Ladies and Gentlemen,
dear Transatlantic friends
If we could envisage one striking illustration of modern Norwegian-US bonds and ties suited for the 21 century - I would happily go for this very one; a gathering of dedicated people from science, government, university, public administration and business coming together to explore how knowledge, research, investment and wise policies can create a better future – for people, for communities, for society and indeed for the world at large.
I offer my sincere congratulations to the organisers of the Transatlantic Science Week – to MD Andersen Cancer Center for hosting us this morning, to Rice University and of course to the Royal Norwegian Consulate General. The Norwegian Ministry of Health is pleased to take actively part in this week. Thank you for making this 11th consecutive event possible – and thank you for lifting health to the centre stage.
Not many months ago our two countries gathered for a purpose with similar inspiration. Back in June I had the honour of sharing the podium with Secretary Hillary Clinton at the Oslo conference for global health. Our focus then was on what Norway and the United States can do together to lead global efforts to help save the lives of mothers and children.
Together we are leading a global effort to make a difference – and we are making headway; more children are being vaccinated, more kids grow up healthy, more mothers can deliver safely – and as a consequence – and I believe this is the essence of all health policy: more communities can develop and thrive to their full potential.
Secretary Clinton once wrote a book where she borrowed the title from the old African proverb – It takes a village to raise a child. We get her point. A safe childhood does not take place in a vacuum. It takes the effort and spirit of a community to secure the quality of life of any child.
The American public health pioneer Bill Phoege later elaborated and expanded on that same proverb when he said: It takes a whole world to immunize a child. Dr Phoege's point was to highlight the extraordinary effort it takes to move from research and innovation to delivery of a medical intervention: all the way from the elaborate search for a breakthrough in laboratories, through numerous clinical trials, and then on the last stretches through complex routes of transportation and everything it takes to get that immunization session organized – at a public health care station in downtown Oslo, here in Houston or somewhere in a rural district in Africa.
To me – this proverb encapsulates the very meaning of the Transatlantic Science Week which I am so proud to attend today. The foundation is the deeply rooted relationship across the Atlantic, spurred by those tens of thousands of women and men, including some of my own ancestors, who headed for the land of opportunity when life in Norway was exactly the opposite back in the 19th century.
And then followed decades where our relationship further deepened by generations creating new ties, matching their potential, complementing each other – like here at this very fine tradition of a science week where we come together to push new frontiers based on the most advanced insight, research and knowledge.
Ladies and Gentlemen,
I am proud to serve as Norway's minister of health since seven weeks, after having served as Minister of foreign affairs during seven years. In both positions I have had the opportunity to see how health offers perhaps the strongest illustration of interdependence and globalization. A pandemic flu originating in Mexico may lead to an effort of mass vaccination in Norway. More and more people and goods cross borders, so do viruses. New technological breakthroughs are rapidly available, if you can pay the cost.
Health Ministers experience very different political contexts around the world, depending on available resources – financial, human and technological. But looking at it from a distance, the challenges we face have very common roots.
The big picture is that we are gradually managing the threat from infectious diseases, more so in richer countries of course, as the burden from diseases such as HIV, TB and malaria and other tropical diseases continue to burden many countries with weak and fragile health systems.
But the big tide of change comes from the rise of non communicable diseases – from chronic life style conditions such as diabetes, obesity and lack of physical exercise – and from cancer, mental health, dementia and the needs of an ageing population.
This challenge comes to nearly each and every country, rich and poor, putting new strains on our health systems – challenging us to adapt and adopt suitable policies – based on experience, available resources – and of course: on knowledge and research.
One fundamental lesson from this knowledge is that we will need innovative approaches to public health challenges. Yes, there will be an ever growing market for new medicines, for new interventions, for new technology and for new instruments that can help address the need of known and unknown patient groups. Many of you present here today will help formulate demand and help develop the answers, and it is our ambition that collaboration between us will help spur that effort.
But let us include in our broad perspective the need to excel far better in the art of prevention, which includes every effort it takes to help people head off the burden of disease while it can still be prevented.
Let us focus and prepare far better on facing what I would describe an epidemic of non communicable diseases. Let us envisage what kind of mass mobilization for public health it will take, for the right individual choices when it comes to nutrition and physical exercise. And since these are challenges that go to entire societies it will also have to comprise of a mobilization for rethinking of public policies.
A key objective for me as Minister of Health is to ensure that scientific research and assembled knowledge will underpin the objectives of our policies. In short, our health and care services must be available, equitable and effective.
A real leap forward for securing high public health standards will depend on our ability, as a society, to prevent illness - or to detect illness early enough to increase the chances of curative treatment or other preventive measures. To help each individual make the right choices actions must be taken both at the community level – and across sectors. Our priorities must pull in that direction, so must our incentives.
Ultimately the state of our health relies on our individual choices. But in this effort governments must take a lead. Risk factors such as tobacco, obesity, diabetes and mental health must be addressed, using policy instruments at population level. National health systems must be strengthened and better tailored to face this epidemic, especially by being there for the most vulnerable – the youngest generations, whose choices in adolescent years may determine individual living conditions for a lifetime.
We who hold positions in public health - all of us – must take part in this advocacy. But we know all too well that this cannot be dealt with by the health sector alone. We need active involvement of sectors like urban planning, finance, industry, transportation, trade, education, culture and agriculture.
We need to focus our attention on the determinants for health, such as the social, physical, economical environment and individual characteristics and behaviours.
We need strong partnerships between national government and local government. The Norwegian Public Health Act tasks the municipalities to find their own measures to promote public health tailored to their specific needs. They are assisted by detailed public health profiles for each Norwegian municipality and each county, elaborated by the Institute of public health.
This is an example of how we are using knowledge to directly reinforce our public health work. This is knowledge about Norway. But it draws on methodology elaborated beyond our borders. National policies are greatly helped by global norms and standards. In fact, in complex political landscapes, national health policies will fail if they cannot relate to such international frameworks. That is a fundamental lesson from global health work since many decades.
To take but one example: Our efforts to implement and enforce tobacco legislation were boosted by WHO's Tobacco Free Convention. They would have been very vulnerable without that convention. Last week, a panel of experts from 120 countries agreed nine global targets for policies against non communicable diseases, to be adopted at the World Health Assembly next May. This will give us much needed cover as we adopt targeted policies against NCDs and help head off expected opposition from economic interest groups.
In short, we need to further deepen knowledge based health policies. We need advanced data from up dated and systematic population health surveys. Here Norway has a lot to offer. We are fortunate to have access to the acclaimed HUNT study from the county of Nord Trøndelag in Norway – detailed data assembled in three sequences since the 1980's until the present.
Norway also benefits from unique national health registries. Data from health surveys and national health registries provide leaders at the national and local level with important knowledge, allowing us to make evidence-based decisions. And such data help guide researchers from around the world in their search for new breakthroughs.
Norway has had – and will continue to have - a long-term commitment to health research and to the development of new knowledge within health. One immediate result of this investment has been the increase in the ratios of medicine and healthcare PhDs compared with all PhDs.
Today we have research activity in all our hospitals – as well as an increase in research productivity in our university hospitals. Year by year, more funding is allocated to research in health. Recent evaluations show an increase in the quality of health research, in particular in clinical research.
Ladies and gentlemen,
The health sector continues to push frontiers. We are treating more people in our hospitals each year and waiting times for treatments is going down. Treatments are becoming more technologically advanced and every year we are introducing individualized treatments as new knowledge is implemented in practice. This is an ongoing process.
The results are encouraging. We then need to move on and focus our attention. I wish to see a stronger emphasis on the quality of care – the quality of intervention – the quality of our services throughout the health sector. Here too our policies must be underpinned by solid research – including research on patient safety - and a generation of innovative knowledge on how to meet the modern challenges in the health sector.
Much is being done to improve quality of healthcare and patient safety. Shortly I will present a White Paper on Quality and Patient Safety - the first ever paper of its kind in Norway. It will give direction to the work to improve quality and patient safety.
A second white paper on digital services in the health and care sector will be presented in parallel. Information technology is a pivotal tool to improve quality and patient safety in the health sector.
Ladies and Gentlemen,
Modern health policies will have to strike many balances, between needs and constraints, offer and demand, people and technologies. The health sector is about people, and nothing can replace people in addressing the unmet health needs of other people. At the same time it is – as we know - a sector where progress is driven by technology.
A public health policy requires a strategy for managing these opportunities – often costly – offered by innovation. In particular we need a set of criteria to determine our priorities. This is no normal market. We cannot and will not leave it to the market to determine who will get what treatment at what cost. This is a task for democracy – on behalf of us all.
Improving quality will include exploring new technological opportunities. But innovations also have to be about how we organise and manage our services and resources.
So we need to keep emphasising the right mix of continuity of care and innovation in both technologies and methodology in the way we organize our work – in closer interaction with the patient. Here lies the key to improved quality.
Ladies and gentlemen,
Both Norway and the United States have that global outlook when it comes to knowledge. Our universities and research communities are firmly integrated into broad international networks.
We have experienced an almost 30 % increase of scientific publications from Norway with international collaboration in the period from 2003 to 2010 including at least one co-author from a US research institution. Similarly, 36 % of the Oslo University Hospitals international collaborations were with colleagues from the US. This I welcome.
Health research and research in information technology represent the largest of six research collaboration themes between Norway and the US. When it comes to health research, we have strong research collaboration within fields such as nutrition, epidemiology, cardiology, genetics, cancer, neurology and psychiatry. This too – and in particular – I welcome!
The highest increase in research collaboration between the US and Norway is seen in three university hospitals; St. Olavs Hospital in Trondheim, Oslo University Hospital and Haukeland University Hospital in Bergen – all represented here this week.
The collaboration between MD Anderson Cancer Centre and its sister institutions Stavanger University Hospital and Oslo University Hospital and the Cancer Registry of Norway is another good example. These collaborations have so far resulted breakthroughs in our understanding of cancer and numerous exchange programs for our scientists. Over the past few years, Oslo University Hospital has also referred several patients who need highly specialized treatment to the MD Anderson Cancer Center.
It is no surprise to the experts, but it needs to be mentioned: Not all research will immediately translate into cures, as the improvements resulting from the collaborative works will be incremental. Nevertheless, if we persevere, the resulting improvements will be real.
And let me bring back that global perspective where I started. Seen from a broader perspective, most countries – rich, middle income and poor face similar health challenges. But access to resources is not evenly distributed.
We are still faced with the 90/10 challenge – 90 per cent of research in health benefit the needs of 10 per cent of the world population, people like us, while 90 per cent of the world population have their specific needs addressed by only 10 per cent of the resources.
There is no quick fix to this. But it needs to be recalled and it needs to challenge us: how can better governance for global health help correct this? I hope The Lancet, University of Oslo and Harvard University study on global health governance will address this dilemma with fresh ideas.
In closing, let me thank Texas and Houston for convening us, and let me say that I have seen a lot that will help argue the case for a quick return.
Here is one reason among many: The Norwegian Consulate General in Houston recently initiated a pilot study to develop a strategy for the launch of a public private partnership between institutions in Texas and Norway, involving universities, health-related institutions, and companies focused on biomedicine and healthcare technologies. Another initiative aimed at bridging transatlantic partnerships through joint research projects is taking shape. In addition, the joint development and commercialization of novel and disruptive multi-disciplinary technologies could contribute to solve some of the most challenging issues in healthcare.
The proposed partnership, coined NorTeX, is an exciting initiative that will now be considered by the proposed partners. May the meetings and encounters resulting from this conference help strengthen this fine initiative.
I wish you an interesting, stimulating and result-oriented conference, in keeping with the TSW12 mantra: Making a Difference!