As the world enters the post-2015 era, it faces health challenges that are far more complex than they were at the start of this century.

The sharp distinctions between health problems in wealthy and developing countries are dissolving. Everywhere, health is being shaped by the same universal pressures: the globalized marketing of unhealthy products, population ageing, and rapid urbanization.

Our very definition of what constitutes socioeconomic progress is being challenged.

Beginning in the 19th century, improvements in hygiene and living conditions were followed by vast improvements in health status and life-expectancy. These environmental improvements aided the control of infectious diseases, totally vanquishing many major killers from modern societies.

Today, the tables are turned. Instead of diseases vanishing as living conditions improve, socioeconomic progress is actually creating the conditions that favour the rise of noncommunicable diseases. Economic growth, modernization, and urbanization have opened wide the entry point for the spread of unhealthy lifestyles.

The ancient burden of deaths from infectious diseases has been joined by a newer burden of even more deaths from NCDs. Rapid unplanned urbanization has added a third burden: deaths from road traffic crashes and the mental disorders, substance abuse, and violence that thrive in impoverished urban settings.

The rise of NCDs adds considerably to the costs of health care. The costs of cancer care, for example, are becoming unaffordable for even the wealthiest countries in the world. In 2012, the US Food and Drug Administration approved 12 drugs for various cancer indications. Of these 12, 11 were priced above $100,000 per patient per year. How many countries can afford this cost?

Prevention is by far the better option, but this, too, is more problematic than for infectious diseases, many of which can be prevented by vaccines or cured by medicines, all delivered by the health sector.

The root causes of NCDs reside in non-health sectors. They escape the direct purview of health. When health policies cross purposes with the economic interests of sectors like trade or finance, economic interests will trample health concerns nearly every time.

Implementation of the WHO Framework Convention on Tobacco Control is a notable exception. It provides one of the best examples of cross-ministry collaboration, driven by overwhelming evidence of the health and economic costs of tobacco use.

It tells us that the health sector, working in tandem with others, can generate huge benefits. It can even tackle a powerful, devious, and dangerous industry on multiple fronts, including through fiscal and regulatory measures.

As yet another challenge in the post-2015 era, health and medical professionals in every region of the world are losing their first-line antimicrobials as drug resistance develops. In several cases, second-line medicines are failing as well. For some cases of multi-drug resistant tuberculosis and gonorrhoea, even last-resort antibiotics fail.

With few replacement products in the pipeline, the world is moving towards a post-antibiotic era in which common infectious diseases will once again kill. A post-antibiotic era is a game-changer on a par with climate change. But antimicrobial resistance will kill us before climate change.

Ladies and gentlemen,

I began with the strategies used by Singapore to achieve and sustain universal coverage. Let me conclude with the strategies used in a very different country: Bangladesh.

The Bangladeshi story shatters the long-held assumption that countries must first reduce poverty, then better health will follow almost automatically. Bangladesh decided to reverse the order by first freeing populations from the misery caused by ill health.

Driven by a commitment to equity, the country aimed for universal coverage of its vast and very poor population with a package of high-impact interventions. To compensate for a severe shortage of doctors and nurses, the country trained and then closely supervised a brigade of community health workers, mostly women, who followed a doorstep-delivery approach.

The country also used its world-class research capacity to experiment with innovations. Formal and contractual arrangements were made with nongovernmental organizations that were best placed to win community trust and reach marginalized populations. Improvements in school enrolment, especially for girls, and in agriculture brought huge benefits for health.

The efforts of Bangladesh were driven by another reality. When government health services fail to reach poor areas, private providers and shops selling medicines will mushroom. Charges for services from these unregulated and largely unqualified health care providers work to deepen poverty, not reduce it. To prevent this from happening, the government built and ran nearly 12,000 strategically located community clinics

Perhaps most important was the strong strategic bias towards women and girls. The approaches used explicitly recognized that empowered women will turn health into a nation-building strategy.

Their needs, including for sexual and reproductive health services, came first. Their human rights were legally protected. That approach led to a stunning reversal in excessive mortality of girls compared with boys

As we have learned from ample evidence, investing in health is investing in economic growth, investing in the health and well-being of people. Every country needs healthy human capacity to sustain development. Without this capacity, it is hard to even begin to talk about sustainable development.

The Singapore experience and all of the other experiences we have heard about give us one compelling message. Any country that really wants to move towards universal health coverage can do so. There are no excuses.

Health is likely one of the most precious commodities in life. But it is highly political and it requires investment. You need political leadership. You need commitment. And you need a conversation with the public, as has been done here in Singapore. I thank you for the opportunity to participate in this discussion.

Thank you.