This morning the Economic and Social Council began its Annual Ministerial Review, which this year focuses on implementing the internationally agreed goals and commitments in regard to global public health. In that framework, it heard national voluntary presentations by Jamaica and China on measures their Governments had taken to meet the health-related Millennium Development Goals, moderated by Michael Marmot, Chair of the Commission on Social Determinants of Health. At the beginning of the meeting, Sha Zukang, Under-Secretary General of the United Nations Department of Economic and Social Affairs, presented the report of the Secretary-General on the health theme of this year’s Annual Ministerial Review.

The Millennium Development Goals on poverty eradication, alleviation of hunger, health, environment and the global partnership were intertwined, noted Mr. Sha, introducing the Secretary-General’s report on implementing the internationally agreed goals and commitments in regard to global public health. Ignoring any one in favour of another would have serious consequences. The world could not afford to turn to short-term answers for a temporary respite for the difficult circumstances it faced – it needed sustainable long-term solutions. The report showed the situation with regard to progress in achieving the Millennium Development Goals, but visible gaps remained. Inequalities in health existed in many countries, including developed countries. Also, unacceptably, health outcomes for women and girls often lagged far behind those for men and boys.

Rudyard Spencer, Minister of Health of Jamaica, presenting Jamaica’s voluntary national report, said that, overall, Jamaica had experienced mixed results in the achievement of the Millennium Development Goals. They had achieved the goals for reduction in absolute poverty, reduction in hunger and universal access to primary education. Jamaica was also on track to achieve universal access to reproductive health, halt and reverse the spread of HIV/AIDS, malaria and tuberculosis, and to achieve universal access to potable water and basic sanitation. Unfortunately, they were lagging behind in the areas of gender equality, empowerment of women, and in the reduction of bio-diversity loss. They were also slipping in the reduction of child mortality and maternal mortality, as well as in achieving significant improvement in the lives of slum dwellers. Jamaica recommended that more health-related development aid be made available to countries that were heavily indebted and were likely to flounder and fail in meeting the Goals, especially in light of the global recession.

In the general debate on the presentation of Jamaica, speakers welcomed the remarkable progress Jamaica had made in a number of key areas, such as the reduction in poverty levels, malnutrition and hunger, universal primary education, provision of safe drinking water and basic sanitation. As Jamaica had rightly recognized, the progress achieved was increasingly fragile in the context of the current global economic downturn. Sustaining it would entail continued and concerted efforts to find solutions to the challenges in achieving the Millennium Development Goals, through close coordination with international development partners. Speakers repeatedly noted that the impact of climate change and natural disasters had the potential to reverse achievements, as well as the current financial and economic crisis.

The following countries took the floor in the debate on the report of Jamaica: Brazil, Canada, Namibia, Barbados, Namibia and New Zealand.

Chen Zhu, Minister of Health of China, introducing the national report of China, said that the Chinese Government had earnestly fulfilled the commitments towards the Millennium Development Goals. China had made great achievements, for instance, in eradicating hunger and poverty, combating malaria, reducing maternal mortality and combating tuberculosis. With respect to social and economic development, China enjoyed rapid economic development with an increase of 8.9 per cent of the gross domestic product. China had conducted a study on the causes of poverty in the country, which showed that a major cause was disease. Therefore, the Government had taken measures to step up health and nutrition in response. In combating AIDS, malaria and other diseases, China had made good progress. Free treatment was provided for tuberculosis patients, with 100 per cent coverage.

In the discussion on the China’s report, speakers were impressed by China’s achievements and noted that it was a model for the developing world. Despite an enormous population, China had made remarkable progress in raising the standard of living and quality of life of its entire population over the past three decades. It was clear that, with the challenges faced by China due to scale, providing basic medical and health care was not only a matter of focusing on health policies, but also involved paying necessary and adequate attention to other supportive and interrelated areas, including poverty eradication, education, and hygiene. China’s efforts in dealing with pandemics was particularly underlined, as well as the rise in life expectancy from 35 years of age to 73 years of age currently; China’s international cooperation in promoting the right to health; and reduction of maternal, child and infant mortality. Speakers were interested in traditional Chinese medicine and asked how China ensured its safety, quality and effectiveness.

The following representatives commented on the report of China: Egypt; Pakistan, Malaysia, the Russian Federation, Cuba, Singapore, Sri Lanka, Indonesia, Venezuela and the International Organization for Migration.

ECOSOC will meet again this afternoon at 3 p.m. to hear voluntary national presentations of Japan, Bolivia and Mali.

Documentation

The Council has before it the report of the Secretary-General, theme of the annual ministerial review: implementing the internationally agreed goals and commitments in regard to global public health (E/2009/81), which notes that health is at the heart of the Millennium Development Goals: it is the specific subject of three Goals and a critical precondition for progress on most of them. The need for coherence and partnerships among United Nations entities, national and international actors, including Governments, civil society, the private sector, philanthropy and academia is crucial to helping countries achieve their health priorities. Progress has been made in some areas, but much remains to be done. For many countries meeting the health goals remains a daunting task, especially since improving health outcomes is linked not only to the provision of health services, but also to interventions outside the health sector. With more resources and greater political will, health targets can be reached. However, in this time of financial and economic crisis, there is a danger that social goals like health will be neglected. If this occurs, previous gains will be jeopardized and in both high- and low-income countries, it will be the most vulnerable groups of society that will be most negatively affected. Progress in achieving the Millennium Development Goals must be sustained, but this will require new energy and stronger commitment. The report highlights priority actions and recommendations to achieve the health Millennium Development Goals, including by strengthening efforts to improve maternal and newborn health, and to ensure progress in the areas of universal health coverage, health system strengthening, and aid delivery and effectiveness.

Presentation of the Report of the Secretary-General on Implementing the Internationally Agreed Goals and Commitments in Regard to Global Public Health

SHA ZUKANG, United Nations Under-Secretary-General for Economic and Social Affairs, introducing the report of the Secretary-General (E/2009/81), said the Millennium Development Goals were the most prominent expression of the world's development aspirations. The Goals on poverty eradication, alleviation of hunger, health, environment and the global partnership were intertwined. Ignoring any one in favour of another would have serious consequences. The world could not afford to turn to short-term answers for a temporary respite for the difficult circumstances it faced – it needed sustainable long-term solutions. The report showed the situation with regard to progress in achieving the Millennium Development Goals, but visible gaps remained.

The global financial and economic crisis was increasing those gaps. Livelihoods of rural and urban poor families were deteriorating rapidly. Jobs were being lost at a quick pace, with women being disproportionately affected. There was a grave risk of reversing progress towards the Millennium Development Goals, with negative consequences for human well-being, development and economic growth, as well as for international peace and stability. In the area of health, the progress made in the past decade should be recognized. Success could be found in the progress made on HIV/AIDS, malaria, and tuberculosis, as well as in control of tropical diseases and non-communicable diseases. Sadly, there was a lack of progress in maternal mortality and newborn health. There was a need to change the grim statistics on maternal death. Maternal health and women's health needed to be kept high on the development agenda, with plans and policies to train, retain and deploy skilled health workers. Funding should also be provided in their regard.

Inequalities in health existed in many countries, including developed countries, Mr. Sha said. Unacceptably, health outcomes for women and girls often lagged far behind those for men and boys. Improving health outcomes was linked not only to improving health services, but also to interventions outside the health sector. The challenge was ensuring that all policy actors were involved, providing health equity. Aid to the health sector had been increasing – contributions from the private sector had shown remarkable results; however, the global economic downturn could lead to a drop in aid flows. This should not be allowed to happen, as it would be devastating for developing countries, in particular the least developed. The issues of human resource development and brain drain also needed to be addressed, with global and regional solutions including South-South cooperation. Leaders had shown so far a strong commitment to the health-related Millennium Development Goals, but that had not yet been translated into coherent multilateral action.

Annual Ministerial Review on Jamaica

RUDYARD SPENCER, Minister of Health of Jamaica, introducing the national report of Jamaica, said that overall, Jamaica had experienced mixed results in the achievement of the Millennium Development Goals. They had achieved the goals for reduction in absolute poverty, reduction in hunger and universal access to primary education. And Jamaica was on track to achieve universal access to reproductive health, halt and reverse the spread of HIV/AIDS, malaria and tuberculosis, and to achieve universal access to potable water and basic sanitation. Unfortunately, they were lagging behind in the areas of gender equality, empowerment of women, and in the reduction of bio-diversity loss. They were also slipping in the reduction of child mortality and maternal mortality, as well as in achieving significant improvement in the lives of slum dwellers. Jamaica was confident that, with the successful implementation of some critical policies, they could meet the health-related Millennium Development Goals. Chief among those policy interventions were the renewal of primary health care to focus on, among other things, the upgrading of infrastructure, the re-engineering of human resources and improved information systems; and the abolition of user fees at public health facilities. Those exemptions covered all services being accessed by public patients including, diagnostic tests, drugs, admissions and surgeries.

A major area of success for Jamaica was in its efforts to address the HIV/AIDS pandemic. While there was room for improvement in tackling stigma and discrimination, significant inroads had been made in increasing access to anti-retroviral drugs, resulting in a significant reduction in mother-to-child transmission and deaths due to AIDS. Since the historic United Nations Millennium Development Goals Declaration, the prevalence of chronic non-communicable diseases presented new challenges to public health. Jamaica recommended that ECOSOC place before the United Nations General Assembly a new target relating to halving the incidence of chronic non-communicable diseases by 2015, and a new target pertaining to the prevalence of chronic non-communicable diseases by sex and age. Jamaica also recommended that more health-related development aid be made available to those countries that were heavily indebted and were likely to flounder and fail in meeting the Millennium Development Goals, especially in light of the global recession.

SHEILA CAMPBELL FORRESTER (Jamaica), providing complementary information on the report, said that Jamaica was a small developing island State in the middle of the Caribbean Sea. As such, it was a hot spot for natural disasters, and was third out of 75 countries with two or more dangers. Its assets included arable land, with modest mineral resources, high levels of biodiversity, and outstanding scenic beauty. It was a middle income country, ranked 101 on the Human Development Index. In achieving the Millennium Development Goal targets, it had achieved reduction in absolute poverty, a reduction in poverty, and universal access to primary education. However, there were challenges: poverty reduction was fragile due to the global recession. There were major quality and equity issues in early childhood and primary education, including rural attendance problems associated with poverty. Jamaica was on track for universal access to reproductive health, halting and reversing the spread of HIV/AIDS, universal access to treatment for HIV/AIDS, halting and reversing the spread of malaria and tuberculosis, and universal access to potable water and basic sanitation. Targets which were on track represented solid gains despite remaining challenges.

Jamaica was lagging behind on some indicators. For gender equality, there was unevenness: while Jamaica recognized that empowerment of women was critical to Jamaica, and there were high levels of unemployment and low levels of representation, there was also underperformance by males at all levels of education, and thus both aspects of gender needed to be addressed. While elimination of ozone-depleting substances had been achieved, there was a lag in integration of principles of sustainable development, and slippage in carbon dioxide emissions. Jamaica was also far behind in reduction of child mortality and reduction of maternal mortality. Jamaica had comparatively low child and maternal mortality rates, hence target reductions were more difficult. Shortage in midwifes had negatively impacted resources. Maternal deaths from direct causes had been halved, but deaths from indirect causes had increased. There was also slippage in one important area, namely to achieve significant improvement in the lives of slum dwellers. Inner city areas were often violence and injury hotspots, and their deterioration could impact many Millennium Development Goals.

On meeting some of the challenges of primary health care, Jamaica focused on equity, access and social justice, and innovative developments in relation to the health team, and was developing a new primary health care strategy to meet challenges of sustainability, cost-effectiveness and quality in the face of increased demand. Strategies for renewal included innovative health financing, infrastructure upgrading, improved information systems, better-trained leadership and managers, and community empowerment. The National Health Fund was a Government agency that had been established in 2003, and Jamaica was the first country in the world to have an innovative health fund of this kind. The National Health Fund was financed through taxation of cigarettes, and the main focus was the provision of individual benefits, presently by way of pharmaceuticals. Recognizing the AIDS epidemic to be a development concern as well as a health issue, the Ministry of Health had implemented a multi-faceted response. There was also focus on tackling challenges to the health and well-being of children, including early childhood care and development. The greatest long-term challenge in meeting the Millennium Development Goal targets was the debt burden, which was the fourth highest in the world, and made it almost impossible to make significant headway in educational transformation, full primary health care renewal, youth vulnerability, and urban decay. More development aid was needed to prevent deterioration. In spite of this, Jamaica was moving towards the Millennium Development Goals.

MARIA NAZARETH FARANI AZEVEDO (Brazil) said that the high quality report clearly set out the national development priorities and the main challenges ahead. As the report pointed out, Jamaica had made remarkable progress in a number of key areas, such as the reduction in poverty levels, malnutrition and hunger, universal primary education, provision of safe drinking water and basic sanitation. The World Bank had rightly recognized that many of those social indicators for Jamaica compared well with those in countries with higher income levels. It was true that additional progress was needed on some areas, but the diagnosis and policy solutions presented in the report demonstrated that Jamaica was not only aware but also fully determined to tackle the challenges. The focus on public health was an understandable priority. In order to further reduce child mortality and improve maternal mortality rate, however, substantial additional human resources and financial resources might be required. Overcoming the challenge regarding women’s empowerment was crucial as women were disproportionately affected by, for example, unemployment and gained lower wages even when performing the same tasks as men. Brazil also welcomed Jamaica’s initiatives to promote sustainable energy. The introduction and planned expansion of the use of ethanol produced from sugar cane in the gasoline that powered the country’s vehicles should contribute to reducing carbon dioxide emissions and promote rural development, while at the same time reducing the reliance on imported oil. For a country that depended on foreign oil this was welcome news.

PETER OLDHAM (Canada) said the quality of the presentation of Jamaica and its clarity was quite impressive, there were lots of interesting lessons to learn. Canada valued its close relationship with Jamaica, and congratulated the Government of Jamaica on the results attained to date, particularly in the areas of poverty reduction and access to primary education. As they had rightly recognized, the progress achieved was increasingly fragile in the context of the current global economic downturn. Sustaining it would entail continued and concerted efforts to find solutions to the challenges in achieving the Millennium Development Goals, through close coordination with international development partners. In that regard, Canada commended Jamaica for the ongoing work and critical analysis undertaken in identifying obstacles to progress, remaining gaps, and lessons learned – particularly in areas in which goals had proven particularly challenging, such as child and maternal mortality targets.

The report reflected the seriousness with which the Government of Jamaica had embraced the Millennium Development Goals as a framework for advancing Jamaica’s human and social development. It was particularly noteworthy that, within that framework, Jamaica had sought to insert the factors and indicators especially relevant to its own context and reality – for example, the long-term impact from investments in early childhood education across a range of social development indicators; and gender inequalities in high levels of female unemployment despite better educational performance than males.

RICHARD KAMWI (Namibia) said Namibia was a friend of Jamaica's voluntary presentation, which brought forth aspects that were common to most middle-income countries like Namibia. Jamaica had made great strides to achieve the Millennium Development Goals – over 50 per cent of targets were met, and others were on course. This progress was a result of commitments by the leadership, and the strategic and prudent deployment of scarce resources. The people of Jamaica deserved congratulations.

However, Jamaica was still facing challenges, in particular with regard to child and maternal mortality, and was lagging behind in that regard mainly due to lack of human and institutional capacities and financial resources. Gains could be reversed if the international community did not rise to the occasion and support the efforts of Jamaica. The impact of climate change and natural disasters had the potential to reverse achievements. The current financial and economic crisis could also affect progress. Jamaica did not receive financial aid or loans that were needed for social investments, and that was beyond the control of the people of Jamaica, as was climate change and the financial and economic crisis. The international community was therefore responsible to ensure that Jamaica remained on course to meet the international agreed development goals, including the Millennium Development Goals, and should re-examine the situation of the middle-income countries, as it was inconceivable to fight poverty without increasing aid and resources provided to those countries. Jamaica needed resources to make progress.

CHRISTOPHER F. HACHETT (Barbados) said that Jamaica, as a low- to middle-income country, did not qualify for financial aid. However, its efforts to achieve the Millennium Development Goals showed the need for such support. The threat of the increasing frequency of natural disasters could worsen the situation of migration and the displacement vulnerable groups. In that context, climate change had to be mentioned and Barbados underlined the importance of the upcoming Copenhagen conference. Concerning HIV/AIDS, the initiatives undertaken by Jamaica highlighted the need for additional funding to halt the disease. ECOSOC should also identify the role of men to support females in programmes directed at women specifically. Given the present crisis, the middle-income countries were experiencing special challenges. Although Barbados recognized ECOSOC’s focus on low-income countries, more attention should be given to these middle income countries.

RUDYARD SPENCER, Minister of Health and the Environment of Jamaica, in response to comments and questions raised, said that violence in-country amounted to a significant amount of hospital time being used up, where there was little or no resources to expend. The Government of Jamaica was addressing this issue in two ways: it had increased the health budget; and it hoped that international organizations and countries would come to Jamaica’s aid. With regard to the situation of middle income countries and small island countries, which had been largely left out, those countries were ever striving. However, those efforts could only go so far and those countries could not do more without more funding.

In the formal economy, in Jamaica there tended to be more men than women, whereas the informal economy was dominated by women. The Government of Jamaica was trying to formalize the informal economy, and had been seriously considering how to merge the informal economy with the formal economy.

RICHARD KAMWI (Namibia) noted that the World Bank and the International Monetary Fund (IMF) were not present, and wondered whether if in their absence the Chair could consider asking for comments from United Nations agencies in the room?

MARIA NAZARETH FARANI AZEVEDO (Brazil) said that in the absence of the World Bank and IMF, was it possible to learn from Jamaica what response had been received from those institutions with regard to debt alleviation, debt equity swaps, and financing for health care in order to move towards the Millennium Development Goals? It was important to consider what could be done in terms of the suggestions put forward by Jamaica, and perhaps to invite the institutions to comment on those later.

RUDYARD SPENCER, Minister of Health of Jamaica, said that it was a real concern how the multinationals were dealing with the debt. Even Brazil was now considered a developing country and financial support was directed at the country.

SHEILA CAMPBELL FORRESTER (Jamaica) said that there was some assistance from the World Bank, especially for the HIV/AIDS programme. But it was not adequate and it was a matter of the ability to pay back the loan. Those issues needed to be addressed by Jamaica. Jamaica tried to pay back the debt, but it did not help when Jamaica’s rating fell. Community intervention had helped. Jamaica had learned to do a lot with a little. It was true that sustainability was an issue Jamaica had to grapple with at the moment.

TONY FAUTUA (New Zealand) said that the presentation made by Jamaica today was excellent. There had been progress made in the field of education throughout the various different levels, but there were challenges in sustaining skilled labour in the public health sector. Was Jamaica affected by the “brain drain”, where skilled labourers left the country to pursue their professions in other countries? Furthermore, what was Jamaica doing about trying to maintain skilled labour and its sustainability in the public health system?

SHEILA CAMPBELL FORRESTER (Jamaica) said that Jamaica had been working on this with its partners, including Canada, to try to see how it could retain and recruit health workers into the system. It was not a short-term solution, and had an impact on the quality of service delivery. Jamaica needed to recognize that it was not competitive where salaries were concerned, and much of its migration was to North America, which had a need for health professionals. The World Health Organization should work towards completing the Code of Practice in that regard. Many countries were suffering from the brain drain, and attaining the Millennium Development Goals was predicated on retaining the health workforce. Jamaica was continuously training its health workforce, as the loss was really tremendous.

RUDYARD SPENCER, Minister of Health of Jamaica, estimated that about one third of the trained medical workforce emigrated.

CHRISTOPHER F. HACHETT (Barbados) remarked that it was unfortunate that there was no representatives present from the World Bank and the IMF to discuss increased support from the international finance institutions for low-to-middle-income countries. Barbados would be grateful to the Chair if that request could be communicated to the representatives of the concerned institutions.

SYLVIE LUCAS, President of the Economic and Social Council, regarding the question concerning the code of practice for health professionals, said the issue had been discussed as part of the negotiations on the draft Ministerial Declaration. Also, regarding the issue of special challenges of middle-income countries, she again highlighted the draft Ministerial Declaration, where that issue was mentioned.

Annual Ministerial Review on China

CHEN ZHU, Minister of Health of China, introducing the national report of China, said that, since the Millennium Development Goals had been set nine years ago, the Chinese Government had earnestly fulfilled those commitments. China had made great achievements, for instance, in eradicating hunger and poverty, combating malaria, reducing maternal mortality and combating tuberculosis. With respect to social and economic development, China enjoyed rapid economic development with an increase of 8.9 per cent of the gross domestic product. The poor in China in 2000 had totalled 10.2 per cent of the population, and in 2008 their number had decreased to 4.2 per cent, which meant that China had fulfilled the anti-poverty goal as set by the Millennium Development Goals ahead of schedule. China had also conducted a study on the causes of poverty in the country, which showed that a major cause was disease. Therefore, the Government had taken measures to step up health and nutrition in response. The health services and health technologies had been greatly enhanced. Major diseases and endemic diseases had either been wiped out or brought under control. The under-five child mortality rate – which had stood at 61 per cent in 1991 – had decreased to 18.1 per cent in 2007. China had also made progress in reducing maternal mortality. In 1990 maternal mortality had been 94.7 per 100,000 live births, which had declined to 34.7 per 100,000 live births in 2008. China was well on course to reducing maternal mortality by three fourths, but of course more needed to be done.

In combating AIDS, malaria and other diseases, China had made good progress. Free treatment was provided for tuberculosis patients, with 100 per cent coverage. Since the severe acute respiratory syndrome (SARS) breakout in 2003, the Government had strengthened the public health system response mechanisms, and emergency response networks had been set up. Joint actions and coordination at the international level had been greatly improved as well. With the outbreak of H1N1 flu, the Government of China had adopted measures to prevent and control the outbreak in the country and region. Those measures had effectively slowed down the import, spread and prevalence of the disease in China, and gained time to prepare for a more serious potential outbreak and to stockpile vaccines and drugs, and had contributed to lowering the global peak of the first wave of the pandemic, Mr. Chen noted. With a large population and floating populations, a total of 1,114 cases of H1N1 had been recorded, and no critical cases or deaths had been reported. Furthermore, China had made a contribution to the global prevention and control of H1N1 through international exchanges and assistance by providing diagnostic services, training and personnel to countries in need.

The Government of China believed that it was important to put people at centre stage, and their health was the basis to social and economic development in a country. However, despite progress, challenges remained for China. Five key tasks for 2008-2010 included the improvement of grassroots medical and health service systems; making primary public health services equally accessible for all; expediting the construction of basic medical insurance systems; establishing a national system of essential medicines; and promoting reform pilot projects in public health. In conclusion, Mr. Chen said that China was devoted to addressing the inequalities in income, social insurance, medical services and education, and actively involved in international cooperation and to making contributions to the realization of Millennium Development Goals in the world.

HISHAM BADR (Egypt) observed that – undaunted by a heavy population burden – China had transformed that burden into an asset, making noteworthy and remarkable progress in raising the standard of living and quality of life of its entire population over the past three decades, reducing the population living in absolute poverty from 250 million to 15 million. No review of any public health policy would be complete without reference to the global financial and economic crisis and its impact t on the national health system. Contrary to the threat menacing many national health systems, China had laudably decided to inject a massive 850 billion yuan in investments to further develop its healthcare system, a bold move presenting a direct benefit to the Chinese public health system and an impressive stimulus package for the entire economy. The Government had also undertaken successful efforts in dealing with pandemics. No treatment of China's public health record would be complete without an assessment of medicine strategy: China had consistently supported the development of traditional medicine. The Chinese example highlighted the importance that such traditional systems of medicine could have in enabling developing countries to diversify their medicine policy base as a cornerstone of their public health systems.

ASAD M. KHAN (Pakistan) said that China had presented a compelling case of how a clear political vision supported by nationally led, cooperatively framed and seriously implemented strategies, based on the principles of equity, social justice and equal opportunity, could bring about a fundamental transformation in a society. The most striking aspect of China’s endeavours was that it was people-driven, people-led and people-focused. China had increased its per capita gross domestic product from 379 yuan to 18,934 yuan in 2007 and had met all the Millennium Development Goals targets.

China was today a trailblazer in the developing world, not just in the areas of achieving health-related goals and commitments, but also in advancing the welfare and prosperity of its people. Pakistan found particularly interesting the five health reform measures being implemented by China, including universal health coverage through a basic medical insurance system; improving access to medicines and doctors; improving the basic medical and healthcare system; promoting equalization of basic public health services; and reforming the public hospital system and operational mechanisms. Pakistan asked, inter alia, how China integrated traditional medicine into existing health plans built around contemporary health systems and how other countries could tap into that important health resource?

SIH HAJJAR ADNIN (Malaysia) said it was clear that the efforts taken by China to analyse the trends and policies, and assess the implementation and impact regarding the internationally agreed goals and commitments in regard to global public health, had been undertaken through a multisectoral approach involving the relevant stakeholders. Malaysia recognized the scale of ensuring public health in China. The large population of China required a commitment to public health that was unprecedented anywhere else or at any other time in history. Malaysia welcomed that, despite that enormous challenge, China was committed to providing universal access to basic medical and healthcare services, including undertaking reforms to widen coverage for urban and rural residents, strengthen Government responsibility and ensure that everyone had access to primary health care. In that regard, the various programmes that had been identified in China’s report and presentation, inter alia, scaling-up medical infrastructure, accelerating the establishment of a basic medical insurance system and establishing a national essential drug system were welcomed, and could be models for other developing countries.

Within the report, it was clear that with the challenges faced by China due to scale, providing basic medical and health care was not only a matter of focusing on health policies, but also involved paying necessary and adequate attention to other supportive and interrelated areas, such as poverty eradication, education, and hygiene to name a few. Also welcomed were other indicators of China’s progress, such as, the rise in life expectancy, the drop in child and maternal mortality rates and free treatment for tuberculosis patients. Given China’s long and wide-ranging history and experience of traditional medicines and given it had equal status in the legal, academic and health-service spheres as that of Western medicine, how did China ensure that its traditional medicines were safe, of quality and effective, and how could that experience, including the traditional knowledge itself, be shared with other countries?

ANDREY I. DENISOV (Russian Federation) said the presentation was very interesting and informative in the context of efforts to achieve the Millennium Development Goals, where there had been impressive success in the area of health care. There was significant progress, in particular, in the reduction of maternal, child and infant mortality, and in combating the spread of infectious diseases, particularly in areas where formerly modern health care did not exist. The work of Chinese specialists in the important area of pandemics required greater attention and popularization. China also had experience in harmonizing traditional and other medicine. The reform of the health care system was also noted. China acted in an unbiased manner to construct its future activities.

CHEN ZHU, Minister of Health of China, responding to a first round of questions, said that although China had made progress in the field of public heath, it still faced enormous challenges. The achievements should always be divided by 1.3 billion, as well as progress multiplied by 1.3 billion. In China, a major decision had been made of how to govern a country, which was to put people at the centre. That was a strategic decision. Investment in the health sector was also an investment in economic development: in investing in the health sector, China had seen a boost in domestic consumption. Regarding the flu, 1,014 cases of H1N1 had been confirmed. In response to that development, a joint body of several government bodies was set up to deal with that flu. Containment had to be combined with mitigation as two components. Since SARS, a reporting system had been set up which now played a great role. China had also decided to step up efforts to produce vaccines and was also focusing on community-level measures. With the deepening of medical care reform, the monitoring system would be strengthened.

Mr. Chen clarified that Chinese traditional medicine was a major component of human medicine; it had borrowed heavily from other civilizations as, for example, the ancient Silk Road had allowed the Chinese to borrow from Persian knowledge and also knowledge from South-East Asia, which had then been incorporated. About a quarter of patients in hospitals received treatment of traditional medicine and the figures where even higher in the rural areas. Regarding the concerns about the safety of traditional medicine, China said that control mechanisms were strengthened, for example through scientific research into the matter.

RESFEL PINO ALVAREZ (Cuba) said that, from the beginning of the setting up of the State of China in 1949, the model upon which society had been built had been based on equity and social justice for all. Social security, employment, food and public health, among other things, constituted a priority for the Government of China. Enormous progress had been made in China, and in particular with regard to access to medical health services across the country. China had made strides in increasing life expectancy in the country, where it had increased from 35 years of age to 73 years of age currently. The reform of the public system, which aimed at raising the national level of health in the country, was also welcomed. Cuba asked what specific measures were included in that national health care reform strategy, and what impact would it have on access to medical health care services at the national level? China was an example of international cooperation in promoting the right to health and the right to the development of people.

SYED NOUREDDIN (Singapore) said, coming from the same region, Singapore was quite aware of the significant progress China had made in its giant steps towards accomplishing the public health-related Millennium Development Goals, in particular with regard to the health of rural populations. That was laudable. What China did would certainly have an important impact on all those in the region. China should further share its useful experience in assisting developing countries to move forward in accomplishing the Millennium Development Goals.

Mr. KAHENDELIGANAGE (Sri Lanka) said that Sri Lanka was impressed that China, with such a large population and large regional disparities, had achieved such progress, notably in reducing maternal and child mortality. Sri Lanka would like to know more about China’s experience using a health scheme.

GHAFUR DHARMAPUTRA (Indonesia) said that prevention and control of diseases were common challenges faced by countries. The emergency response network and the information release system noted in the report were therefore welcomed. Indonesia asked China for more information about institution-building and lessons learned that could be shared.

JULIO CESAR ALVIAREZ (Venezuela) said the report was comprehensive, revealing major developments in social development and health in China, which had the human at the centre, with the goal being universal, free health care. Investments had been made in health and in international cooperation in health and other sectors. China was congratulated for its major progress towards attaining the Millennium Development Goals. That so much had been achieved was an example for the whole world, in particular for the developing countries. What was the situation in the area of human resources for the health sector and training in terms of technical staff and health personnel in both Western and traditional medicine? Like Cuba, China was an example to the world in the field of health and social security.

DAVIDE MOSCA, of the International Organization of Migration (IOM), said that China had mentioned a high number of migrants in the country and IOM wanted to know more about their access to healthcare services and whether there was a specific body in the Government dealing with that group.

CHEN ZHU, Minster of Health of China, in response to the second round of questions and comments, said that as a whole China had achieved considerable progress in the healthcare field, yet compared to advanced countries in the developed world they still had along way to go. For instance, with respect to life expectancy, China had a five-year gap to fill between its life expectancy rates and that of Cuba. Moreover, due to unbalanced development in China there was a huge imbalance in life expectancy between the western and eastern provinces. In most cases it could be said that there was a difference of 10 years from one side of the country to the other in terms of life expectancy. As a result of the imbalance the Government aimed to reform the healthcare system and to ensure basic health care for all. The system currently covered more than 90 per cent of farmers. Health was the responsibility of both Governments and individuals.


With regard to the development of human resources, during the reform of the medical health services, more than 1 million medical and technical persons needed to be trained in order to ensure more than 1 million doctors in the countryside. One main challenge faced by China was how to promote doctors to practice in the countryside and western and eastern provinces. Only by improving the level of medical services in rural areas would people trust the system. With regard to training and balance between Western and traditional Chinese medicine, there was currently a crisis in developing and extending traditional medicine because of the market situation. Three types of medical teams needed to be established in China, one team which focused on traditional medicines, the second which focused on Western medicine, and lastly one that would combine both. However, in order to create that last team, a special policy would be necessary. In conclusion, Mr. Chen said with regard to coordinating mechanisms, in order for health services in China to be further developed it was necessary to note that this responsibility did not solely rely on the Ministry of Health, but was the responsibility of all ministries.



For use of the information media; not an official record


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