What do you consider to be WHO's most immediate priorities as we move into the next millennium?

As I said in my speech to the World Health Assembly when I was elected - given certain basic assumptions of the role and the importance of WHO, and the value and outcomes we can achieve and help countries to achieve - I said, on this basis, my priority is WHO. Why did I say that: because of our ability, through renewal, and the use of our 3,500 staff members working together in the best possible way to reach out to others and to be better advisers and supporters of the efforts on the ground, at the country level.

That is what I think is my first obligation as the new Director-General. It is seeing to it that we are making a difference towards attaining the goal of "Health for All", and that we are doing this together - qualifying, training and making a more transparent and accountable organization that can measure results in a better way.

The concern about the transition from communicable to non-communicable diseases is a recurring theme in WHO's publications. What is meant by that and what will be the impact of such a transition on the provision of health care and WHO's priorities?

Historically, the activities of WHO, naturally, were strongly focussed on the terrible burden of infectious diseases around the world. This is still the case. We continue to face re-emerging diseases like tuberculosis, new diseases like HIV/AIDS, and an increase in the incidence of malaria in certain countries. Therefore, the unfinished agenda of communicable diseases is still with us.

Although we eradicated small pox, which is a success story, broadly speaking, the whole challenge of communicable diseases will be with us into the next century. But, in addition, increasingly the non-communicable diseases C cancers, heart disease, diabetes C are on the rise. And that is occurring not only in the North, in the developed countries, but is happening all over the world, in the developing countries as well. So we have to focus on preventing the increase in the incidence of these lifestyle diseases.

We refer to these developments as the double burden of disease. That double burden will, 10 or 20 years from now, be greatest in developing countries because they will still have to struggle with communicable diseases, with poverty and with new diseases like HIV/AIDS. And, in addition, they will face the costly scenario of the non-communicable diseases, with people requiring expensive treatment which will burden the health systems and be an excessive and added burden on society. Therefore, we must focus on prevention.

In that regard, when I call for the "Tobacco Free Initiative", it is because I see an increasing consumption of tobacco in the developing world more than anywhere else. And when I see the 3.5 million tobacco-related deaths, which is the present picture, and I am aware that 15 years from now there will be 10 million deaths and that all of that increase is going to be in the developing world, I realize that this is a great burden of disease and mortality for developing countries. So it has to be taken seriously and we have to try to convey the message about the dangers of starting smoking. Most people start when they are young, long before they are 18 or 20, and can make their own deliberate decisions with the knowledge of the dangers of it. And, of course, smoking contributes to cancers and adds to the burden of heart disease.

Is there any concern for the fact that once you take on the issue of tobacco so forcefully you are taking on the powerful tobacco interests around the world?

I have an obligation to look at the burden of disease and the threats to public health, and to healthy communities and populations, which is my agenda, and to do whatever is necessary to make a difference. I cannot avoid addressing the tobacco issue when it may, 15 years from now, move up the ladder to become the biggest burden of disease globally.

"Health as a human right" is one of the principles set out in the 1948 WHO Constitution: "The enjoyment of the highest attainable standards of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." As the world commemorates the fiftieth anniversary of the Universal Declaration of Human Rights this year, how important is it, you think, to focus on health as a human right?

It is very clear in what our WHO founding fathers wrote about health. Furthermore, the goal of "Health for All" which in a way is the shortest "soundbite" for what was already in the WHO Constitution - the attainment for all peoples of the highest possible level of health - is stated in what I would call a human rights perspective. What they indirectly say is that health should be available to all. That was the thinking in 1948, which was the same time the Universal Declaration of Human Rights was drafted. And, of course, that was the thinking of the time. Certainly, health is a human right. Although it is accepted that education is a human right and that health is a human right, we still are far from establishing them as rights in many practical circumstances.

There is a lot of work to be done in that regard. Not many people will question health as a human right. Anyone thinking about it will acknowledge that a newborn child should have the right to be immunized, to be given the opportunity to grow and develop, and to be a full, responsible and active participant in society. I think most people share that vision.

Do you think health as a human right has enough status as one of the rights and is being acknowledged as a right internationally?

I think we are some steps from that. And I think that's why it is important that we work together across the United Nations system, focussing on human rights, health and education as human rights. This we should do together as far as possible. But I think we need to address the issue beyond that of the question of human rights. I think the human rights argument is clear. It is central and important. But I think we also should convince finance ministers, private industry, the private sector and civil society that it will be profitable in a societal sense to invest in health because healthy people will contribute greatly to increased economic development. There are many points of advocacy on this issue that are important.

Dr. Gro Harlem Brundtland of Norway was elected Director-General of the World Health Organization (WHO) last May and assumed office on 22 July 1998.

A medical doctor with a Master's Degree in Public Health, Dr. Brundtland spent more than a decade as a physician and scientist in the Norwegian public health system before moving into public life. She held political office for more than 20 years and was Prime Minister of Norway for 10 years.

In the 1980s, she attained particular international recognition, championing the principle of sustainable development, as Chairperson of the World Commission of Environment and Development.

POINT OF FACT:

Today, according to WHO estimates, there are approximately 1.1 billion smokers in the world, which represents about one third of the global population aged 15 years and over. Of these, 800 million are in developing countries.