Then, I would like to address the Portuguese physicians who have advanced scientific knowledge through research and techniques of importance to the advancement of endocrinology.

I would like to share with you a few brief reflections on the working of the health system in our countries.

The first relates to the of involvement of the citizens

In matters of health I believe that politicians, physicians and other health-care workers should be able to rely on a more committed contribution by the citizens. For two fundamental reasons: to lend substance to a right of citizenship and because choices are necessary in the field of health.

Citizenship rights constitute duties of the State towards its members, as a means to their social and political integration.

Nevertheless, the culture of our organisations is not yet motivating enough to bring about greater citizen involvement, nor does it yet have any considerable concern for the transparency of processes and is all too often satisfied with mere normative exhortation.

Health-care user participation in the discussions about planning the services and in the publication of information understandable to the citizens could well promote the users of the services to a standing of true partners in the health system, to healthy accomplices and critics of health-care workers and political decision makers.

They will be the main parties having an interest in ensuring that the system is both more efficient and more equitable, and that the choices made are the right ones. When explicit choices are not made, the decision, taken in an arbitrary and floating fashion, means that problems of scarcity are dealt with without due thought; that is, a choice is made silently, without clarity: choices ought to be transparent so that the more powerful lobbies do not impose their interests on the collective sphere.

When priorities are established in health matters they should be guided by values ensuring the social justice, solidarity and equitableness of our systems. European experience in recent decades has shown that the improvement of health indicators has been quite significant, though with no major gains in equitableness: in other words, as the indicators have improved in Europe, the richer are increasingly healthy, but this is not true of the poorer.

I therefore exhort you to seek more intense involvement in and evaluation of the health system by the citizens, beginning with a clear, transparent enunciation of the information.

Which leads me to my second reflection on rationality in political decisions
It is therefore necessary to bring more rationality to political decisions in health matters. National Health Plans, for instance, are intended to be an element of rationality, though they stand in a context in which, for example, the health budget, human resources management and the information systems are factors of lesser rationality. They are factors of lesser rationality because the clinical component of health has advanced more quickly than its political and organisational involvement. And so, here too, we must discus and set up goals, preferably consensual, constantly appraise processes, correct whatever may be necessary, and modernise the organisations. The advance of Medicine and the interests of the citizens are not compatible with antiquated structures and with the arrogant or negligent behaviour of health-care workers or senior administration officials.

It is therefore fundamental, and this is my third reflection, that the approach to health be undertaken through gains in health, which, for example, will allow funding to be matched to the results that have to be achieved. Otherwise, we could well be simply injecting money into the system without necessarily bringing about anything relevant as far as the citizens are concerned.

On the other hand, networking in health is essential, articulating it in particular with schools and with social security, for progress in health will be achieved only through these three areas working in conjunction.

But it is also necessary that we do not view health care as the mere provision of medical acts, in which, in isolation, operations, consultations or transplants are added one after the other. One must view health and the provision of care from a standpoint of the management of health and of illness. And there are illnesses that are important, both from the point of view of the lives of the people and from that of their economic impact. And the system and the health-care workers should not ignore this.

For this, too, there will be no progress, not only in the quality of medical care but also in containing costs, unless there is clear investment in clinical research, especially in the post-graduate training of physicians.

I have become accustomed to seeing health, as a prime indicator of the progress of nations and of human development, which is reflected in an increase of life expectancy and of the quality of life, and in a reduction of the morbility and mortality rates.

The consequences of illness are terrible both for people and for their families, and for society as well, which is left unable to rely on active people who generate wealth. Health promotes research, knowledge and employment, and makes the economy grow.

Therefore, improvement of health levels should constitute a strategic goal bringing the whole of society together, and the same should happen in fight against inequalities that penalise or exclude from health care the more vulnerable segments of the population.