Dr. Carissa Etienne Acceptance Speech on the Election to PAHO Director

September 19, 2012.

carissa_etienne Señor Presidente, Honorables Ministros, Honorables Embajadores, distinguidos miembros de la Organización Pan Americana de la Salud, Doctora Chan, Director General de la OMS, Doctora Roses, Directora de la OPS, Amigos y Colegas de OPS y OMS Saludos y muy buenos días.

As I approached this room today, my immediate emotion was thank God it is over. However, the reality is that it has only just begun! Today I am humbled. Humbled by the faith you have shown in me to lead this great Organization. For a woman from one of the smallest nations in the world to be elected to the helm of our distinguished and beloved PAHO is truly an honor and a privilege for me and my country, Dominica. I pledge to you that I shall do my best to live up to what I know are your high expectations.

This year we celebrate PAHO’s 110th birthday as the leading health agency of the inter-American system, and its 64th year as WHO’s regional office for the Americas. Throughout its long history, PAHO has played a seminal role in the health development of this Region, and remains uniquely placed to catalyze progress in advancing public health.

This is a time and an opportunity for renewal. Successful organizations must be able to simultaneously hold on to their proven core values and principles, and to innovate. Dr Roses has provided great vision and leadership for PAHO over the last 10 years. Many of you have given testimony to her achievements and I ask the Members of this august body to join me in congratulating her on a job well done. In succeeding Dr Roses, I bring to you a sense of excitement, of anticipation, about what is possible for us to do together in an ever-changing environment.

As the great Octavio Paz expressed so eloquently: América no es tanto una tradición que continuar como un futuro que realizar.

In my presentation to the candidate’s forum, in my campaign communications and individual meetings with many of you, I have presented what constitutes my vision for health in the Americas. While it is something of a mouthful, I take the opportunity to repeat it now:

Son las sociedades libres de la desigualdad, donde las personas tengan acceso a las determinantes sociales y medio ambientes saludables las que les permiten llevar una vida larga, digna, saludable y productiva. Esto incluye el acceso universal a los servicios de salud sin temor al empobrecimiento.

This vision is an encapsulation of the hopes and dreams that I have kindled during a career in public health spanning more than thirty years. And it is not dissimilar to your own aspirations for your peoples. It represents a synthesis of what I have heard from many of you, and I look forward to working with you to achieve it. While the vision consists of only two sentences, there is considerable work to do to make it a reality.

This work will require a full expression of the values many of us hold dear: universality, equity, and last but not least Pan American solidarity.

Despite the great advances made in the last decade, there remains much unfinished work from the landmark Health Agenda for the Americas 2008-2017 which set out eight priority areas for action that guide our work. If we are to achieve our health goals at the local, national and regional levels, we must work together in the spirit of solidarity that so characterizes our Region, sharing our knowledge with one another, and using our resources to serve those who need our help the most.

Campaigns can be divisive. At the same time, a rigorous campaign among strong candidates to lead PAHO is a good thing – it shows the importance of PAHO’s work, and highlights the major public health issues that our nations face today. I would like to commend the other candidates, great advocates for health in their fields of expertise.

Now that the campaign period is over, I hope that we can achieve unity in our efforts, that we will all pull together in solidarity to bridge barriers of language and geography.

Some people have called me a reformer, a change agent. I accept these titles and I hope to take PAHO forward in new and challenging directions, working hand in hand with PAHO’s able and dedicated staff. At the same time, I pledge never to forget that PAHO belongs to you, the Member States, and that I am your humble servant. You demand wise and transparent use of our financial resources, with full accountability to Member States and donors, and together with the PAHO Secretariat you have instituted various mechanisms to ensure these outcomes. We will work with you, our Member States to ensure full implementation and compliance.

Our region is strong. We now see political stability and economic prosperity in the Region at unprecedented levels. At the same time, there are millions of people, some of them in our wealthiest Member States, that do not have access to the social determinants of health or the health care they desperately need. Seventy -four million people live in conditions of extreme poverty. This is a reflection of the inequities that afflict many of our Member States and our region, and present a challenge to us all to strive for social justice, to ensure social inclusion, and to be proactive in addressing the needs of vulnerable and marginalized peoples. As Woodrow Wilson put it in his Inaugural address:

These are matters of justice. There can be no equality or opportunity, the first essential of justice in the body politic, if men and women and children be not shielded in their lives, their very vitality, from the consequences of great industrial and social processes which they can not alter, control, or singly cope

Health systems in the region are often segmented and fragmented, and funding mechanisms inadequate to ensure universal access for all. Infectious diseases continue to plague many of our citizens, while at the same time, non-communicable diseases place an increasing burden on individuals and health systems in countries across the economic spectrum. Violence, preventable injuries and mental health disorders hurt families and stress crucial public services.

All of this occurs in a context of increasing awareness of the importance of the social and economic determinants of health. Successfully addressing these challenges will require a strong multisectoral approach from PAHO, national governments and our health partners.

As we approach the 2015 mark, I am optimistic that in the post-MDG era there will be global agreement to work towards universal health coverage as a fundamental public health goal. Universal health coverage represents for me the spirit of Alma Ata in 21st century terms. It opens up a new opportunity to place people at the core of development, to ensure access to the determinants of health, including comprehensive health care, which is predicated on the needs of persons and communities and promotes their dignity.

PAHO has been a great facilitator and convener, enabling dialogue and a flow of information among the countries of the region. There is such a wealth of knowledge and information in our countries. The challenge is, how can we get the right information to those who can most benefit from it in the shortest time, in this Region and beyond. Many PAHO Member States have made great strides in improving their national capacity and attaining a high level of technical
expertise in a broad range of health fields. Building on this success, PAHO must work to find a new working model based on partnership, knowledge transfer, and collective leadership that brings to bear the “latest and greatest” methodologies, the “best and brightest” minds in order to confront and address our individual and shared public health challenges.

But all of this exciting work lies ahead of us. Today, I would like to thank the many individuals and governments that have supported me in my career thus far, and most recently in my campaign for Director. First and foremost I thank the Government and people of Dominica – we are a small island with a total population of seventy thousand and with only limited resources, but I have seen the untiring commitment of my countrymen as they have sought to place one of their own as the head of this esteemed institution. I am indebted to the Member States of CARICOM that united in 2011 to support Dominica’s candidature and have remained steadfast; the Caribbean will remain strong so long as it remains unified. Other governments in the Region have also given me great support. Mexico and Chile have adopted me as their own and I am deeply grateful. The member states of ALBA, the Bolivarian Alliance for the Americas, have been important to the realization of this day. I would like to make special mention of Colombia. As some of you may know, during the closing weeks of my campaign my husband suffered from a serious medical situation that Dominica’s health services were unable to handle. I was able to quickly organize his evacuation to Bogota, where he received world-class care at the Fundacion Cardioinfantil hospital. I am glad to say that he is doing well and is here in this room today. I thank him for his steadfast love and support over 36 years.

In addition to appreciating Colombia’s help and support in that difficult time, I believe this incident is an example of the new breed of effective cooperation and mutual support that links the countries of our region, and will ultimately make us collectively stronger as we seek to provide the highest quality care to all of our citizens. There are two ladies in this room without whom I would not be giving this speech now. One is Dr Mirta Roses, who invited me to PAHO as Assistant Director from Dominica, ten years ago. She has been a great mentor to me, and I hope that I can count on her continued advice and guidance in the coming years. The other is my DG, Dr Margaret Chan, who welcomed me to WHO as Assistant Director General for Health Systems. Dr Chan introduced me to the
world stage and has taught me many valuable lessons in how to lead and manage in an organization as complex as WHO.

To list all of those individuals who have helped in my career, during my studies and during my campaign would take some time and no doubt put some of you to sleep. Rest assured that then and now I value greatly your wisdom, support and friendship. Finally, I thank God who has made all this possible. I close as I started, humbly assuming the role you have seen fit to grant me. Pledging to work with each and every one of you as we carry PAHO into the next phase of its long and illustrious history.

Thank you, and may God bless you all.

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