GABARONE, Botswana, 4 March 2013 – “Who said that: ‘Healthy citizens are the greatest asset any country can have’?
It was Winston Churchill. But it could have been anyone with common sense. Because the ambitions of a society can only be realized through the ambitions of its people ― their energy, intelligence, education and vision. Without health, these ambitions will never take root and never support the growth all countries need to secure their futures.
Health must always be at the heart of the global development agenda. When people are denied a fair opportunity to live healthy lives ― when they are denied vaccinations, proper nutrition, access to health services ― they are being denied a basic human right. And their societies are being denied their “greatest asset.”
As the Millennium Development Goals deadline approaches, there is much to celebrate ― reduced poverty rates, the near eradication of polio, increased immunizations, great progress in combatting AIDS, more children surviving their fifth birthdays than ever before and better access to clean water and nutrition.
But there is much more to do. Good health is a universal goal ― and a universal challenge. But the most disadvantaged families, the least developed countries, and the most fragile nations continue to bear the heaviest burden of poor health and preventable deaths.
Disaggregate the data and we find that our statistical national successes are masking moral and practical failures. People who are left behind simply because they live in rural communities or urban slums, in conflict zones, as part of indigenous groups, with disabilities or because they are girls. They are suffering or dying from diseases and deprivations that we know how to prevent ― through immunizations, nutrition, and simple lifesaving interventions like bednets, medicines to treat illnesses like diarrhoea, and proper, sterile medical equipment.
The neglected and hardest to reach may be the hardest to help. But these are precisely the people we must help. It is not only right in principle ― it’s right in practice. Focusing on equity is more cost effective than our current approach ― and it spurs sustainable economic growth over the long term.
It’s also the only way to get to our goals in our health campaigns. For example, in our final push to end polio or in reversing the march of HIV and AIDS by helping those who are most at risk ― the most excluded, isolated and vulnerable.
So we must be ambitious ― keeping global attention on health as we draw closer to the 2015 deadline, redoubling our efforts to reach those most in need and making sure that our approach is universal rather than focused narrowly on the ‘easiest to reach’ communities, or on one set of nations.
And if all of us are to be effective in our common cause of promoting health as a human and development priority, each of us must be willing to compromise. We meet at a time when there is still little clarity on the structure, much less the substance, of the post-2015 agenda. And while those of us in this room agree on the importance of investing in health, with clear targets for after 2015, we undoubtedly differ ― I hope, usefully so ― on what our specific goal or goals should be.
To be realistic, while we must make all the practical progress possible in the next two days, it is unlikely we will reach final agreement at this meeting on whether there should be one or two new broad, measurable and achievable health goals, with a set of ambitious sub-goals or whether the MDGs should be updated as stand-alone goals beyond 2015 or be incorporated into a broader set of ‘sustainable development goals.’
Happily, the consultations for this meeting have generated a variety of possible goals, for example:
universal health coverage;
an increase in healthy life expectancy;
a reduction in non-communicable disease mortality in each country by 25 per cent by 2025, as proposed by the World Health Assembly last May;
sexual and reproductive rights goals;
an AIDS free-generation, as promoted by UNAIDS; and
ending preventable child and maternal deaths. (I offer this, of course, with no institutional interests in mind.)
And there are many more. All worthy. While we may not leave this meeting with full consensus on a goal or goals, I do hope we will rigorously examine those proposed and agree on a way forward to stay together as we finalize a compelling document. I hope that we can uncover some common threads that run through our many issues and coax simplicity out of complexity in a way that can capture the imagination and support of publics and governments.
We cannot build and sustain such a case for health if we look at the issue solely through the clear but narrow lenses of our institutional interests ― or if we settle for the blurred vision of a watered down or imprecise goal or goals. Health goals must be universal, explainable, measurable and equitable.
Universal, because is there any society without a malnourished child? Without a woman who dies in labour? Or without a family denied the nutrition, medicine and care to prevent ― or cure ― non-communicable diseases?
Explainable, because without a broad, convinced and committed health constituency, our efforts are doomed to fail.
Measurable, because results are all that truly matter. Think of the World Health Assembly’s goal of reducing the number of stunted children under five by 40 per cent by 2025 ― 70 million children saved from this fate. Or the goal set by A Promise Renewed to dramatically reduce preventable child deaths ― to 20 or fewer per 1,000 live births by 2035― not a goal pulled out of thin air, but predicted through a rigorous modelling exercise. We must apply the same rigour, the same accountability to results, the same clarity of purpose across our health goals.
And equitable, because too many children, families and communities have been left behind in the march of progress. We should encourage and support countries to gather and use good, disaggregated data, to better track ― and accelerate ― progress for those still being denied the help and the care they need. We can take inspiration from countries like Botswana, which is making such impressive strides ― for example by treating HIV positive mothers and children with such a high degree of success, and by achieving an extraordinary high 96 per cent DPT3 immunization coverage.
Throughout, we must continually make the case that you cannot separate a nation’s economic development from its ‘greatest asset’ ― a healthy, and I would add, well-educated and well-nourished citizenry. Because health is both an effect and a cause of a strong economy.
When an economy is strong, we should invest its benefits in health, education, sanitation, clean water and nutrition. When growth stalls, we should spare no effort to protect these investments.
But we must better make the case that health investments are not only a benefit of growth ― they’re a driver of growth, as well, as Gunilla noted. A dollar invested in the health of a mother, a child or a community does more than strengthen the social protection floor ― it helps create an escalator of growth, an ascending stage from which families, communities, and countries can realize their ambitions.
When we fail to make this investment, the economic costs are high. Two studies by Bloomberg School of Public Health show that if we scaled up the use of existing vaccines in 72 of the poorest countries, we could save 6.4 million lives, and avert US$6.2 billion in treatment costs and US$145 billion in productivity losses over the next decade. Our failure to immunize people in these countries is exacting a staggering human and economic toll.
And as we consider the economic costs of inaction, we must also weigh the benefits of action. For example, the World Bank estimates that improving basic nutrition can boost a poor country’s GDP by two to three per cent annually. A recent paper by Bloom and Fink demonstrates a causal link between overall life expectancy and per capita income. And The Lancet’s Commission on Investing in Health is now revisiting the World Bank’s influential World Development Report ’93, which examined the importance of investing in health. The Commission’s work will help us continue building our case for health among governments and partners.
But the economic case, however powerful, should never overshadow the moral case ― or lessen the full weight of responsibility we all bear towards the millions of women, men and children who are living and dying on the margins of hope.
A global commitment to health can pull these lives back from the brink, and unleash the full potential of Churchill’s ‘greatest assets’ found in every nation, every community and every family ― everywhere.”
About UNICEF UNICEF works in more than 190 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments. For more information about UNICEF and its work visit: http://www.unicef.org