Secretary-General Ban Ki-moon this morning opened the Economic and Social Council’s 2009 substantive session, which will run from 6 to 31 July at the Palais des Nations in Geneva. The Council began with its high-level segment, which will be held from 6 to 9 July, and which focuses on current global and national trends and their impact on social development, including health, hearing opening addresses by the Secretary-General, Swiss President Hans-Rudolf Merz and Economic and Social Council (ECOSOC) President, Sylvie Lucas.

Secretary-General Ban observed that the Council met in difficult times. The crises of the past 12 months – the energy crisis, the food crisis and the current economic crisis – had caused widespread hardship and grief. The growing impacts of climate change were also a source of grave concern, and a threat to all the Millennium Development Goals. There should be a renewed multilateralism based on universal principles and buttressed by resources, political will and respect for internationally agreed commitments. This year’s Millennium Development Goals Report delivered a message that should not surprise them but which they must take to heart: the current economic environment made achieving the goals even more difficult. They had been moving too slowly to meet their goals. Yet the report also showed that when they had the right policies, backed by adequate funding and strong political commitment, actions could yield impressive results. Fewer people today were dying of AIDS. Many countries were implementing proven strategies to combat malaria and measles, and they were edging closer to universal primary education. They were also well on their way to meeting the safe drinking water target.

Mr. Ban urged the Group of Eight (G8) to set out, country by country, how donors would scale up aid to Africa over the next year. The credibility of the international system depended on whether donors delivered. Governments should also take a strong lead in strengthening national health systems in partnership with community leaders, faith-based organizations, charitable foundations and the private sector.

ECOSOC President Lucas said that, since the beginning of the year, the Council had collectively worked to bring to the forefront the challenges faced by the world community in the area of development, and in particular in the area of global public health. Governments needed to take the lead in developing effective health systems, but their efforts should be complemented by other stakeholders for better and more equitable health outcomes. More sustained investments were needed to support the health agenda, including fair systems of health financing and a system of governance that ensured equity, participation, and efficient use of resources. The inter-linkages between health and other elements of the United Nations development agenda could also not be ignored.

President Merz said that the current pandemic demonstrated strikingly that heath was a precious and fragile public good. It also showed the need for effective and equitable public health systems, not only to assure the basic health needs of the general populous, but also to contribute to the security that was necessary for social and economic development. While substantial progress had been made in recent decades, everyone had to redouble their efforts to achieve the goals that they had set themselves. Of all the indicators on public health, maternal health was the one that revealed the most striking inequalities between rich and poor: each year, half a million women died in developing countries due to complications in pregnancy or during birth. In order to face those growing challenges, everyone was in need of a universal organization such as the United Nations which could guide everyone’s efforts towards a freer, fairer and safer world.

World Health Organization Director-General, Margaret Chan, in a lead address on health, reflected bluntly that “the world is in a mess”. Climate change was a gradual and now inevitable event, but the effects of more frequent and more extreme weather events would be abrupt and acutely felt and the gaps and inequities that all were trying so hard to address were likely to grow even greater. There were calls from multiple world leaders for transformational changes in the policies that governed the way the world worked. A focus on health as a worthy pursuit for its own sake was the surest route to that moral dimension that was so sadly lacking in international systems of governance, and was the surest route to a value system that put the welfare of humanity at its heart.

The Council heard keynote addresses from Her Royal Highness Princess Muna Al-Hussein of Jordan; Urmas Paet, Minister of Foreign Affairs of Estonia; Nicolas Schmit, Minister Delegate for Foreign Affairs and Immigration of Luxembourg. Other high-level dignitaries addressing ECOSOC this morning were Michael Marmot, Chairman of the Commission on Social Determinants of Health (2005-2008); Cherie Blair, of the Cherie Blair Foundation for Women; and Sarah Omega Kidangasi, a maternal health advocate from Kenya.

The Council also heard policy messages stemming from the various regional meetings organized in preparation for the substantive session. In this framework, in it heard interventions from the President and Chief Executive Officer of the Global Health Council, who spoke on the ECOSOC Special Event on Philanthropy and the Global Public Health Agenda on 23 February 2009 in New York; from the Secretary of the Ministry of Healthcare and Nutrition of Sri Lanka, speaking on the South Asia Regional Ministerial Meeting on financing strategies for healthcare; from the Minister of Health of China, outlining the outcome of the Annual Ministerial Meeting of the Asia and Pacific Regional Meeting Promoting Health literacy; from the Minister of Health and Secretary General of the Supreme Council of Health of Qatar, speaking on the outcomes of the Western Asia Regional Meeting on controlling non-communicable diseases; from the Minister of Health and the Environment of Jamaica, addressing the result of the Latin American and Caribbean Regional Meeting on progress in the reduction of the HIV/AIDS pandemic and its interconnection with development; and from the Minister of Health of Ghana, speaking on the African Regional Health Ministers Review Meeting on E-Health,

At the opening of the session, the Council viewed a short film showcasing the United Nations Secretary-General's initiative on "Global Impact and Vulnerability Alert System" to monitor the impact of crisis in real-time. This system will be officially launched in September 2009, at the General Assembly in New York.

The began its meeting by adopting its agenda and programme of work for its 2009 substantive session (E/2009/100 and E/2009/L.8, respectively).

The next meeting of the Council will be at 3 p.m., when it will hold a high-level policy dialogue with the international financial institutions.


Statements

SYLVIE LUCAS, President of ECOSOC, said that, since the beginning of the year, the Council had collectively worked to bring to the forefront the challenges faced by the world community in the area of development, and in particular in the area of global public health. With the world being confronted with the worst financial and economic crisis since the Great Depression, the international community was all too aware of the fact that maintaining momentum towards the development priorities in times of crises would not be easy. That was particularly true for the Millennium Development Goals (MDGs) in the area of global public health. The theme of this year's Annual Ministerial Review – implementing the internationally agreed goals and commitments in regard to global public health – was therefore particularly relevant.

Governments needed to take the lead in developing effective health systems, but their efforts should be complemented by other stakeholders for better and more equitable health outcomes. More sustained investments were needed to support the health agenda, including fair systems of health financing and a system of governance that ensured equity, participation and efficient use of resources. The growing challenge of non-communicable diseases needed to be given high priority. Relatively modest investment in the fight against neglected tropical diseases would have an enormous effect. Commitments made to combat communicable diseases should be honoured, as while progress had been made, there was a continued need for vigorous action. The information and communication technology (ICT) resolution offered tremendous potential for significant health outcomes. Multilateral approaches and international cooperation had the greatest potential for success.

Real and measurable progress had been made in health outcomes, such as in the areas of HIV/AIDS, tuberculosis, and reduction in child deaths. Serious gaps remained, however. Increased political will and commitment were urgently required to eliminate the unacceptably high global rate of preventable maternal mortality and morbidity and to ensure the full and effective implementation of the human rights obligations in this field. The inter-linkages between health and other elements of the United Nations development agenda could also not be ignored. The pervading inequities in health among and within countries had to be addressed, as should the impact of the social determinants of health, and effective social protection systems should be established to ensure universal access to health care. Managing the risks and rewards of health and development was increasingly a critical challenge facing all stakeholders. Some progress had been made in promoting a "whole-of-Government" approach, but strong follow-through, firm resolve and leadership were needed to keep the momentum. It was time to help foster the common development objectives, and to make this session and this Council count.

BAN KI-MOON, Secretary-General of the United Nations, in opening remarks, observed that they met in difficult times. The crises of the past 12 months - the energy crisis, the food crisis and the current economic crisis - had caused widespread hardship and grief. The influenza pandemic was the latest reminder of their vulnerability and mutual interdependence. The growing impacts of climate change were also a source of grave concern, and a threat to all the Millennium Development Goals. That was why they had to “seal the deal” in Copenhagen in December. Such challenges demanded a renewed multilateralism based on universal principles and buttressed by resources, political will and respect for internationally agreed commitments. This year’s Millennium Development Goals Report delivered a message that should not surprise them but which they must take to heart: the current economic environment made achieving the goals even more difficult. Higher food prices in 2008 had reversed the nearly two-decade trend in reducing hunger. Momentum to reduce overall poverty in the developing world was also slowing. Tens of millions of people have been pushed into joblessness and greater vulnerability. Some countries stood to miss their poverty reduction target. The target for eliminating gender disparities in primary and secondary education by 2005 has already been missed. If they were to achieve the sanitation target, 1.4 billion people must gain access to improved sanitation by 2015.

They had been moving too slowly to meet their goals, the Secretary-General noted. Yet the report also showed that when they had the right policies, backed by adequate funding and strong political commitment, actions could yield impressive results. Fewer people today were dying of AIDS. Many countries were implementing proven strategies to combat malaria and measles, two major killers of children. They were edging closer to universal primary education. They were also well on their way to meeting the safe drinking water target. In Africa and across the developing world, they had abundant evidence that aid could help transform lives. But delays in delivering aid, combined with the financial crisis and climate change, were slowing progress. That was why, when he had met with world leaders, he had repeatedly called for solidarity and special attention on the poor – those least responsible for the crisis, and those least able to bear its impact. He had done so in April at the G20 London Summit. He would do so again at the G8 meeting two days from now. The G8 and G20 had made specific commitments to increase financial and technical support to developing countries by 2010 to achieve the Millennium Development Goals. Those commitments included raising annual aid flows to Africa, yet aid remained at least $20 billion below the Gleneagles targets. Mr. Ban urged the G8 to set out, country by country, how donors would scale up aid to Africa over the next year. The credibility of the international system depended on whether donors delivered. The United Nations, for its part, would continue to do its utmost to speak up for those most in need. As the President of the Economic and Social Council said earlier, the United Nations was establishing a Global Impact and Vulnerability Alert System to be able to better track the impact of the economic crisis on the poorest and most vulnerable population.

Turning to global public health, the focus of this year’s Annual Ministerial Review, Mr. Ban said that health was the foundation for peace and prosperity. Investments in health were investments in society. They saved lives and benefited economies through improved productivity. Prevention efforts could avoid huge future expense. However, many of the determinants of health lay outside the health sector. Even in wealthy countries, factors such as ethnicity, gender, socio-economic status and geographical area dictated life expectancy. Gaps of more than a decade existed between different groups. The Millennium Development Goals Report and Mr. Ban’s report to the Economic and Social Council gave a snapshot of where they stood. Children’s health showed mixed results. Some countries in sub-Saharan Africa had achieved significant success with key child-survival interventions. Those were expected to produce further declines in under-five mortality over the next few years. But many countries, both in sub-Saharan Africa and South Asia, have made little or no progress at all. He was especially concerned about maternal health, which was a barometer of how well a health system functioned. Multi-sectoral approaches were needed, with a greater focus on reducing poverty, increasing incomes and providing decent income. Governments should take a strong lead in strengthening national health systems in partnership with community leaders, faith-based organizations, charitable foundations and the private sector.

HANS-RUDOLF MERZ, President of the Swiss Confederation, in his opening address, said that it was here at the heart of Europe that the first pillars of the multilateral system had been built. It was here in 1919 that the League of Nations, the precursor to the United Nations system, was born. Since then, Geneva had become a centre of global diplomacy, as well as a place where dialogue and mutual respect was cherished. In many respects, that “Spirit of Geneva” also symbolized Switzerland’s international commitment to those values. He hoped that that spirit accompanied the work of Economic and Social Council and enabled it to find responses to the challenges facing the world. At a time when the weakest felt the full brunt of the financial and economic crisis, thus rendering the task of fighting poverty even more arduous, it was necessary to reaffirm everyone’s commitment to development, based on respect for human rights. The Millennium Development Goals were at the heart of that commitment. In the context of the global crisis, those goals had to remain as the compass which guided efforts in the fight against poverty. In no case should the financial and economic crises prevent them from pursuing the Millennium Development Goals, he stressed.

The Economic and Social Council Annual Ministerial Review was an opportunity to assess the state of progress in achieving those goals. It was particularly timely that the topic of this year’s ministerial review was global public health, observed Mr. Merz. The current pandemic demonstrated strikingly that heath was a precious and fragile public good and that everyone had to do all they could to protect it. It also showed the need for effective and equitable public health systems, not only to assure the basic health needs of the general populous, but also to contribute to the security that was necessary for social and economic development. While substantial progress had been made in the field of global health in recent decades, everyone had to redouble their efforts to achieve the goals that everyone had set themselves. Of all the indicators on public health, maternal health was the one that revealed the most striking inequalities between rich and poor: each year, half a million women died in developing countries due to complications in pregnancy or during birth. As the Secretary-General had stated in his address to the last World Health Assembly, maternal health was a barometer of the functioning of public health systems. That was why Switzerland supported the concerted efforts of the World Health Organization (WHO), the United Nations Children Fund (UNICEF) and the United Nations Population Fund (UNFPA), which formed the spearhead of United Nations efforts to fight that scourge, responsible for the deaths of so many mothers and children every year.

In order to face those growing challenges, everyone was in need of a universal organization such as the United Nations which could guide everyone’s efforts towards a freer, fairer and safer world. Daily reality showed that without a multilateral response, the fight against poverty and inequality would remain a lost cause. Within the United Nations, the Economic and Social Council played a leading role. ECOSOC was a political forum for global debate on new trends in the field of economic and social development. Furthermore, as the United Nations system’s coordinator, ECOSOC had to ensure the coherence and efficiency of United Nations operations. As they found themselves confronted with financial, economic and food crises, both of those roles were more important than ever before. It was therefore in the interest of all to strengthen ECOSOC. With that in mind, Mr. Merz sincerely hoped that the Council’s deliberations would help to overcome common challenges, and therefore wished everyone the necessary success to fulfil that great responsibility.

Muna Al-Hussein, Her Royal Highness, Princess of Jordan, remarked that, for the first time, childhood deaths had dropped below the 10 million mark. Billion-dollar commitments in official development assistance for health had more than doubled over the past few years. Health had never before enjoyed such attention. But those commitments were not enough. Progress had stalled. The global maternal mortality rate had barely changed since 1990. Powerful interventions and the money to purchase them would not buy better health outcomes in the absence of stronger health systems based on primary health care. Weak health systems were the bottleneck that slowed progress and blocked the delivery of effective interventions. Health systems were weak because of decades of poor planning, poorly coordinated aid and unbalanced investments in basic health infrastructures, services and health workforce. The world faced problems beyond those targeted by the Millennium Development Goals.

Health in rich and poor countries alike was now threatened by three universal trends: population aging, rapid unplanned urbanization, and the globalization of unhealthy environments and behaviours. As a result, the conditions that caused the most death and disability in developing countries now included cardiovascular diseases, cancers, diabetes, chronic respiratory diseases and injuries. Non-communicable diseases and injuries were responsible for 70 per cent of all deaths around the world, affecting developing countries disproportionably. The rise of non-communicable diseases and injuries in developing countries had uncovered further problems, revealing the burden of long-term care on health systems and budgets. Stalled progress during past years towards the health-related Millennium Development Goals had forced a hard look at the consequences of decades of failure to make balanced investments in primary health care. Non-communicable diseases and injuries had to be addressed if the international community was to put an end to poverty in 2015. Working in partnership and multi-sectoral action was key. Development agencies were virtually absent in providing technical support to build national capacities in the areas of non-communicable diseases and injuries in developing countries.

URMAS PAET, Minister of Foreign Affairs of Estonia, said that, as declared in the WHO Constitution, the highest attainable standard of health was a fundamental right of every human being. That universal right seemed very straightforward and simple, but for millions of people it was yet an unreachable privilege. Ensured access to the best attainable health care had to go hand in hand with the improvement of the global health standard as the situation in that field was far from satisfying. There were major and often growing health inequalities also within countries. However, there were some encouraging signs of progress made over the past years. Child mortality had been reduced, as well as malnutrition. However, in several developing countries, particularly in sub-Saharan Africa, the death of children under five still remained unacceptably high. The keys to reducing it were clearly social and needed to be urgently addressed. Also, the analysis affirmed that the progress towards health-related goals continued to be slowest in countries with severe social problems – those with high HIV prevalence or those affected by conflict. Steps forward have been made in relation to HIV/AIDS, tuberculosis and malaria. That testified that their concerted efforts could lead to results. That progress needed to be sustained and carried further in the current challenging environment. The lagging progress in maternal and newborn health was still worrying, causing great suffering around the world. Each year, some half a million young women died of complications during pregnancy or childbirth, 99 per cent of them in developing countries and most of them for preventable causes for which there was effective treatment. Millions of young women on their planet unfortunately lived in conditions with limited access to maternal or reproductive health services, which were essential for improving maternal health and reducing maternal mortality. Access to family planning, skilled attendance at birth and emergency obstetric care were critical for making progress towards that goal. The persisting lag in this field called for increased political leadership, as well as for more resources to protect both the health and the rights of women.

Mr. Paet said that, firstly, they needed to promote the international cooperation on coordinating the efforts of the United Nations, Governments, non-governmental organizations and the business community, and to foster the building of public-private partnerships. The importance of the cooperation and commitment of all actors had become very obvious to him during his visits to Afghanistan, including to the hospitals in the southern regions. Estonian experience in coordinating the healthcare-related activities in Helmand province was encouraging and showed that it could make a real difference, even though it might be very difficult under extreme circumstances. Among other things, assignments like distributing mosquito nets had been carried out, thereby saving hundred of lives. It went without saying that in order to ensure the efficiency of their actions they had to coordinate activities with other actors involved in the health sector. Secondly, the efficiency of the existing health system had to be improved and demonstrated. When health systems were run and financed more effectively, thousands of lives could be saved. Here, it was essential to build effective partnerships with other sectors to deliver more affordable health services. By combining smart investments and smart economizing, not only the health sector, but also other spheres, for example technology and science would benefit as well.

The focus should be set on research and innovation in the medical field, as well as on the development of new technologies. Accelerated technological innovation would multiply the potential to improve global health and help to mediate health literacy in more advanced and modern global society. He called on everyone to support the ECOSOC m-health initiative, which aimed to develop health care knowledge and health information access through mobile phones. In Estonia, electronic health initiatives had gained speed since 2002 and by now Estonia was seeing fantastic benefits from the use of innovative technologies. In conclusion, Mr. Paet emphasized that the global financial crisis might have a serious impact on the efforts to meet the health-related Millennium Development Goals. In an increasingly globalized world, their response had to be effective, coordinated, flexible and global.

NICOLAS SCHMIT, Minister Delegate for Foreign Affairs and Immigration of Luxembourg, said that it was a particular pleasure to address the Council today because the subject of the Annual Ministerial Reviews was central to the Government of Luxembourg. The implementation of public health policies was crucial to the successful outcome of the Millennium Development Goals, to reduce extreme hunger and poverty in the world, and also in safeguarding other Millennium Development Goals. Luxembourg was behind the WHO initiative when it launched an annual follow-up process to the World Health Assembly aimed at implementing the Millennium Development Goals. According to WHO, some strides had been made in the area of child mortality, where the rate for children under the age of five had been cut by 25 per cent since 1990. However, little had been done to reduce the rates of maternal mortality, where statistics revealed that 5,000 women died each year due to birth complications. The right for each woman to life, health, equality, dignity and non-discrimination had to be ensured, and depended on the political resolve to tackle differences to improve the status of women and protect their health. The promotion of sexual and reproductive health had to be tackled as a main priority.

Regarding HIV/AIDS, it was now important to strengthen at the worldwide level structures, in particular to allow access to services with respect to prevention and treatment implemented on an equitable basis for all. For instance, integrated services and non-separate services had to be ensured for treatment of cases dealing with HIV/AIDS and Hepatitis B and C. Luxembourg believed that the United Nations had a prime role to play in coordinating, strengthening and supporting the work to combat HIV/AIDS. The main international partners with which Luxembourg was closely working in this regard included WHO, the Joint United Nations Programme on HIV/AIDS, UNICEF and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

A fresh effort had to be made to ensure universal health care for all countries. In that connection, eradication of poverty in the least developed countries was of particular importance. In 2008, Luxembourg had donated 0.95 per cent of its gross national income to official development assistance, and had second ranked in the area of the health development aid. Luxembourg supported the work done to improve the quality of life, with particular attention paid to equality between men and women and measures taken to reduce maternal mortality and birth complications. In closing, Mr. Schmit stressed that it was not only necessary to consolidate progress made over the years; it was equally important to bring about a significant improvement in the lives of all people across the world.

Margaret Chan, Director-General of the World Health Organization (WHO), observed that the world faced multiple crises on multiple fronts. In a sense, that was nothing new, but today's crises were different. They had some unprecedented dimensions, and were revealing, in ominous ways, what it meant to live in a closely interdependent and interconnected world. They were revealing some fundamental flaws in the policies and systems that governed the way nations and their populations interacted internationally. The fates of all nations were bound together as never before – mistakes made in one part of the world spread quickly throughout the international system. The consequences of flawed polices were profoundly unfair. Global trends, such as the industrialization of food production and the globalization of its marketing and distribution, helped to feed the world, but those trends had also contributed to a public health crisis. As the century progressed, more and more crises were likely to be global in nature, with global causes and with global consequences that were unfairly biased against countries and populations least able to cope. That was happening at a time when the international community was engaged in the most ambitious drive in history to reduce poverty and reduce the great gaps in health outcomes.

The world was in a mess, Ms. Chan said. The financial crisis had hit it like a sudden jolt, and hit the world where it hurt the most: money. Climate change was a gradual and now inevitable event, but the effects of more frequent and more extreme weather events would be abrupt and acutely felt. The need for humanitarian assistance would grow at a time when all countries were stressed to one degree or another by climate change. The gaps and inequities that all were trying so hard to address were likely to grow even greater. Crises like the food crisis, the financial crisis, climate change and pandemics would deepen the misery and worsen the health of people and countries that already suffered the most. There were calls from multiple world leaders for transformational changes in the policies that governed the way the world worked. International systems needed to be re-engineered to incorporate a moral dimension. A focus on health as a worthy pursuit for its own sake was the surest route to that moral dimension that was so sadly lacking in international systems of governance, and was the surest route to a value system that put the welfare of humanity at its heart.

MICHAEL MARMOT, Chairman of the WHO Commission on Social Determinants of Health, in a statement supported by a PowerPoint presentation, said that the Commission was concerned with the issue of health equity. There were dramatic inequities between life expectancies, for example in Zambia, where life expectancy could be as low as 40.5 years while it was 82.3 years in Japan. But, as a study in different parts of the city of Glasgow (United Kingdom) had shown, life expectancy could also greatly vary within the same city. One should not only focus on the poorest of the poor, although they rightly deserved attention. Societal action was needed through all classes. Inequities in health were not the same as inequities in health care. Every sector in society was a health sector and every minister of Government was also a health minister. Health equity was a measure of how well a country was doing in other sectors. He was glad that in Britain the Prime Minister had commissioned a study on social determinants of health, as well as Brazil, India, Sri Lanka and others.

Often, Mr. Marmot was asked what the role of a ministry of health was. He always answered that they needed to put in order their own healthcare systems and needed to develop universal access to health. For example, people should not be denied access to health care because of inability to pay. The health sector should be the advocate for action to work across the Government. That also applied to WHO, which should take the lead in international health policies. The report of the Commission on Social Determinants of Health, called “Closing the Gap in a Generation”, was based on the assumption that the knowledge to close the gap of health inequality in a generation was there in there heads, as well as the means were in their hands, but the question remained what was in their hearts. It was an intensely moral issue. The goal was creating the conditions for people to live flourishing lives.

CHERIE BLAIR, of the Cherie Blair Foundation for Women, said that it was a great honour to speak today on the subject of women and non-communicable diseases. She had a passion, professional and personally, for championing the issue of women’s rights – and, through her foundation for women, helping lift barriers which prevented women from playing their full role in the world’s societies. There was no doubt that ill health and poor healthcare systems were major barriers to those goals – sometimes explicitly recognized in a wide range of international conventions for over 60 years. The enjoyment of the highest attainable standard of health was specifically seen as a fundamental right when WHO had been set up. Health was also rightly included in the preamble to the Universal Declaration of Human Rights. Recognizing something as a fundamental right was, of course, a vital first step. It did not on its own ensure those rights were upheld and safeguarded. In many parts of world, even basic standards or health care were lacking. And the main victims of that injustice were girls and women. It should be no surprise, sadly, that the burden of ill health and poor health provision fell disproportionately on women and girls.

As WHO had noted, “Health was linked to status in society. It benefited from equality and suffered from discrimination”. Because women were still denied equal status in many societies, their health suffered – and through them, the health of their families and communities. That discrimination started right at the beginning of life. Despite progress in meeting many Millennium Development Goals, the mortality rates for mothers and newborn babies remained largely unchanged, Mrs. Blair stressed. Nor had one seen concerted action to prevent and treat fistula – a humiliating condition from which 2 million women suffered globally. It was clear, as those statistics underlined, that improving maternal and child health and care had to be an absolute priority. Efforts also had to be stepped up on tackling the impact of non-communicable diseases for women. There was a growing realization that non-communicable diseases were a silent epidemic threatening everyone’s hope for improving global health. They were already the major killer in every region apart from Africa. By 2020, even conservative estimates predicted that they would be the cause of three out of four deaths worldwide.

Sarah Omega Kidangasi, a Maternal Health Advocate from Kenya, said the story of a woman was the story of all society: her success was the success of the world, and what affected her affected all of humanity. The billion-dollar question was "How safe was motherhood?" Records indicated a disgusting reality – a woman died every minute from complications arising from pregnancy and childbirth. On average, in a year, 15 million others suffered severe health problems, or were left with life-threatening disabilities like fistula, which had a devastating mix of medical, social and psychological consequences. It was disappointing to note that maternal health was the area of least progress of all the Millennium Development Goals. In the socio-cultural context, belief, values, harmful traditional practices, illiteracy and gender discrimination prevented women from making decisions about their own lives. Their only option in life was limited to childbearing, irrespective of the risks achieved. That had to change. Women needed to be able to make voluntary, informed choices.

Political and economic conditions such as poverty and civil war also had a direct impact on maternal health. Lack of basic resources, poor infrastructure, limited access to reproductive health care, insecurity and all related factors needed solidarity, commitment and action to end them. Access to universal sexual and reproductive health care called for increased funding. Maternal health should be a priority – women should not have to suffer. The international community had to move in with strong policies, advocacy, systems and funding. Women should live, laugh, and live again.

JEFFREY L. STURCHIO, President and Chief Executive Officer of the Global Health Council, speaking on the ECOSOC Special Event on Philanthropy and the Global Public Health Agenda on 23 February 2009 in New York, said that more than 500 representatives from the private sector, philanthropic institutions, non-governmental organizations (NGOs) and academia participated in discussions with Member States and experts from the United Nations system on how to improve health outcomes for women and girls and how to raise awareness of the opportunities to prevent and treat neglected tropical diseases. Two facts demonstrated that those issues were of utmost importance: according to 2005 data, more that 500,000 women continued to die every year of causes related to pregnancy and childbirth. That was the Millennium Development Goal on which there had been the least progress. Second, more than 1 billion people throughout the world were affected by neglected tropical diseases, the control of which would help alleviate conditions that promoted poverty.

The dialogue in New York had concluded that there was a clear need for a broad global initiative with a common framework to bring all stakeholders together to improve health outcomes for women and girls. Existing frameworks – the Cairo Programme of Action, the Beijing Platform and Countdown 2015 – offered important points of departure for coordinated action to implement what they knew would reduce maternal and child mortality dramatically. To address the magnitude of the need, there was an opportunity through enhanced incentives to catalyse corporate involvement in the cause. The roles of philanthropy, NGOs and local associations were also recognized during the dialogue. For example, the Partnership for Maternal, Newborn and Child Health had been supporting capacity-building among health professionals to contribute to achieving the Millennium Development Goals. Further, the Global Health Council had worked with leaders from the maternal, child and reproductive health communities to develop a Global Family Health Action Plan to accelerate progress on health-related Millennium Development Goals.

H. A. P. KAHANDALIYANAGE, Secretary of the Ministry of Healthcare and Nutrition of Sri Lanka, speaking on the South Asia Regional Ministerial Meeting on financing strategies for healthcare, said that the Annual Ministerial Review process had strengthened the role of the Economic and Social Council in tracking progress and stepping up efforts towards the realization of the internationally agreed development goals, including the Millennium Development Goals, by 2015. Sri Lanka was pleased that the 2009 Annual Ministerial Review focused on the implementation of the commitments in the health sector. The South Asia Regional Ministerial Meeting had been hosted by the Government of Sri Lanka in collaboration with United Nations Department of Economic and Social Affairs and the World Health Organization. The meeting had been divided into four substantive sessions on: financing strategies for health care including external financing; health systems in a crisis situation; initiatives and recommendations presenting best practices and new initiatives; and progress made in achieving the Millennium Development Goals.

Mr. Kahandaliyanage noted that the discussions had taken place against the backdrop of a worsening international economic and financial crisis and other crises which affected progress in the achievement of the Millennium Development Goals, including in the health sector. The key messages that had emerged from the discussions were as follows: with regard to domestic sources of healthcare financing, it was agreed that for universal coverage to be achieved, it was necessary to find increased domestic funding and enhance efficiency in the use of resources. Equitable access to healthcare required a move away from out-of-pocket payments to other options. Even though national growth rates had been decreasing against the current global background, rising incomes provided an opportunity in many Asian countries to expand domestic health funding. With regard to external sources of funding, it was agreed that that needed to be increased, and had to become more predictable and better aligned with national priorities. Innovative sources for health financing had to be additional and not a substitute for external official development assistance funding. In addition, donors’ tendency to focus on particular countries while neglecting others had to be avoided. Finally, with regard to health care in conflict situations, improving health care was possible even when countries were facing crises. Expenditure on health care had to be on par with other areas in the recovery and rehabilitation phases.

Chen Zhu, Minister of Health of China, said with regard to the Annual Ministerial Meeting of the Asia and Pacific Regional Meeting Promoting Health literacy, said the Chinese Government had organized that event, which had included health ministers from the Asia-Pacific region and representatives of the United Nations, relevant regional organizations and national organizations, as well as domestic and foreign academic institutions and NGOs. The Conference had four items on its agenda, namely: challenges facing health literacy in Asia-Pacific; promoting cross-departmental cooperation and action; the role of the media and empowerment in the promotion of health literacy; and enhancing capacity-building of health literacy. Health literacy referred to an individual’s ability to gain access to, understand and use health information for promoting and maintaining health. It described the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions. Improving health literacy was one of the most effective weapons in the prevention of chronic non-communicable diseases and infectious diseases, delegates agreed, and it also played a key role in achieving the public health-related Millennium Development Goals.

The Conference had reached the following consensus: health was a basic human right and promoting health literacy was a fundamental cost-effective strategy for disease prevention, effective utilization of health services, improvement of primary healthcare and national health levels, and promoting social development. While promotion of health literacy was an important responsibility of Governments, at the same time, multi-sector participation, coordination and cooperation were needed for its effective implementation. It was indispensable to establish partnerships among the relevant Government departments, agencies, NGOs, private institutions, enterprises, media and civil groups and the role of medical and health institutions and professionals should be given full play. Concrete measures to promote health literacy should be based on the social and cultural background of the country, guided by the "people first" principle, and put into action. Global, regional and national action plans should be formulated at the earliest date, and scientific and feasible index systems should be developed to carry out evidence-based monitoring and evaluation of health literacy.

ABDULLAH BIN KHALID AL-QAHTANI, Minister of Health and Secretary General of the Supreme Council of Health of Qatar, speaking on the outcomes of the Western Asia Regional Meeting on controlling non-communicable diseases, said that that meeting had been hosted by Qatar between 10 and 11 May 2009 in Doha and had taken place under the patronage of Prime Minster Sheik Hamad bin Jassim Jaber al-Thani. The report of the meeting showed that more had to be done to help save and improve the lives of millions of peoples and their families in the region by addressing heart disease, stroke, diabetes, cancers, asthma, as well as injuries, including road traffic crashes. The meeting in Qatar also witnessed how policymakers in the region were increasingly challenged to formulate more effective strategies for preventing those non-communicable diseases and injuries. One of the key issues identified during the meeting was that the requests of many countries for technical support in strengthening national capacities to address non-communicable diseases and injuries remained unanswered by the international development community because those problems had not yet been included in their development priorities – despite their enormous negative impact on low- and middle-income countries – and were beyond the targets of the Millennium Development Goals.

It was time to start listening to the evidence and no longer be guided by mistaken beliefs. For example, the report estimated that almost 1 million people in the Middle East died prematurely every year from preventable heart disease, stroke, diabetes, cancers and asthma as a result of increased exposure to modifiable risk factors for non-communicable diseases and weak primary healthcare services which did not respond efficiently and equitably to the healthcare needs of people with non-communicable diseases. Premature deaths and chronic poverty traps from non-communicable diseases and injuries could be prevented through reducing the level of exposure of individuals and populations to common risk factors such as tobacco use, unhealthy diets and physical inactivity. Primary health care should be strengthened and the epidemic of non-communicable diseases should be mapped, as well as their risks and determinants. Non-communicable diseases and injuries could no longer be excluded from global discussion on development.

RUDYARD SPENCER, Minister of Health and the Environment of Jamaica, speaking on the Latin American and Caribbean Regional Meeting on progress in the reduction of the HIV/AIDS pandemic and its interconnection with development, said that the meeting had taken stock of progress made in controlling HIV in the region, analysed the main obstacles to achieving further success, and discussed ways of making further advances in the prevention, treatment and care of HIV, towards the achievement of the HIV-related Millennium Development Goals. The meeting had been organized around four panel discussions on the following themes: challenges of HIV as a development concern and Latin American and Caribbean responses; challenges and solutions in the response to HIV in reaching universal access goals; presentations of best practices and policies in response to HIV in the region; and the implications of the global financial crisis for HIV and health. Four key messages had emerged from the presentations and discussions: addressing HIV was central to public health, socio-economic development and human security; the region had to provide renewed leadership and keep HIV on national and regional agendas; prevention of HIV infection was a critical component in halting and reversing the HIV epidemic; and urgent and increased investment and interventions were needed in support of human rights, including sexual rights, and social justice programmes in accordance with the legal framework of each country to address stigma, homophobia and discrimination. A clear consensus of the participants was that a future response to the epidemic had to involve a multisectoral approach, including the labour sector, in order to address the social determinants of the epidemic.

Consensus had been reached on 11 recommendations, including that Governments needed to develop a balanced approach to the HIV response that addressed the social infrastructure and legal factors and barriers that underpinned risk-taking and vulnerability; investments should be targeted to strengthen integrated public health systems; Governments had to promote the active engagement of the mass media and civil society in the promotion and implementation of comprehensive sexual education, promotion of sexual health and prevention of HIV; gender inequity had to be addressed across development programming given the feminization of the epidemic; most-at-risk populations required targeted interventions, including outreach services and improved access to basic sexual health services; and antiretroviral drugs should be made available to all at lower costs.

GEORGE SIPA-ADJAH YANKEY, Minister of Health of Ghana, speaking on the African Regional Health Ministers Review Meeting on E-Health, that participants in the meeting had agreed that, while significant developments had and continued to take palace in the application of information and communication technology in health, there still remained challenges in the area of e-health governance, policies, strategies and quality measures that would assure countries, particularly in Africa, of sustained and targeted investments in the health sector. It had been agreed that, when systematically implemented, e-health would help to solve some of the problems of underdeveloped infrastructure, shortages, and inequitable distribution of health personnel in many developing countries, and would also help empower people by improving access to knowledge that would enable them to access services and make healthier lifestyle choices.


The application of e-health, in addition, had the potential for vast improvements in both management and technical efficiency of the health workforce at all levels through reliable information dissemination systems and by supporting the decision-making process. In Africa especially national e-health plans, policies, and strategies, as well as legal, ethical and legislative frameworks, had remained very weak, leading to very minimal progress in effective development and integration into mainstream healthcare. Financing e-health infrastructure and services required strong collaboration between the public and private sectors. The meeting urged the Council, in collaboration with WHO and other United Nations organizations, among other things, to develop a global framework to guide the development of regional and country-specific policies on e-health. Countries should develop legal, policy, and regulatory instruments for health data protection, confidentiality, ownership and access, among other things. The adoption of e-health solutions should not create a new divide between the developing and developed world.


For use of the information media; not an official record


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