This morning the Economic and Social Council (ECOSOC) continued the general debate of its high-level segment on the impact of various crisis on their national health systems, as well as public health in general and the achievement of the health-related Millennium Development Goals.

During the general debate, speakers noted that the international economic and financial crisis, the global food crisis and the food crisis had negative and very serious repercussions on the whole international community. Increased unemployment, poverty and hunger could significantly increase levels of malnutrition, child mortality and maternal mortality. Those effects were all the more serious, and the repercussions all the more dangerous, for poor and developing countries. The crises were aggravating their vulnerability and marginalization, weakening the social fabric, and threatening political and social stability. As the crisis had dealt a severe blow to the fight against poverty, hunger, inequality and marginalization, it was time to focus on the impact on the most vulnerable sections of society: migrant workers, wage earners, children and the elderly. Perhaps one of the biggest repercussions of the financial crisis was the low real growth rate and lack of confidence, as well as the limitation of capital input in developing countries and nascent democracies. It was the best proof of the dire need to reform the financial system, especially regarding the poor countries that were disappointed by globalization.

Speakers underlined that public health was a priority for their countries. While national health-care systems were the primary responsibility of respective Governments, the United Nations and its specialized agencies, funds and programmes, including the World Health Organization (WHO), had to be actively involved in the global health agenda, in particular with regard to combating infectious diseases. The three health-related Millennium Development Goals were the most measurable, reportable and verifiable of the Millennium Development Goals. Maternal, newborn and child mortality needed particular focus in international aid efforts. Regarding the threat of H1N1, a speaker optimistically noted that, while countries might face a solidarity test internationally, they might also pass it.

Although the world was confronted with the worst financial and economic crisis since the Great Depression, with impacts going far beyond financial and economic boundaries, as well as geographical borders, and with grave consequences for the daily lives of millions of people all around the world, countries could not be overwhelmed because they were living with a crisis upon a crisis. They had to be steadfast and push forward towards 2015 and beyond, when they had pledged to save millions of lives of little children and their mothers. It was also possible and desirable to view the interlinked crises and challenges as an opportunity to foster international cooperation and determination in realizing internationally agreed development goals, in particular the Millennium Development Goals. Speakers agreed that the international community should come together to provide additional and more effective financing to strengthen health systems and get the Millennium Development Goals back on track.

Speaking in the general debate this morning were high-level representatives from Iraq, Sri Lanka, Libya and Republic of Congo. National representatives of the following countries also took the floor: the Republic of Korea, Chile, the Russian Federation, Peru, Turkey, Indonesia, Mauritius, France, Uruguay, El Salvador, Algeria, Nepal, Zimbabwe, Norway, Iran, Belarus, Cuba, the United Kingdom, Pakistan and the Holy See.

When the Council meets this afternoon at 3 p.m. it will conclude its general debate and then close its high-level segment with the adoption of a ministerial declaration.

Statements

MOHAMMED AL-HUMAIMIDI, Minister Plenipotentiary of the Ministry of Foreign Affairs of Iraq, said the world was facing an international financial crisis that had had negative and very serious repercussions on the whole international community. Those effects were all the more serious, and the repercussions all the more dangerous, for poor and developing countries. The financial crisis resulted in political and economic crises, as well as others relating to food, health, and energy. Their gravity varied from one country to another, but ultimately no country had been spared. Perhaps one of the biggest repercussions of the financial crisis was the low real growth rate and lack of confidence, as well as the limitation of capital input in developing countries and nascent democracies. That led to increasing unemployment and the loss of thousands of jobs – millions had been deprived of their right to food and health, and there were more and more poor people in developed countries, as well as a deterioration of exports. All that had had a negative effect on balance sheets and budgets and capacities to finance development programmes, as well as the provision of necessary services to the population. The current financial crisis was an obstacle to the implementation of the United Nations Development Goals, in particular those relating to poverty reduction.

H. A. P. KAHANDALIYANAGE, Secretary of the Ministry of Healthcare and Nutrition of Sri Lanka, said health promotional policies and spending were justified, not only because they promoted human welfare, which was valued for its own sake, but also because they were a part of a society’s investment for further production and growth. Health was an essential input to the process of human capital accumulation, which enabled individuals to achieve greater material success in life and States to generate higher national economic growth. Despite limited resources as a developing country, Sri Lanka had made commendable progress in the health sector. In Sri Lanka the infant mortality rate had declined from 19.8 per 1,000 live births in 1990 to 11.2 in 2005, which was one of the lowest rates for a developing country. The maternal mortality rate had also declined, from 4.23 per 10,000 live births in 1991 to 1.97 in 2003 and was now on par with developed countries. The under-five mortality rate had declined in 2005 to less than half of what it was in 1990. In addition, Sri Lanka had already eliminated the debilitating diseases filariasis, leprosy, polio, measles and iodine deficiency disorders. Progress in the health sector had been positively influenced by the progress made in other spheres of human and social development. Those include high literacy rates among men and women, which reached 89 per cent for females and 92 per cent for males.

OMAR ABUSABIAA, Director of the Planning Institute of Libya, said that the efforts made by the United Nations to promote the development of peoples and to achieve the best ways and means to finance efforts to achieve the Millennium Development Goals was proof that the international community was aware of international development issues. Today, they met as the world faced several crises, such as the food crisis, the economic crisis and epidemics such as the swine flu. Libya called for an exchange of information, especially regarding the swine flu in order to find means to combat it. Libya believed that intellectual property rights should not be linked to trade agreements but to research only. The current financial crisis was the best proof of the dire need to reform the financial system, especially regarding the poor countries that were disappointed by globalization. The solutions for the crisis had to be universal: developed and developing countries had to contribute to the solution of the crisis. It had become clear that climate change and its repercussions had also become an obstacle to development and international coordinated effort, such as a comprehensive agreement, was needed to reduce greenhouse gases. Libya had allocated $5 billion to provide food for Africa, especially for the Sahel.

LAZARE MAKAYAT SAFOUESSE, Chief of the Department of Multilateral Affairs of the Democratic Republic of Congo, said there should be greater solidarity in facing the challenges before the international community, the scope of which required a multilateral approach in order to reduce poverty and improve health services in countries which had been hit by the crisis, the causes for which they were not responsible. That was crucial if the goals in health were to be achieved. Sub-Saharan Africa was the region where the situation continued to be of great concern. Sub-Saharan Governments were deprived of resources to continue their work, impeding progress in economic and social development. The health-care situation of the people in general should be improved, particularly that of women and children. Concrete efforts to achieve the Millennium Development Goals in the Democratic Republic of Congo had been made at various levels, including malaria treatment, free tests for HIV/AIDS, and strengthening of disease control, as well as free maternal treatment. There was a National Road Map to reduce maternal and child mortality. The aim was to ensure that each person in the Democratic Republic of the Congo could choose and obtain reproductive health-care items freely. The Government required support in those efforts, as it was difficult for it to continue that fight alone. The cooperation from the United Nations system was appreciated; partnerships were ever more necessary if countries such as the Democratic Republic of Congo were to continue efforts to improve the situation of health.

SUNG-JOO LEE (Republic of Korea) said a country was not up to the immense task alone, as global health challenges, including epidemics, did not recognize national borders. Only by working together could the international community reduce the global health risks that would eventually impact all. Developing countries should maintain existing budgetary allocations to health, education and social protection provision; they also needed to extend social protection coverage to include the growing number of people in poverty. However, heavier responsibilities lay with developed countries. It was in all States’ collective interest to help developing countries by keeping their previous commitments to scale up official development assistance; by providing technical assistance to develop appropriate policies and services; and by coordinating and harmonizing development assistance programmes to increase effectiveness and maximize their impact. Despite immense pressure on the official development assistance budget, the Republic of Korea had made efforts to deliver their official development assistance commitment of 0.15 per cent of gross national income by 2012, and were working hard to ensure that a large portion of it was distributed to least developed countries.

AHMET UZUMCU (Turkey) said that the financial crisis had intensified since September 2008 and global output was now expected to shrink by an unprecedented 2.9 per cent. International trade was likely to experience the sharpest drop since the Second World War. Total private capital flows to developing countries were expected to decrease by half in 2009 – to $363 billion from $707 billion in 2008. Those events would have serious social implications for developing countries. Unemployment was reaching record high levels in many developing countries with the International Labour Organization estimating that more than 50 million people would lose their jobs worldwide over the next two years. To make things worse, remittances, which constituted a key source of revenue for many small developing countries, and which in 2008 had amounted to three times the amount of official development assistance, were expected to fall in 2009. The financial crisis was the biggest challenge since they had agreed on the Millennium Development Goals in 2000. Turkey was firmly committed to its responsibility not to let those crises turn into a global social and welfare crisis. Turkey’s official development assistance had reached an annual average level of $650 million during the past three years. Turkey had also expanded the geographical scope of its assistance by assisting African countries in their struggle against poverty. In order to coordinate those efforts, the Turkish International Development and Cooperation Agency had opened regional field offices in sub-Saharan Africa, namely Ethiopia, Sudan and Senegal.

VALERY LOSCHININ (Russian Federation) said the Millennium Development Goals were at the heart of the global health-care agenda for the period until 2015. The results of United Nations interagency monitoring indicated that in general the situation in that field was worrying, though there was certain progress in infant health care and in combating malaria. The major concern was the lack of sustainable trends in reducing maternal mortality. At a time of global financial and economic crisis, it was important to provide adequate social protection for every group of the population, and efforts should be concentrated not only on overcoming the crisis, but on shaping a new set of values for society, aimed at uniting, not dividing. Measures to support health-care systems should not be limited to tackling the crisis. In Russia, budget expenses had been restructured due to the crisis, but it still managed to safeguard the national social protection programmes. While national health-care systems were the primary responsibility of respective Governments, the United Nations and its specialized agencies, funds and programmes, including the World Health Organization (WHO), had to be actively involved in the global health agenda, in particular with regard to combating infectious diseases.

GONZALO GUTIERREZ (Peru) said public health was a priority for Peru. Considering that three of the human development goals were health-related –improving maternal health, reducing child mortality, and combating HIV/AIDS – further stressed the relevance of that discussion. Peru had promulgated legislation to ensure access to universal health-care services, and had implemented measures to address the negative stigma associated with child mortality, maternal mortality and HIV/AIDS. A national strategy for the period 2009 to 2015 had been launched to change those negative indicators. There were still many widespread diseases that had not been explicitly highlighted in the Millennium Development Goals, and which were serious threats in Peruvian society. Some of those diseases include strokes, high blood pressure and diabetes, to name a few. Moreover, in Peru 3,500 people died every year as result of traffic accidents, and 118,000 people were disabled for life. It was important to facilitate access to low-cost medicines, through a better adjustment of the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), as well as under the Doha Declaration on Public Health. Peru remained convinced that a topic as challenging and pertinent as public health could not be ignored as it would hinder the opportunities and experiences of generations to come.

CARLOS PORTALES (Chile) said that Chile wanted to reiterate its commitment to comply with the Millennium Development Goals, especially with Goals 4 (reduce child mortality) and 5 (improve maternal health). Approximately 10 million children died before the age of five and more than 500,000 women died every year related to complications arising from childbirth – 98 per cent of them in developing countries. That situation was unacceptable. The majority of those deaths could have been prevented with basic medical care and measures to alleviate the effects that poverty had on the health of the population. Strategic alliances between countries at different stages of economic development were efficient and necessary to meet the challenges posed by public health issues. Chile agreed that health was a broad objective with national, regional and international implications that required the broadest international attention and cooperation. Despite the importance of specialized services, they were not the only social determinants, as had been noted in the report by the Special Commission of WHO, led by Michael Marmot. That report emphasized the importance of strengthening efforts to reduce poverty and inequality in all countries.

DIAN TRIANSYAH DJANI (Indonesia) said there were a new set of challenges to the achievement of the Millennium Development Goals, and addressing the multifaceted crisis posed a daunting task. The meeting was therefore timely, as it provided an opportunity to renew support for a strong United Nations, leading the international community through the crisis. Efforts were currently at a crossroads – there was a real danger that social goals, such as health care, could slip down on the list of priorities, and global efforts needed to ensure continuing support for health care. There should be a global partnership; international measures were required to continue the socio-developmental process. The participation of all stakeholders was even more crucial, in particular in determining priorities that required immediate and long-term attention. It was also vital to promote national health-care issues and priorities. That effort should be integrated into poverty-alleviation programmes. The main aim was to achieve the health-related Millennium Development Goals. Indonesia supported all efforts to improve the situation of women, as well as to fight communicable diseases such as malaria, HIV/AIDS, and tuberculosis. Tackling that issue was one of the main challenges for development in the twenty-first century. It was important to secure access to health care and affordable medical products, and thus there should be a fair, transparent and equitable international system for medical products.

Mr. S.B.C. SERVANSING (Mauritius) said, given the high impact of non-communicable diseases on the socio-economic fabric of all nations, non-communicable diseases had become an issue of global governance. Without concerted global action, non-communicable diseases would certainly attain unsustainable epidemic proportions, if they had not already, especially in rapidly changing societies. Mauritius was a case in point. Indeed, over the past two decades there had been rising incidents of non-communicable diseases, particularly diabetes, cardiovascular diseases and cancer in Mauritius. Evidence-based national data over the past few years indicated that non-communicable diseases represented about 80 per cent of total disease burden in Mauritius and accounted for 85 per cent of the total deaths every year. Non-communicable diseases surveys on disease and risk-factor prevalence had been carried out in 1987, 1992, 1998 and 2004 in Mauritius. The 2004 survey revealed, among other things, that 38 per cent of the population aged 30 years and above were either overweight or obese; 39.3 per cent of the population were smokers; and 19.1 per cent were heavy drinkers. Those statistics were alarming indeed. That had compelled Mauritius to review its policies and develop a national strategy to address those problems. The Ministry of Health and Quality of Life had therefore elaborated the national nutrition action plan, the national tobacco control action plan and the national action plan on physical activity, among others.

JEAN-BAPTISTE MATTEI (France) said that in a world characterized by major crises, public health remained at the heart of its concern. In that context of uncertainty and instability, it was their duty to define their priorities and reaffirm their solidarity. Health had to remain a major investment in national and international policies. Many statements earlier this week had highlighted the explosion of non-communicable diseases in developing and middle income countries. Thus, they had to make an effort, particularly for reasons of prevention, to fight those diseases that were often diseases of poverty, related to poor nutrition, poor environment and poor education. It was also imperative to integrate the issue of health in the international diplomatic agenda. The initiative “diplomacy and health”, which included the Ministers of Health of seven countries from different continents, had set as its objective the integration of questions of health in the formulation of their policies. The resolution “diplomacy and health” which was adopted last year by the General Assembly of the United Nations would be followed by a report to the Secretary-General on the links between global health and diplomacy, which could then lead to further discussions on the subject. France was also concerned about how to improve international cooperation, how countries could, in the field, better control the flow of assistance proposed to them. It was important to achieve progress in that matter.

ALEJANDRO ARTUCIO RODRIGUEZ (Uruguay) said that the different crises that the world system was undergoing – the economic, financial, climate and food crises – seriously undermined the international community's ability to meet the challenges of social justice. Increased unemployment, poverty and hunger could significantly increase levels of malnutrition, child mortality and maternal mortality. Uruguay had undertaken a political commitment to provide health services for the entire population, irrespective of the economic capacity of the users. That was why legislation had been adopted to create an integrated national health system, to level opportunities through universal coverage for the entire population. Health costs were allocated in keeping with the ability to pay. Patients with insufficient income were not charged for health-care services. Uruguay wished to particularly emphasize the situation of children: their vulnerability exposed them more than adults to the adverse effects of the crises. The child health programme in Uruguay was crafted to protect them from those repercussions, and respect the different phases and needs of the child's development. The impact of the crises on the health and well-being of mothers and girl-children should also not be ignored, as it could have an impact on future generations. It was important to mainstream the health issue throughout policy. There should be collective action to combat health problems at the international level, such as the abusive use of tobacco.

CARMEN MARIA GALLARDO (El Salvador) said El Salvador aligned itself with the statement made by Sudan on behalf of the Group of 77 and China. El Salvador highly valued the efforts undertaken by the Secretary-General to present important information on public health for delegations to reflect on. The Government had decided to promote public health through a project called “hope is born, change is coming.” Based in the Constitution, health was a fundamental right and strategy for reform. This axis of national policy in terms of health contemplated political, biological and social factors, among others. The Government had decided to promote a national policy on medicines, which would guarantee access by the population to essential medicines, ensuring the availability, accessibility and regulation of prices and quality in the whole public health services network. In that context, it was indispensable to take into account the Doha Declaration on the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and public health, as well as the decision of the WHO, which advocated for better access to medicines for all.

The Government of El Salvador was concerned about the effects of the global economic and financial crises on social cohesiveness. The fact that countries had been pushed to reduce expenditures on public health further exacerbated the effects of the crisis, and engendered a reduction in human capital gains. There was a political will in El Salvador to address the epidemic of HIV/AIDS in the country. Maternal mortality was an important challenge for the Government, and women had to participate increasingly in family planning. El Salvador had a great vulnerability to climate change which was linked to malnutrition. Cooperation for development had to be strengthened through regional and national development banks as well as the world’s institutions. This Council had to advocate a coordinated response within the United Nations system, including specialized agencies in order to effectively address economic and social development strategies and policies.

IDRISS JAZAIRY (Algeria) said that, of the Millennium Development Goals to be achieved by 2015, three were directly linked to health – those on the reduction of infant mortality, improvement of maternal health and the fight against HIV/AIDS and other diseases. Some developing countries had achieved impressive results; however, there were far more that were far behind, especially those in sub-Saharan Africa. Access to health-care services and generic medication, as well as to new technologies were some of the fields where much was left to be done. Even worse were the living conditions of the vulnerable groups, especially those living under foreign occupation. During the past five years, Algeria had spent $160 billion on its infrastructure network. The indicators for human development had shown the efficiency of those actions, as primary education had reached 97 per cent, access to drinking water 93 per cent and life expectancy had reached 76 years, which was an increase of five years during the last decade. In a perspective of prevention, Algeria invited the international health community to think about the appropriate measures to be taken in order to integrate health as a factor to promote stability and socio-economic development. Coordination should be improved between the Joint UN Programme on HIV/AIDS (UNAIDS), WHO and the Global Alliance for Vaccines and Immunization to evaluate the effects of the economic crisis on public health and to propose the necessary measures to mitigate the impact on the development and the health systems in the developing countries.

DINESH BHATTARAI (Nepal) said that, since the last ECOSOC meeting, there had been changes of far-reaching consequences: a series of successive crises, including a global food crisis, fuel crisis, financial and economic crisis, looming effects of climate change and an influenza pandemic had engulfed the world, posing threats to economic and social development. Their implications were varied, and not confined to geographical limits. The fast-spreading and deepening financial and economic crisis continued to entail a heavy toll on employment opportunities, trade and development prospects, and had caused negative impacts of unprecedented scale and magnitude on States' ability to protect and fulfil the rights of their people, including the right to the enjoyment of the highest attainable standards of physical and mental health. Tragically, the hardest hit by those crises were the poor, marginalized, unemployed, and those living in the developing countries, the least developed countries in particular. The crises were aggravating their vulnerability and marginalization, weakening the social fabric, and threatening political and social stability. As the crisis had dealt a severe blow to the fight against poverty, hunger, inequality and marginalization, it was time to focus on the impact on the most vulnerable sections of society: migrant workers, wage earners, children and the elderly. It was time to deliver on promises of a fair, free, non-discriminatory trade regime, and demonstrate international solidarity not to allow the small and vulnerable economies from sliding further, and prevent social chaos and instability.

CHITSAKA CHIPAZIWA (Zimbabwe) said developing countries, particularly in Africa, bore the greatest burden of diseases. Zimbabwe was concerned that the current global economic and financial crises had driven millions into further poverty and increased unemployment and reduced ability to maintain social safety nets and to provide other social services, such as health and education service delivery, resulting in increased infant and maternal mortality and greater hunger. The situation was exacerbated by the fact that all that was happening at a time when the world was faced with other challenges, due to climate change and high food and energy prices. Urgent collective responses to address those challenges were required. In the context of global health, it was imperative that attention be paid to the underlying causes of weak public health systems, which was the root cause of poor health service delivery. Concerted and coordinated efforts had to be made if States were to provide impetus to the achievement of the Millennium Development Goals, whose progress was already threatened. National commitments to adequately fund public health systems, as well as commitments to increase aid funding and technical support made by the Group of Eight (G-8) and Group of 20 (G-20) countries should be followed through. New players like the Global Fund to Fight AIDS, Malaria and Tuberculosis, the Global Alliance for Vaccines and Immunizations, and UNITAID had increased the resource base and technical support available for the health agenda.

MORTEN WETLAND (Norway) said that the Norwegian Statistical Survey Office had estimated the value of Norway’s human resources to be in the order of 70 per cent of Norway’s total asset base. Likewise, in all countries, a healthy and educated population was any country’s most valuable resource and the most essential requirement for economic growth. The three health-related Millennium Development Goals were the most measurable, reportable and verifiable of the Millennium Development Goals. And ECOSOC was enhancing its importance and ascertaining its relevance by focusing on health during this Ministerial week. Effects of the influenza and the threat of the pandemic were not known. Few were willing to share an educated guess on how serious it might become. Countries were watching and taking positions. They might face a solidarity test internationally, but they might also pass it. Focus and international attention was needed. But they could not be overwhelmed because they were living with a crisis upon a crisis. They had to be steadfast and push forward towards 2015 and beyond, when they had pledged to save millions of lives of little children and their mothers. That was the way to solidify the human resource base, which would lift the world out of poverty.

HAMID BAEIDI NEJAD (Iran) said the world was confronting the worst financial and economic crisis since the Great Depression, with an impact going far beyond financial and economic boundaries as well as geographical borders and grave consequences for the daily lives of millions of people all around the world. Developing countries that were not responsible for the crisis were being hit harder. The acute human cost clearly highlighted once again the long-standing systemic inequalities and imbalances of the current international order. And the grim outlook resulting from the crisis could worsen if developed countries resorted to more protectionist measures and decreased their level of official development assistance. It was also a source of concern that some developing countries could be forced to adopt the kinds of policies that would harm their public expenditures, including public health expenditures. Health and poverty were mutually interlinked, and achieving the health-related goals were central to sustainable development. It was also possible and desirable to view the interlinked crises and challenges as an opportunity to foster international cooperation and determination in realizing internationally agreed development goals, in particular the Millennium Development Goals. It was not a time to resign, but a time for the international community to renew its commitments to global public health, especially in developing countries. Political will and commitment, cooperation, training and technical assistance at the international and national levels were essential.

ANDREI SAVINIH (Belarus) said this session gave new impetus to the internationally agreed goals, and in particular with regard to public health. Up until now progress in the health-care sector had been uneven. Negative trends had increased considerably and were further exacerbated by the global economic and financial crises. Reducing poverty around the world, and in particular with regard to least developed countries, showed that most would not achieve the development goals, especially with respect to health. Every minute a woman died during pregnancy or labour. Despite progress made in the area of HIV/AIDS around the world, only two out five HIV patients received medical assistance. Many people would continue to die of diseases that were preventable. Eleven million children under the age of five, and more than a half a million women due to pregnancy and labour complications, died each year. Addressing global public health challenges could only be done through increased investment and development assistance.

For its part, Belarus had made progress towards achieving the health related Millennium Development Goals. For instance, based on results from 2008, infant morality was 4.5 per 1,000 live births, which was one of the lowest in the Commonwealth of Independent States, and the maternal mortality rate was 2.48 per 100,000 live births. The year 2008 had been declared the year of health, and as such a number of measures had been taken in terms of preventative strategies. In addition, emergency medical assistance was also made available to the entire population. Belarus was counting on the strengthening of the role of ECOSOC in health-related challenges.

JORGE A. FERRER RODRIGUEZ (Cuba) said that, although it was hard to acknowledge, the Millennium Development Goals would not be met everywhere in the world. The reason for that was not that the goals were based on the too big expectations. That was why non-compliance was even more shameful. The reason was that, today, inequality, injustice, selfishness, vast and limitless consumerism prevailed. Despite the stringent financial blockade imposed by the United States, despite the fact that Cuba was a developing country and despite the recent blow of natural disasters, Cuba had achieved commendable results in the achievement of the Millennium Development Goals and was one of the Third World countries with the best results. Cuba had met almost all of the Millennium Development Goals, and the few goals that it had not reached would be met ahead of time. In the realm of health, the Cuban national system was free for all citizens and had enabled Cuba to meet the “health for all goal” well ahead of time. Cuba attached important priority to prevention of HIV and the treatment of people suffering from HIV/AIDS, entirely free of charge. Cuba had been able to produce six antiretroviral drugs. Without international cooperation based on respect it would not be possible to achieve the Millennium Development Goals. Cuba had therefore extended its modest solidarity to other third world countries. Cuban solidarity was not based on giving others its surplus. It was based on sharing the little it had. The countries in the Third World did not need more promises, but more action. They needed more social justice and equality.

PHILLIP TISSOT (United Kingdom) said the first day of life continued to carry the highest risk of death, with over a million newborns per year dying within their first 24 hours of life for lack of quality care, and 3.7 million dying in their first weeks. Up to two thirds of those deaths were preventable. There had been progress, and that should be acknowledged, but the world was off track to achieve the health Millennium Development Goals by 2015. There should be action now to avoid the reversals in health that had been seen in previous global recessions. The international community should come together to provide additional and more effective financing to strengthen health systems and get the Millennium Development Goals back on track. Efforts needed to be made as effective as possible. The International Health Partnership offered a framework to mobilize donors behind countries' own health strategies, and to ensure countries got the long-term, predictable financing they needed to implement their plans. Maternal, newborn and child mortality needed particular focus. Two of the health Millennium Development Goals, four and five on maternal and child mortality, remained the most off-track. The collective progress on maternal and newborn health was a bellwether of the success in delivering strong health systems that addressed the needs of the poorest and most vulnerable. The year 2009 was one of many challenges for global health, but was also a year of great opportunity, which should be seized if their collective efforts were to get back on track.

ASAD MAJEED KHAN (Pakistan) said several important messages had come out of the deliberations this year. First, the challenge of meeting global health goals and commitments had become ever more daunting in the wake of the present economic crisis. Second, there was clear political will and determination to address health-related challenges globally. Third, there were a number of good practices in many countries that others could learn from and emulate. Fourth, while communicable diseases remained a challenge, there was an urgent need to tackle the prevention, control and cure of non-communicable diseases particularly in the low income countries. Fifth, an integrated, coordinated, system wide effort both at the national and international levels was needed to effectively advance the achievement of global public health goals and commitments. Sixth, ever greater North-South collaboration through enhanced financing flows and technology access and capacity-building support was needed to help developing countries deal with the health-related challenges.

In addition, While Members had been successful in securing proactive national participation, engagement by international economic and development institutions, including the United Nations system agencies, could be further intensified. In Pakistan’s experience, its health policy 2009 had been based on the key principles of equity, universal access to essential healthcare, timeliness and accountability, among other things. The strategy envisaged addressing special needs of the vulnerable populations, especially women and children particularly in the rural areas.

SILVANO TOMASI (Holy See) said that a key obstacle to achieving the internationally articulated goals in public health was to address the inequalities that exited both between countries and within countries, and between racial and ethnic groups. Tragically, women continued in many regions to receive poorer quality health care. That situation was well known to people and institutions working on the ground. The Catholic Church sponsored over 5,000 hospitals, over 18,000 health clinics, over 15,000 homes for the elderly and disabled and other health care programmes throughout the world, but especially in the most isolated and marginalized areas and among people who rarely enjoyed access to health care provided under national, provincial or district level governmental health schemes. The mere quantitative tracking of aid flows and the multiplication of global health initiatives alone might no be sufficient to assure health for all. Access to primary health care and affordable life-saving drugs was vital to improving global health and fostering a shared globalized response to the basic need of all. In an increasingly interdependent world, even sickness and viruses had no boundaries, and therefore greater global cooperation became not only a practical necessity, but an ethical imperative of solidarity. However, they must be guided by the best health care tradition that respected and promoted the right to life from conception until natural death for all regardless of race, disability, nationality, religion, sex and socio-economic status.



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