Session 8: IN CONVERSATION: DR. GRO BRUNDTLAND
Ann MacMillan (CBC): I'm afraid I'm not coming out of a cupboard, no virtual reality today. Just, plain old "in conversation" with our very very famous, and deservedly so, guest. If you read Dr Gro Brundtland's biography I defy any of you even all you really famous people out there not to feel just a little bit jealous. Here is a medical doctor who became the top politician in Norway. She set up and chaired the United Nations World Commission on Environment and Development and became director general of the World Health Organisation. She retired from that job just three months ago and she has flown into this meeting from New York where she was attending a board meeting of the Turner Foundation, part of the one billion-dollar gift that Ted Turner gave to the UN, and while she was in New York she was asked by the Secretary General of the UN himself if she could join a panel of eminent persons which will analyse the threat to peace and security and perhaps more importantly advise the UN on reform.
She started life in Oslo and had an idyllic sounding childhood. Her father was a prominent member of the Norwegian Labour Party and politics were part of family life. At the age of seven she joined the children's section of the Norwegian Labour Movement. When she was 10, Young Gro's father also a doctor won a Rockefeller scholarship and the family accompanied him to the United States. They later lived in Egypt where he worked as United Nations expert on rehabilitation.
 After qualifying as a doctor in Norway and becoming a mother Brundtland herself won a scholarship to the Harvard School of Public Health. She started working at Norway's Ministry of Health in 1965 specialising in children's health issues. She worked on the children's departments in two hospitals and became director of health services for Oslo's young people. Somehow in all of this she managed to bring up four kids and travel all over the place representing Norway internationally. By the way, her husband Arnd Brundtland was a prominent member of Norway's Conservative Party, perhaps when his party was out of power and yours was in, he helped bring up the kids, I certainly hope so! He did support his wife's career, there is no doubt about that in fact he wrote two books about it, the last one just came out. The first one is called "Married to Gro" and the second one which came out last week is called "Still Married to Gro". I hope he wrote at length about the incident he told me about last night when he fell overboard in a big storm and you two were sailing together. And he credits Dr Brundtland with a saving his life, pulling him out of the water.
Dr Brundtland: He is especially happy because he realised that I could have just dropped him at that moment and nobody would have known!
Ann MacMillan: In 1974 Dr Brundtland became Minister of the Environment where she used her health expertise to greater advantage. In 1981 at the age of 41 she became the youngest and first female prime minister of Norway. She served as prime minister for more than 10 years in three governments. While temporarily out of office in 1983, not one to hang about, Dr Brundtland was asked by the United Nations Secretary General to get involved with the World Commission on Environmental Development whose recommendations led to the Earth Summit in Rio de Janeiro 11 years ago. She was elected director-general of the World Health Organisation in 1998 and in her acceptance speech Dr Brundtland and said that the WHO's key mission is to be the "moral voice and technical leader in improving health of the people of the world". She saw its purpose to combat disease and ill-health and promote sustainable and equitable health systems in all countries. So how do you think you did on that mission?
 Dr Brundtland: I think the world has moved forward on certain issues. However sustainable health systems is a far reach still. When I came in the slogan was "health for all by the year 2000". I entered the WHO in 98 and we were so far from hell for all that we had to focus on important evidence based issues in order to move in this direction. In the year 2000, you remember, the United Nations expressed the Millennium Development Goals. They are the ones that can help us reach a level where child mortality, maternal conditions, ill nutrition, all of the key areas that are necessary to fight poverty can be overcome. So we helped formulate that agenda. Health concerns are major in the Millennium Development Goals and we all have to work together to reach those goals.
Ann MacMillan: I have spoken to some of your colleagues at the WHO and they were very complimentary about you. They said you came in, you had a totally new approach, they said you took a quite sick organisation and gave it a new credibility, you really turned things around. There was some criticism and one of them was, that under your leadership the WHO moved away perhaps from Third World poverty issues and spent more time worrying about Western diseases like obesity and cancer. How would you answer that criticism?
Dr Brundtland: Well I wonder who can have interpreted so wrongly what we were doing. The whole effort to put health on the global agenda was linking it to poverty, moving the whole United Nations system and main donors to realise the links between health and development, development and poverty and the key place of health in overcoming poverty in poor countries. So the main effort we did was evidence based, however it would be stupid of the WHO not to build on the evidence of the global burden of disease. When we chose to fight tobacco it was because tobacco is killing more than 4 million people a year and will continue to 10 million if we continue the trend for another 20 years. And 70% of those deaths will be in the developing world, that is where the markets are targeting poor people who have enough to struggle with already. Obesity and malnutrition, eating too little or eating too much is a major public health problem, we need to address both the things that lead to heart and brain diseases, cancers which are very much linked besought, sugar and fat. And in more and more or even developing countries we see a parallel burden of malnutrition, poverty linked to ill health and over nutrition, now nutrition on the other side. We need to address what the global burden of disease is. Looking forward because we have to prevent now. You know, that one-third of American kids are obese and lifestyles in the US and in the Western world are being copied through the effect of media and all of us moving across the world. We need to alert the world about what is happening. So there is no contradiction between telling the evidence about heart disease and obesity and telling the evidence about how HIV/Aids spreads and how we need to invest in people in poor countries, give them medicines and make it possible to move ahead out of ill health and poverty to join the international community also free trade and everything else that you all know, will be the solution for the world to be a will to work together and to overcome poverty.
Ann MacMillan: Now I do want to talk you at length about SARS, being a Canadian I have to do that because it was one of the major stories in Canada this year. But I just wondered if anybody in the audience had any comments to make a about this last answer before I moved on.
Helen Fisher (OECD): Most of the countries be who have signed on to the MDG's at this point give more money in agricultural subsidies than they do in foreign development aid. What can you do about that?
Dr Brundtland: This is a major challenge, it is a big problem and in fact in the latest Human Development Report that came out from the UNDP, I just read the foreword today. Also Mark Mallet Brown who leads that agency it makes it very clear in his introduction to this report that focuses on the millennium development goals that the agricultural subsidies and the whole problem in that area has to be overcome. It is outrageous really when you look at those numbers, the billions and billions and billions that are used for no really good long term cause. And when the breakdown happened in Cancun this year obviously the lack of progress on those issues combined with some others but it was the major problem that stops the world from getting into very important trade negotiations which will benefit everyone and more than anything, the developing world if it is done rightly.
Helen Fisher: But you must get so frustrated because everybody knows the problem and nothing gets done.
 Dr Brundtland: No, and this is a weakness of our democracies. There is no way to change the policies of the US or the European Union which are the main problems in this area. Unless the politicians of those countries are willing to face this challenge and tell their people that this has to change. And so again if you look at democracy, the media and how it influences can help influence the debates and the politicians, you have to keep pressing on on this issue because that is the only way it can move. And the European Union is taking steps but they are too slow and the widening of the European Union has in one way it also made it more difficult because countries like France and others are keeping back from taking too much change which will effect in the short term their own economies and certainly their agricultural sector. But this has to be solved and we have to keep pressing on to make those changes. They are bad, really bad.
Ken Tiven (Intelligent Media Consultants): Could you perhaps spend a few minutes and enlighten us on the issue of genetically modified food, which I think in a sense grows out of that question which is that certainly several large countries the US in particular would like to sell that kind of content and knowledge into the Third World on the grounds that it would increase food production and do good things. And it is very difficult in the general media to get a sense of what that is all about with regard to that issue.
Dr Brundtland: Well, I don't think you could have asked me a more difficult question. Because of the complexity of the science and the knowledge place behind it there is still in serious scientific environments quite a lot of discussion and disagreement about the potential long-term consequences of parts of this on the one hand. Which makes us say look at the precautionary principle, avoid making mistakes that can affect the environment and all of us next time. You remember Monsanto pulling back from some of their products that they were gaining a lot of profit from, in the face of the NGOs and public opinion against what they were producing. On the other hand if you look at the green revolution in India going back 30 years or so, there was genetic modification and use of of new technology to make that happen. The question is what genetic modifications are OK? Which ones are questionable? So what we are doing now is developing a collaborative effort between the WHO and the FAO these are the international organisations that through the code it's an entirely us which works out of Rome gives advice about what kinds of foods have health problems linked to them and what is acceptable. On the other hand you had in the African crisis a lot of pressure from the US to enter genetically-modified food and if they had been entered without having been milled you could spread these seeds in an environment that is not prepared for it. There is a lot of complicated problems involved in this which makes it difficult for everybody. For media and politicians. But the only way we can do it is to really put together the science, what is acceptable and where do we have to have a precautionary principle and what we did in the WHO giving advice about the crisis in Africa, was please mill what is coming so that people can get fed because there was no alternative but the African leaders didn't want to accept maize coming in which was genetically-modified so we had to find a compromise that was safe enough and which could could counter the hunger catastrophe that was there.
Ann MacMillan: I do want to move on to SARS, we can come back to third world issues if you don't mind. But SARS as I mentioned was a huge story in Canada. I'm going to show you a video just remind you about the chronology because it is such a long time ago it seems that people might have forgotten about the dates. You'll notice that this is rather a Toronto centric report that is because we used a lot of for CBC footage but I'm also using, and I thank ABC Australia CNN and Star TV.
(runs videotape)
So I think it is fair to say that there were mistakes made certainly in Toronto, in China and at the World Health Organisation. Would you do anything differently next time?
Dr Brundtland: I'm really proud of what the WHO staff, our system, the network that we have established over years and which had been further developed since 1998, that we had it and that it was used correctly. So for me it was a success story for the World Health Organisation and for international collaboration on public health. However, when you mention China and Canada those are two examples and we have to look at what happened in each outbreak. What did each government do? How did they deal with it? You see, this is not a situation where the World Health Organisation takes over the running of the health systems worldwide. We are advisers and experts together the evidence, it to help survey the situation from a global perspective so that each nation can get the advice they need from us to be part of the response to a public health threat which could have become a much much worse situation than what we saw. In public health terms as history unfolds you have identified a new disease, a new virus within four weeks and to have contained outbreaks in 29 countries within four months is absolutely sensational. Why was it possible? Because of the surveillance system, the respect of the advice that came from the WHO, the ability of numbers of health professionals worldwide to work together through our expert advisories in the different concrete areas, and by health workers all over the world who did what they could to help contain each outbreak.
Ann MacMillan: But it took quite a long time from the first case being identified in November of last year to you slapping the travel ban on Toronto?
Dr Brundtland: No, well you see the point is this until the situation that came in the film here when the doctor came to the hotel, the Metropole and travelled. No one knew that we were encountering a new disease. It was interpreted by public health experts both in the WHO but certainly in the local countries where public health professionals were looking at it. We were trying to get more information out of the Guandong and you saw that there was one example where we had issued a press release from the WHO saying that there is a respiratory syndrome happening in Guandong and in parts of China, we don't really know what it is, we are watching it, and the Chinese authorities of course were partly collaborating but partly concealing the extent of the problem. Until the doctor moved from out of Hong Kong into Hanoi via Beijing and he created an outbreak in a French hospital in Hanoi. Our people in the Vietnam office of the WHO was consulted by the French hospital there was a terrible outbreak happening in that hospital, our own WHO expert Carlo Urbani from Italy entered into the situation, up and worked with the people in the French hospital, he himself died three weeks later in Bangkok. But he identified that something new was happening, he was describing the epidemiology, how it spread. That helped us prepare the global alert which we only could do on 15th March. WHO issued its first ever, in history, global alert to every government around the world, to civil society, to the media that something new was happening there is a new disease it is deadly, it is spreading along airline routes, everyone now has to take charge and contain each outbreak. It has never happened before but the situation was different from anything we have experience before. Never has a disease come out like this, it it was new it was identified and had the degree of spread and mortality. Remember you had numbers here of about you had about 180 cases and 27 deaths. That illustrates the mortality rate, this is the typical mortality rate of the disease. So when this film said SARS in November there was no SARS until March, nobody knew. Although after the fact we can go back and say some of these first cases which were called respiratory syndrome by the Chinese authorities were in fact SARS.
Ann MacMillan: Can I just ask our Chinese colleague Tao Yei how you reported this disease?
Tao Yei (CCTV, China): The pictures I just saw really make me remember the terrible days this brought. I have to say that the SARS outbreak was a really big challenge both to the Chinese government and to Chinese journalists but I have to say Chinese journalists took their responsibility treating the first outbreak. In April and May of this year ordinary business, most business stopped in Beijing.
 Ann Macmillan: Did the government put pressure on journalists not to play the story up?
Tao Yei: I don't think there was any pressure from governments but our journalists had a responsibility to do anything we had to do. At that time as I say business stopped there was nobody in the streets, no cars but there were only two groups of people still working, one was doctors and the other was journalists. We had to wear the face masks in our studio and to take pictures and also there was a group of journalists who stayed in hospital and at that time they were not allowed to go back home every day.
Ann MacMillan: Dr Brundtland can I ask you how you think the story was covered by the world's media?
Dr Brundtland: Yes but can I make comment about the China thing. There is no question in my mind that China for too long and for too many weeks in fact was trying to conceal. When I tried to make contact with the Chinese Health Minister for days and weeks we couldn't get through to him. The argument being, everybody is in the People's Assembly electing the new President and for the first five days I said let them have these five days before they respond because they were arguing that the minister was there and he can be reached but obviously there is no question that they were not willing to face the problem. And it took changes at the top level of the Chinese government to change it and this is why the mayor and the health minister was sacked.
Tao Yei: Maybe you're right there, from the journalists point of view I don't think I'm in a good position to comment on my government. But for the journalists point of view I have so say it that at the beginning that no one knew what caused SARS, or what it was.
Dr Brundtland: But I told them, we knew already. So the problem was that they didn't want to discuss and they didn't want our experts to coming it took too much time for China learn from it. Fine!
Tao Yei: Actually I think that SARS was a very big illness for the Chinese people and to the WHO and I think at the beginning noone knew the seriousness of what was happening.
Ann MacMillan: What about the Western press?
Dr Brundtland: They me say this about the media and SARS, we started then systematically from 15th March onwards daily press briefings, daily releases from the WHO updating the factual information on what was happening worldwide. And all the knowledge that was gathered by us was shared with the world media. And it was covered, the media covered it and it was very important because there was no other quick way to get the knowledge out to health personnel all over the world. So in my mind there is no doubt that the media played a crucial role but it also played a role of reporting the facts. Of course there were discussions about how things were developing, questions raised and all that but there was always a stream of factual evidence. And it was very important for the ability of the world to tackle the situation.
Ann MacMillan: Any comments for many journalists here who actually covered the SARS story? Do you have any comments to make about the World Health Organisation?
Stephen Claypole (DMA Media): I was wondering whether we could ask through you the colleague from CCTV about the way in which the Chinese State Council eventually responded. I was at an event in Chingwa University in Beijing recently and I was told that for the first time ever really the State Council was fielding spokespersons on a daily basis to respond in almost a Western PR way to the whole crisis. I was wondering whether our colleague could provide a little more illumination on how the authorities actually handled the media, once the Mayor had been removed and the Health Minister?
Tao Yei: As I said I don't think I have any right or am in any position to tell you anything about our authorities. But I have to say that from the beginning from a journalists point of view as reporters we did our best to report the SARS outbreak.
Ann MacMillan: Heaton Dyer this is an ongoing problem isn't it for Canadian Broadcasting?
Heaton Dyer (CBC): Yes it is on the point about Western media, I do have a concern as we in Canada, consider if there is another outbreak and we see that as a real issue for the country. I was actually living in New Zealand at the height of SARS preparing to move back to Toronto and everybody thought I was mad. In the end the reality was, there was a, nobody underestimates the significance of SARS and the significance of the health concerns around the world but there was a distorted view about just how great, in Toronto particularly, the actual impact of SARS on the street was. One of the things that really struck me when I ended up in Toronto was that the reality was for anybody living in the City is that you didn't see people on the street wearing masks. If you saw one or two over the course of a month that was the exception, certainly in hospitals that was the case. But the point was, we as global media professionals and we get images from Toronto of a few people in face masks and the reality was that internationally it was being told as a story that people were dropping like flies on the streets of Toronto from SARS. And that just wasn't the case and in actual fact what we had in Toronto was a very contained but very, absolutely extended and lethal outbreak but it was all traced to the original source.
Ann MacMillan: Can I ask the Danish representatives here with the you said that Toronto and China this was a terrible plague?
Ulla Terkelson (TV2 Denmark): I would like to broaden its slightly to the media thing. What do you think about us? You had a political career you have been a prime minister and you have been an international official, what do you think about the media and us as journalists. Do you see us as opponents or as collaborators? What do you think about journalists?
Dr Brundtland: Well I can tell you it has varied all my life. Basically when I was a young environment minister the media was a very important conveyor of the new thoughts and the need to take the environment seriously and it helped really raise the issue. I have never lost my conviction that media has a crucial role to play in creating awareness, in letting people know, in having anything close to the right to know as an ideal being spread around the world. And that is the major role of the media in a democracy. Which is why also the media, like you are doing here should be looking at your own role, when is it good? When is it not so good? How can we improve and all that. Because it is absolutely crucial and it plays a big role in democracies worldwide. Now it happens of course that media go overboard, it happens that they report falsely, that they come up with allegations which are wrong. And as a politician you sometimes have a great problem finding when to spend your time countering wrong or ill-advised ways of presenting an issue, or letting it pass because you have other things to deal with, so let this go. Now the less you have of that the better of course because people also get confused when the media conveys in balanced or even wrong impressions. But sometimes as a political leader even you have to just disregard it and hoping the long-term that the correct reasonable picture will come out. But basically the role is an essential one in a democracy to my mind.
Ulla Terkelson: Did you ever have a spin doctor when you were a politician?
Dr Brundtland: None.
Ulla Terkelson: Why not? Your husband?
Dr Brundtland: I never found anybody good! I didn't see people around me that were better than myself and my political colleagues to analyse what messages we tried to convey to people, what were our goals, what is the programme that we are elected on, what do we want to convey to people. And we were the spokespersons ourselves. That doesn't mean that there were no media people giving advice about what media to spend time on, to report back to us on how things were reported, whether we needed to push in this direction or so on. I'm not saying that we were completely naive but the whole spin doctor issue of the last 10 years or so was never really part of my life.
Ann MacMillan: Any questions related to that?
(unidentified): When you were prime minister of Norway you of course met with journalists and they had an attitude towards you. How was that attitude in comparison to when you're in the position of an international leader?
 Dr Brundtland: There were things that were basically of the same nature but much more, especially when you lead an international organisation that is a specialised agency and you put emphasis like I did on the evidence base, on the knowledge base, everything that we do as the WHO is based on evidence. Then the media connection becomes different, it is are your facts correct? Are you looking for the right facts? In a national political scene you have all the backs and forths of all the balls going from one political party or political leader to another and the media running between them trying to have the bounce as high up in the air to get the sound bites as intense as possible. And sometimes you get absolutely exhausted, as a serious political leader, by it. Because you know that people are being misled through this about the realities of the complexities of the many nuanced issues you have to deal with. But as the WHO leader it was easier to have the media respects that you had a role as a technical leader, not as a politician. Let's take the case of Canada. You mentioned that what happened in Canada was that the politicians of Canada protested against the recommendations of the WHO.
Ann MacMillan: How did you respond to that because you didn't remove the travel ban within a week, does that sort of pressure get you?
Dr Brundtland: What happened was we were in fact in my mind we were a little too late in our Travel Advisory on Canada. We should have issued that about a week before but because it was Canada and because we had collaborating centres both in the US and Canada we in a way let some days go because we thought that Canada had things under control. Now Canada didn't because the picture you painted was a little too rosy in a way. Because what was starting to happen, was, because of the method that was used in Canada was voluntary quarantine. And those voluntary quarantines were certainly voluntary because people were moving out in the community, they went to funerals. You know one member of the family dies from SARS and you have a gathering of 200 people from the Chinese community and moving in together using the public transport and a couple of those people had SARS, they broke the voluntary quarantine. In some other countries where more tough measures were implemented it was in fact easier to avoid this happening because they used forced quarantine and people were not moving around, so there was a danger point in Canada. So the nice picture that it was all contained within hospitals was starting to get out of hand at a certain point when we had to issue a travel advisory. What happened then was a discussion with the Canadian authorities.....
Ann MacMillan: The Mayor of Toronto was very angry did you talk to him?
Dr Brundtland: I didn't talk to him at all, I refused to speak to him because he was shouting his mouth off, he didn't know what he was talking about. I kept my line with the Canadian government, the Minister of Health. And the Prime Minister called me and I told him that I could not remove the travel advisory, you have had spread in the local community outside of hospitals, you have not been doing exit screening which we had advised a month before. Canada just didn't do it. Do so there were Canadian cases, it coming from Canada into the Philippines because people were leaving Canada with SARS. We had to tell them and they changed their system. We also went through every spread in the community and waited until there were at least 15 days from the last case until we lifted it. So it if I had had to I would have waited two more weeks before I lifted it. I was not scared either of Chretien or of the minister but I also was evidence based, I removed the Travel Advisory when the picture was correct.
Ann MacMillan: We are down to the last question which is very sad because the time has come very quickly. But I wanted to talk about SARS showing that the danger of global disease is incredible, and is this something you feel is a really serious problem for the 21st century.
Dr Brundtland: Yes it is. I think that the SARS experience was a great public health lesson many people had no clue as to our real interdependence in this world until they realised what happened with SARS. Why? Because Aids, Tuberculosis all the other things that are hampering development in the Third World they are all either contained in those areas or if they are in rich countries they are treatable or at least amendable by high cost health services. If you get even a dangerous Tuberculosis for a Western person with health insurance they get treated and they get rid of for Tuberculosis. The difference here was that it showed that we are interdependent in a way that people from any country can get the deadly disease by moving from one country to another and unless there is a public health system in place in all countries, anything can get out of control. To people learned an important lesson, the surveillance system, all the links between people who deal with public health issues so that the knowledge base is as great as possible and the sharing of information. All of this will be used when we get a new difficult situation, not necessarily stars, it could be SARS but it could be influenza. What were we scared about in November/December when the first reports about something respiratory happening, we were scared about a new flu epidemic. Remember the flu epidemic of 1980/90 it killed more people than both world wars. So a new flu epidemic is something where everything we have learned from SARS will come in to good use.
Ann MacMillan: Thank you so much that was very interesting. I'm afraid we have to stop now.
Transcript by Tony Callaghan
Photo Credits: Piotr Azia, EBU; Balint Eder, Brill Productions; and Mark Milstein, North Foto
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