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GENEVA, Feb 23 2009 (IPS) - Countries at all levels of economic development are concerned about the impact of the financial crisis on health. If unemployment continues to rise, safety nets for social protection fail, savings and pension funds erode, and public spending drops, it is inevitable that people’s health will suffer.

The impact is direct when stress causes a rise in mental illness and in the use of tobacco, alcohol, and other harmful substances. It is made worse when health services cannot sustain the level of care that people need when they fall ill.

This prediction is not based on theory but on what has happened in past recessions, most of which have been less deep and of shorter duration than what most experts predict we are now facing.

Financial markets, economies and businesses are more closely interconnected than ever before. As we have seen, financial turmoil is contagious, moving rapidly from one country to another and spreading quickly from one sector to others. Making matters worse, particularly in developing nations, the financial crisis comes hard on the heels of food and fuel crises, which are estimated to have tipped more than 100 million people back into poverty.

The crisis thus comes at a precarious time for public health. We are in the midst of the most ambitious drive in history to tackle the root causes of poverty and reduce the gaps in health outcomes. No one wants this momentum to stall.

In past recessions, development aid was cut just when it was needed most. This must not happen again. We cannot afford to sacrifice hard-won gains in child and women’s health, in the fight against AIDS, TB, and malaria, and in building strong, health delivery systems. The financial crisis cannot be allowed to undermine our pursuit of the Millennium Development Goals.

In times of economic crisis, people in all countries tend to forego private care and turn to publicly-financed services. This comes at a time when public health systems in many countries -in both the developed and developing world- are already overstretched and underfunded.

In many low-income countries, more than 60 percent of domestically-sourced health spending is private, largely in the form of direct out-of-pocket payment. Economic downturn increases the risk that people will neglect health care and prevention. A drop in preventive care is particularly disturbing at a time when demographic ageing and a rise in chronic diseases are global trends.

We know, too, that women and young children are among the first to be affected by a deterioration in financial circumstances and food availability. Moreover, recent trends in international trade have left many countries with little self-sufficiency in the production of staple food items, a cornerstone of food security.

The World Health Organisation (WHO) recently held a high-level consultation that brought together Member States and experts from around the world representing donor agencies, development banks, national governments, and civil society. Five areas for action emerged from the discussion:

First, leaders in health must be prepared to speak out, unequivocally and on the basis of sound evidence. Regional institutions can be a powerful force in bringing countries together to exchange information in a rapidly-changing environment. The need to safeguard progress in health and ensure that donors keep their promises must become a focus in all meetings of global leaders.

Contingency planning must be based on high-quality information. The impact of the crisis will vary country by country. Early warning systems will require collaboration among organisations with complementary fields of expertise -economists working with health experts. WHO will be monitoring financial flows from governments and donors and looking carefully for signs that the utilisation of health care is falling.

Counter-cyclical public spending provides a means of reviving economies in those countries that can afford it. Aid will play a key role in providing a boost that many low-income countries cannot finance alone. The challenge is to ensure that spending genuinely helps the poor and positively effects health.

Renewing the focus on primary health care is crucial at a time of financial crisis. Primary health care stresses the importance of equity, solidarity, and gender. It is concerned with working towards universal coverage and the pooling of risk. It recognises that good health depends on access to clean water, sanitation, education, nutritious food, and many other factors -not just on health services alone.

Lastly, the financial crisis requires that the international health community ask some fundamental questions about the way we do business. We cannot afford duplication between different agencies. We must insist on co-ordinated modes of working that ensure maximum synergy among health programmes. The crisis has to be seen as a spur to reform of the UN development system, not a constraint. And, above all, we have to use this opportunity to make sure our joint efforts are aligned with countries’ priorities. It is they who face the toughest choices.

This crisis poses an enormous challenge to global health. But it also offers opportunities which we should not forego -to lay the foundations for more equitable and effective health systems in the future, and to rationalise and improve the way that international organisations work for the health of people throughout the world. (END/COPYRIGHT IPS)

(*) Margaret Chan is Director-General of the World Health Organisation (WHO).

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