Vancouver, 11 May 2003
It is so heart-warming to follow that wonderful tribute to Dr. Wah Jun Tze, and the background to this Congress, by Maggie Catley-Carlson.
After listening to Maggie, who has been a mentor and a role model for me and so many others in UNICEF, I feel doubly privileged to have this opportunity to address this 3rd World Congress on Child and Youth Health 2003.
UNICEF has been associated with this Congress, from the very beginning.
We were happy to see that the first Congress in 1992 gave a strong impetus for the follow-up to the historic World Summit for Children.
The second Congress in 1995 celebrated the progress being made for children at mid-decade, and reaffirmed a strong commitment to pursuing the Summit goals for the year 2000.
Wah Jun Tze was the driving force behind these Congresses and Jim Grant of UNICEF provided much of the initial inspiration.
As Maggie said, together John and Jim inspired a whole generation of activists for child survival and development. I feel proud to be among the inheritors of their great legacy, along with many of you at this Congress.
My current boss, and Jim Grant's successor at UNICEF, Carol Bellamy, is delighted that the Child and Youth Health Congress this year has chosen as its theme the UN Special Session on Children and its challenge for the future.
The Special Session held exactly a year ago at the United Nations, adopted a bold new agenda for child health and development. Entitled A World Fit for Children, the Declaration and Plan of Action of the Special Session committed to complete the unfinished agenda of the World Summit. And it refined and endorsed many child-specific goals distilled from other major UN conferences and Summits of the last decade.
Promoting healthy lives, providing quality basic education, protecting against abuse, exploitation and violence, and combating HIV/AIDS, are the four key pillars of the World Fit for Children agenda.
The ultimate objective is to create a child-friendly world:
- where all children get the best possible start in life,
- where they all have access to quality basic education,
- and where all youngsters have ample opportunity to grow to their full human potential.
A child friendly world is also one where the human rights of children are respected, democracy flourishes and poverty is not an insurmountable barrier to human progress.
We were thrilled that we had a huge turn out of leaders from all walks of life at the Special Session.
Besides some 70 top government leaders, we had religious leaders and parliamentarians, media moguls and civil society activists, Nelson Mandela and Bill Gates, a host of celebrities and Nobel laureates - all united in their resolve to create a genuine global movement for children.
Indeed in the lead up to the Special Session, UNICEF and a coalition of activists working under the banner of the Global Movement for Children had launched a "Say Yes for Children" campaign. It garnered pledges of support from nearly 100 million people across the globe.
The campaign sought to promote a 10-point agenda that was later adopted by world leaders at the Special Session.
The 10 rallying calls of the "Say Yes for Children" campaign were:
- Put Children First
- Eradicate Poverty: Invest in Children
- Leave No Child Behind
- Care for Every Child
- Educate Every Child
- Protect Children from Harm and Exploitation
- Protect Children from War
- Combat HIV/AIDS
- Listen to Children and Ensure their Participation
- And Protect the Earth for Children
The best advocates and activists of this campaign were children and young people themselves. They were also among the most inspiring participants at the Special Session.
For the first time in the history of the United Nations, young people were official delegates of their countries.
They were not only seen but they were heard. They shared their diverse yet unique testimonies of childhood in the 21st century. They charmed and challenged all adults with their energy, creativity and commitment to build a better world for themselves, their siblings, friends and future generations.
All of us have reason to be proud and pleased by what was accomplished at the Special Session, when we solemnly declared our intention to change the world for, and with, children.
The question now, one year later, is whether the solemn promises of the Special Session are being translated into strategies, actions and investments in children.
UNICEF has just issued a brief progress report on the first anniversary of the SSC. Its headline says, "A Year Later, Children Still Waiting for Leaders to Deliver - Goals Agreed by All Nations in May 2002 Are Slow to Take Hold".
I would hope that all of us attending this Congress, will do our part to keep the promises and commitments that we have made repeatedly to the world's children and youth.
Friends and colleagues, I will present to you shortly what I see as 5 key challenges for our follow up to the SSC.
But before addressing these challenges for the future, let me take a few moments to look back at how we have arrived at this point in the global agenda for maternal, child and youth health in the 21st century.
"Health for All" - and the Child Survival Revolution
The groundwork for realising the grand vision of a World Fit for Children was laid in the 1980s, when UNICEF and its partners helped place children's health issues firmly on the world's political and social agenda.
Some of you may recall that "Health for All" was the vision of the primary health care movement launched at Alma Ata, in 1978. Along with the World Health Organization, UNICEF was a driving force behind that movement.
Then, in the 1980s, we went one step further. Invoking the potential for a major child survival revolution, we sought to invert the "Health for All" motto into "All for Health".
In the past, health was often seen as the exclusive domain of medical professionals. But when it came to children's health, we sought to broaden the responsibility and ownership. We tried to galvanise action by village health workers and mayors, governors and parliamentarians, school teachers and religious leaders, the media and the academia.
Two major killers, diarrhoea and vaccine-preventable diseases were targeted to demonstrate that dramatic progress could be made in promoting child survival.
Millions of lives were saved with the low-cost, high-impact techniques of oral rehydration therapy and childhood immunization.
The concept of social mobilization was used as a powerful tool in support of these and other interventions to promote child health.
The child survival and development revolution saw everyone, from film stars, singers and famous athletes, to civil society activists and heads of states, actively involved in promoting ORT, immunization and other health and nutrition interventions.
Goals for Children and Development
Inspired by the success of the child survival revolution of the 1980s, UNICEF helped convene the World Summit for Children in 1990.
This Summit, the largest gathering of world leaders until that time, adopted an ambitious agenda for promoting child survival and development through measurable goals with time-bound targets, using relatively low-cost and high impact public health and nutrition actions.
This simple concept of focusing on time-bound goals and results has had a profound influence on our modern development thinking.
Through successive major international conferences and summits of the 1990s, the international community has committed itself to a common development agenda with measurable goals and targets, culminating in the Millennium Development Goals.
The goal-oriented approach to public health and development has been a powerful complement to pursuing the standards and principles of the UN Convention on the Rights of the Child, which came into force in the lead up to the World Summit for Children, and which has now become the world's most universally ratified human rights treaty.
A Decade of Progress, and Setbacks
It is often said that in many UN conferences, goals are ever set but never met. And that commitments on paper are rarely translated into action on the ground.
The systematic follow-up and monitoring that followed the World Summit for Children, helps us to objectively assess the achievements and setbacks, and the lessons learned for the future.
Predictably, the picture that emerges is one of mixed results. There has been real and significant progress in a number of areas. But there has also been setback, and in some cases, real retrogression.
On balance, there has been net progress, and a good foundation has been laid for accelerating further progress in the coming decade.
On the positive side, although total world population in 2000 was some 800 million higher than in 1990, 13 million fewer children were born and 4 million fewer children died in the last year of the decade compared to the first year.
This is a remarkable testimony to the continuing progress in child survival and family planning.
In the last decade some 63 countries did achieve the Summit goal of one-third reduction in under-five mortality, and over 100 countries achieved a reduction of one-fifth.
Diarrhoeal disease, the number one cause of U5MR in 1990, was downgraded to number two at mid-decade. The goal of reducing diarrhoeal deaths by 50 per cent during the decade was achieved, saving the lives of 1.5 million children annually.
There was dramatic progress in tackling the world's major cause of mental retardation - iodine deficiency disorders. During the course of the decade nearly 2 billion additional people got access to iodized salt, protecting 90 million new-borns world-wide from brain damage and a loss in their learning ability.
Total external investment for this massive outreach was less than $200 million - perhaps the greatest bargain in the history of public health.
Regrettably, the progress has been uneven. And the poorest region of the world, Sub-Saharan Africa, has experienced considerable retrogression, as did most of the former communist countries of central and eastern Europe and central Asia.
Quite a few of the Summit for Children goals remain unachieved. Over 10 million children still die each year, often from readily preventable causes. 150 million children remain malnourished. 120 million children are still out of school, a significant majority of them girls.
HIV/AIDS has grown into a catastrophic pandemic in several parts of the world. It is unravelling decades of gains in child survival and development in large parts of sub-Saharan Africa, and is spreading like wildfire in other regions.
In an historical reversal, the young generation of many countries in Africa today can expect to live a shorter life than their parents or grand-parents.
The Summit for Children in 1990 was held at the time of the end of the cold war, amid high hopes for a peaceful world, where we had hoped that resources previously squandered in military expenditures might be available for development purposes.
Unfortunately the decade since the Summit witnessed unprecedented levels of ethnic conflicts and civil wars, in which children and women have become direct targets or collateral victims.
Perhaps more children have become victims of armed conflicts and violence during the past decade than at any comparable period in history.
On this important issue, I know that we all look forward later in this Congress to hearing General Romeo Dallaire speak about his personal experience of working with war-effected children.
On the whole, if the goals of the World Summit for Children remain under-achieved, it is not because they were too ambitious, or were technically not feasible. It is largely because of insufficient investment.
With a few honourable exceptions, throughout the 1990s investments by developing countries and donors fell far short of the internationally agreed norm that developing countries should allocate 20 per cent of their national budgets and donors should allocate 20 per cent of their aid budgets to meet the most pressing needs of children in primary health care, nutrition, basic education and sanitation.
In the larger scheme of things, the resources needed to provide for the basic needs of children and adolescents are modest and affordable. With modest amounts of external support, even the poorest countries of the world would be in a position to afford basic social services.
The missing ingredient often is not resources, but lack of vision, unwise priorities and leadership.
It was to summon such vision, commitment and leadership that the United Nations convened a new set of Summits, in particular the historic Millennium Summit in 2000 and the Special Session on Children of the UN General Assembly in 2002.
Millennium Development Goals
All of the eight major Millennium Development Goals are directly related to children:
- eradicating extreme poverty and hunger
- giving every child a primary education
- promoting gender equality
- reducing child deaths
- improving maternal health
- combating HIV/AIDS, malaria and other diseases
- protecting the environment
- and increasing international support and solidarity for these goals.
There is unprecedented global consensus and commitment for the MDGs. Both developing countries and donors, UN agencies, international development banks and many NGOs subscribe to the MDGs.
Yet prospects for achieving the MDGs look most daunting.
Indeed based on current trends, most of the MDGs are doomed to fail, if we pursue "business as usual" approach.
However, in our recent human history, there have been many countries which have achieved such accelerated progress as required to reach the MDGs.
And in the field of child health and nutrition, there are many proven, cost-effective approaches that could enable us to reach the MDGs, as well as other goals of the World Fit for Children.
Challenges Ahead in Reaching Global Health Goals
Friends, what will it take to change the current trends and pave the ground for dramatic progress in child and youth health in the next decade?
I foresee 5 major challenges ahead to achieve the global health goals:
- The Challenge of mobilizing "All for Health"
- The Challenge of Global Interdependence
- The Challenge of Going to Scale
- The Challenge of Mobilizing Resources, and
- The Challenge of Leadership
Let me share with you some of the specifics under each of these 5 challenges:
1. The Challenge of Mobilising "All for Health"
It is often said that health is too important to be left to medical professionals. While we all need and value the expert advice and treatment by doctors and nurses, each one of us need to take greater responsibility for our own health and the health and well-being of our loved ones.
From the point of view of child health, the number one health worker is the mother.
The more we can do to empower her with basic knowledge, information and skills in good infant feeding practices, care and stimulation of the young child, nutrition, hygiene, sanitation, better birth spacing, etc. the better the health outcomes of her child. Good maternal health and nutrition too is, of course, of paramount importance.
One of the best ways to promote this is through action in the education sector. As we know, girls' education is probably the most effective of all health interventions.
An educated girl marries later. She can better protect herself from diseases, including HIV/AIDS. She has reduced fertility, lower infant and maternal mortality. Her children are likely to be better nourished and healthier. They are more likely to go to school and perform better. And as they become adults, they help break the intergenerational cycle of ill health and poverty.
Teachers are another group of potential health workers that we tend to underestimate.
Most children spend many years as a captive audience of their teachers. If teachers were better informed about psycho-social stimulation and development of children, if they had the basic knowledge of nutrition, hygiene and sanitation, and if they were empowered to impart such knowledge to their students, they could make an enormous contribution in bringing about good health outcomes.
Most schools in developing countries tend to be breeding grounds for sicknesses and malnutrition. Millions of school age children are infected by worms and parasites, which leads to malnutrition, anaemia and retards their physical development and learning capacity.
Lack of safe water and sanitary facilities in schools is a major impediment to good learning outcomes in schools, particularly for girls.
That is why if every primary school in the world had separate sanitary facilities for girls and boys - and had clean and safe drinking water, that would make a major contribution for both education and health outcomes.
Malnutrition is the underlying cause of much mortality and morbidity. Improvement in nutrition through better feeding and caring practices, household food security, and micronutrient supplementation or fortification is of vital importance for better child health.
And in today's world, mass media and communication can be a great provider of good health information or a promoter of unhealthy life-styles. The communications media, both public and private, can therefore be the greatest ally of ministries of health in their mission of health promotion.
As we look to the next wave of revolution in health outcomes, I have no doubt that mobilizing "All for Health" will be the key to the kingdom of better health in the 21st century.
2. The Challenge of Global Interdependence:
We cannot be healthy in an unhealthy world. Unlike people, diseases do not need a passport or visa to travel. No amount of border controls in today's world can effectively seal a country from the stealthy, unannounced transmission of diseases, as we have seen most recently with the SARS outbreak.
We must consider support for many health interventions in developing countries as global public goods.
Campaigns to eradicate or eliminate diseases such as smallpox, polio, malaria, TB, HIV/AIDS, etc. are the classic examples of global public goods with mutual advantages for all parties concerned.
The same can be said for epidemiological surveillance at the international level, analysis of global health trends, and technical cooperation among countries to combat diseases and to promote public health.
Here is an example of insecticide treated bed nets, for the prevention of malaria.
A large insecticide treated bed net trial in Kenya, has just confirmed that these nets can cut child mortality by up to 25 per cent and morbidity by 50 per cent. The study further showed that wide coverage and use of such nets can have a significant "community effect".
Such nets provide protection from malaria not only for those who sleep under a net but also for other vulnerable people who live in the same community, but who do not have a treated net in their household.
As malaria currently costs Africa one million lost lives and $12 billion in lost GDP every year, control of malaria through widespread use of bed nets will not only improve the health and wellbeing of millions of peoples but also save these poor, endemic countries substantial amounts of money. And these gains will keep accruing for many years to come.
Thus investment in programmes like malaria prevention and control, can truly be considered global public goods and a win-win proposition for all.
3. The Challenge of Going to Scale:
To be really useful, development programmes should attempt to take action on a scale commensurate with the problems that they are trying to tackle.
We often waste too much time and resources in small scale experimental projects, while failing to take to scale approaches already known to be effective.
Tonight only two per cent of African children will sleep under a treated mosquito bed net which costs less than $3 and can provide significant protection against malaria.
Two thousand children in the world will die today - and three-quarters of a million this year - from measles, because they have not received the readily available vaccination against it.
And 4,000 children will die today - and 1.5 million during the course of this year - from simple diarrhoea because of lack of access to oral rehydration salts costing less than 25 cents.
At a time when we are all rightly so scared of SARS and the West Niles virus, the needless deaths of thousands of children every day from such readily preventable causes ought to outrage us far more than it does.
Lack of essential drugs and other commodities at the community level is a frustrating experience for health workers and caregivers in many developing countries.
Too often after walking for several hours to a clinic, caregivers have to leave empty-handed. How can we make those essential commodities more available to households? Are we ready to empower families with a survival pack of essential medicines to prevent the 70 per cent of child deaths that occur at people's homes?
Examples abound of low-cost and high impact interventions crying out to be taken to scale.
We already have globally approved goals and targets and proven strategies for action.
What we need now is scaling-up fast - of focused plans, strong partnerships, competent and motivated human resources, essential supplies, reliable monitoring, and sufficient funds.
4. The Challenge of Finance:
What is to be done when there are so many needs and never enough resources?
In times of scarcity, difficult choices must be made. Fortunately, we have plenty of evidence to help guide our investments in the health of children and adolescents that yield particularly high returns.
The WHO Commission on Macroeconomics and Health, led by Professor Jeffrey Sachs estimates that the financial resources required for essential interventions against infectious diseases and nutritional deficiencies that could potentially save 8 million lives per year in low income countries would cost around $34 per person per year.
The Commission estimates that additional resources needed from donors for such investment would amount to an increase of about 0.1 per cent of their GNP.
Such a modest increase in aid for health ought to be eminently feasible.
The low income developing countries too would need to increase their domestic budgets by 1 to 2 per cent of their GNP to achieve these priority health goals.
This too ought to be both feasible and desirable considering that these countries now invest less than 4 per cent of their GNP for health, compared to the global average of about 8 per cent.
At a time of unprecedented global prosperity, in a $30 trillion world economy, where a new person becomes a billionaire every 2 weeks, and billions of dollars or euros are spent every month for non-essential drugs and surgery, it is obscene to think that we cannot afford to invest these relatively modest amounts for improving the health and productivity of hundreds of millions of people.
The public sector alone need not bear the burden of investment in health. The pharmaceutical industry must be an enlightened partner in this effort.
It needs to show a sense of corporate social responsibility, especially in making essential drugs available at cost or discount prices, and in investing in research and development activities catering to the health needs of the poor.
In recent years we have seen laudable examples of generous corporate contribution to such initiatives as the Global Alliance for Vaccines and Immunization (GAVI), the Global Fund against AIDS, Tuberculosis and Malaria (GFATM), and development efforts of UNICEF, WHO and others by private sector donors such as the Bill and Melinda Gates Foundation, the Rockefeller Foundation, by Ted Turner-funded UN Foundation, etc.
These are to be commended, as are the efforts of such service organizations as Rotary International and Kiwanis.
The public sector must encourage and provide tax and other incentives for the private sector to be enlightened partners in the promotion of Health for All.
5. The Challenge of Leadership:
Finally, we need strong leadership at the local, national and international level to promote health for all and to achieve the ambitious but achievable goals aimed at creating a World Fit for Children.
We now have the tools and technology required to reach these goals. The global economy surely has the resources needed, if only we can muster the vision and the commitment.
Under the leadership of our Secretary-General Kofi Annan, I can assure you that the United Nations system is poised for an activist role. UNICEF, WHO, UNFPA, the World Bank are all now guided by these agreed common goals.
We owe it to the children and youth of the world and to the future of humanity to bring the benefit of our knowledge, expertise and commitment to the cause of health for all.
Human beings have the right to the highest attainable standards of health, and health is closely associated with human security, productivity, national development and international solidarity.
Dear friends and distinguished delegates, each of us attending this Congress is called upon to play a leadership role in our own sphere of work, to build a World Fit for Children, and youth - a vital role in which UNICEF stands shoulder-to-shoulder with you.
As we ride the next wave of revolution in child survival and development, I have no doubt that together we will rise to this challenge of leadership - and write a new chapter for health and development in the 21st Century.