This afternoon the Economic and Social Council (ECOSOC) began the general debate of its high-level segment on current global and national trends and their impact on social development, including public health, which is expected to culminate in the adoption of a ministerial declaration. At the beginning of the meeting it heard a presentation by Sha Zukang, United Nations Under-Secretary-General for Economic and Social Affairs, of the report by the Secretary-General on this year’s theme, followed by a statement by the Chairperson of the Committee for Development Planning, Ricardo Ffrench-Davies.

Opening the general debate of the high-level segment, ECOSOC President Sylvie Lucas noted that this year’s discussions on global public health were extremely timely and relevant, especially in light of the recent influenza pandemic, which more than ever called for concerted global actions. The centrality of health in the effort towards the achievement of the Millennium Development Goals had been reiterated throughout the preparatory process. Immunization was as important as was access to safe drinking water, adequate nutrition and proper service delivery in hospitals and clinics. Only an all-Government approach would bring about the desired effect. Also highlighted was the role of partnership was key in generating momentum towards achieving the Millennium Development Goals.

Introducing the report of the Secretary-General on the theme of current global and national trends and their impact on social development, including public health, Mr. Sha said the global financial and economic crisis had exacerbated the effects of the food and energy crises, constituting a major setback in efforts to achieve the Millennium Development Goals, particularly the goal of eradicating extreme poverty and hunger. Social cohesion was under threat, with rising social tensions and an increase of violence; and fiscal revenues of low-income countries were likely to fall, which could force cutbacks in social spending. The current crises were set to have profound implications for public health, with populations' health, as well as health services, worsening. In this interdependent world a global and long-term perspective should be taken.

Mr. Ffrench-Davies, presenting the report of the Committee of Development Policy, said the Committee was especially concerned with health inequalities and how those could be reduced in developing countries. There was an urgent need to reform existing mechanisms of compensatory financing and assistance in response to external shocks and global demand downturns. Tax collection for the financing of health had to be improved. There was also much room for further improvement in global partnerships for health, which did not coordinate well with other existing programmes. Measures agreed at the G-20 meeting in London in April were welcome, but delivery on the commitments made had to be expedited.

During the general debate, most speakers evoked the current and future impacts of the multiple global crises – the financial and economic crisis; the food crisis; and climate change – which were exacting a heavy toll on social and economic development. That meant Governments in developing countries were faced with shrinking fiscal space that adversely impacted their allocation of resources to key social sectors like education and health precisely at a time when social nets needed to be enlarged and strengthened to include the millions who were in danger of being pushed back into poverty by the crisis. Moreover, globalization meant the management of health could no longer be done within the borders of one country. There was an urgent need for intergovernmental cooperation and policy coordination, speakers said, as well as improved capacity-building and knowledge sharing between developing and donor countries in order to mitigate any further social fallout from the current economic and financial crisis. Also, while acknowledging that the key players in delivering health outcomes would always be national Governments, speakers called on development partners to further enhance coordination of their support to the numerous global and national health initiatives.

Speakers also shared their national experiences and best practices, including a pan-African e-network project, which, inter alia, was linking major hospitals in Africa with super-specialty hospitals in India to provide quality tele-medicine. Speakers also raised a number of serious challenges, including high maternal and infant mortality; serious disparities in health care between rural and urban areas; lack of health infrastructure; a lack of trained health care providers; the need to focus on non-communicable diseases and injuries within global discussions on development; a lack of sufficient attention to health issues in the least developed countries; and the need to balance the intellectual property rights of patent holders with the right to health.

Many speakers highlighted the issue of women’s health as a priority area for improvement. It was noted that of all health indicators, maternal health was the one that most clearly revealed the enormity of the gap between the rich and the poor, with 99 per cent of deaths during pregnancy and childbirth occurring in developing countries. That number had not changed for many years and that was the field in which least progress had been achieved. A speaker said increased investment in family planning alone would reduce maternal mortality by up to 40 per cent.

Speaking in the general debate this afternoon were the Ministers of Health of China, Namibia, the Maldives, Oman, Guyana, and Qatar; the Minister for Foreign Affairs of Liechtenstein; the Minister of State for External Affairs of India; the Minister for the Family and Social Development of Morocco; and the Minister of Economic Affairs of Barbados. Among Vice Ministers and other high-level representatives taking the floor were representatives from Sweden, speaking on behalf of the European Union; Poland; Venezuela; and the Netherlands. National representatives speaking included Sudan, on behalf of the Group of 77 and China; Bangladesh, on behalf of the least developed countries; Bulgaria; Kenya; Switzerland; Malaysia; Kazakhstan; Brazil; Monaco; the United States; and Malta. The following international and non-governmental organizations also took the floor: the International Association of Economic and Social Councils and Similar Institutions; the International Federation of the Red Cross and Red Crescent Societies; the Conference of Non-Governmental Organizations in Consultative Relationship with the United Nations; the International Planned Parenthood Federation; the Association of Medical Doctors of Asia; the Research Circle on Duties of the Human Person; and Ius Primi Viri International Association.

When the Council meets tomorrow, at 10 a.m., it will continue its high-level debate.

Documentation

The Council has before it the report of the Secretary-General on current global and national trends and their impact on social development, including public health (E/2009/53), which says the world economy is in the most severe financial and economic crisis since the Great Depression. Virtually all economies will see a marked slowdown in 2009, with the contraction in developed economies translating into weaker growth in all other countries. The slowdown is being rapidly transmitted through trade, which it is estimated will decline by roughly 9 per cent in 2009. Unemployment rates are rising in many countries, straining national budgets and putting pressure on household disposable incomes. In many developing countries, the negative impact of the crisis on employment constitutes a major setback in efforts to achieve the Millennium Development Goals, in particular the goal of eradicating extreme poverty and hunger. The impact of the global financial and economic crisis seems to have exacerbated the effects of the earlier food and energy crises, which, according to some estimates, pushed between 130 million and 155 million people into poverty. The report analyses the impacts of those trends on social development, focusing on poverty and hunger; social cohesion; public spending on social areas, such as social protection, safety nets, education and health; job security; and food security. The report also pays special attention to the implications of the current trends for health-related goals and makes a number of recommendations on how to deal with the attendant challenges.


Introduction of the Report of the Secretary-General

ZHA ZUKANG, United Nations Under-Secretary-General for Economic and Social Affairs, introducing the report of the Secretary-General on current global and national trends and their impact on social development, including public health (E/2009/53), said the report covered in detail the impacts of recent trends in the financial, economic, food, fuel and climate change areas. The world economy, after several years of robust global growth, was forecast to contract significantly. Of particular concern was that growth would fall below the level needed to make meaningful progress towards the Millennium Development Goals. The threat of climate change loomed large. All evidence pointed to the need for bold collective actions to reduce greenhouse gas emissions and for a comprehensive agreement at Copenhagen later this year, on both the developmental and environmental challenges of addressing climate change. The global financial and economic crisis had exacerbated the effects of the food and energy crises, and that constituted a major setback in efforts to achieve the Millennium Development Goals, particularly the goal of eradicating extreme poverty and hunger.

The sense of urgency surrounding the food crisis could not be allowed to fade, as it was far from over, and food shortages were likely to resurface, Mr. Sha said. At this time of economic hardship, social cohesion was under threat, with rising social tensions and an increase of violence. Fiscal revenues of low-income countries were likely to fall as a result of the economic downturn, which could force cutbacks in social spending, with long-lasting effects on human development. Job losses were increasing rapidly, which would have a deep impact on the livelihoods of the working poor, pushing many under the poverty line. The current crises were set to have profound implications for public health, with populations' health, as well as health services, worsening. In this interdependent world, many of the threats and challenges could not be met by independent actions – a global and long-term perspective should be taken. Development cooperation should not falter, and there should be no backtracking on commitments to the developing world. The implementation of large-scale internationally coordinated fiscal stimulus packages, aimed to reactivate the global economy, should be aligned with long-term sustainable development goals.

Statement by the Chairperson of the Committee for Development Planning

RICARDO FFRENCH-DAVIES, Chairperson of the Committee for Development Planning, presenting the report of the eleventh session of the Committee of Development Policy, said that over the past decades, health outcomes had improved worldwide; however, large disparities existed between and within countries. The Committee was especially concerned with health inequalities and how those could be reduced in developing countries. Existing inequality in social and economic and financial crisis conditions was the main determinant of inequalities in access to health care and that affected health outcomes. Poor rural areas often had few health facilities and there was discrimination against certain groups. International action had larger rewards if they focused on the poor.

Fiscal policy was a crucial ingredient in the way out of the present critical world situation. There was an urgent need to reform existing mechanisms of compensatory financing and assistance in response to external shocks and global demand downturns. Tax collection for the financing of health had to be improved and domestic resources continued to be insufficient. There was also much room for further improvement in global partnerships for health. Those partnerships did not coordinate well with other existing programmes. The Committee welcomed the measures agreed at the Group of 20 (G-20) meeting in London in April, but delivery on the commitments made had to be expedited. Moreover, sufficient resources needed to be made available to low-income countries. The promised $50 billion in emergency financing might well fall short of what was needed if not complemented by accelerated delivery on all commitments.

General Debate

SYLVIE LUCAS, President of the Economic and Social Council, opening the general debate of the high-level segment, said that the debate was not only the culmination of a long and intense preparatory process, but also a starting point for collaborative action. The primary purpose of the segment was to track progress, share practices, and accelerate action towards the achievement of the development agenda. This year’s discussions on global public health were extremely timely and relevant, especially in light of the recent influenza pandemic, which more than ever called for concerted global actions. The centrality of health in the effort towards the achievement of the Millennium Development Goals had been reiterated throughout the preparatory process, including at the regional meetings held in preparation for this session. It had been noted again and again that comprehensive, multisectoral, people-centred and results-oriented approaches were needed to create effective and strong health systems that would provide better health outcomes.

The importance of integrating health policies into the broader national development strategies and plans had been emphasized repeatedly. Immunization was as important as was access to safe drinking water, adequate nutrition and proper service delivery in hospitals and clinics. Only an all-Government approach would bring about the desired effect. In these times of crises, the importance of sustaining investments in public health was essential. One could not afford to forgo continued investment in social protection systems that mitigated the worst affects of crisis. Ms. Lucas was encouraged to hear from the presentations made yesterday and this morning that health policies indeed lay as a priority in countries’ development strategies. She could not overstate the need for broader engagement and dialogue in overcoming the challenges faced in the timely realization of the Millennium Development Goals, particularly in the area of health. The role of partnership was key in generating momentum towards those Goals. In conclusion, she hoped that this debate would provide a platform for launching and strengthening partnerships for health and development.

LUMUMBA DI-APING (Sudan), speaking on behalf of the Group of 77 and China, said it was the Group's expectation that this thematic discussion would contribute optimally to the discussion held under the Annual Ministerial Review. The world was in the midst of a severe financial and economic crisis; the exponential rise in food and fuel prices last year and the continuing volatility of commodity prices had exacerbated the impact of the global economic crisis. Compounding the situation was the challenge of climate change. The current trends were exacting a heavy toll on social and economic development, and the crisis had come at a time when public health was at a crossroads. The current crisis could result in donor countries reducing the already scarce resources they allocated to official development assistance, and many countries would see a decrease in the international assistance they received in support for social programmes. The international community could not allow denial of the right to health by patent holders who abused intellectual property rights. If there was a genuine desire for change, if there was a vision to create a better and fairer world, then the goal of health for all could be achieved in this generation, but it required urgent action and long-term measures.

ANDERS NORDSTROM, Director General of the Swedish Agency for International Cooperation and Development, speaking on behalf of the European Union, said that global economic growth had over the last decades, in combination with social policies, permitted vast groups of people in many parts of the world to improve their living conditions and health standards. They had seen strong mutual links between power, economics, wealth and health. Those important links between living conditions and health had recently been analysed in depth by the World Health Organization (WHO) Commission on Social Determinants of Health. The Commission had noted that the dramatic and growing disparities in health and life expectancy were closely linked to the underlying difference in people’s daily living conditions. While trying to cope with the impact of the current financial and economic downturn it was also key to address other major threats to well-being and global health. A major case in point was climate change and the millions of people affected already today. New pandemics would hit poor countries hardest and make poor people suffer most. For hundred of millions of people, poverty-related diseases were realities. There were huge gaps globally, both with regard to non-communicable diseases and communicable diseases such as HIV/AIDS.

For billions of females, male violence both in times of armed conflict and in times of peace further aggravated mental and physical ill-health and constitutes maybe the most severe obstacle to women’s empowerment. The European Union, the world’s largest provider of development assistance would continue to take global responsibility to promote global development, including social development and health. The key player would, however, always be national Governments. In a number of countries, including in sub-Saharan Africa, many Governments would need external support to meet the challenges. Development partners must take further action to enhance coordination of their support to the numerous global and national health initiatives.

MUSTAFIZUR RAHMAN (Bangladesh), speaking on behalf of the least developed countries, said they endorsed the statement made by Sudan on behalf of the Group of 77 and China. One third of the deaths in the world – some 18 million people a year or 50,000 per day – were due to poverty-related causes. Every year more than 10 million children died of hunger and preventable diseases – that was over 30,000 per day and one every 3 seconds. In least developed countries, one out of every 10 children died before the age of five. Malaria, together with HIV/AIDS and tuberculosis, was one of the major public health challenges undermining development in the least developed countries. Malaria killed an African child every 30 seconds. In sub-Saharan Africa, where many least developed countries were situated, there were currently more than 4.1 million people with AIDS who were in immediate need of life-saving anti-retroviral drugs. In addition, least developed countries had to tackle new diseases like the Avian and Swine Flu without having the capacity and technology to produce the necessary vaccines. It was indeed regrettable that the dire situation of least developed countries had not been reflected in the reports prepared by the Secretariat, and expected clarification from the Secretariat in this regard.

AURELIA FRICK, Minister for Foreign Affairs of Liechtenstein said the main topic of this year's high-level segment was both an essential element of the individual well-being, and a prerequisite for a well-functioning, productive society and for socio-economic development. Health had therefore become a core issue for the Millennium Development Goals. Progress in the implementation of the health Millennium Development Goals was indispensable for sustainable progress in the others, including those on poverty reduction, hunger, gender equality or education. There was a world economic crisis with negative consequences for the most vulnerable countries and communities and in particular on women and children. In the current economic circumstances, holding on to gains and moving forward on the Millennium Development Goals were objectives that were in jeopardy. More than ever, the current global economic crisis required international solidarity, and ECOSOC was a useful global platform for galvanising interest and cooperation.

CHEN ZHU, Minister of Health of China, said that China had set a target of basic health care for all and emphasized the responsibility of the Government in basic health care. China had made it clear that the medical and health reform should resolve the issue of fairness in the first place and achieve equal access to public health services to ensure that every citizen’s basic health needs were met. More and more persons were moving into cities, and the Chinese Government was aware that the well-being of those people was very important for the stability of the country. The migrant workers with long-term contracts had access to medical insurance for urban employees and those without such contracts could enjoy the new rural cooperative medical scheme in their regions of origin or in the places where they resided. In addition, the Government provided an extra budget each year to provide medical assistance to the poor population in the society, including poor migrant workers. It also revised education laws especially to protect the right to education in cities for children of migrant workers.

In this globalized age, any emergent public health incident could burst beyond borders and become a shared problem. Therefore, the Chinese health department was taking health-care system reform as an opportunity to enhance the public health level in all around way as soon as possible. The Chinese health services would be happy to work together with the WHO and others.

PRENEET KAUR, Minister of State for External Affairs of India, said India was encouraged that various efforts were under way to address the global financial crisis. India was actively engaged in the G-20 process. Last month’s United Nations conference on the crisis had been a landmark event, bringing together all countries to collectively respond to the crisis. The impact of the economic and financial crisis on social development was perhaps the most pernicious and least-visible manifestation of the global crisis. Governments in developing countries were faced with shrinking fiscal space that adversely impacted their allocation of resources to key social sectors like education and health. Unfortunately, that was happening precisely at a time when social nets needed to be enlarged and strengthened to include the millions who were in danger of being pushed back into poverty by the crisis. It was timely and apt that this year’s high-level segment focused on health. Public health was critical not only in directly ensuring human well-being, but also was a key determinant to overall productivity and economic growth.

In the spirit of South-South cooperation, India had been privileged to share its development experience, including in the health and related sectors, with fellow developing countries. The pan-African e-network project, which, inter alia, was linking major hospitals in Africa with super-specialty hospitals in India to provide quality tele-medicine, was a good example of this.

RICHARD N. KAMWI, Minister for Health and Social Services of Namibia, said health was indeed an important component of the development agenda; however, it had not been enjoying the prominence that it deserved. Development depended on the human factor. Namibia had made significant progress towards meeting the Millennium Development Goals through investments in the social sectors. Despite that, there had been slow progress in respect of reduction of child and maternal deaths. The challenges that Namibia was faced with in achieving targets for Goals 4, 5 and 6 was a result of financial and human resource constraints, as well as continuous cross-border transmission of diseases.

This year's Ministerial Review was taking place against the background of multi-crises that affected the world's economy adversely. The Government of Namibia was deeply appreciative of those development partners who continued to extend official development assistance and emergency relief to Namibia, which needed continued external support in the form of grants and concessionary loans as well as technical assistance to build and strengthen its capacities. Resources should be provided to address the human and social impacts of the crisis in order to safeguard the hard-won economic and development gains to date. For the international community to sustain and accelerate progress, decisive actions needed to be taken at global, regional and country levels. Sound and targeted investments had to be made in order to address the large gaps within countries, and meet the needs of the poorest and most vulnerable.

NOUZHA SKALLI, Minister for Social Development of the Family and Solidarity of Morocco, said that during the past decade and since the accession to the throne by King Mohammed VI, Morocco had known an exceptional dynamic. He had started a large economic, social and political reform programme placing the individual human being at the centre. On the economic level, big modernization programmes had been launched in order to integrate Morocco into the free trade areas. Despite the economic crisis, the grow rate was more than 5.5 per cent today, thanks to an exceptional agricultural season. The issue of power sharing between men and women and the establishment of a partnership between men and women was a way of leveraging development to meet the challenges in fighting poverty, illiteracy and all forms of discrimination against women. Regarding health, there were huge disparities between rural and urban areas. Maternal mortality was high, at 227 deaths per 100,000 live births. Every day, four women died giving birth, which was 1,500 deaths per year. Infant mortality was at 40 deaths per 1,000 living births, which meant 2,500 children died every year before reaching their first birthday. The causes were the lack of infrastructure, distance between rural areas and health care providers, as well as the inaccessibility of means of transport.

DAVID ESTWICK, Minister of Economic Affairs, Empowerment, Innovation, Trade, Industry and Commerce of Barbados, said the worsening global economic environment was giving rise to unemployment, a reduction in Government revenues and the diminution of social services. The concomitant effect from declining global gross domestic product threatened small high income economies such as Barbados. That could lead to social unrest and further social deprivation, particularly with regard to access to good quality health care. There was an urgent need for intergovernmental cooperation and policy coordination, as well as improved capacity-building and knowledge sharing between developing and donor countries in order to mitigate any further social fallout from the current economic and financial crisis. The Government of Barbados had crafted a multisectoral response (framed by the strategic plan for health 2002-2012) to the economic crisis in an effort to ensure that the broader social and economic determinants of health were addressed. Furthermore, it was their belief that the multilateral process remained the most effective institutional arrangement to tackle issues such as public health.

AMINATH JAMEEL, Minister of Health and the Family of the Maldives, said that if the international community was to see countries like the Maldives graduate from least developed country status, then it was important to create a new development category of small and vulnerable economies, to sit alongside but separate from middle-income country status. That would allow preferences and support to be tailored to the needs and vulnerabilities of relevant States.

In a globalized world, health issues presented new challenges that went far beyond national borders, and had an impact on the collective security of people around the world. There was a need for effective surveillance and strategies such as collaboration among countries, proper infection control measures, and coordinated efforts by several actors and networks of relevant scientific institutions to maximize the knowledge and capacity to handle such new challenges. Lifestyles were changing rapidly, and with development and urbanization there were new emerging challenges to the health system. The emergence of non-communicable diseases was putting a heavy burden on already burdened economies. Primary health care was the right approach to strengthen health systems, taking into account the social determinants of health for achieving the Millennium Development Goals. International coordination and partnerships should be further strengthened and experiences should continue to be shared.

ALI BIN MOHAMMED BIN MOOSA, Minister of Health of Oman, said that during the adoption of the Ministerial Declaration tomorrow, they would have the opportunity to reflect on how far they had come, and what lessons they could draw from their experiences so far. This year they found themselves at a significant milestone, where all had to face the basic questions: do they need to continue the momentum that ECOSOC had given to position non-communicable diseases and injuries within global discussions on development? After the past two days there was already progress on including those in global discussions on development. On the negative side, overall progress in addressing non-communicable diseases and injuries in developing countries was too slow. Developing countries were demanding technical assistance, through aid and expertise, to build national capacities enabling them to combat those issues. Yet, less than 1 per cent of official development assistance was allocated in response to those requests for technical assistance. A critical stepping stone would also be a world summit on non-communicable diseases.

LESLIE RAMSAMMY, Minister of Health of Guyana, said non-communicable diseases represented an unquestionable threat to global development. Guyana noted with great concern the omission of provisions to address non-communicable diseases in all the global development instruments and called for countering that anomaly. There was no need for further debate; there was a need for global solidarity. A special session of the United Nations to galvanize solidarity and define global action to reduce and reverse the disease burden of non-communicable diseases was advised, and the heads of States of Caribbean countries had already made such a call. Revision of the goals and targets of the Millennium Development Goals, to include a Millennium Development Goals Plus which would define specific goals and targets for non-communicable diseases was needed. Non-communicable diseases should not omit mental health. As a global community there was also a need to address the worrying problem of health workers’ migration. Guyana believed that there was need for greater compliance for the Framework Convention on Tobacco Control, and a strategy on Diet, Nutrition and Physical Activity. In conclusion, help for all was not possible unless health systems were strengthened to address the problems that stemmed from non-communicable diseases and mental health.

KONSTANTIN ANDREEV, Permanent Secretary of the Ministry of Foreign Affairs of Bulgaria, said the issue of public health concerned all Member States and hundreds of millions of people worldwide. The achievement of sustained health was one of the main prerequisites for a successful implementation of the Millennium Development Goals. Progress attained in preserving public health must be steady – and that needed more vigorous measures to be taken by the whole international community. It would not be possible to reach the Millennium Development Goals without coordination and cooperation among all countries and international organizations. Yet the growing number of international initiatives related to public health also revealed problems, such as a risk of fragmentation of efforts, insufficient coordination of actions, and a lack of new adequate channels for financing health care and applying new technologies, which would ensure better opportunities to reduce the impact of the interlinked global challenges over the past two years – the food security crisis, climate change, regional conflicts, and the economic crisis. The international community shared a common goal – to alleviate the negative impact of the global economic crisis, to secure health protection, and preserve the health of all people from possible unfavourable implications.

PETER KENNETH, Assistant Minister of State for Planning, National Development and Vision 2030 of Kenya, said that the theme of the high-level segment was particularly relevant at this moment in time when the world economy was experiencing unprecedented multiple challenges that had severe consequences on the commitments and funding of key programmes, including in the health sector. The global financial crisis had affected many countries in different magnitudes. For developing countries, especially those in Africa where the crisis had not originated, the effects were devastating. There had been a marked reduction in international trade, investments flows, diaspora remittances, tourist revenues, capital flows and there had been adverse impacts on stock and money markets. Many of the developing countries, particularly in sub-Saharan Africa, were experiencing difficulties funding health, education, poverty initiatives, infrastructure and nutrition programmes. That had a negative affect on the achievement of the Millennium Development Goals. Further, climate change, use of cereals for production of bio-fuels and volatile oil-prices had contributed to the food crisis. That state of affairs had led Governments to divert budgetary resources from development priorities to humanitarian assistance. The attainment of the Millennium Development Goals was seriously threatened by the economic and financial crisis.

ADAM FRONCZAK, Under-Secretary of State, Minister of Health of Poland, said Poland supported the statement delivered by Sweden on behalf of the European Union. The Government of Poland undertook intensive actions to provide health care, with a strong emphasis on the most vulnerable groups. Poland made efforts to ensure that pregnant women and children received the highest possible standard of health-care service. In Poland, a uniform and integrated anti-retroviral therapy had been implemented for eight years, in accordance with international recommendations and commitments, including the Millennium Declaration. The national AIDS centre carried out wide-scale educational and informational activities, aimed at the prevention of new cases of HIV infection. In order to reach the largest number of doctors with information about HIV/AIDS, an e-learning programme had been launched. In addition, there was a national telephone helpline that had been operating for 12 years, as well as free anonymous HIV tests in offered in more than 25 testing points. Poland had always stressed the need to address global development disparities, emphasizing the importance of the fight against poverty, of the improvement of global public health, universal access to education, gender equality and promotion of democratic principles.

KARIM SLOLWING UMANA, Executive Secretary in the Office of the President for Planning of Guatemala, said Guatemala had thought it would escape the crisis, but forecasts showed that growth had been less than expected, and could drop to zero. The real economy had suffered due to a drop in remittances from outside the country, particularly from economic migrants in the United States. Without remittances, family incomes intended for spending on health services risked dropping due to the world economic crisis. The Government had thus been recovering the right to health through a range of public health services paid for by the State. Children had to be enrolled in school and stay there to gain free public health care. Work was also being done to integrate other actions, including food aid, and the implementation of a scheme for proactive support of migrants in the rural areas, formulated in concert with the indigenous and other stakeholders, including work towards food security. The world crisis had been reflected in an accelerated decline in national tax revenue, which was unprecedented in terms of scope and speed, threatening policies, including the basis of the whole public system. Increases of inequality were felt by those whose main income derived from remittances. There were some preliminary indicators showing that there were some programmes that could cushion families from the situation. The Government needed resolve on the part of national stakeholders in order to improve the situation and make progress, however there should also be external financing.

ALEXANDER A. PADILLA, Undersecretary in the Department of Health of the Philippines, echoing the words spoken by the WHO Director-General at the opening of the ECOSOC session, they were meeting at a time when the world faced multiple crises on multiple fronts. The food, energy, global financial and economic crises, climate change and the H1N1 pandemic all had detrimental effects on global public health. In light of the economic downturn, flows of official development assistance and remittances had already begun decreasing. Furthermore, growing protectionist tendencies could close markets and societies when what the world needed was an environment in which all could prosper in a fair, equitable and accountable manner. Hard-fought gains in poverty reduction, infant and maternal mortalities, gender equality, education, health, fighting communicable diseases, protecting human rights and promoting sustainable economic developments stood to be reversed if the community of nations did not act in a coherent and coordinated manner to overcome these challenges together. They could simply not allow public health to become a casualty of the global crises. International cooperation and investments in the field of public health had to be top international priorities.

Turning to the situation in his the Philippines, the years leading up to the global economic and financial crises had seen a steady increase in their health budget. Those new funding flows for health had enabled them to pursue a health sector reform agenda which had brought them closer to the fulfilment of the Millennium Development Goals.

JULIO CESAR ALVIAREZ, Vice Minister for Health Resources of Venezuela, said that during the last 10 years Venezuela had gone through a favourable social transformation, led by the President Hugo Chavez. Venezuelans had started enjoying improvement in their quality of life and their social well-being, as national indicators elaborated by international organizations clearly showed. The economic and social policies implemented by President Chavez had made it possible to turn the achievement of the Millennium Development Goals into a reality in Venezuela. The indicators of the human development index had improved, as well as social investment in relation to gross domestic product, which had reached the level of 18.8 per cent by 2008, up from only 8.4 per cent in 1988. Concerning health issues, the number of persons treated with free anti-retroviral medication had increased from 1,000 in 1999 to over 25,000 in 2008. Yellow fever had been combated by vaccination, with the immunization of 10 million persons during the past three years. Prevention, treatment and reintegration for persons involved in the consumption of illicit and licit drugs now covered 11,000 patients of both sexes.

Regarding poverty, Mr. Alvarez said that 29. 8 per cent of all Venezuelans were living in extreme poverty in 2004. However, even though the fixed target for 2010 was to reduce that number to 12.5 per cent, Venezuela had so far reduced it to only 9.4 percent, thus surpassing the fixed target.

ABDULLAH BIN KHALID AL-QATANI, Minister of Health of Qatar, said these were strenuous circumstances – more than 1 billion people continued to scrounge on less than $1 a day, and the current global crisis was sure to increase that number. Even with the progress in achieving the Millennium Development Goals, the overall quality of life seemed to be worse for the growing number of poor with non-communicable diseases. At the same time, those diseases were undermining Government efforts to create a prosperous society, and the links between them and poverty continued to loom over the horizon, ensuring a derailment of most of the efforts to end all poverty in 2015. Decisive action was needed to ensure that the economies of developing countries could prevail, poverty be eradicated, and people's health enhanced. In that regard, there were areas that the international community needed to address together in a concerted manner. There was a need for a global approach that built on the United Nations as an indispensable force in mobilizing support for a global partnership towards combating non-communicable diseases in developing countries. An official indicator on deaths from non-communicable diseases needed to be added to Millennium Development Goal 6 during the upcoming 2010 Review process. All – Governments, individuals, and business across the globe – should be doing their part to save millions of lives in developing countries each year from dying prematurely.

MARC SPRENGER, Director General of the Netherlands National Institute for Public Health, said that the report of the Secretary-General stressed the importance of political leadership for global health. Social cohesion was at stake and vulnerable groups became even more vulnerable when health systems were not sustainable enough to offer stability during economic crises. Further efforts were needed to streamline health financing. There were six crucial points to implement the agreed commitments to improve global public health. First, access to health care was a human right and effective policies should focus on health inequalities. Second, top priority should be given to the development of sustainable health-care systems. Third, universal access to sexual and reproductive health was a very important separate target under Millennium Development Goal Five and should be recognized as a central condition. Fourth, high-quality primary health care was saving lives at a relatively low cost. It was a prerequisite to rapidly respond to outbreaks of infectious diseases. Primary health care should be community-based and should have the capacity to integrate prevention, treatment and control. Fifth, disease and injury prevention depended on health promotion: well-informed citizens would more likely benefit from early detection and access to care. Sixth, solidarity and predictability of aid were vital for the realization of all Millennium Development Goals. The time had come to start with implementing what they all knew was necessary. One small step towards implementation might be more effective than more reports with grand designs.

MARTIN DAHINDEN, Director of the Swiss Agency for Development and Coordination, said that health was both a human right and a global public good. Thus, non-discriminatory public health systems were a necessary contribution to a harmonious economic social development. The implementation of integrated approaches reinforcing and consolidating the governance of national public health systems had been made necessary by globalization. Management of health could no longer be done within the borders of one country. The global public good was requiring a global approach and good coordination with the national systems. The realities and specific nature of each system had to be recognized however. Inequality of treatment persisted, particularly as far as women and marginalized groups were concerned.

Mr. Dahinden underlined the importance that should be given to public health in negotiations for an international trade and intellectual property system in accordance with the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) principles. Switzerland was also convinced of the necessity to invest in sexual and reproductive health. Guaranteeing universal access to reproductive health care would help to reduce maternal mortality. The international community had agreed to specific commitments at the World Summit in 2005, and those commitments had to be respected. In reality, their investments had fallen short. Of all health indicators, maternal health was the one that most clearly revealed the enormity of the gap between the rich and the poor, with 99 per cent of deaths during pregnancy and childbirth occurring in developing countries. That number had not changed for many years and that was the field in which least progress had been achieved.

JANOS TOTH, President of the International Association of Economic and Social Councils and Similar Institutions (AICESIS), said that their report looked at public health in terms of the economic and social development of countries worldwide. They believed that public health should be given absolute priority. The facts, however, brought them up against the disturbing conclusion that, despite extensive reform programmes currently under way in their health systems, health was a low priority for Governments in poor countries. Health expenditure statistics on overall public spending in African and southwest Asian countries spoke for themselves. Developed countries spent between $3,000 and $6,000 per capita on health care, whereas poor countries spent just $15 to $40. In other words, poor countries spent 150 to 200 times less than developed countries on health care.

Conscious of that global injustice, the International Association of Economic and Social Councils and Similar Institutions, on behalf of international civil society and on behalf of those people who “had no voice”, had decided to appeal to the international community at large, to developed countries and development organizations and institutions in particular, for equal treatment and solidarity with the world’s poor in order to put an end to that unacceptable, inhumane injustice, and to come together to build a fairer world where all could live in peace and security.

HAMIDON ALI (Malaysia) said that the international community had agreed on, committed and recommitted itself to ambitious targets, goals and definitions. They had aimed for health for all and had embraced a notion of total health, defining health as not only the absence of diseases. It was appropriate that they did review their progress in this area, six year short years before 2015. Malaysia, however, noted that progress had been uneven, not only among countries but within countries too. Inequities in health were at unacceptable levels; there were no biological reasons for why there should disparities of 50 years in life expectancies between members of the human family. Further, there were now no exclusively localized diseases. The international trading system could and should do more to promote public health interests. There was also no doubt that the inequalities in global public health had been exacerbated by the convergent financial, economic, food and climate change crises. Support of the international community to developing countries could not waiver. Further, the H1N1 pandemic required that they urgently adopted the Pandemic Influenza Framework to ensure the timely access to adequate and affordable vaccines, diagnostics and their medical products required in a pandemic, especially for developing countries.

BYRGANYM AITIMOVA (Kazakhstan) said that the global financial crises had worsened the food crisis and, as a result, exacerbated the situation of the poorest ant the most vulnerable worldwide. Due to the unprecedented sudden economic downturn States were forced to cut budget costs, for some including in the social sphere. That raised valid concerns about possible deterioration across all development indicators, particularly in health and its social determinants. The combination of financial strains and climate change and natural disasters had also shown significant impact on human health, and demonstrated the interdependency of the global community. Under the existing challenges, the increase in prices for pharmaceutical and medical supplies might lead to conditions when essential life-saving medication might become either unavailable or unaffordable. Kazakhstan also welcomed the United Nations Secretary-General’s efforts in attracting attention of the international community to the problem of unacceptably high mortality and morbidity rates for women at pregnancy and childbirth and their newborns, which put present and future generations at risk. One of the most important tasks and challenges in the health care area lay in the provision of food security that was closely interlinked with the problems of healthy nutrition and safe food rations of the poor and most vulnerable. Malnutrition was not a challenge for Kazakhstan, while imbalanced nutrition, undernutrition, particularly micronutrient deficiency, posed a threat to the health of the people.

MARIA NAZARETH FARANI AZEVEDO (Brazil) said a clear message came out of the Forum on Advancing Global Health in the Face of Crisis and of the many high quality preparatory meetings leading to the Annual Ministerial Review: global health underpinned human development and was deeply interwoven with many other key policy areas for development. International cooperation should be enhanced to ensure access to affordable, good quality and effective medicines for all, particularly vulnerable groups in developing countries. Brazil’s experience in combating HIV/AIDS pandemic highlighted the importance of sustained universal access to prevention, treatment, care and support, which encompassed access to medicines, including generic medicines. In that regard, she highlighted the critical role intellectual property played as a determinant of access, affordability, innovation, local production and trade, both in brand name drugs and generics, especially where they were needed the most, in poor developing countries. A political message needed to be conveyed on the importance that Member States strove to resolve the intellectual property agenda. A discussion on global public health should also address the role of biodiversity and traditional knowledge. Furthermore, medicines derived from nature’s bounty, developed over time by indigenous and traditional communities could significantly contribute to their fight against disease and poverty.

ROBERT FILLON (Monaco) said that, as the Secretary-General had mentioned in his report, the major crisis they were currently going through was affecting all sectors and countries. The most vulnerable populations would probably be affected. Official development assistance might also be affected. The Principality had also been affected by the crises. However, public services in Monaco had not been affected and all members of the society including the most vulnerable ones continued to be cared for. Monaco’s commitment to increase its share of official development aid had not been questioned. They would continue to help reduce extreme poverty, and provide help in sanitary and social areas. According to their forecast, the health sector should represent 50 per cent of their international aid by 2010. In the last years, the Principality had financed projects related to sanitary and social aid, including combating pandemics, combating malnutrition and discrimination, caring for the handicapped, providing access to water, literacy and microcredit, among others. Civil society in Monaco had also multiplied initiatives and several had collaborated with the Government. Monaco was one of the smallest countries of the world but was making efforts, on its scale, to help the poorest.

JOHN F. SAMMIS (United States) said that health ministries and the health sector around the world were struggling to manage and respond effectively to the economic crisis. Tax revenues were down in many countries. Poverty and hunger had risen in some. The United States was working in many venues to respond to the economic crisis – stabilizing markets, strengthening regulations so that this would not happen again, and restoring economic growth. President Obama had emphasized that his was a unique moment in history, a moment when they had to unite to improve the health of their nations, and protect the health of the most vulnerable among them. The United States was committed to partnering with the United Nations and Member States to work towards achieving the Millennium Development Goals, to advance the cause of social justice to expand access to health care and to reduce health disparities. Working together, they would achieve the goals that they all shared. The United States had an important role to play in their shared work to improve the health of their people and their nations. It was working closely with international partners to address new threats, such as H1N1, as well as continuing its long-term global efforts to deal with persistent diseases such as polio. The United States Government was also the largest donor to the Global Fund, with more than $ 2.5 billion in contributions to date.

VICTOR CAMILLARI (Malta) said that while economic growth and wealth were essential to health improvements, growth was not in itself sufficient to achieve improved health outcomes. Without investment in health systems and policies aimed at equitable access to health care, public health interventions would fail to deliver effectively. Strong health systems should be put in place to tackle the challenges arising from the global disparities, both with regard to non-communicable diseases, and communicable diseases such as HIV/AIDS. The international community and policy-makers should take concrete steps to solve the most soluble of problems, maternal death, once and for all. Malta also shared the ambition to attain the targets set in 2005 regarding universal access to reproductive health, the 2010 milestone to have 35 million more births attended by skilled personnel each year, and the reduction of maternal mortality by 75 per cent by 2015.

Malta strongly believed that the right to life extended to the unborn child from the moment of conception, and that the use of abortion as a means of resolving health or social problems was a denial of that right, and therefore Malta consistently disassociated itself from, and considered invalid, all statements or decisions that used references to sexual and reproductive health, directly or indirectly, to impose obligations on anyone to accept abortion as a right, a service or a commodity that could exist outside the ambit of national legislation.

BEKELE GELETA, Under-Secretary General of the International Federation of Red Cross and Red Crescent Societies (IFRC), said IFRC had launched a document on 6 July which was directly relevant to the theme of this segment. It was entitled “The Epidemic Divide”, and analysed the very different economic and social impacts of epidemic diseases on developed and developing countries. It called for much more attention and resources for prevention, and in a way which galvanized resources at the community level. A community-based approach was critical if they were to make a meaningful difference in times of crisis. It was important to illustrate geographically why that was so critical. People hit by epidemics usually died in the most productive years of their lives, when they were young and active. Their death or even the very fact of them being ill and unproductive for a long time prevented them from using the skills they learned at school, from cultivating their land, from contributing to the economy. In addition, the inability of stricken people to take care of their families, of their elderly parents as well as younger brothers and sisters and their other dependants, placed additional strains on communities and economies, which needed to be taken into account in policy formulation.

LIBERATO C. BAUTISTA, President of the Conference of Non-Governmental Organizations in Consultative Relationship with the United Nations (CONGO), said that CONGO had met here in Geneva from 2 to 4 July, in the fourth year of a series of its Civil Society Development Forum. Close to 60 non-governmental organizations (NGOs) from all regions of the world had gathered to grapple with the same agenda as ECOSOC had before it now. CONGO had gathered at a time when the worldwide food, energy and environmental crises were reinforced by the devastating effects of the financial and economic crises. The combination of those crises was threatening the socio-economic roots and stability of the Global North and inflicted even greater burdens, with debilitating effects, in the Global South, cancelling momentary socio-economic gains achieved over the three to five years. Now, more than ever, United Nations Member States had to reaffirm their commitment to fulfil the promises they had made with regard to official development assistance and for Member States and international financial institutions to take into account the conclusions and recommendations of the United Nations Conference on the World Financial And Economic Crisis and Its Impact on Development held in June 2009 in New York. Those recommendations reminded all States and international financial institutions to ensure adherence to the social and economic rights of the most vulnerable, especially their right to health.

GILL GREER, of the International Planned Parenthood Federation, said that health was a human right, and the cornerstone of social and economic development. No one should die or suffer from preventable causes because they lacked basic health services. Women paid the highest price with their health, well-being, and ultimately their lives. Increased investment in family planning alone would reduce maternal mortality by up to 40 per cent. Yet, support for population and reproductive health programmes had significantly declined as a percentage of overall health aid. In the crises brought about by climate change and the global downturn that threatened human security, even this level of funding by donors and national Governments could be further jeopardised. Millennium Development Goal Target 5b required a comprehensive, life-cycle approach that addressed the social, economic, political, environmental and physiological determinants of sexual and reproductive health- but the world was still far from achieving universal access to reproductive health, let alone realising a vision of a health and development framework that incorporated sexual rights for all. Some could argue that issues related to sexual and reproductive health were contentious- but what was contentious was that women and girls were dying needlessly.

SHIGERU SUGANAMI, President of the Association of Medical Doctors of Asia (AMDA), highlighted “coexistence of diversity” in the Association’s motto. When public health measures were administered properly and efficiently, they could be very powerful tools. They not only contributed to general health, but also helped to promote community building. In 2003, when the peace treaty was established between Sinhalese and Tamils in Sri Lanka, the Japanese Government asked the Association to join its peacebuilding initiative. As a non-governmental organization founded in Japan, they immediately accepted the offer for one important reason: they wanted to reciprocate what had been given to them by Sri Lanka. At the request of the Government of Japan, they came up with the unique method of rebuilding peace using public health measures – “Peace Building Project through Health”. The project was implemented in the south of Sri Lanka for Sinhalese, in the north for Tamils and in the east for Muslims. The project consisted of three main elements: mobile clinics, publication of health newsletters, and cultural exchange programmes. In conclusion, it was hoped that their universal approach to humanitarian assistance based on respecting the views of counterparts, fairness and seeking ways to promote mutual understanding, would serve as model for future projects in this field.

BELL HILAIRE, of Cercle de recherche sur les droits et les devoirs de la personne humaine, said that the Circle specialized in research on new international standards. The theme of the Annual Ministerial Review this year had them take stock of the situation at the international level concerning public health problems. The Circle commended the Secretary-General for his statement made at the beginning of the session, particularly to the changing of behaviour regarding the non-communicable diseases related to the consumption of alcohol and tobacco. The epidemic H1N1 had spread from one end of the world to the other. In this case the United Nations must adopt a global strategy. The draft declaration on human duties included values such as moderation, faithfulness, altruism and cleanliness. If those values would be transmitted via education programmes, diseases would be reduced.

ANGELAMARIA LORETO, of Ius Primi Viri International Association, said 60 years after the Universal Declaration for Human Rights, destruction and conflicts still dominated the world. There was an urgent need to build a new society, dissolving the conflicts that were mainly in humanity's minds. Conflicts in humans, families and nations should be dissolved, allowing each human being to resist information leading to self-destruction and destruction of others. To put into practice human rights, false memories should be eliminated, which caused enormous disparities in the task in involving all human beings in consciousness-raising. Every pathological form due to the absence of knowledge should be eliminated. Considering the implementation of the Millennium Development Goals, this project, based on the creation of a network of NGOs in consultative status with ECOSOC foresaw different training courses aiming to foster new methods of communication to foster peace and global health in families and then within nations.


For use of the information media; not an official record

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