Nils Daulaire’s speech

Linked with Nils Daulaire – USA, and with Global Health Council.

29th annual Conference, 28-31 May, 2002, Washington DC

Keeping a candle burning is no small thing. Not when the winds howl and the waters rise. It takes courage, optimism, love, perserverance.

Global health in times of crisis is more than a title, a slogan. It is our charge, it is what we are here for.

Wei-ji, the Chinese character for crisis, encompasses two powerful symbols: danger and opportunity. Let us not romanticize or trivialize the danger that faces us, or minimize the courage needed to meet it. As C.S. Lewis said, courage is not simply one of the virtues, but the form of every virtue at its testing point, which means at the point of highest reality. We are a community that places at the center of our values human life and human dignity. If we were to allow that commitment to be tempered by danger, to turn away until it is safer to act, then this would be a value subject to conditions; it could be bargained away. So courage is required of all of us, simply to fulfill our reasons for following our calling. This is part of our charge.

We celebrate the courage on behalf of health and dignity shown in the face of danger by Dra. Merida’s father, by our friends and colleagues whose names you have just seen, and the many more like them. They are just a small selection. Like the rescue workers at the World Trade Center on the morning of September 11, these are true heroes who rush in to places from which others are rushing out.

We have heroes here in our midst today. People like Dr. Cynthia Maung, winner of the 1999 Jonathan Mann Award for Global Health and Human Rights, who has operated her clinic for Burmese refugees on the Thai border in the face of repeated attacks from the military junta that forced her from her native land; for the very first time, she has been free to come to the United States and we are honored to have her here with us today. Like Salah Haj Yehya, one of this year’s Mann Award winners, an Arab Israeli who has with his colleague Dr. Ruchama Marton operated mobile clinics across the closed borders of the West Bank at a time when even health workers are considered legitimate targets. Like Nitin Madhav, who lost his leg and whose three colleagues lost their lives in a militia attack against their efforts to provide health care to the victims of the Rwandan genocide.

The danger is real for public health workers who rush in to help.

True courage is not ignorance of danger, it is action taken in the full understanding of danger. Courage knows no nationality, no single faith, no special beneficiaries. It is the true act of healing. This room and the communities all of you here represent is full of such examples. The world, it seems, provides us with a seemingly endless and still expanding set of dangers to face in the name of health and human dignity.

We have seen what has happened to health conditions in places subject to prolonged conflict – Afghanistan, Sierra Leone, Somalia, and until recently East Timor. And we see with ominous foreshadowing what could happen if the current unstable and threatening conditions continue along their current dangerous path in previously peaceful havens such as Madagascar and Nepal; already public health conditions are deteriorating there. And women and children are suffering first. We also face the potential for the greatest public health catastrophe in the history of the world if today’s saber-rattling between India and Pakistan were to lead to a nuclear exchange.

What is the role of the global health community in this dangerous world? Response, certainly. This community represents the emergency response mechanism of global health in times of crisis, and over the coming days we will hear from some of the world’s leading experts in the field how our work can be made even more effective. But our obligation and our special contributions go far beyond response. Our work is the hard work of the world, the polar opposite of those who seek to divide, to instill hatred, to destroy. Our job is to rescue, to restore, and to rebuild.

But we are also public health workers, and the first obligation of public health is to prevent. If an epidemic of hatred, sectarian strife and violence threaten global health, we are called to be on the front lines. Raising the alarms, naming the challenges to health and dignity, calling on the conscience of the world as well as its sense of self-preservation to make the world a safer place for all our children.

Our voices must be heard.

Global health in times of crisis. While violent conflict is often seen to be synonymous with crisis, you in this hall know all too well that we face a crisis of health itself. No single violent conflict in history has taken the lives of sixty million victims, yet one microscopic virus alone, unknown barely two decades ago, has already exceeded that toll in deaths and infections. HIV/AIDS needs no introduction to this audience, but we will learn more about it in the coming days. Unless something significant is done to change its course, by the end of the first decade of this twenty-first century AIDS will have claimed more victims in one single generation than all the wars of the twentieth century put together.

And who is called on to change its course? You are, the people in this hall and the communities you represent – researchers, practitioners, policymakers, and advocates. Just over a week ago on May 19, in over 1800 communities around the world, more than a million people came together for the International AIDS Candlelight Memorial, another lighting of candles of remembrance and commitment for those who have fallen victim to this scourge. Many of you participated, and brought your friends and neighbors into the expanding embrace of those dedicated to turning the tide on AIDS. Meeting illness and suffering with care, and meeting the virus itself with effective barriers to its onward spread. Responding and preventing.

Pestilence was one of the ancient horsemen of the apocalypse, but today it rides a second mount. Not only must we face the natural causes and dynamics of infectious disease, we must find ways to address its new challenges now that it has entered into the armamentarium of war and of terror. Yesterday, many of you spent the day in the Hart Senate Office Building as part of the Global Health Council’s Advocacy Day; only a few months ago, that building was closed and sealed because of the anthrax spores set loose there. And one of the great triumphs of global health, the eradication of smallpox, has emerged as a potential weapon of mass destruction.

Who suffers most in these crises, man-made or natural? The weak, the powerless, the disenfranchised. Children, women, the infirm. They are the first to suffer and suffer the most in times of crisis.

Yet in responding to new crises, we must not contribute to another by forgetting that over 10 million children and more than a half million women continue to die needlessly each year, not from any new threat but from age-old challenges – childhood disease and unsafe pregnancy – that we already know how to address but upon which we have not yet adequately acted. This is truly a crisis of conscience: that we know what to do and yet the world has not yet taken the actions needed to end this suffering.

War and conflict feed on misery. Ill health is not just a consequence of crisis, it is one of its root causes. This has been well-documented by hard-nosed international security analysts. And so our work in preventing conflict must reach down to the deepest traditions of our calling. Global health is the medicine the world needs, especially in times of crisis.

And in this comes the other side of the Chinese symbol for crisis, wei-ji: Opportunity.

Because the crises we face provide us with the opportunity to place global health squarely at the center of humankind’s endeavors. Just a few short years ago, the only ones talking about global health were those of us traditionally committed to health services for the poor and underserved. Today we have economists, national security experts, businessmen, politicians, even rock stars calling for investments and improvements in global health. We welcome their conversion and their support.

Three years ago we called for a doubling of U.S. investment in global health, from one to two billion dollars a year, as a down-payment on America’s responsibilities to the world. Hopeless optimism, we were told, in an era of budget downsizing. Today that two billion has become a budgetary reality, and we have set our sights higher yet.

Opportunity.

The threat of bioterrorism has finally opened everyone’s eyes to the vital needs of public health systems to detect and respond to disease. Suddenly, funds that had not been possible have been mobilized overnight to support health infrastructure here in the U.S. and around the world.

Opportunity.

We did not need AIDS to teach us that women should have the power to decide the terms of their sexuality; yet in a world of AIDS, that empowerment is now recognized as essential to survival. We did not need AIDS to show us that health systems in the poorest of countries needed to be strengthened to reach out to the neediest; yet in a world of AIDS, those systems are essential if the promise of care is ever to be delivered. We did not need AIDS to tell us that pregnant women should receive prenatal care and trained assistance with their deliveries; yet in a world of AIDS, those services are essential if we are to prevent the infection of their newborns.

So in many places and many ways, the crises of global health have opened the doors of opportunity, not just to address the immediate issue at hand, but to fundamentally change the dynamics of global health.

After all, our charge is to maximize life, in all it wonder and complexity. To do that, courage is needed, of course. But also optimism, love, and perserverance.

That is what this meeting is about. Over the next three days you will hear from experts in the field, front-line workers, and leaders of the world community. I ask you to welcome and embrace the many new friends you will make and the many new ideas that will suffuse our very air. Share with us the Global Health Council’s ABCs of global health: advocacy, building partnerships, and communicating experiences.

Welcome to the Global Health Council’s 29th annual international conference (2002).

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