Honourable Ministers
Honourable President of the Portuguese Academy of Medicine
Honourable Director of the Faculty of Medicine of Lisbon
Honourable President of the National Academy of Medicine of Brazil
Honourable Director of Santa Maria Hospital
Ladies and Gentlemen,

I would firstly wish to salute the Portuguese Academy of Medicine, in the person of its President, and all those that are taking part in this opening session of its academic year. With my presence, I wished to show the appreciation of the President of the Republic for all who strive in the improvement of the health of the Portuguese people.

Health is a central and unquestionable theme of contemporary societies. The recent history of Portugal, particularly since the creation of the National Health System, is an example of success and of real improvement of the sanitary indexes. We travelled a long route, marked by undeniable successes which place us in a high level on an international basis, as is the case with the reduction of infant mortality, but which also brings an ever greater level of demand. In these days no one doubts that health is one of the more relevant components of people’s well being. For this reason, the certainty that the pressure for greater health care will not diminish is inescapable.

Health is a precious benefit for the people, but it is also an important asset for the community. Healthy people are more productive and qualified, generate more and better employment and riches and have more efficient means available to fight poverty and social exclusion. A healthy society has better conditions to be a fairer society. Poverty, in itself, is a hindrance to health.

Every one knows that I have striven to stimulate the Portuguese to fight against social exclusion. In the campaigns I have promoted, health emerged as an extremely important inclusion factor.

The sicknesses which are characteristic of poverty and social exclusion are well known. These are infections and hunger, diseases of body and mind which are evident everywhere and as such are next door to all of us, wherever we happen to be.

Sicknesses like tuberculosis and AIDS are not solely a problem of far away countries of the so called Third World. In effect, in the era of globalization, there are no further sanitary challenges which are strictly national or regional. The threat of pandemics, the emergence of new sicknesses and the rapid variations of climatic standards make it imperative to anticipate scenarios and to conceive strategies which are adequable to future contingencies.

As we are all aware, problems still exist amongst us in accessibility to information, to measures of health promotion, to prevention of sickness and even to therapeutic and rehabilitation care. Such problems result from economic inequalities, but also from other conditioning circumstances.

In spite of the undeniable successes we have reached, we continue to have marginalized urban populations, homeless persons, chronic sick without support, human beings not integrated in their communities, handicapped people with invincible barriers, and immigrants with lack of conditions to access medical assistance. There are fringes of society with a clear disadvantage in the access to medical care.

The circuit of poverty which generates sickness and consequently generates poverty must be fought against through an extraordinary support for the needy. Everything must be done in order that there are no exclusions to the basic right to health. With this I mean that, if we have made notable progress in terms of health, we still face challenges which will not allow us to rest.

The sicknesses which are characteristic of poverty are not the only ones which are worrying. There are, as well, the sicknesses typical of more developed societies, the societies of plenty, of those who care more for immediate satisfaction and less with the future, as if health and longevity were an acquired right exclusive to economic progress.

Although it is true that the life expectancy of the Portuguese has increased, this cannot be solely accredited to the growing investments in health systems. It is necessary to live more, but to live with better quality. To ensure a longer and a better life is a duty of the State but equally of the people.

The State is responsible for training and information, to educate and create the conditions for each citizen to be able, responsibly, to live with health and for health. This is exactly what we require from a clear juridical legislative frame and from a strict implementation of administrative policies and procedures to deal with phenomena like addiction to tobacco, excess consumption of alcoholic beverages, and addiction to drugs, obesity or accidents in traffic and at work.

In addition, an urgent and deep reflection is necessary in terms of the safeguard of life in contemporary society. We must fight for better zoning, healthier accommodation and cities with free spaces for leisure and physical exercise, for better resource planning and development, for adequate water supply and sanitation systems, and for an environmental policy which effectively reduces the levels of pollution.

In the area of the State, responsibilities today are transversal, and overflow the traditional field of influence of the Ministry of Health. Practically all policies, directly or indirectly, have an impact on health. In this context, we have to widen the scope of responsibility in choosing healthy public policies, from transport to urban planning, from nourishment to sports, from industrial development to agriculture, from the environment to education.

Policies with impact on health must be well found, perceptible to the people in their reasoning, objectives and consequences. Only thus will it be possible to obtain the participation of all the interested parties, from the decision makers to the users of the services, and, of course, through the operators of the health systems, who are naturally the main pivot in this procedure.

But it is important to clarify that health is a responsibility of each and every one of the people. All the efforts to inform, to educate and to produce legislation will not bear fruit if each Portuguese will not personally assume the responsibility to conserve and improve his own health. The right to health presupposes a duty of responsible freedom, centralized in self respect and in respect for the others. Each person must understand that he is, primarily, the guardian of his own health. No health system will be able to carry out its duties, with quality and equity, if the people overload it with unhealthy life styles and behaviour.

Ladies and Gentlemen,

This session of the Portuguese Academy of Medicine takes place in a building where knowledge is produced and transmitted. An added reason to underline the importance of science and innovation as essential tools for the progress and construction of a better Portugal. The best policies are those that result from an adequate use of knowledge.
We now have available a source of scientific and technical knowledge that never existed in the past. But there is still room, naturally, for further advances in health, as in other areas. The country needs to firmly invest in scientific research and technological investigation, selectively guided for high quality programmes.

In a context of lack of means, where public funds are necessarily limited, the need to use what is available rationally and efficiently is a collective duty from which researchers and providers of health care cannot be exempt. I am certain that we can reckon with the participation of the civil society and with the support of sponsors, especially if we are able to promote a real collective project to improve the health of the Portuguese, by bringing to bear the political parties, the social partners, the local authorities, the charitable institutions and the people in general.

The academies, of which the Portuguese Academy of Medicine is a good example, are places where the spirit of discovery is born and becomes fruitful. In this sense, this Academy can provide an important contribution, on a par with other institutions, for a more precise definition of concepts and good practices. The example of this audience fills us with hopes and certainties. On the one hand, the certainty of having in Portugal a set of medical personalities of the highest level, many of whom are present in this hall. On the other, the hope that this ceremony of extolling the academic spirit may be renewed, and that we can count with more contributions from the civil society, such as that which results from the protocol which has just been signed.

We want a healthier Country, in which its population feels satisfied to live and work. To attain and maintain high standards of personal and public health must be a guiding objective for the political decision makers, whether central or local, and, above all, for each one of us.

It is in the families, schools, Universities, places of work, and also in the professional associations, in scientific societies and in the academies that the will to be healthy is created and strengthened. I am certain that it is this will to contribute for a healthier Portugal that stimulates the spirit of the Portuguese Academy of Medicine. That is the reason why I accepted the invitation to attend this session of the opening of its academic year.