To the AMA'S National Leadership Conference
Washington, 5 March 2001
President Smoak, Dr. Distlerath, Dr. Foege, Ms Garrett, Members of the Association, Ladies and Gentlemen:
I am very pleased to join you for this important discussion. As Laurie Garrett has shown, the pursuit of public health on a global scale is an increasingly daunting and complex challenge. But it is also one in which the vision and leadership of organisations like the AMA continue to make a difference.
Mr. President, we live in an age distinguished by what the late AIDS crusader Dr. Jonathan Mann called "the globalisation of disease," a phenomenon in which the movement of ever-increasing numbers of people across international borders is a testament not only to the world's growing interdependence - but also to its widening vulnerability to infectious diseases, both old and newly emergent.
Yet there are signs that a new and emerging approach to public health is also developing - one that goes beyond the here and now of disease prevention and pathology as it embraces the broader and more future-oriented imperatives of health promotion.
As Dr. Foege has observed, it is an approach that attracts leaders who understand that the vast majority of the public they serve has not yet been born - leaders whose decisions originate with questions that ask: What is good for the future? What is good for the entire world?
We are all generally agreed that children are the bearers of our common future. One hundred and ninety-one nations acknowledged as much when they ratified the Convention on the Rights of the Child - and vowed, a little over a decade ago, to implement the goals of the World Summit for Children, including measures to ensure the right of every child to the highest attainable standard of health.
We have seen some remarkable successes because of the breadth and power of that consensus - and the hard work of governments, multilateral organisations, non-governmental groups and countless others, including AMA members whose thinking has helped shape public health policy.
Indeed, the movement that gave the world the Child Rights Convention helped bring about the greatest advances in child immunisation ever achieved - successes literally unimaginable two decades ago, when just 5 per cent of infants in developing countries were immunised against the six major vaccine-preventable diseases.
The campaign that has all but eradicated polio is the work of a global partnership - one involving government agencies like the U.S. Centers for Disease Control and Prevention; international organisations like WHO and UNICEF; the pharmaceutical industry, which produces the vaccine; and diverse levels of civil society, from communities and grassroots and religious groups to organisations like Rotary International, the UN Foundation and the Bill and Melinda Gates Foundation - not to mention millions of caring individuals.
The same drive for Universal Child Immunisation that UNICEF, WHO and other international partners began in 1986 elevated global immunisation rates for the five other major childhood diseases to nearly 80 percent by the early 1990s.
As a result, under-5 deaths dropped by 3 million a year, with measles deaths reduced by 80 per cent - and neonatal tetanus eliminated in over 100 countries.
Simple interventions like oral rehydration therapy have cut yearly diarrhoea deaths from 3 million to 1.5 million, while iodised salt and vitamin A supplements have saved countless children from death or disability; and there has been significant progress in promoting the many benefits of breastfeeding.
Mr. President, these are achievements that demonstrate, as powerfully as anything can, what can be accomplished when national commitments and partnerships are matched by resources and political will.
Yet for all the millions of young lives that have been saved, and for all the futures that have been enhanced, we have failed to reach the key survival and development goals that were set at the World Summit for Children in such critical areas as basic education, under-5 mortality, maternal mortality, child malnutrition, and sanitation.
Although the annual toll of children under 5 who die of preventable causes has now dropped from 14 million in 1990 to less than 10.5 million in 1999, we are still far from achieving the one-third reduction in child mortality that governments vowed.
At the same time, the combined impact of HIV/AIDS, the collapse of health systems weakened by the effects of armed conflict and debt, and the spread of drug-resistant strains of malaria have all reduced the rate of decline of under-5 mortality - and indeed, led to an increase in many countries.
Because we have failed to ensure universal access to maternal health care, nearly 600,000 women still die each year of complications in pregnancy and childbirth.
Because we have failed to fulfil the commitment to provide a quality basic education for all, more than 110 million children are not in school - and most of them are girls, who are thus denied the chance to make the most of their abilities, and are deprived of the capacity to make informed life choices, including what they must do to protect themselves and their families against HIV/AIDS and other diseases.
Mr. President, all this is tragic - and utterly unacceptable. And yet the obstacles to fulfilling these and other promises to children are becoming even more menacing - none more so than the HIV/AIDS pandemic, which threatens to reverse infant and child mortality rates, aided and abetted by the persistence of diseases like malaria and tuberculosis.
The current HIV infection rate among children and young people, especially in sub-Saharan Africa, is a catastrophe of almost unimaginable proportions, one rooted in deepening poverty and inequity, along with the crushing burden of external debt; gender discrimination and violence, environmental degradation, and natural disasters.
Moreover, the rapid proliferation of armed conflict - along with attendant problems like anti-personnel land mines, the spread of small arms, and the merciless recruitment of child soldiers - has placed an enormous strain on UNICEF and other organisations working to protect children's rights, to help meet their basic needs, and to expand their opportunities to reach their full potential.
Yet UNICEF believes that the world now stands at the most opportune moment imaginable for reaching the Summit goals - and for mobilising a global alliance dedicated to achieving a breakthrough in human development based on specific actions for children.
The moment is especially opportune for a variety of reasons.
First, we are steadily amassing the resources that, if widely applied, could offer protection against the biggest killers of children.
Last July, the eight major industrialised democracies committed themselves to the Okinawa Initiative on Infectious Diseases, vowing to mobilise the resources necessary to make major reductions in the burden of HIV/AIDS, malaria, TB, pneumonia and other communicable childhood diseases. As you know, this is a crucially important step because some 60 per cent of all under-5 deaths are caused by communicable diseases.
It comes at a time when a cornucopia of revolutionary new vaccines is under development - vaccines that could save the lives of up to 8 million additional children a year in the next 5 to 15 years alone.
For example, it is estimated that if we could reach all children in the developing world with the newest Hepatitis B and Hib vaccines, along with vaccines against the other six major child killers, we could prevent an additional 1.3 million deaths per year.
Made universally accessible along with existing immunisations, these new vaccines, added to micronutrients like Vitamin A, could make an enormous difference to the world's poorest countries in coming years - not only in terms of children's lives saved, but in improving the overall health of the poor - including the 1.2 billion people, half of them children, who are somehow surviving on less than a dollar a day.
At the same time, we know that protecting and improving children's nutritional status is as important as immunisation in reducing child deaths and disability. Moreover, it is increasingly evident that the benefits of immunisation are optimised when children are well nourished.
Another reason for hope is that globalisation has created conditions that are speeding the creation of new partnerships between the public and private sectors, non-governmental organisations, community and grassroots organisations - and poor children and their families themselves.
On one end of the spectrum, there are community-based partnerships that actively involve the poor - alliances that have proven themselves to be the most cost-effective and sustainable way to reduce the impact of infectious diseases in impoverished communities.
On the other end, there are vast partnerships like the Global Alliance for Vaccines and Immunisations (GAVI), a coalition of business leaders, philanthropic foundations, development banks and national governments dedicated to ensuring that all children are immunised.
They are working amid indications that governments and private enterprise are searching seriously for ways to make life-saving drugs accessible and affordable to all.
Mr. President, it is a measure of UNICEF's commitment that the largest share of our resources is devoted to health and nutrition - and that nearly all of our country offices include professional health staff.
In some of the very poorest countries in which we work, there are teams of five or more people working in health and nutrition - professionals with strong field experience and working relationships with governments and NGOs alike, who plan, implement and monitor sustainable health interventions.
As a field-based agency, UNICEF's strengths are in our 161 country programmes - and in the capacity of our field offices to support health initiatives. For example, UNICEF is able to move relatively large amounts of money to support agreed-upon actions in an efficient and accountable way. We also have a Copenhagen-based supply and logistics operation that is unrivaled - and that has been designated by GAVI to be the procurement focal point for hundreds of millions of dollars in new vaccines over the next five years. And we have years of experience in supporting public-information efforts to help educate families on how to care for their children's health.
Mr. President, UNICEF's overall health strategy is focused on three objectives: creating sustainable outreach services; improving family and community-based health care for children; and promoting health services for women.
Building on the National Immunisation Days, sustainable outreach services are perfect opportunities to reach remote communities with a whole package of health services, including not only new and improved vaccines, but Vitamin A and other micronutrient supplements, impregnated bednets, deworming - as well as vaccines and other supplies to cope with epidemics of diseases like meningitis and yellow fever.
At the same time, UNICEF is encouraging community health systems to help manage outreach sessions, ensuring that every child is effectively reached.
UNICEF has found that a sustainable way to financing the delivery of these outreach services is through cost-sharing, based on performance contracts with communities, NGOs and other public and private providers. The approach is being implemented in the context of GAVI for the delivery of standard and newer vaccines.
UNICEF also supports family and community-based health care that entails a range of measures, from preventative services like hygiene education and provision of insecticide-treated bednets to improved care of children brought down by such ailments as pneumonia, malaria, diarrhoea, measles and malnutrition - and increasingly, by HIV/AIDS.
We are also working to improve the access, affordability, quality, and welcoming atmosphere of health services for adolescent girls and women, especially in antenatal and delivery care. It is an effort aimed specifically at reducing maternal and neonatal mortality - and at preventing HIV infection in adolescents and young children.
To eliminate potentially fatal delays in referrals of obstetric and other emergencies, UNICEF also supports community-based insurance and transportation. And to promote the accountability of health-care staff and to mobilise civil society, we are encouraging surveillance and audits of all child, adolescent and maternal deaths.
In short, UNICEF and its partners have the strategies and the tools - in new health technologies, health promotion possibilities, and information and communications systems - that will allow us to promote health care in every village and hamlet. And, in the Convention on the Rights of the Child, we have the moral and legal grounds to act.
Moreover, we know that in a $30 trillion-plus global economy, the resources already exist to give children the best possible start in life, to ensure that they get a quality primary education, and that they have help in navigating the complex passage from adolescence to adulthood - all crucial first steps if we are to break the poverty cycle.
In the last 10 years, we have seen remarkable progress for children - but not nearly enough. What we need now is action - action to achieve not only the commitments that were made a decade ago, but to launch nothing less than a second revolution in child survival - a revolution aimed not only at saving lives, but at imbuing those lives with dignity and worth, in a world based on equity - the world that my predecessor Jim Grant so dearly wished for, and to whose creation he devoted every waking hour.
In January, we concluded the second preparatory meeting of donor and developing country governments, NGOs and representatives of the UN community in advance of the 21st Century version of the World Summit for Children - the UN General Assembly's Special Session on Children.
Mr. President, we believe that the Special Session on Children has the potential to surpass the success of the original Children's Summit in terms of global attention and specific results.
That is because the Special Session offers an unparalleled opportunity not only to assess the Summit goals through an end-decade review of progress from a global, regional and national perspective - but also to re-energise the international commitment to realising a global vision for children now and in the years to come.
The international commitment to building a better future for every child is strong and it is clear. The challenge now is to bring it to critical mass - to engage millions of additional people who can lead the fight for child rights at every level.
That means enlisting the active support not only of established leaders, but of all people with influence, whether from the highest echelons of government or civil society, non-governmental organisations, business and private enterprise, people's movements, academia and the media, community and grassroots groups, the family - and children themselves.
The galvanising power of the partnerships we are building was demonstrated last year in Johannesburg, where Nelson Mandela and Graça Machel announced that they would assume a direct and personal role in mobilising leaders from every sphere to act on a basic recognition: that if we want a more just, equitable and thriving world, we must invest in children now, acting always in their best interest.
As Graça Machel declared, leaders at every level are accountable - which is a shorthand way of saying that all of us have a responsibility to use our position and influence to lead.
Mr. President, we are already witnessing what real leadership for children can accomplish.
We have seen it in the global campaign against polio and the creation of GAVI.
We have seen it at the World Health Assembly, where WHO's Director-General hailed the growing embrace by the large pharmaceutical companies of the idea that life-saving and life-enhancing pharmaceuticals, including those for treating HIV/AIDS, must be made available to all who need them, and not just the few who are fortunate enough to be living in industrialised countries.
And we saw it just last week in the United Kingdom, where the Chancellor of the Exchequer, Gordon Brown, and the International Development Secretary, Clare Short, inaugurated an extraordinary global initiative to ensure that the international community fulfils its obligations to eliminate child poverty.
The campaign, to which UNICEF has pledged its full support, includes new resources and incentives to provide poor children and women with necessary drugs and life-saving vaccines, as well as steps to achieve universal primary education.
Ladies and Gentlemen, the General Assembly Special Session in September offers a historic opportunity to mobilise universal support for a new global vision for children - one that makes the benefits of globalisation accessible to every child.
It is an undertaking in which we look to your ideas and your recommendations for the goals and strategies that will best ensure child survival and development now - and in the coming years of this new century. I know UNICEF can count on each of you.