourquoi le Nicaragua reprend la parole. Excusez-moi, mais nous sommes en train d'adopter l'ordre du jour. Le Nicaragua a rappelé une requête qu'il avait adressée à la Direction générale et dont il n'entendait pas parler. Donc le Conseiller juridique a tout à fait raison de poser la question comme il la pose. Je vous remercie. I thank the honourable delegate of Côte d'ivoire. I would like to maintain the position explained by the Legal Counsel. If Nicaragua wants to appeal against that position I would like to give them the floor again. El Sr. ROSALES (Nicaragua): Señor Presidente: Las reglas de procedimiento están claras: están establecidas en el Reglamento Interior de esta magna Asamblea. Repito, en ningún momento esta Asamblea puede supeditar una decisión soberana a lo que pueda o no decidir la Mesa. La Mesa es un órgano restringido de la Asamblea Mundial de la Salud, que es el órgano soberano. Sin embargo, si usted pide, Señor Presidente, a esta magna Asamblea que siga el Consejo del Asesor Jurídico, entonces la Asamblea debe decidir a cuál de las dos propuestas debe concederse prioridad: a la propuesta de la Mesa de la Asamblea o a la propuesta de la delegación de Nicaragua. Eso es lo que tenemos ahora que decidir. Muchas gracias. ~18 ;

19 A50/VR/3 I thank the honourable delegate of Nicaragua. I believe the honourable delegate of the Netherlands also wishes to speak on a point of order. Ms TERPSTRA (Netherlands): Thank you very much, Mr President. Well I think there is total confusion. I agree with you that we are in the process of adopting the agenda and, as far as I am aware, there is nobody who has asked for a vote so why should there be a vote? I thank the honourable delegate of the Netherlands but, as I said, there are some Members who wish this item to be included as a supplementary agenda item. We must therefore proceed to a vote. I still hold the position that has been explained by the Legal Counsel, so now I would like to put this proposal to the vote. I give the floor once again to the honourable delegate of Nicaragua. El Sr. ROSALES (Nicaragua): Señor Presidente: Creo que estamos dándole vuelta al tarro. Tenemos que aclarar, creo que para bien de todos, cuál es la situación. El Asesor Jurídico pretende que lo que se tiene que votar es la propuesta de la Mesa. La delegación de Nicaragua piensa que lo que se tiene que votar con prioridad es la petición formal que ha hecho hace unos momentos. Como Presidente de la Asamblea, va a tener usted que someter a votación cuál de las dos propuestas tiene que votarse en primer lugar: la de la Mesa o la de Nicaragua, que ha sido apoyada por múltiples delegaciones. Ésa es la decisión que tenemos que tomar ahora; luego, en función de la decisión que tomemos, votaremos sobre la propuesta de la Mesa o la propuesta de Nicaragua. Muchas gracias. I thank the honourable delegate of Nicaragua. I believe the honourable delegate of India also wishes to speak on a point of order, so I would like to give the floor to the honourable delegate of India. Ms GHOSE (India): Thank you very much, Mr President. My delegation would not have wished to take the floor at this point in time, but I think that we are being slightly indisciplined ourselves. The Legal Counsel to the World Health Assembly is the ultimate adviser to the President. All of us may have different interpretations of the rules but when we are in a confusion, when we are in disagreement we rely on the advice of the Legal Counsel which is why he is here. The Legal Counsel has, in fact, advised this Assembly that, in accordance with Rule 12, the recommendation of the General Committee to reject the proposal of Nicaragua should be voted upon. This, to my delegation, is extremely clear. The proposal of Nicaragua was made formally to the Director-General of the World Health Organization. In accordance with the rules, the Director-General forwarded this for consideration to the General Committee. The General Committee considered it and unanimously agreed to reject it. In accordance with the rules, you Mr President brought this decision of the General Committee to the World Health Assembly. In the World Health Assembly, there is disagreement on the unanimous recommendation of the General Committee. Therefore, the vote will have to be on the basis of the General Committee's recommendation, and I think this should be made very clear because I think the issue is getting very confused. The Legal Counsel is our Legal Counsel; he is here to advise the World Health Assembly and to advise you. All of us may have different interpretations, but I do not think we have the right to insist on our individual interpretations. So, Mr President, I hope that my intervention has been of some help. We are quite ready to go ahead with the vote, but I believe that a roll-call vote was called for. Thank you. 19

20 A50/VR/3 I thank the honourable delegate of India and now I would like to give the floor again to the Legal Counsel. Mr TOPPING (Legal Counsel): Thank you Mr President. Just to try to clarify things again, in accordance with the advice I gave to the President, the proposal before this Assembly is the recommendation of the General Committee not to include this item as a supplementary agenda item. There was a point of order by Nicaragua challenging that interpretation. The President ruled on that and said that he maintained my interpretation. Now, as matters stand, that is the interpretation that will be applied unless Nicaragua insists on challenging that interpretation, the ruling of the President, and appeals against that ruling. That would then require that that appeal be put to a vote to this Assembly, so therefore, Mr President, you may wish to determine whether the delegate of Nicaragua is prepared to accept your ruling. If not, then we would have to vote on his appeal. Thank you. I would ask the honourable delegate of Nicaragua if he is in agreement with what the Legal Counsel has said and with my interpretation. El Sr. ROSALES (Nicaragua): Señor Presidente: La delegación de Nicaragua sigue pensando que la interpretación del Asesor Jurídico es errónea. Sin embargo, creemos que es importante que esta Asamblea tome ya una decisión al respecto. Nicaragua no va a poner objeciones a la propuesta del Presidente, pero sí quiere dejar constancia de que la interpretación del Asesor Jurídico discrepa de lo que Nicaragua deduce del Reglamento. Muchas gracias. I thank the honourable delegate of Nicaragua. I think the honourable delegate of Jordan wishes to speak on the point of order. I give the floor to the honourable delegate of Jordan. Dr. KHARABSHEH (Jordan): Jjuí JJSTJÜI 1 jlia ^JLP jí oujl tojüi 声 Jlp q^dl 一 OIIPÎ J \ I ^ l/^) (S^" IУ^ yji fj^j ^ c d J b - 1 J I thank the honourable delegate of Jordan. Now we can go to the vote. I would like to ask the honourable delegate of China whether he would maintain his request about the roll-call vote, or can we just go for a general vote? I give the floor to the honourable delegate of China. 20

21 A50/VR/3 Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 谢谢大会主席 我坚持唱名表决的方式 谢谢 I would like to give the floor again to the Legal Counsel to explain the procedure. Mr TOPPING (Legal Counsel): Thank you, Mr President. There has been a request under Rule 74 of the Rules of Procedure for a rollcall vote. Any delegate may request a roll-call vote and that shall then be taken in the English or French alphabetical order of the names of Members; this year it is in the English alphabetical order. The name of the Member to vote first shall be determined by lot, for which case you should put your hand in the bag to pull out a letter... the letter "D" - Democratic People's Republic of Korea. Therefore the roll-call vote will commence with the Democratic People's Republic of Korea. Each name will be called out and the delegation of the name being called out should indicate "Yes", "No" or "Abstention". "Yes" is in favour of the General Committee's recommendation not to include this item, "No" is against that recommendation. We should then proceed. I believe the honourable delegate of Dominica wishes to speak on a point of order. I will give the floor to the honourable delegate of Dominica. Mrs PAUL (Dominica): Mr President, I would like to seek clarification from Legal Counsel as to whether a proposal for a rollcall vote by any Member is automatic. Previously, the President indicated that we would determine whether we would vote by acclamation or by roll-call. So may we please have some clarification from Legal Counsel? I give the floor again to the Legal Counsel. Mr TOPPING (Legal Counsel): Thank you, Mr President. There has been a request for a role-call vote under Rule 74. A single request is sufficient and therefore that has to be honoured. Once voting has started, only points of order concerning the method of carrying out the vote can be taken, nothing else. A vote was taken by roll-call, the names of the Member States being called in the English alphabetical order, starting with Democratic People's Republic of Korea, the letter "D" having been determined by lot. The result of the result of the vote was as follows: In favour: Afghanistan, Albania, Algeria, Andorra, Angola, Argentina, Australia, Austria, Bahrain, Bangladesh, Barbados, Belgium, Belize, Benin, Bhutan, Bolivia, Botswana, Brazil, Brunei Darussalam, 21

22 A50/VR/3 Bulgaria, Cambodia, Cameroon, Canada, Cape Verde, Chile, China, Colombia, Congo, Cook Islands, Côte d'ivoire, Croatia, Cyprus, Czech Republic, Democratic People's Republic of Korea, Denmark, Ecuador, Egypt, Eritrea, Estonia, Ethiopia, Finland, France, Gabon, Germany, Ghana, Greece, Guinea, Hungary, Iceland, India, Indonesia, Islamic Republic of Iran, Ireland, Israel, Italy, Jamaica, Japan, Jordan, Kenya, Kiribati, Kuwait, Lao People's Democratic Republic, Lebanon, Lesotho, Libyan Arab Jamahiriya, Lithuania, Luxembourg, Madagascar, Malaysia, Maldives, Malta, Mauritius, Mexico, Monaco, Mongolia, Morocco, Mozambique, Myanmar, Namibia, Nepal, Netherlands, New Zealand, Nigeria, Niue, Norway, Oman, Pakistan, Papua New Guinea, Peru, Poland, Portugal, Qatar, Republic of Korea, Romania, Russian Federation, Samoa, San Marino, Sao Tome and Principe, Saudi Arabia, Seychelles, Singapore, Slovakia, Slovenia, South Africa, Spain, Sri Lanka, Sudan, Suriname, Sweden, Switzerland, Syrian Arab Republic, Thailand, The Former Yugoslav Republic of Macedonia, Togo, Trinidad and Tobago, Tunisia, Turkey, Uganda, United Arab Emirates, United Kingdom of Great Britain and Northern Ireland, United Republic of Tanzania, Uruguay, Vanuatu, Viet Nam, Yemen, Zaire, Zambia, Zimbabwe. Against: Burkina Faso, Central African Republic, Dominica, El Salvador, Fiji, Gambia, Grenada, Guatemala, Haiti, Honduras, Malawi, Nicaragua, Paraguay, Saint Vincent and the Grenadines, Senegal, Solomon Islands, Swaziland, Tonga, Tuvalu. Abstaining: Bahamas, Costa Rica, Palau, Panama, United States of America. Absent: Belarus, Burundi, Djibouti, Guyana, Mali, Marshall Islands, Federated States of Micronesia, Nauru, Philippines, Rwanda, Saint Kitts and Nevis, Saint Lucia, Sierra Leone, Uzbekistan. The proposal was therefore adopted by 128 votes to 19,with 5 abstentions. Il est procédé à un vote par appel nominal,les noms des Etats Membres étant appelés dans l'ordre alphabétique anglais. Le premier appelé est la République populaire démocratique de Corée (Democratic People's Republic of Korea), la lettre D,,ayant été choisie par tirage au sort. Le résultat du vote est le suivant : Pour : Afghanistan, Afrique du Sud, Albanie, Algérie, Allemagne, Andorre, Angola, Arabie Saoudite, Argentine, Australie, Autriche, Bahreïn, Bangladesh, Barbade, Belgique, Belize, Bénin, Bhoutan, Bolivie, Botswana, Brésil, Brunéi Darussalam, Bulgarie, Cambodge, Cameroun, Canada, Cap-Vert, Chili, Chine, Chypre, Colombie, Congo, Côte d'ivoire, Croatie, Danemark, Egypte, Emirats arabes unis, Equateur, Erythrée, Espagne, Estonie, Ethiopie, Ex-République yougoslave de Macédoine, Fédération de Russie, Finlande, France, Gabon, Ghana, Grèce, Guinée, Hongrie, Iles Cook, Inde, Indonésie, Iran (République islamique d,),irlande, Islande, Israël, Italie, Jamahiriya arabe libyenne, Jamaïque, Japon, Jordanie, Kenya, Kiribati, Koweït, Lesotho, Liban, Lituanie, Luxembourg, Madagascar, Malaisie, Maldives, Malte, Maroc, Maurice, Mexique, Monaco, Mongolie, Mozambique, Myanmar, Namibie, Népal, Nigéria, Nioué, Norvège, Nouvelle-Zélande, Oman, Ouganda, Pakistan, Papouasie-Nouvelle-Guinée, Pays-Bas, Pérou, Pologne, Portugal, Qatar, République arabe syrienne, République de Corée, République démocratique populaire lao, République populaire démocratique de Corée, République tchèque, République-Unie de Tanzanie, Roumanie, Royaume-Uni de Grande-Bretagne et d'irlande du Nord, Saint-Marin, Samoa, Sao Tomé-et-Principe, Seychelles, Singapour, Slovaquie, Slovénie, Soudan, Sri Lanka, Suède, Suisse, Suriname, Thaïlande, Togo, Trinité-et-Tobago, Tunisie, Turquie, Uruguay, Vanuatu, Viet Nam, Yémen, Zaïre, Zambie, Zimbabwe. Contre : Burkina Faso, Dominique, El Salvador, Fidji, Gambie, Grenade, Guatemala, Haïti, Honduras, Iles Salomon, Malawi, Nicaragua, Paraguay, République centrafricaine, Saint-Vincent-et-Grenadines, Sénégal, Swaziland, Tonga, Tuvalu. Absentions : Bahamas, Costa Rica, Etats-Unis d'amérique, Palaos, Panama. Absents : Bélarus, Burundi, Djibouti, Guyana, Iles Marshall, Mali, Micronésie (Etats fédérés de), Nauru, Ouzbékistan, Philippines, Rwanda, Sainte-Lucie, Saint-Kitts-et-Nevis, Sierra Leone. La proposition est donc adoptée par 128 voix contre 19,avec 5 abstentions. 22

23 A50/VR/3 There is a request to speak from the honourable delegate of the Dominican Republic. I give the floor to the honourable delegate of the Dominican Republic. El Dr. VASQUEZ (República Dominicana): Señor Presidente: La República Dominicana no fue llamada a votar. Nuestra votación es: no. Thank you very much, but I would like to give the floor to the Legal Counsel. Mr TOPPING (Legal Counsel): The Dominican Republic was not called because it has lost the right to vote by a decision of the Health Assembly for being in arrears in payment of its contribution. I give the floor to the delegate of the Dominican Republic. El Dr. VASQUEZ (República Dominicana): Señor Presidente: Tan sólo queríamos aclarar que no sabíamos que se hubiera precisado qué países pueden votar y cuáles no. Quisiéramos saber si se ha votado con ese espíritu y con esa dktecminación de antemano, porque de lo contrario la República Dominicana reclama que todo lo que se ha hecho es vano, porque habría que saber quién está al día y quién no. The honourable delegate of China is requesting the floor. Is that in explanation of the vote? I give the floor to the honourable delegate of China. Professor LI Shichuo (China): 李世绰教授 ( 中国 ): 谢谢主席先生 在结束了这个投票之后, 我想再讲两句话 第一 非常感谢所有主持正义的国家支持总务委员会的正确决定 这说明, 我们大多数会员国是主持公道的 ; 第二 非常遗憾, 为这个本不该存在的议题耽误了这么长时间 我希望今后不要再出现这样的情况 谢谢主席先生 23

24 A50/VR/3 I thank the honourable delegate of China. The recommendation of the General Committee not to include this item is adopted. May I therefore assume that the Assembly agrees to adopt the provisional agenda as amended and with the supplementary agenda item on cloning in human reproduction? Are there any comments? The agenda is adopted as amended. Regarding the programme of work, since the Assembly has agreed to consider the supplementary agenda item on cloning, does the Assembly agree to the proposal that this item be discussed in Committee В after it has completed discussion of item 31 on Tuesday, 13 May in the afternoon? It is so decided. A revision of document A50/1 reflecting the changes will be distributed tomorrow morning. The provisional agenda of the Assembly was prepared by the Executive Board in such a way as to indicate a proposed allocation of items to Committees A and В on the basis of the terms of reference of the main committees. The General Committee has recommended that the items appearing on the agenda of the plenary as amended which have not yet been disposed of be dealt with in plenary. As to the items appearing under the two main committees in the provisional agenda, they should be allocated as shown in document A50/1 Rev.l which will be distributed tomorrow. It is understood that later in the session it may become necessary to transfer items from one committee to the other depending upon each main committee's workload. I take it that the Assembly agrees with this recommendation. It is so decided. 3. ANNOUNCEMENTS COMMUNICATIONS I wish now to make an important announcement concerning the annual election of Members entitled to designate a person to serve on the Executive Board. Rule 101 of the Rules of Procedure reads: At the commencement of each regular session of the Health Assembly the President shall request Members desirous of putting forward suggestions regarding the annual election of those Members to be entitled to designate a person to serve on the Board to place their suggestions before the General Committee. Such suggestions should reach the Chairman of the General Committee not later than forty-eight hours after the President has made the announcement in accordance with this Rule. I therefore invite delegates wishing to put forward suggestions concerning these elections to submit them to the Assistant to the Secretary of the Assembly not later than Wednesday afternoon, 7 May at 16:00,in order to enable the General Committee to meet to draw up its recommendations to the Assembly regarding these elections. For the remainder of this afternoon, in accordance with the decision of the General Committee, the plenary will hear the introductions to items 9 and 10,review of the Executive Board reports and review of The World Health Report 1997, incorporating the Director-General's report on the work of WHO. The programme of work for tomorrow, Tuesday, and for Wednesday will be as follows: on Tuesday, 6 May, the plenary will continue with the debate on items 9 and 10; Committee A will meet concurrently. In the afternoon, the debate on items 9 and 10 will continue in the plenary and Committee В will hold its first meeting. The Committee on Credentials will hold its first meeting at 14:30. On Wednesday, 7 May, in the morning, the plenary will consider the first report of the Committee on Credentials and continue and complete the debate on items 9 and 10; Committee A will meet simultaneously with the debate on items 9 and 10, and Committee В will meet following the conclusion of plenary. In the afternoon, there will be no plenary but both Committees A and В will meet. On Thursday, 8 May, there will be no plenary in the morning, but both Committees A and В will meet and will continue in the afternoon until 17:00,when the plenary will meet to deal with item 13, "Awards" and its subitems. On Friday, 9 May, there will be no plenary meeting. Committees A and В will meet in the morning and afternoon until 17:10,when the General Committee will meet to draw up the list for the annual election of Members entitled to designate a person to serve on the Executive Board and to review the programme for the remainder of the week. Does the Assembly agree with these proposals concerning this programme of work of the Assembly? It is so decided. 24

25 A50/VR/3 I would also like to remind the few delegates who have not yet submitted their formal credentials that they should hand them over to the Secretariat of the Credentials Committee in office A.671 in this building before 12:00 tomorrow. 4. REVIEW AND APPROVAL OF THE REPORTS OF THE EXECUTIVE BOARD ON ITS NINETY-EIGHTH AND NINETY-NINTH SESSIONS EXAMEN ET APPROBATION DES RAPPORTS DU CONSEIL EXECUTIF SUR SES QUATRE-VINGT-DIX-HUITIEME AND QUATRE-VINGT-DIX-NEUVIEMESESSIONS We shall now pass on to item 9 of the agenda, "Review and approval of the reports of the Executive Board on its ninety-eighth and ninety-ninth sessions". Before giving the floor to the representative of the Executive Board, I should like to explain briefly the role of the Executive Board representatives at the Health Assembly and of the Board itself, in order to avoid any uncertainty on the part of some delegates on this matter. The Executive Board has an important role to play in the affairs of the Health Assembly. This is quite in keeping with WHO's Constitution, according to which the Board has to give effect to the decisions and policies of the Health Assembly, to act as its executive organ and to advise the Health Assembly on questions referred to it. The Board is also called upon to submit proposals on its own initiative. The Board therefore appoints four members to represent it at the World Health Assembly. The role of the Executive Board representatives is to convey to the Health Assembly, on behalf of the Board, the main issues raised during the discussions and the flavour of the Board's discussion during its consideration of the items which need to be brought to the attention of the Health Assembly, and to explain the rationale and nature of any recommendations made by the Executive Board for the Assembly's consideration. During the debate in the Health Assembly on these items, the Executive Board representatives are also expected to respond to any points raised whenever they feel that a clarification of the position taken by the Board is required. Statements by the Executive Board representatives, speaking as members of the Board appointed to present its views, are therefore to be distinguished from statements of delegates expressing the views of their governments. I have pleasure in giving the floor to the representative of the Executive Board, Mr Ngedup, Chairman of the Board. Mr NGEDUP (representative of the Executive Board): Mr President, Mr Director-General, honourable delegates, Excellencies, ladies and gentlemen, on behalf of my fellow members of the Executive Board, I congratulate you, Mr President and the Vice-Presidents for the confidence that the Assembly has placed in you for directing its work. It is my pleasure as representative of the Executive Board to report on highlights of the work of the Board during its ninety-eighth and ninety-ninth sessions. I am here with three of my colleagues and we would be pleased to respond to any questions you may have on the Board's deliberations. A written statement has been submitted to you in document A50/2. At its ninety-eighth and ninety-ninth sessions, the Board continued its follow-up of WHO reform and response to global change which it had begun at its ninety-third session. It considered reports on the role of WHO country offices and personnel policy and practices. It will keep under review the reforms being made in these important areas. The Board has requested the Director-General to submit to the session following the Health Assembly a draft policy for the twenty-first century for the renewed health-for-all strategy and urged the Director-General to ensure involvement of Member States in the process of preparing this global health policy. The Board also adopted a resolution which recommends to the Health Assembly a resolution linking the renewed health-for-all strategy with the Tenth General Programme of Work, programme budgeting and evaluation. 25

26 A50/VR/3 In the context of reform, the Board decided to continue the mandate of the special group on the review of the Constitution of WHO. The Board has also decided to broaden the mandate of the special group to questions relating to WHO's regional arrangements. A progress report is to be made to the Board at its forthcoming session. A meeting of the special group to discuss regional arrangements was held on 3 and 4 April. That meeting agreed that another meeting on the matter should be held at the time of the Health Assembly. This meeting has now been scheduled for 10 May. The Board considered the proposed programme budget for the financial period , which is submitted to the Health Assembly for review and approval. In connection with this consideration of the proposed programme budget, the Board adopted a resolution on programme budgeting and priority-setting which requests the Director-General to take certain factors regarding budget developing, priority-setting, budgetary savings and multilateral coordination into account for the proposed programme budget for and future biennial budgets. The Board also adopted a resolution on WHO collaborating centres which recommends to the Health Assembly a resolution aimed at better utilization and promotion of WHO collaborating centres. The Board considered seven progress reports on technical matters submitted as requested by previous resolutions and decisions. Five of these reports are forwarded to the Health Assembly for consideration; they concern, prevention of violence, reorientation of medical education and medical practice, reproductive health, tobacco or health, and HIV/AIDS and sexually transmitted diseases. In addition, the Board adopted resolutions on guidelines on the WHO Certification Scheme on Quality of Pharmaceutical Products moving in International Commerce, the quality of biological products moving in international commerce, and World Tobacco Day. Reports on these matters are also forwarded to the Health Assembly. The Board adopted four resolutions on control of tropical diseases which recommend resolutions to the Health Assembly dealing with lymphatic filariasis, malaria, dracunculiasis and African trypanosomiasis. The Board adopted two resolutions relating to collaboration within the United Nations and with other intergovernmental organizations. It approved the proposal that the Executive Board of UNFPA be invited to join an expanded UNICEF/WHO Joint Committee on Health Policy to be named the WHO/UNICEF/UNFPA Coordinating Committee on Health. It also adopted a resolution on persistent organic pollutants in response to a request from the UNEP Governing Council. This resolution and the resolution on protection of the marine environment are being forwarded to the Health Assembly. Under personnel matters, the Board adopted resolutions on geographical representation and employment and participation of women in the work of WHO, both of which recommend resolutions to the Health Assembly. Finally, having reviewed a report on the method of work of the Health Assembly, the Board adopted a resolution recommending to the Health Assembly a resolution revising certain aspects of its method of work. The resolution is designed to make it possible to achieve savings through a rationalization of the Assembly's work. I should like to express the appreciation of the Board at having the opportunity to present this report to the Assembly. Thank you Mr Ngedup for your excellent statement. I should like to take this opportunity of paying a tribute to the work of the Executive Board and, in particular, to express our appreciation and our warm thanks to the outgoing members who have contributed very actively to the work of the Board. 26

27 A50/VR/3 5. REVIEW OF THE WORLD HEALTH REPORT 1997 EXAMEN DU RAPPORT SUR LA SANTE DANS LE MONDE 1997 I give thefloorto Dr Nakajima, Director-General so that he may present, under item 10 of the agenda, The world health report incorporating his report on the work of WHO. Dr Nakajima you have the floor. The DIRECTOR-GENERAL: Mr President, excellencies, honourable delegates, ladies and gentlemen, last month, on World Health Day, WHO called on its Member States and all other partners in health to mobilize an effective response to the global threat of infectious diseases. Two weeks ago, the Scientific and Ethical Review Group of the WHO-based Special Programme on Human Reproduction reviewed the issue of cloning and its potential risks and benefits for human beings. Today, with its 1997 issue of The world health report, WHO is providing the public health community with a sharp analysis of the emerging epidemiological transition and its dramatic implications for human well-being. These are just three examples of WHO's day-to-day activities but they give some idea of the range of our responsibilities. These responsibilities derive from the obligation placed upon us by our Constitution to direct and coordinate international health work so that all the people of our Member States can have equitable access to health. In 1995 our first issue of The world health report highlighted the gaps in health between the rich and the poor. It stressed the need to reassess the health situation and its determinants, and to rethink our healthfor-all strategy so that new policies and partnerships could be defined that would enable us to bridge these gaps. In this spirit, we have undertaken a worldwide consultation, with all interested partners, to explore the biomedical, social, institutional and economic approaches that can help us to further the equitable development of health globally in the years to come. The 1996 issue of The world health report alerted the international community to the continuing threat of infectious diseases. It gave an overview of the premature death and disability they cause, as well as the huge losses in trade and economic development. It also reviewed some of the main factors that account for the re-emergence of infectious diseases. These include economic and ecological changes, new industrial practices, increased movement of goods and populations, inadequate water and sanitation systems, and, equally importantly, inadequate health infrastructure. WHO has always been at the forefront in the fight against infectious diseases. In recent years, we have intensified our prevention and control activities against these diseases, which kill about 17 million people each year and disable many millions more, a large proportion of whom live in developing countries. The special campaigns for the eradication of poliomyelitis and dracunculiasis and the elimination of leprosy, Chagas disease and other diseases have made very encouraging progress. Some countries and even some regions have already reached their goals, others are approaching the certification stage, and others are in the surveillance phase. The formidable effort currently being deployed by Africa, led by heads of state, to achieve universal immunization against polio is a remarkable contribution to global health development and deserves our full support. Tuberculosis, malaria and HIV/AIDS are major causes of suffering and death in the world today. They involve many difficult biomedical, social and economic challenges. The fact that we now have a new and effective strategy for controlling one of them, tuberculosis, has been hailed as an important public health breakthrough. The strategy has been developed and tested extensively in different countries by the programme set up in 1993 in WHO to stimulate a global effort to control tuberculosis. "DOTS" (Directly Observed Treatment Short Course) is not only curing patients but also helping to contain the risk of drug resistance. The recent development of antiretrovirals used in triple therapies against HIV/AIDS is also a remarkable achievement and a source of hope for people living with AIDS. Many questions remain unanswered, however, about long-term effectiveness and side-effects, and just as importantly about the accessibility of the treatment to so many people in the world who urgently need it. These are technical and ethical issues to which WHO is particularly alert and on which we held a special consultation just last week. Efforts continue to promote integrated community-based strategies for malaria control and to find more effective technologies for prevention and treatment. 27

28 A50/VR/3 WHO's activities in the area of global surveillance and control of infectious diseases have included the coordination of emergency response to epidemic outbreaks such as dengue haemorrhagic fever, Ebola, cholera, meningitis, dysentery and yellow fever. Some of our interventions have been in complex emergency situations, to ensure technical support for humanitarian assistance to refugees and displaced populations. We have paid particular attention to networks for the surveillance of diseases and antimicrobial resistance and have supported capacity-building for this at country level. We have continued our work for standard-setting on drugs, biologicals and medical devices. The revision of the International Health Regulations is in progress and will provide us with an updated and more flexible instrument to respond more effectively to the health requirements of the new social and economic global environment. The emergence of spongiform encephalopathies and their possible cross-species transmission, the outbreaks of Ebola haemorrhagic fever, and the recent epidemics of food poisoning caused by E.Coli 0157 have required us to respond quickly to the changing nature of public health. WHO has maintained close contact with the relevant experts and organized consultations as necessary to monitor the situation and provide advice on the various issues involved. These are issues that show the complex links between health policies and industrial, technological and economic policies, and the need for ways to manage and regulate them. They also show that better use must be made of epidemiology to anticipate future trends and health needs. This is what The world health report 1997 attempts to do, concentrating on chronic conditions, disability and ill-health caused by noncommunicable diseases. These diseases, which include cancer, diabetes, and cardiovascular diseases, cause more than 24 million deaths a year and a vast range of disabilities. They appear later in life but are the result of long years of exposure to behavioural and environmental risk factors. Between 1990 and 1995, the number of people in the world aged 65 and above increased by 14%. In the coming 25 years, it will increase by another 82% globally - more than 100% in the developing countries and about 40% in the developed countries. This calls for major changes in the organization of health services. In 1996,more than 15 million deaths and a much larger number of cases of severe disablement were caused by circulatory problems such as heart disease and stroke. Of these deaths, approximately 64% occurred in developing countries and 15% in countries in economic transition. In 1996 cancer caused 6 million deaths, of which 4 million occurred in developing countries. More than 10 million new cases appeared globally, of which nearly 60% were in developing countries. Cancer patients and their families and friends endure a particularly heavy burden of anxiety and suffering. Conditions and effectiveness of treatment are gradually improving, however, and many types of cancer are both preventable and curable. Lung cancer causes about one million deaths a year, most of which are preventable since 85% of the cases in men and 46% of those in women are caused by smoking. It is estimated that no fewer than 135 million people in the world are suffering from diabetes and this number is expected to double in the next 25 years. Diabetes can seriously restrict people's autonomy and lead to complications such as heart disease, renal failure, gangrene, and blindness. Major risk factors for chronic diseases are improper diet, physical inactivity and smoking. Although more research needs to be done to elucidate the genetic and lifestyle-related factors as well as the infectious agents involved in these conditions, preventive action can already be taken. We have promoted several multicentre, multicountry projects, such as INTERHEALTH on noncommunicable diseases, through the WHO Collaborating Centres, working with national institutions, professional associations and private foundations. The chronic conditions dealt with include asthma (in the GINA project), diabetes (DIABCARE), cardiovascular diseases (CARMEN), circulatory diseases (MONICA) and nicotine dependence (CINDI). Within these projects WHO has coordinated epidemiological studies, set up global computerized databases, and developed and disseminated protocols for prevention, treatment and rehabilitation. We have supported health worker training and health education and promotion strategies in these areas. We are carrying out similar work in the areas of rheumatology, oral health and hereditary diseases such as thalassaemia, sickle cell disorder, haemophilia and cystic fibrosis. The WHO International Agency for Research on Cancer, in Lyons, deals with all cancer-related research issues, including epidemiology. It works in close collaboration with our Geneva-based programmes, in particular those dealing with occupational health, environmental health and chemical safety. Other chronic conditions requiring urgent attention include blindness, mental disorders and substance abuse. Nearly 45 million people in the world are blind. Most of this blindness is treatable or preventable,

29 A50/VR/3 but persists for want of access to affordable eye care. In close partnership with nongovernmental organizations, we have been particularly active in promoting prevention, treatment and rehabilitation for conditions such as trachoma and cataract. After successful completion of the onchocerciasis control programme in 11 African countries, co-sponsored control activities have been undertaken in other countries where this disease is endemic. Mental and neurological disorders affect hundreds of millions of people. In many countries, drugs to treat conditions such as epilepsy and schizophrenia are not available. Age-related forms of dementia such as Alzheimer's disease are becoming more common worldwide. The serious challenges ahead include improving mental health at the primary health care level, as well as providing neuropsychiatrie care, essential drugs and essential psychosocial interventions. In this area, in 1996, WHO produced guidelines on primary prevention, essential treatments, and basic principles relating to patients' rights. It also supported the development of a major intersectoral initiative called "Nations for Mental Health". Substance abuse is growing, starting earlier in life, and shifting to new products such as amphetamines. These trends are particularly worrying because of their links with organized crime, and because of the selfinflicted and interpersonal violence to which substance abuse often leads. Drug injection is becoming increasingly common, with the additional risk of spreading HIV/AIDS, hepatitis В and C, and other bloodborne infections. All of this represents new and heavy demands on the health system. And it is not just a matter, when setting priorities, of choosing between noncommunicable and infectious disease programmes, for the two are not always separable. For example, in addition to specific genetic factors, some infectious agents have been shown to be associated with the etiology of chronic diseases, such as Helicobacter pylori in the case of stomach cancer. These diseases also share common risk factors related to lifestyles and the environment. In all cases, prevention is urgently needed. Prevention must be fully recognized as the guiding principle of public health policy. In the long run, it is the only way to achieve cost containment and to reduce the incidence of diseases and the harm they do to individuals and societies. The current worldwide effort to rethink health systems will only succeed if it takes this approach to the so-called "double burden" of infectious and noncommunicable diseases. In doing this our concern is to increase not only life expectancy but disability-free health expectancy. WHO, its staff, its programmes and its administration, are ready to support the new effort required to promote this inclusive approach to health development. We have organized various consultations on issues such as the reorientation of medical education and practice, health system development, essential public health functions, human resources for health, nursing and midwifery services, community health care, traditional medicine, social security and sustainable funding, and new approaches to care. All these issues are central to the policies and activities that must be brought in to support the new health-for-all strategy that our Member States will finalize and adopt in The thorough reform process I have been conducting for the past four years has helped to shape a streamlined, more flexible and more focused Organization. The outcome is enhanced effectiveness and accountability. Within this reform process, the organizing principle has been to redefine structures according to the functions and activities to be carried out. Programmes have been redesigned to encourage the sharing of expertise and avoid duplication. The availability of a clear statement of each programme's functions will facilitate both the definition and the evaluation of its priorities, planned activities, goals and targets. This improves management through closer budgetary and operational monitoring. The reform has also improved coordination and consultation among the regions. Decentralization to the national level has been enhanced by the clarification and strengthening of the role of WHO representatives. Greater flexibility and delegation of authority contribute to enhancing people's sense of responsibility and initiative at all levels of the Organization. This has gone together with the revision of our administrative, financial and personnel procedures and policies to ensure transparency and quality of performance. The development of our Management Information System will play a crucial role in ensuring communication between all our offices and our Member States. At this session, the Health Assembly will consider the proposed programme budget for For the second time, this document is organized as a strategic planning tool. In preparing it we have greatly benefited from the collaboration of the Executive Board and its Programme Development Committee, and its Administrative, Budget and Finance Committee. 29

30 A50/VR/3 This is a transitional programme budget in that it reflects current priorities and at the same time prepares for our activities under the Tenth General Programme of Work as they will develop in the twentyfirst century. This programme budget follows our administrative and programme structures as they have been redesigned at all levels of the Organization to respond to global change. Subject to our statutory obligations within the United Nations system we have made every effort to contain costs, and thanks to the dedication of our staff we have continued to work efficiently while doing this. I wish to stress, however, that the Organization has to have sufficient resources to be fully operational and effective. It will be the responsibility of this Health Assembly to provide the Organization with the means to fulfil its mission. WHO's reform must be seen as a continuous process. Changes are taking place at an accelerated pace in the world, and health sector reform is still under way in most countries. The ongoing consultation on the renewal of WHO's health-for-all strategy has helped us and our Member States to assess jointly the Organization's role in promoting health development globally. To advance our goal of health for all, WHO has had to carry out tasks which can be grouped under three main headings: information, normative activities, and technical support. This broad categorization helps to highlight the main areas of need that are common to our Member States. It also helps us to ascertain what benefits Member States feel they can obtain from our activities and expertise, and what comparative advantage they see in WHO. Information must be understood here as consisting not only of the collection and dissemination of data but also of a careful process of validation and analysis. The tracking of epidemiological trends, the definition and monitoring of health indicators and determinants, as well as the worldwide exchange of knowledge based on science and experience, are all part of WHO's information function. WHO's role in the area of research must be seen in this light: it must stimulate and guide scientific work by providing information on actual public health needs, and help countries make practical use of the relevant knowledge and technology. Through advocacy for health, WHO must also alert policy-makers and the general public to health problems and opportunities. WHO's normative activities include the definition and harmonization of technical and ethical standards and, less stringently, guiding principles on health policies, products and practices. In view of the accelerated development of biomedical and information technology, it is particularly important that we should define technical and ethical standards which protect the health and dignity of human beings. This has always been a core concern of our programmes, as illustrated by their work in areas such as reproductive health, quality and accessibility of drugs, disability, genetic disorders, clinical research and organ transplants. The universal membership of our Organization, and its close familiarity with conditions in the field, place it in a unique position to facilitate national and regional debate on such matters, so that a meaningful consensus can be reached at global level. The emergence of new diseases and the growing pressure of industrial and?trade policies make such consensus indispensable. Our responsibility towards our Member States and their people, however, does not end with the production of information, standards and strategies. All these must be tested in the field to evaluate their usefulness and undertake revisions where needed. We must be ready to provide technical advice and support to the countries that lack the necessary resources, structures and experience. Our task is then to help them adapt health policies, monitor outcomes, and build up their own capacity. The demand from our Member States has been particularly pressing not only for disease control and prevention but also in areas such as family health, ageing, drug policies, human resources and health system development. In this regard, one of our essential tasks is to act as a catalyst for technical cooperation, especially among developing countries. In 1998,we will celebrate WHO's fiftieth anniversary. At that time, you will adopt a New Health Charter that sets out the principles of health development and international cooperation in the twenty-first century. In doing this, you will express your own vision of WHO and clarify the functions and partnerships through which you consider that the Organization can best fulfil its role in the future. Mr President, distinguished delegates, as this Assembly reviews the Organization's achievements and addresses its long-term perspectives, particularly the health-for-all strategy for the twenty-first century, I remind you that a nomination and selection process for new leadership of WHO will commence in approximately two months' time. Under new procedures, the 32 members of the Executive Board and all 191 Member States will be invited to nominate candidates. Next January the Executive Board will nominate a new Director-General who will be considered by the Fifty-first World Health Assembly for appointment to a term beginning 21 July 1998.