To the American Academy of Pediatrics
San Francisco - 22 October 2001
President Berman, President-elect Cooper, Executive Director Sanders, Members of the American Academy of Paediatrics, Friends:
It is a privilege to join you for this important gathering. That so many of you are here, after long and probably trying journeys, is one more measure of your commitment to the cause of children - and to the mission of the AAP, which has worked tirelessly for six decades to promote the health and full development of all infants, children, adolescents and young adults.
In the 11 years since the World Summit for Children, we have seen gains in immunisation that have brought polio to the brink of eradication; reductions in micro-nutrient deficiencies through vitamin A supplementation and salt iodisation; the promotion of breastfeeding standards; improved access to safe water; and progress in the drive to provide quality basic education for all.
These are achievements that would not have been possible without partnerships - and the hard work of governments, multilateral organisations, individuals, non-governmental groups and countless others, including this organisation and its members, whose energy and devotion have helped shape and drive public health policy.
My Friends, that spirit of partnership and service is undiminished in the wake of the terrorist atrocities visited on this country. The events of September 11th have shaken our innate sense of security to its very foundation. And the specter of bioterrorism has left millions of people gripped by foreboding and dread.
But these criminal acts have also brought the international community together as never before - and the outrage expressed on September 12th by the Security Council and the General Assembly is reason to hope, as Secretary-General Kofi Annan put it, that the unity born of this tragedy "will bring all nations together in defense of the most basic right - the right of all people to live in peace and security."
Mr. President, the ideal of a just and peaceful world, sustained by collective international action, remains a beacon of hope, 56 years after it was first proclaimed in the Charter of the United Nations.
It is a vision rooted in compassion and a profound sense of responsibility to our fellow human beings - and it begins with children and the realisation of their rights. Each of us has the power to help build that world - and make it a place where every child can grow to adulthood in health, peace and dignity.
That is the premise behind the General Assembly Special Session on Children, the biggest global conference on children since the World Summit for Children in 1990. As you probably know, it was to have opened in New York on September 19th with some 80 heads of State and Government in attendance. But because of the September 11th tragedy, the Special Session has been postponed until early next year. But the drive for child rights goes on - and UNICEF and its many partners are more determined than ever to see it through.
Yet as we are reminded daily, insecurity and suffering are spreading as never before - and the very children that we seek to help nurture, immunise and educate are being systematically targeted and brutalised in armed conflict, from Sri Lanka and Sierra Leone to Colombia and the Democratic Republic of the Congo.
Mr. President, the plight of Afghanistan's children was desperate even before the latest conflict began.
A 1997 UNICEF study found that 95 per cent of children in Kabul had witnessed horrific violence first-hand. Seven of every 10 had lost a family member to violence. And 90 per cent of Kabul's children believed that they would someday die in the fighting.
Each year, almost 300,000 young Afghan children die of preventable causes like measles, diarrhoea, and exposure. Every 30 minutes a young Afghan mother dies in childbirth, leaving children with an irreplaceable void.
These days, UNICEF convoys enter Afghanistan almost daily, where UNICEF and its nongovernmental partners are distributing winter clothing and blankets to tens of thousands of children. We are also providing safe drinking water in the camps for the displaced, food supplements for the malnourished, and safe birthing environments for young mothers.
But, like the ongoing airdrops of American food rations, it may not be nearly enough. The fact is that with 7.5 million Afghan civilians at risk - 60 per cent of them children and women - we have the makings of a human rights and humanitarian catastrophe.
That is why UNICEF is appealing to all its partners and donors to give generously toward the $36 million to carry out the immediate emergency work that is needed. And I am pleased to tell you that a portion of the proceeds from the Trick or Treat for UNICEF drive, run by the US Fund for UNICEF, will be earmarked for Afghan relief.
The children of Afghanistan are hardly alone. Countless numbers of children are in similarly desperate straits in other parts of the world - brought down, in one way or another, by poverty and inequity and its consequences, including disease and poor nutrition, unsafe water and inadequate sanitation, illiteracy and the lack of education, and by violence and exploitation, much of it gender-based.
My Friends, none of this has to be. In a $35 trillion global economy, we know that the knowledge, the resources and the strategies already exist to assure the well-being of all children, That means ensuring that they get the best possible start in life, that they receive a quality primary education - and that they get help in navigating the complex passage from adolescence to adulthood. These are all crucial first steps if we are to break the poverty cycle.
In all of this, we have made a start.
In the years since the World Summit for Children and the all-but-universal ratification of the Convention on the Rights of the Child, we have witnessed triumphs for children and their families on a scale like none other - from the fight against preventable illness and malnutrition to increased access to education, especially for girls; the promotion of breast-feeding and early childhood care and development, and in access to safe water.
One measure of that progress is evident in the under-5 mortality rate (U5MR) - one of the most sensitive indicators in measuring the well-being of children - and of the progress of nations generally.
Over the last decade, and despite population growth, global under-5 mortality declined by 14 per cent, with some 60 countries reaching the one-third reduction called for at the World Summit for Children.
But in such regions as sub-Saharan Africa and South Asia, the burden of childhood mortality is still high - and points up the urgent need to address the plight of those 25 countries where the under-5 mortality has either increased or remained unchanged.
Their situation was foremost in mind in the shaping of the global goals on child survival and development for the next decade. These include: the reduction of infant and under-5 mortality by at least one-third by 2010; the reduction of maternal mortality by at least one-third by 2010; reduction of the incidence of low-birth weight by at least one-third, and the reduction of child malnutrition.
The reduction of child malnutrition, especially among children under the age of two, holds great promise as we learn more and more about the links between health and nutrition, and why it is fundamental to child survival and development.
We already know that protecting and improving children's nutritional status is as important as immunization in reducing child deaths and disability. What's more, it is increasingly clear that the benefits of immunization are optimised when children are well-nourished.
One of the most significant success stories in micronutrients grows out of the progress we have seen toward the elimination of iodine deficiency disorders (IDD). Until recently, IDD posed a very significant public health problem to millions of people worldwide. Now some 72 per cent of households worldwide are using iodised salt - up from less than 20 per cent in 1990.
Another success has been the introduction of Vitamin A capsules during supplementary immunization campaigns. The World Health Organisation and UNICEF estimate that the widespread dissemination of Vitamin A capsules has prevented as many as a million child deaths over the last three years.
Iron deficiency remains by far the most prevalent form of malnutrition. However, the provision of supplements has not been entirely effective - and new strategies are needed in order to redress this serious problem. Key nutritional goals for the next decade include the sustainable elimination of Vitamin A deficiency by 2010 - and the one third reduction of anemia, including iron deficiency, by 2010.
The momentum for improved child nutrition that has been generated was reflected recently during an international meeting in Seattle, Washington, on food fortification. The gathering, sponsored by the Bill and Melinda Gates Foundation, marked a significant step in promoting low-cost, high-impact population-based interventions - and was a unique opportunity to discuss the importance of creating a global nutrition alliance.
Another area in which considerable progress has been made is, of course, in immunization - one of the most widely recognised and cost-effective interventions for ensuring the survival and well-being of children.
The effects over the last decade have been dramatic. We have seen the elimination of neonatal tetanus in over 100 countries - and the formation of the Global Alliance for Vaccines and Immunization (GAVI), a coalition of business leaders, philanthropic foundations, development banks and national governments, all dedicated to the goal of universal child immunisation, with special emphasis on new and improved vaccines.
For example, it has been estimated that if we could reach all children in the developing world with new vaccines, such as Hepatitis B and Hib, along with vaccines against the six major child killing illnesses, the lives of nearly 3 million additional children a year could be saved.
You are of course aware of the huge inroads we have made against polio - an effort in which the AAP has played an invaluable role as a member of the US coalition to eradicate polio, especially in helping to secure Federal funding in a joint drive with the US Fund for UNICEF.
Despite such success stories, there have been setbacks in regional in coverage over the last decade. Indeed, in sub-Saharan Africa, immunization rates have decreased.
The proposed draft outcome document for the rescheduled Special Session on Children reiterates the importance of childhood immunization - and calls for renewed global efforts to ensure 90 percent immunization coverage in every country.
My Friends, the remarkable progress we have witnessed over the last decade in child health and nutrition has helped lay a solid foundation for further gains. But we need to focus every waking hour on the unfinished business - the challenges that threaten to overturn the progress made to date.
Foremost among these is the scourge of HIV/AIDS, whose current infection rate among children and young people, especially in sub-Saharan Africa, is a catastrophe of almost indescribable proportions, much of it rooted in chronic poverty.
The growing awareness of the threat was acknowledged not long ago by the Security Council, which declared that the health and well-being of women and children is directly linked to international peace and security.
Other challenges include child poverty and its many consequences, including the nearly 2 million under-5 children who die each year of one or another of the most common - and most preventable - child killers, such as measles, diphtheria and tetanus.
Moreover, the rapid proliferation of armed conflict, including the exploitation of children as soldiers, has not only made it more difficult to reach the most vulnerable with immunisation, education, and special protection - it has also made it more dangerous for UNICEF staff and our many partners in humanitarian work, who are themselves targets.
Despite these challenges, UNICEF believes that the world now stands at the most opportune moment to re-energise the international commitment to realising a global vision for children now and in the years to come.
My Friends, for all the new uncertainty around us, I am convinced that the future remains in our hands as never before.
That is why, as we move toward a rescheduled Special Session, UNICEF and its partners are stepping up the work of mobilising a Global Movement for Children - a worldwide campaign to build a shared sense of responsibility for the well-being of every child.
To succeed, the Global Movement will need to enlist not only established leaders, but people of influence representing every part of civil society, from non-governmental organisations, religious groups and private enterprise to people's movements, academia and the media, community and grassroots groups, families - and children themselves.
President Nelson Mandela and Graça Machel have already assumed a direct and personal role in this effort, telling leaders from every walk of life that if we want a just, equitable and thriving world, we must invest in children now.
The Global Movement is about hope rather than despair. It is an opportunity for citizens everywhere to Say Yes to Children - to remind the world that it is not only citizens who have obligations to children. Governments, corporations and civil society organizations of all kinds have obligations as well - and that those obligations must be met.
My Friends, peace and security does not imply simply the absence of war. It means having the confidence that our children will not die of measles or malaria. It means having access to clean water and proper sanitation. It means having primary schools close to our homes that educate our children free of charge. It means having the basics of life that allow quality of life. It means building a world fit for children, where every child can grow to adulthood in health, peace and dignity.
That world has remained a dream for more years than anyone can count. But UNICEF is convinced that working together, we can make it come true - for each and every child on this planet.