C^Fe) World Health Organization ^^^^ Organisation Mondiale De La Santé

C^fe) World Health Organization ^^^^ Organisation mondiale de la Santé

:ORTY-NINTH WORLD HEALTH ASSEMBLY A49/VR QUARANTE-NEUVIEMQUARANTE-NEUVIEME ASSEMBLEE MONDIALE DE LA SANTE 20 May 19199Í 6 20 mai 19199S 6

PROVISIONAL VERBATIM RECORD OF THE FIRST PLENARY MEETING

Monday, 20 May 1996，at 10:00 Palais des Nations, Geneva

Acting President: Dato Dr Haji Johar NOORDIN (Brunei Darussalam)

COMPTE RENDU IN EXTENSO PROVISOIRE DE LA PREMIERE SEANCE PLENIERE

Lundi, 20 mai 1996’ à 10h00 Palais des Nations, Genève

Président par intérim : Dato Dr Haji Johar NOORDIN (Brunei Darussalam)

CONTENTS

Page

1. Opening of the session 3 2. Address by the Director-General of the United Nations Office at Geneva 3 3. Address by the representative of the Conseil d'Etat of the Republic and Canton of Geneva 5 4. Address by the Acting President 6 5. Appointment of the Committee on Credentials 7 6. Election of the Committee on Nominations 8

SOMMAIRE

Page

1. Ouverture de la session 3 2. Allocution du Directeur général de l'Office des Nations Unies à Genève 3 3. Allocution du représentant du Conseil d'Etat de la République et Canton de Genève 5 4. Allocution du Président par intérim 6 5. Constitution de la Commission de Vérification des Pouvoirs 7 6. Election de la Commission des Désignations 8 A49/VR/1

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 8 July 1996.

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 8 juillet 1996.

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 8 июля 1996 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 8 de julio de 1996.

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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。本记录属临时性质，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19%年7月8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。 A49/VR/1

1. OPENING OF THE SESSION OUVERTURE DE LA SESSION

The ACTING PRESIDENT:

The Assembly is called to order. Distinguished delegates, ladies and gentlemen, as President of the Forty-eighth World Health Assembly I have the honour to open the Forty-ninth World Health Assembly. I now have much pleasure in welcoming on behalf of the Assembly and the World Health Organization Mr Vladimir Petrovsky, Director-General, United Nations Office at Geneva; Mr Guy-Olivier Segond, Councillor of State, Chief of the Department of Social Action and Health of the Republic and Canton of Geneva, representing the Geneva authorities; Mr Walter Gyger, permanent representative of Switzerland to the international organizations at Geneva and permanent observer to the United Nations; Mr Pierre Muller, Administrative Councillor for the City of Geneva; Mr Peter Schatzer, Director, External Relations, International Organization for Migration; Mr Carlos Fortin, Deputy to the Secretary-General of UNCTAD; Mr Eric Roethlisberger, Vice-President, International Committee of the Red Cross; Mr Steve Davey, Deputy Director, International Federation of Red Cross and Red Crescent Societies; the representatives of the United Nations specialized agencies, and the representatives of the various United Nations bodies; and the delegates of Member States. I also welcome the observers of non-Member States, the observer from Palestine and the observer from the International Committee of the Red Cross; and the representatives of intergovernmental and nongovernmental organizations in official relations with WHO. I also welcome among us the representatives of the Executive Board.

2. ADDRESS BY THE DIRECTOR-GENERAL OF THE UNITED NATIONS OFFICE AT GENEVA ALLOCUTION DU DIRECTEUR GENERAL DE L'OFFICE DES NATIONS UNIES A GENEVE

The ACTING PRESIDENT:

I now have much pleasure in giving the floor to Mr Petrovsky, Director-General of the United Nations Office at Geneva, and representing the Secretary-General.

Mr PETROVSKY (Director-General of the United Nations Office at Geneva):

Mr President, Mr Director-General of the World Health Organization, Excellencies, ladies and gentlemen. I would like to begin by expressing my pleasure in addressing this distinguished Assembly of the World Health Organization, and to convey to you the good wishes of the Secretary-General of the United Nations, Mr Boutros Boutros-Ghali, for the success of your work. It is evident that the present international agenda, characterized by the growing interdependence of the world economy, is fluid and uncertain. The concepts of the past have lost much of their relevance. Past methods of operation provide little guidance as we search for a new stable and equitable international order. Today cooperative international action is more than ever needed to address a widening set of problems related in particular to the increasing impact of globalization and to the fragmentation which is provoking an upsurge in confrontation and conflict. In his recent address to the Ninth United Nations Conference on Trade and Development in Midrand, South Africa, the Secretary-General of the United Nations stated, "Globalization brings progress. It should be encouraged but dangers remain. The global economy can be hard on those unable to benefit from its opportunities. Traditional ties of community and solidarity can be undermined. Whole countries and regions can become marginalized. So the gap between rich and poor grows ever wider". A49/VR/1

I quote the Secretary-General's remarks because of their relevance to this World Health Assembly and to its themes - "fighting disease, fostering development". Reflecting on this issue, it is worth noting the enormous efforts of the international community in promoting a new and comprehensive vision of development. At the Rio conference in 1992，and especially the World Summit for Social Development in Copenhagen in 1995, great advances were made toward the recognition that economic growth is necessary but not sufficient for overall and sustainable development. In this context, United Nations conferences and summits have become an essential mechanism for bringing together all the relevant State and non-State actors to focus on issues of global importance and to generate agreements and specific commitments that provide a comprehensive framework for further international development cooperation. The United Nations Conference on Human Settlement, Habitat II will be held in Istanbul in June this year. More than 150 countries as well as local authorities, private sector companies, nongovernmental organizations, groups of women and youth are actively engaged in preparatory activities for the conference. It is hoped that they will have the foresight and political will to give shape to a new urban world. Hundreds of millions of people are now living in decaying urban areas that are detrimental to their health and even endangering their lives. By the end of the century more than half of the developing world's population will be living in cities and thus exposed to major health hazards. In the circumstances, WHO's Healthy Cities programme is welcome as an important contribution to the Conference on Human Settlements and for its aim of calling on local governments and community associations to form coalitions for improving urban health and solving environmental problems in over 1000 cities around the world. The summit in Istanbul holds out the promise that Habitat II will not be a conference that only dwells on problems - it should also provide solutions. It will hopefully be creative and workable and will motivate the world to make sustainable human settlements the rule and not the exception in the coming century. The world now is in transition and the most apparent feature of this process is that the policies of nations and groups have perhaps never been as greatly influenced by the new economic tendencies and developments as at present. The international community is increasingly obliged to deal with the problems of development, including health development, in a world which is being torn asunder by new conflicts arising from fragmentation. These conflicts are taking place not so much between states as within nations. Every day the institutions of the United Nations family are called to act in conditions of civil wars, secessions, partitions, ethnic confrontations and tribal battles. In this regard WHO provides an important contribution to such activities as violence and injury prevention and the prevention of substance abuse, with particular focus on population groups most at risk, such as women, the elderly and migrant workers. WHO is already engaged in the process of updating its mandate and responsibility in the field of emergency and humanitarian action. In response to the United Nations Economic and Social Council resolution of 28 July 1995 on further improvement in the coordination of emergency humanitarian assistance, agencies and bodies of the United Nations system have continued to develop their capacity for humanitarian response in order to cooperate more effectively with governments in dealing with the impact of emergencies. Against this background, it is important to note that WHO has reinforced its coordination mechanism and reaffirmed the Organization's functions, which include responsibility for the assessment of emergency health needs, provision of necessary technical guidance, monitoring and coordination of emergency assistance, and training of national staff in emergency preparedness. Preparedness and prevention activities are an integral part of emergency response. What appears commendable in WHO activities is that the Organization not only provides an indispensable front- line presence in critical situations, but also works at the grassroots level, within the framework of the United Nations system, for a comprehensive and integrated approach to emergency reductions. WHO pursues its activities in close cooperation with governments at national and regional levels through WHO regional offices and country representatives, as well as with other international and interregional organizations concerned. In the fight for achieving health for all with the participation of all, WHO emphasizes in The world health report 1996 the diseases that are the world's leading causes of death. Combating these diseases is crucial to fostering social economic development, and the failure to win control would have catastrophic consequences in terms of delayed development and unacceptable continuation of human suffering. It is an abnormal situation that half of the world's population lack regular access to treatment for common diseases and to most essential drugs. This is why health has emerged as a leading concern in all countries and as a major policy issue for all governments. Continuing conditions of poverty and distress can only exacerbate international tensions. A49/VR/1

I am firmly convinced that WHO, in order to be the health conscience of humankind, should build its health and social development policies on the basis of justice and equity, which are the most powerful instruments for promoting peace, political consensus and social cohesion. In conclusion, let me express my best wishes for the success of the Forty-ninth World Health Assembly, and I thank you very much for your kind attention.

The ACTING PRESIDENT:

Thank you, Mr Petrovsky.

3. ADDRESS BY THE REPRESENTATIVE OF THE CONSEIL D'ETAT OF THE REPUBLIC AND CANTON OF GENEVA ALLOCUTION DU REPRESENTANT DU CONSEIL D'ETAT DE LA REPUBLIQUE ET CANTON DE GENEVE

The ACTING PRESIDENT :

I now would like to call Mr Guy-Olivier Segond, who will address the Assembly in the name of the federal, cantonal and municipal authorities of Switzerland.

M. SEGOND (représentant du Conseil d'Etat de la République et Canton de Genève):

Monsieur le Président, Monsieur le Directeur général, Mesdames et Messieurs les délégués, Excellences, Mesdames et Messieurs, à l'occasion de l'ouverture de la Quarante-Neuvième Assemblée mondiale de la Santé, j'ai le plaisir et l'honneur de vous souhaiter, au nom des autorités fédérales et au nom des autorités locales, une très cordiale bienvenue à Genève. Dans quelques semaines, le 22 juillet, nous fêterons le cinquantième anniversaire de la signature de la Constitution de l'Organisation mondiale de la Santé. En cinquante ans, depuis la fondation de l'OMS, le monde a bien changé politiquement, économiquement et socialement. Après l'effort de reconstruction qui a suivi la Seconde Guerre mondiale, après les luttes de libération nationale, et après l'indépendance de nombreux nouveaux Etats, la rivalité Est-Ouest a été progressivement remplacée par la dynamique Nord-Sud. La globalisation de tous les problèmes a bouleversé le cours ordinaire des choses et, grâce au prodigieux développement des nouvelles technologies de la communication, le monde est devenu un. Chacun le sait et chacun le voit : ces dernières années, de formidables forces de changement sont nées. Les attitudes politiques et culturelles à l'égard de l'Etat se sont profondément modifiées. D'importants problèmes démographiques et sociaux liés aux migrations, au vieillissement et à l'exclusion se sont développés. Partout dans le monde, il y a des mouvements amples et puissants en faveur d'une réforme des systèmes de santé. L'Organisation mondiale de la Santé a pris sa part de ces grands changements mondiaux. Ainsi, la Conférence OMS d'Alma-Ata en 1978 n'a pas seulement défini les objectifs de la santé pour tous en l'an 2000; elle a aussi imposé le passage d'un système de santé centralisé, privilégiant la pathologie urbaine, à une pratique communautaire de soins de santé primaires. Grâce à l'amélioration de l'accès aux soins de santé primaires voulue par la Conférence d'Alma-Ata, les taux de mortalité infantile ont baissé dans la plupart des pays pendant que l'espérance de vie à la naissance augmentait régulièrement. Mais là aussi le temps a passé : de nombreux pays qui n'étaient pas en 1978 à Alma-Ata sont devenus des Etats; de nouvelles technologies, de nouveaux modes d'intervention ont vu le jour, et une nouvelle génération de professionnels de la santé a pris la relève. Comme le montre le rapport annuel de l'OMS, plusieurs facteurs déterminants de la santé 一 qu'ils soient environnementaux, sociaux, politiques, économiques, démographiques ou épidémiologiques - ont affecté le profil sanitaire des populations. Plusieurs problèmes de santé spécifiques vont croissant tels que, A49/VR/1

par exemple, la résistance aux antimicrobiens, la mortalité liée au tabac, et le VIH/SIDA. Enfin, dans trop de pays encore, les inégalités concernant l'état de santé continuent de s'élargir en fonction du niveau de développement et des classes sociales. Cette situation n'est cependant pas désespérée : comme l'a montré la Fondation Health on Net, récemment établie à Genève, des pays et des communautés pauvres, notamment en Afrique, pourront en dépasser d'autres en profitant des nouvelles techniques de communication pour améliorer la santé de leur population. Au-delà, pour concrétiser la vision d'une politique de santé mondiale fondée sur l'équité et la solidarité, il faudra certainement instaurer des partenariats nouveaux et importants, peut-être en s'inspirant du modèle proposé par l'ONUSIDA. Opérationnel depuis le début de cette année, l'ONUSIDA est une nouvelle entreprise des Nations Unies destinée à mettre en place une action internationale concertée visant à aider les populations du monde entier à faire face à l'infection à VIH/SIDA qui touche plus de 6000 nouvelles personnes chaque jour. Programme commun de six organismes des Nations Unies, cette nouvelle entreprise de l'ONU tire profit de toute la somme d'expériences et d'activités de l'OMS, naturellement, mais aussi de l'UNESCO, du FNUAP, de l'UNICEF, du PNUD et de la Banque mondiale. Pour que l'effort commun de ces six organismes soit suffisamment ample et énergique, coordonné et efficace, il est nécessaire que l'ONUSIDA bénéficie de toutes les synergies que peut offrir Genève, siège mondial de l'OMS, mais aussi siège du Centre pour les Droits de l'Homme et du bureau du Haut Commissaire aux Droits de l'Homme. En effet, le SIDA n'est pas seulement un problème de santé, c'est aussi un problème de droits de l'homme, car les personnes atteintes du SIDA doivent pouvoir vivre et se soigner comme tout le monde. Au-delà de sa mission - relever, pour le monde entier, le terrible défi du SIDA -, l'ONUSIDA incarne aussi un nouveau type d'action collective qui peut avoir d'importantes conséquences sur la nature et l'ampleur des réformes que les gouvernements envisagent d'apporter à l'ensemble du système des Nations Unies. Pour ces différentes raisons, la Suisse et Genève - qui recevra en 1998 la Conférence mondiale sur le SIDA - prendront toutes les mesures nécessaires pour accueillir l'ONUSIDA sur leur territoire, dans les meilleures conditions possibles. Enfin, en conclusion, je remercie l'OMS et son Directeur général, M. Nakajima, de toute leur activité, et je vous souhaite, à vous tous et à chacun et à chacune, d'excellents travaux consacrés à la seule cause qui importe : le progrès de la santé pour tous à travers le monde.

The ACTING PRESIDENT:

Thank you Mr Segond.

4. ADDRESS BY THE ACTING PRESIDENT ALLOCUTION DU PRESIDENT PAR INTERIM

The ACTING PRESIDENT:

Your Excellencies, Honourable Ministers, Ambassadors, distinguished delegates, Director-General, ladies and gentlemen, in my opening address last year, I attempted to point out some windows of opportunity that were opened to the World Health Organization in its effort to meet the challenges resulting from global, political, economic, social and, particularly, health changes. You will also remember that, since May 1992, WHO has embarked on a reform process aimed at adapting its role and structure to the realities of today. These reforms and their implementation represent for WHO a meaningful change in management culture. They symbolize a desire for a new and hopefully a better way of improving the quality of life of all peoples everywhere. They signify the determination of the World Health Organization to achieve its goal of health for all amidst the enormous challenges of today. In 1995, WHO published The world health report which portrayed a state of health and a quality of life that required more serious attention, for it told the continuing sad story of peoples everywhere struggling A49/VR/1

for freedom from suffering and abject poverty and from lingering diseases. Gaps were identified and ways of bridging these gaps were suggested and prescribed. In my closing address to the Health Assembly last year, I attempted to describe a new health agenda by calling for help to construct bridges. I solicited your cooperation, I urged your commitment, I pledged my own support so that the renewed mission of WHO would be fulfilled. At the ninety-seventh session of the Executive Board in January this year, Dr Nakajima, Director-General of WHO, defined this mission as a means of achieving health for all with the participation of all based on the principle of justice, equity and solidarity. He said, "Its mission should be to support Member States in formulating, implementing and evaluating health policies to ensure technical cooperation with Member States to help them build and strengthen their own capacity for health development; to set ethical and technical standards in support of national health policies; to ensure global accountability for health including strategy, monitoring and evaluation; to collect, validate and disseminate information on health- related research, products and activities; and to ensure the effective promotion and coordination of international health work including resources, mobilization and creation of health partnerships in support of health for all". Amidst this renewed mission, a more immediate need is to confront the financial crisis of our Organization. I cannot over-emphasize the gravity of this crisis, but there must be a rational solution. You and I share the burden to search and offer a solution that can ensure the accomplishment of our mission. Today, as I open this Forty-ninth World Health Assembly I would like you to'reflect on how we can ensure this achievement, the achievement of this mission and what our expectations are between now and the end of this century and beyond. The real test of our collective efforts will be measured by the impact of the achievements gained as a result of the reform process. I would like to hope that the reforms taken by the World Health Organization will lead to an acceleration of the progress made in national capacity-building, to enhance the capacity of our Organization to deliver its leadership role in the field of health, to attain our common goal of health for all. May I therefore count on your commitment to make use of the windows of opportunity, to ensure the completion of the reform process and to carry forward WHO's mission? Thank you. I shall now suspend the meeting briefly to allow our distinguished guest to leave.

5. APPOINTMENT OF THE COMMITTEE ON CREDENTIALS CONSTITUTION DE LA COMMISSION DE VERIFICATION DES POUVOIRS

The ACTING PRESIDENT:

The meeting is now resumed. We now come to item 2 of the provisional agenda: "Appointment of the Committee on Credentials". The Assembly is required to appoint a Committee on Credentials in accordance with Rule 23 of the Rules of Procedure. In conformity with this Rule, I propose for your approval the following 12 Member States: Austria, Botswana, Cape Verde, Estonia, Federated States of Micronesia, the Islamic Republic of Iran, Jamaica, Kenya, Malta, Myanmar, Syrian Arab Republic, and Venezuela. Are there any objections? If there is no objection, I declare the Committee on Credentials, as proposed by me, appointed by the Assembly. Subject to the decision of the General Committee, and in conformity with the resolution WHA20.2, this Committee will hold its first meeting on Tuesday, 21 May, in the afternoon. A49/VR/1

6. ELECTION OF THE COMMITTEE ON NOMINATIONS ELECTION DE LA COMMISSION DES DESIGNATIONS

The ACTING PRESIDENT:

We now come to item 3 of the provisional agenda. "Election of the Committee on Nominations". This item is governed by Rule 24 of the Rules of Procedure of the Assembly. In accordance with this Rule, a list of 25 Member States has been drawn up, which I shall submit to the Assembly for its consideration. May I explain that, in compiling this list, the following distribution by Region has been applied: African region, six members; Americas, five members; South-East Asia, two members; Europe, five members; Eastern Mediterranean, four members; and Western Pacific, three members. I therefore propose to you the following Member States: Albania, Algeria, Bahrain, Benin, Bolivia, China, Cyprus, Democratic People's Republic of Korea, Djibouti, Ethiopia, Finland, France, Lesotho, Mauritius, Mexico, Nepal, Panama, Republic of Korea, Russian Federation, Saint Lucia, Samoa, Senegal, United Kingdom of Great Britain and Northern Ireland, United Arab Emirates, and Uruguay. Are there any observations or additions to the list? In the absence of observations, I declare the Committee on Nominations elected. As you know, Rule 25 of the Rules of Procedure, which defines the mandate of the Committee on Nominations also states that the proposals of the Committee on Nominations shall be forthwith communicated to the Health Assembly. The Committee on Nominations will meet at 11:00. The next plenary meeting will be held this afternoon at 13:00. The meeting is adjourned.

The meeting rose at 10:45. La séance est levée à 10h45.