Heilbrigðisþjónusta meðal fátækra þjóða

Mr. Chairman, Regional-Director Dr. Luis Sambo, distinguished guests, ladies and gentlemen!

I would like to start by expressing my gratitude to our foreign guests who have travelled very far to come and share with us their experiences and knowledge. For us here such visits are truly important as they shed light on issues that we need to be well informed about.

It is for me a great honour to address this important conference on Health Care Services in Low-Income Countries. I am especially pleased that the conference is held under the auspices of the Ministry of Health, the University of Iceland, the Icelandic International Developmental Agency and the Primary Health Care Organization. This reflects the need for all of these institutions to take an active part in the discussions and to cooperate to the fullest. It is only with a broad view approach, that we can be effective in our work in this area.

Iceland now is among the most affluent countries, but not so many decades ago it was one of the poorest countries in Europe. Therefore, I think that our experience could give hope and even serve in a way as an example for countries on their way from poverty to a more sustainable economic development and welfare.  We are proud of many aspects of our health care system, as the Icelanders score very high on the most common measures of health of nations.  We are indeed willing to share our experiences, and this conference is one way of doing exactly that.

We do feel that we can contribute more than we currently do, and that we can do so in many different ways.  One of the approaches that I would like to discuss is the contribution of health care personnel.  We do have a highly trained staff here and their knowledge and experience can be useful. I am certainly of the opinion that our health care personnel can make a considerable contribution to the work that is needed to improve the situation in many low-income countries.

The World Health Organization devoted the World Health Day on 7 of April this year to the health workforce crises.  The attention was drawn to the fact that in many parts of the world, especially in the low-income countries, there is a chronic shortage of health workers, training, salaries, working environment and management.  This has lead to a severe lack of key skills, increased career switching and early retirement, as well as national and international migration.

The World Health Organization emphasized in its statement on the World Health Day that solutions to these crises must be worked out at local, national and international levels.  At the same time we should realise that there is no single solution to such complex problems, but ways forward do exist and must be implemented as soon as possible.  For example, some developed countries have put policies in place to stop active recruitment of health workers from severely understaffed countries.

However, this can be very difficult because the movement of health workers abroad has also had positive features.  Each year, migrant health workers send high sums of money back to low-income countries and one can argue convincingly that this has contributed to a decline in poverty in some of these countries.  Nonetheless, when significant number of doctors and nurses leave, the countries, that financed their education, lose a return on their investment and become unwillingly donors to the wealthy countries to which their health personnel have migrated.

Ladies and Gentlemen!

In this context I think that we need to emphasise the fact that poverty is the main determinant of health and health inequalities.  The initiative, by the late Director-General of WHO, Dr. LEE Jong-wook, to establish the Commission on Social Determinants of Health, was a very important step in the long-term process to improve health where most needed in the world.

It is important to focus on determinants of health and public health policies addressing relevant determinants, that breed inequalities and poverty related ill-health.  Both absolute and relative poverty are damaging to health. We have been looking at relative health more closely in the recent years, and it is clear that for example, single parent women and their children face bigger health risks, also in more affluent societies like the Nordic countries.

Many studies clearly demonstrate that financial barriers play an important role concerning access to health services.  Firstly, poor people may delay seeking care, because they cannot afford to pay for health services and therefore risk severe consequences.  Secondly, people may be forced to find alternative financial sources, i.e. by selling assets or taking loans and thereby getting into debt.  This definitely supports the view that the amount of service fees should always be limited.  The health system itself must never become one of the causes of poverty.

Mr. Chairman!

I strongly believe that we must create global solutions and secure proper investments in the developing world.  The Commission for Macroeconomics and Health for WHO, which was lead by Professor Jeffrey D. Sachs, estimated in 2002 what was needed to help poor countries to rise out of poverty.  They found that we needed ten cents on every hundred dollars of the rich world income for some time to come to make a difference.  I think we should take a closer look at that assessment, and that idea will probably be discussed here today.

Finally, I would like to extend again my welcome to all of you to this conference, and especially to those of you that have first hand knowledge of the topics at hand.  I do hope that this visit will be as fruitful and enjoyable for you as it will be for us, and I hope that you have the opportunity to see some of our country ….

I declare this conference open.

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