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Margaret Chan is a woman who needs little introduction. As WHO Director-General, her face is a fixture on news bulletins whenever there is a serious disease outbreak, drug safety issue, or food scare. But it was the less sensational—although some would argue more important—work that Chan and WHO are doing to promote universal health coverage that she was keen to talk about when she spoke to The Lancet.
Universal health coverage is, Chan says, “part of her DNA”, and has become an important part of WHO's agenda under her stewardship. After her appointment for a second 5-year term as Director-General in May this year, Chan used her speech to the World Health Assembly to issue a stern rebuke to those “bitter observers” who say that the financial crisis “derailed the best chance ever to alleviate poverty and give this lopsided world greater fairness and balance”. Instead, Chan argued that “the best days for health are ahead of us, not behind us”, in large part because of the critical momentum that has built behind the move towards universal health coverage.
The launch in 2010 of WHO's Health Systems Financing: the Path to Universal Coverage led to “more than 60 middle-income and low-income countries requesting technical assistance and advice to move towards universal health coverage”, Chan told The Lancet. She points to the “amazing achievement” of Mexico as a measure of what progress can be made. Universal health coverage is, Chan says, “the most powerful unifying single concept that public health has to offer, because you can realise the dream and the aspiration of health for every person irrespective of what class you belong to, whether you are a woman, or whether you are poor”.
Chan's commitment to universal health coverage has been shaped by personal experience. Born in 1947 and brought up in Hong Kong under British rule, Chan says she “benefited from a similar system to the National Health Service in the UK”. Her mother, she says, was very “liberal minded”, and always told her to “follow her heart”, but it was following her “childhood sweetheart” (now her husband, David) that led her into medicine. After working as a teacher, Chan followed David to Canada and the University of Western Ontario in the early 1970s, where he was to study medicine. There, Chan was delighted to win a place to train in a Canadian health system already on the last leg of its journey towards universal health coverage.
At around the same time, WHO's then Director-General Halfdan Mahler launched the Health For All by 2000 movement, which was to prove a major source of inspiration for Chan. Mahler was a “visionary”, she says, and he would later reflect privately to Chan that the biggest mistake that the movement made was that they attached the year 2000 to it. Chan explains that if universal health coverage “is such a just thing to do, a fair thing to do, then why would we stop at the year 2000? [Mahler] said that the movement is eternal, and I totally agree”.
In 1978, Chan returned to Hong Kong to take up a post as Medical Officer for the department of maternal and child health, and what was to be one of the most “interesting and happy times” of her career. “I learned the human side of things”, she recalls. “How to work with nurses, to serve parents and families and take care of them, learn their stories. I was famous as a young doctor for always running behind time because I get so interested in people.” It wasn't long before an astute boss spotted Chan's potential, and urged her to go to the National University of Singapore to study for a masters degree in public health. On her return from Singapore, Chan was put in charge of planning maternal and child health services for Hong Kong. She didn't disappoint, and rose steadily through the ranks until, in 1994, she was named the first ever woman to become Director of Hong Kong's Department of Health. There, her assured handling of the outbreak of H5N1 avian influenza, in 1997, and severe acute respiratory syndrome, in 2003, brought her to international prominence. An offer of a job at WHO soon followed, and she was appointed Director-General in 2006.
In terms of economics, the contrast between then and now is stark. A burgeoning global economy has given way to austerity and Chan acknowledges that WHO is “undergoing funding difficulties”, yet she remains firm about the push towards universal health coverage. Anne Mills, Vice Director of Academic Affairs at the London School of Hygiene and Tropical Medicine, “strongly applauds” Chan's promotion of universal health coverage, but argues that “there needs to be much greater thought on how WHO can support country efforts”, warning that “the worst possible outcome is that universal health coverage is yet another slogan that is here today and gone tomorrow”. For Chan, at least, there seems little danger of that, and she is encouraged by the continued emergence of the political will to make universal health coverage a reality. “This May in the World Health Assembly I encouraged ministers from the world to debate on universal health coverage, and I was really touched; more than 80 countries spoke on the subject in favour of universal health coverage”. Importantly, Chan explains, it is political will born of pragmatism. “I truly believe that without health you cannot support your own personal development, you cannot support your family, and you cannot support your country”, she says. “And that's why universal health coverage is even more important at a time of financial crisis, at a time when the poor are most vulnerable.”