The Economic and Social Council (ECOSOC) this evening concluded its high-level segment on current global and national trends and their impact on social development, including health, adopting a Ministerial Declaration on implementing the internationally agreed goals and commitments in regard to global public health. Earlier this afternoon, the Council concluded its high-level debate.

Summing up the achievements of the high-level segment, Sha Zukang, United Nations Under-Secretary-General for Economic and Social Affairs, observed that the session was held when good news was scarce, yet they had come together to produce a comprehensive text. Maternal mortality received a prominent place, lack of health care, pre-natal and post-natal care, lack of education, and others were brought to the forefront. Developing countries were facing serious obstacles in developing public health care systems, including an exodus of skilled health care professionals. Emerging challenges included also the fact that diseases did not respect borders, ranks or class, as H1N1 had shown. The so-called neglected tropical diseases remained a scourge. Developing countries were bearing the brunt of the crisis, especially land-locked countries and small island countries. Next year, they would hold a meeting which would be the test of how far the Declaration had succeeded in changing public health systems.

In the Ministerial Declaration, adopted by consensus, the Council, among other things, calls for political leadership, empowerment of communities and engagement of all stakeholders, including individuals, for attaining the Millennium Development Goals with renewed vigour and in the spirit of global solidarity. The Council also calls on all States to renew their commitment to prevent and eliminate child and maternal mortality and morbidity, and for health system strengthening as a key component of an integrated approach to achieving rapid and substantial reduction in maternal morbidity and mortality. The Council calls upon all countries to strengthen institutional capacity to pursue longer-term health and development goals, and encourages all States to apply measures and procedures for enforcing intellectual property rights in a manner so as to avoid the creation of barriers to the legitimate trade of medicines and to provide for safeguards against the abuse of such measures and procedures.

Speaking after the adoption of the Ministerial Declaration, Japan said it was extremely regrettable that reference to human security had not been made in the Ministerial Declaration. The concept of human security aimed to protect people from critical and pervasive threats to their daily lives and fulfilment and enjoyment of their rights. Japan hoped that this document did not establish a precedent for future consideration of this concept in future United Nations work and outcome documents, and called on all States to support the concept of human security. The United States and Kazakhstan said they also supported the concept of human security, and Sweden, speaking on behalf of the European Union, said it had no problem with that concept, and had committed itself in 2005 to discussing and defining that in the General Assembly. Sudan also spoke, commending Japan for joining the consensus, which would send a loud message about the promotion of global public health for the betterment of the world’s people

In concluding the high-level debate earlier this afternoon, speakers said international donors, along with developing countries, should pay special attention to the need to substantially increase allocation of resources to family planning; and that was critical if there was to be any progress on maternal health. Scaling up and making public health services work was essential for improving public health care, and investing in and building public health services was essential for reducing maternal mortality and improving newborn and child health care. The world was off-track to achieve the health-related Millennium Development Goals and Member States and the international community should work together to get it back on track and help to improve the situation for millions. It was time to be bold and figure out why comprehensive strategies could not be identified in a bold move to improve the current situation. The international community should shoulder its responsibility and work together with Governments.

Speaking in the high-level debate were representatives from the Sovereign Military Order of Malta and Bolivia, as well as representatives of the following international and non-governmental organizations: Partners in Population and Development; the Inter-Parliamentary Union; Oxfam International; Sulabh International Social Service Organization; International Federation Terre des Hommes; and the International Organization for Migration.

On Friday 10 July, at 9:30 a.m., the Council will begin its coordination segment, holding a dialogue with the General Secretaries of the Regional Commissions on regional perspectives on the global economic and financial crisis, including the impact on global public health.

Ministerial Declaration

In a Ministerial Declaration on implementing the internationally agreed goals and commitments in regard to global public health (E/2009/L.12), the Economic and Social Council recognizes that health and poverty are interlinked and that achieving the health-related goals was central to sustainable development. It reaffirms that good public health is better achieved through a combination of good public health policies including multisectoral policies that stress better nutrition, safe drinking water, hygiene, sanitation and sustainable urbanization, and effectively combat major risk factors. It reiterated that each country had primary responsibility for its own economic and social development, and that national policies, domestic resources and development strategies cannot be overemphasized. The Council is determined to develop and strengthen comprehensive, multisectoral, integrated people-centred and result-oriented approaches to achieving the internationally agreed development goals, including the Millennium Development Goals, in order to achieve improved health outcomes and health equity for all among and within countries. The Council calls for political leadership, empowerment of communities and engagement of all stakeholders, including individuals, for attaining these goals with renewed vigour and in the spirit of global solidarity. The Council also calls for action to promote gender equality and the empowerment of women and concerted action for equal access of women and girls to education, basic services, including primary healthcare, economic opportunities and decision-making at all levels. The Council calls on all States to renew their commitment to prevent and eliminate child and maternal mortality and morbidity, and for health system strengthening as a key component of an integrated approach to achieving rapid and substantial reduction in maternal morbidity and mortality.

The Council calls for the full and effective implementation of the Beijing Platform for Action, the International Conference on Population and Development Programme of Action and their review conferences. The Council calls upon all countries to strengthen institutional capacity to pursue longer-term health and development goals, and the need to discharge essential public health functions as part of the broader, post-humanitarian assistance crisis recovery strategy. The Council urges further strengthening of international cooperation in the area of health, inter alia, through exchange of best practices in the area of health systems strengthening, access to medicines, and others. The Council encourages all States to apply measures and procedures for enforcing intellectual property rights in a manner so as to avoid the creation of barriers to the legitimate trade of medicines and to provide for safeguards against the abuse of such measures and procedures. The Council emphasises the need to devise and implement policies to ensure the health and safety of workers in line with relevant ILO standards. The Council is committed to promoting research and development, knowledge sharing and provision and use of information and communication technologies for health, including through facilitating affordable access to all countries, especially developing countries. Finally, the Council expresses its unwavering resolve to implement this declaration.


Statements on the High-Level Debate

MARIE THERESE PICTET-ALTHANN, of the Sovereign Military Order of Malta, said the focus of this year’s Annual Ministerial Review was of the utmost importance to all humanitarian actors engaged in alleviating human suffering. The Order was particularly aware of the link between health and poverty, as its historic mission was to help the sick, the needy and the most disadvantaged in society. The Secretary-General of the United Nations, Ban Ki-Moon, had highlighted the present concerns with regard to the progress in achieving the Millennium Development Goals, and underlined the necessity of enforcing the role of the multistakeholder approach with a view to strengthening health systems. He was to be thanked for encouraging Governments to seek partnerships with community leaders, faith-based organizations, charitable foundations and the private sector. The Order would do its utmost to respond, within the framework of its possibilities, to the challenges global public health was presently facing due to the consequences of the energy, food, and economic crises.

HARRY JOOSEERY, of Partners in Population and Development, said the fact that resource allocation to family planning in international population assistance had come down from 55 per cent in 1995 to less than 5 per cent today, meant that countries were not giving sufficient priority to reproductive health and maternal health. It was their hope that international donors, along with developing countries, paid special attention to the need to substantially increase allocation of resources to family planning. That was critical if there was to be any progress on maternal health. In many countries with high HIV prevalence and high contraceptive use, significant linkages between HIV/AIDS and sexual and reproductive health, including family planning existed and those could facilitate promotion of integrated reproductive health and HIV/AIDS services. In all actions relating to global health issues, including family planning and sexual and reproductive health, the gender perspective had to form an overarching component. Women formed the majority of the poorest and the most vulnerable segments of societies all over the world and success in achieving the global health goals included in the Millennium Development Goals would depend on the attention paid to the removal of all forms of discrimination against women and the promotion of equality between men and women.

JAMES JENNINGS, of the Inter-Parliamentary Union, said that sick and undernourished people did not place democracy high on their agenda. Daily survival was enough to think about. And without the backing of the public, democracy would become increasingly frail. The crisis affected women and men differently, with women hit the hardest. It would consolidate and probably exacerbate inequalities, pushing women even further into poverty. In the field of HIV, it increased the likelihood of hazardous behaviour. For pregnant mothers, it meant less chance for safe delivery. For the Inter-Parliamentary Union, those were not just social issues. They were primary political questions. An alarming number of legislatures were making it a criminal offence to transmit the virus under certain conditions. The Union had made it clear that before rushing to legislate they should give careful consideration to the fact that passing HIV-specific criminal legislation could further stigmatize persons living with HIV, provide a disincentive to testing and create a false sense of security among people who were HIV negative. On the question of maternal and child mortality, the Union said that 97 per cent of all maternal and child death occurred in 68 countries in the world. Only 16 of these countries were on track to reach Millennium Development Goal 4 on child survival. Progress was slow.

ESME BERKHOUT, of Oxfam International, said that, despite some progress, millions of people around the world in developing countries were still living without basic health care. Scaling up and making public health services work was essential for improving public health care, and investing in and building public health services was essential for reducing maternal mortality and improving newborn and child health care. Women's and reproductive and sexual rights must be protected and upheld. It was critical to ensure access to medicines, and strict property rights hindered that free access. The world was off-track to achieve the health-related Millennium Development Goals and Member States and the international community should work together to get it back on track and help to improve the situation for millions.

ABHA BAHADUR, of Sulabh International Social Services Organization, said sanitation was voted the greatest medical advance since 1840 by the British Medical Journal, among more than 100 medical marvels during the past 150 years. It was unfortunate that 2.6 billion underprivileged people in the developing and underdeveloped word did not have access to appropriate sanitation and human excreta disposal facilities. As a result, they continued to suffer the huge burden of infectious diseases. Defecation in the open was still prevalent in India, where 660 million people defecated in the open. Women were the worst sufferers as they had to go out before sunrise or after sunset, for want of privacy. The greatest failures of the past 50 years had been the failure to lay the foundation of public health in the developing world – hygiene, sanitation, and water supply. It was a failure that even today the lack of sanitation deprived hundreds of millions not only of health, but of productivity. It was a failure that polluted fresh water resources with faecal matter on a massive scale, and condemned more than a billion people to live with a daily environmental crisis of squalor, smell and disease. The huge burden of infectious diseases in the developing world, which were primarily related to lack of sanitation, hygiene and safe water, were also responsible for abnormally high child mortality.

EYLAH HAMOUDA, of International Federation of Terre des Hommes, said that each year 9 million children died before reaching their fifth birthday and a large part of those deaths were due to preventable and treatable diseases. A child under one year of age in developing countries was over 10 times more likely to die than newborn babies in industrialized countries. Child mortality was not only a silent emergency, but was at risk of being amplified by the current economic and social crisis. Indeed, women and children were often the first to be denied adequate nutrition and the last to receive health care. At the beginning of 2008, the food crisis was often mentioned in the media, but since then it had been overlooked by the financial and economic crisis. And yet it was estimated that nearly 1 billion people went to bed hungry every night. The risks for children generated by the economic and social crisis should not be underestimated. Terre des Hommes had conducted a study that showed that the level of underweight children under five had multiplied by almost two. The organization had also found that through access to land people were better protected against malnutrition.

ANGELICA NABARRO (Bolivia) said implementing agreed commitments and goals in the field of international public health joined to domestic efforts implied that the international community also undertake commitments in the fair international interest. Neo-liberal policies had had a significant impact on people's health and the achievements of the Millennium Development Goals. Health had become just another commodity, instead of the right to life and the right to food. It was time to be bold and figure out why comprehensive strategies could not be identified in a bold move to improve the current situation. International solidarity played a role in that regard – many international agencies created fragmented policies, and followed a neo-liberal model that did not recognize the globalization of the right to health. The financial crisis was another element of concern, and one for which the developing countries and the poorest of all would pay the most. Losses were socialized, and profits were privatized. The international organizations required urgent reform to support the developing countries, and not drain them. Health interests should be placed ahead of trade interests. The recovery of traditional knowledge and values would enhance that. The international community should shoulder responsibility and work together with Governments.

DAVIDE MOSCA, of the International Organization for Migration (IOM), said IOM welcomed the focus on public health in the context of human development. The Millennium Development Goals had been considered an important way to ensure that globalization benefits were evenly spread and shared. However, their outcomes to date were testimony of the many inequalities within countries, within regions and between sexes. Progress had been uneven: not only between regions and countries, but also between populations within countries and even within cities. For instance, poor and marginalized populations did not see the same reductions in child mortality and maternal mortality as had richer populations. Certain migrant groups were among those populations for whom the Millennium Development Goals had not implied enough progress. Removing barriers that hampered migrants in accessing health preventive and curative health was paramount. Migration itself was not a risk to health, but conditions surrounding the migration process could increase vulnerability to ill health, including violence and exploitation. In addition, the financial crisis had provoked an examination of societal values. IOM believed that it was crucial to guard against policies aimed at sending migrant workers home, as that was not the solution and could have negative consequences for development give the scale of remittances.

Statements Following the Adoption of the Ministerial Declaration

SHINICHI KITAJIMA (Japan) thanked the efforts of the chairperson and all the colleagues in the room who had made it possible to bring about this document. However, it was extremely regrettable that reference to human security had not been made in the Ministerial Declaration which had just been adopted. The concept of human security aimed to protect people from critical and pervasive threats to their daily lives and fulfilment and enjoyment of their rights. It tried to integrate and strengthen initiatives with a human perspective. Japan hoped that this document did not establish a precedent for future consideration of this concept in future United Nations work and outcome documents, and called on all States to support the concept of human security.

JOHN F. SAMMIS (United States of America) said the Ministerial Declaration was strong and forward-leaning. All had shown flexibility in the negotiations in articulating the way forward. All had agreed on the need to strengthen health systems and improve the maternal mortality figures. That the concept of human security, which encompassed so many of the determinants of health, had not been included, was a lack. Member States should work with Japan in this and other United Nations fora to build a consensus around the term of human security and its meaning.

HITIMOVA BYRGANYN (Kazakhstan) said that the facilitator had succeeded in bringing about a consensus. Today the declaration was a historical one. The economic downturn in all countries – everything that touched people, such as access to education, access to medicine, to health and to receive all innovation – everything, concerned human security. Kazakhstan supported a human security trust fund. Kazakhstan expressed its deep appreciation for the Group of 77 and Japan.

MOHAMED ABDALHALEEN (Sudan) thanked the President for her excellent leadership and commended her for the spirit in which she conducted discussions that lead to the consensus which was reached. Sudan also commended Japan for joining in the consensus, and for their contribution and work in the area of global health. Sudan believed that the consensus reached today would send a loud message about the promotion of global public health for the betterment of the world’s people.

HANS DAHLGREN (Sweden), speaking on behalf of the European Union, said the European Union was delighted to join consensus on this Declaration, which provided a powerful statement about the commitment to global health and meeting the Millennium Development Goals, and showed the strong support of all Member States towards pushing progress onwards to meet the Millennium Development Goals, which was critical for all citizens of the world, with direct relevance to men, women, and children. The commitments in the Declaration were significant and important – even more so would be its implementation. "Human security" was not in the Declaration. The European Union had no problem with this concept, and had committed itself in 2005 to discussing and defining this in the General Assembly, and looked forward to participating in this process.

ZUKANG SHA, United Nations Under-Secretary-General for Economic and Social Affairs, said that they had come to the end of an intense and occasionally exiting high-level segment. The Declaration adopted with the greatest controversy were those remembered the longest. This session was held when good news was scarce, yet they had come together to produce a comprehensive text. Maternal mortality received a prominent place, lack of health care, pre-natal and post-natal care, lack of education, and others were brought to the forefront. Poor health of the mother was reflected in her children and had important consequences for future generations. It was therefore important to take action. Developing countries were facing serious obstacles in developing public health care systems, including an exodus of skilled health care professionals. Emerging challenges included also the fact that diseases did not respect borders, ranks or class, as H1N1 had shown. The so-called neglected tropical diseases remained a scourge. Developing countries were bearing the brunt of the crisis, especially land-locked countries and small island countries.

Mr. Sha congratulated the countries that had made voluntary national presentations on the high quality of their presentations, which would support ECOSOC’s work in the future. ECOSOC, despite constraints, was helping countries in advancing and improving their public health systems and was giving public health a new platform. Next year, they would hold a meeting which would be the test of how far the Declaration had succeeded in changing public health systems.


For use of the information media; not an official record


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