POPULATION AND DEVELOPMENT COMMISSION BEGINS THIRTY-FIRST SESSION
Press Release
POP/658
POPULATION AND DEVELOPMENT COMMISSION BEGINS THIRTY-FIRST SESSION
19980223 Various related capacities in the area of population and development at the Secretariat have been brought together under the Department of Economic and Social Affairs to make the intergovernmental process more effective and coordinated, the Commission on Population and Development was told this morning as it began its thirty-first session.Under-Secretary-General for Economic and Social Affairs Nitin Desai also said the Commission had, since its inception, provided a forum for discussion, set an international agenda, and influenced thinking at both national and international levels. One of the purposes of the current session, as it prepared for the fifth-year review of the Cairo International Conference on Population and Development, was to establish a clear understanding of what it really wanted from the review exercise itself.
The Director of the Population Division of the Department, Joseph Chamie, said he would dispel seven population myths: "the population explosion is over; the population debate is over; population growth is progress; populations can be isolated by State borders; the solution to population and development problems is simply more money; we know everything we need to know about population and development; tomorrow's population is not the concern of today".
He stressed that, although financial resources were necessary, more money in itself was not sufficient to ensure progress in resolving population and development problems. Account would have to be taken of political, social and cultural considerations, he noted.
Also this morning, the Secretary-General's Concise Report on World Population Monitoring, 1998: Health and Mortality was introduced by Birgitta Bucht, Assistant Director in the Population Division. Shiro Horiuchi, of Rockefeller University, spoke on the report. Rudolfo Tuiran (Mexico) introduced the report of the intersessional bureau of the Commission, which he chaired.
Statements on the Secretary-General's report were made by the representatives of Belgium, Indonesia (on behalf of the "Group of 77" developing countries), United Kingdom (on behalf of the European Union and associated States), United States, China, Sudan, Russian Federation, Jamaica and Turkey.
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Also this morning, Raj Karim (Malaysia) was elected Chairman of the Commission, and Robert Louis Cliquet (Belgium) was elected Vice-Chairman. The election of two other Vice-Chairmen and one Rapporteur was postponed. The Commission also adopted its agenda for the session.
The Commission will met again at 3 p.m. today to continue its discussion on follow-up actions to the recommendations of the 1994 International Conference on Population and Development.
Commission Work Programme
The Commission on Population and Development opened its thirty-first session at Headquarters this morning. (For detailed background, see Press Release POP/657 issued today.)
Statements
NITIN DESAI, Under-Secretary-General for Economic and Social Affairs, said the Commission, since its establishment 50 years ago, had provided a forum for discussion of population and development issues, set an international agenda for the subjects, and influenced thinking at both national and international levels. Focusing on the issue of how the United Nations could affect the work of the Commission, he said that the various related capacities within the Secretariat had been brought together under the Department of Economic and Social Affairs for purposes of coordination and effectiveness. That, it was hoped, would give the intergovernmental process a much better way of influencing population and development.
Concerning the Population Division, the unit which directly supported the work of the Commission, Mr. Desai noted its record of practical and analytical work, which had tremendous influence both within and outside the United Nations. Another goal of the integration concerned the cycle of United Nations conferences of the past decade, which were part of a package linked by specific themes. It was clear that any follow-up process to those conferences must recognize those commonalities.
With the integration, most of the follow-up processes were now in one department, he said. As part of the process of reform, an Executive Committee on Social and Economic Affairs had also been established, informed by the need to provide for greater coordination in the economic and social fields. Some of the other initiatives included the reform proposal by the Secretary-General for an office for development finance, as well as the need for a millennium Assembly.
Turning to the preparations for the five-year review of the Cairo International Conference on Population and Development, Mr. Desai said one of the purposes of the current Commission session was to establish a clear understanding of what it really wanted from the review exercise itself. That was more important than anything else, as it would determine who had responsibility for what, and other issues. The United Nations had a major responsibility in a rapidly changing world, and there was a need to rethink approaches concerning population's relationship to public policy. The challenge was to move from the achievements of the great conferences to action at the national level.
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JOSEPH CHAMIE, Director, Population Division, Department of Economic and Social Affairs, said that since the Commission was founded some 50 years ago, it has been the primary international forum for building consensus on population and development issues. It was a body where population issues of fundamental concern for individuals, families, communities and nations might be debated objectively and comprehensively.
He said he would focus on a number of population issues that needed to be addressed and clarified, insofar as they had a bearing on the Commission's work. He referred specifically to the following seven population myths: the population explosion was over; the population debate was over; population growth was progress; populations could be isolated by State borders; the solution to population and development problems was simply more money; the international community knew everything ut needed to know about population and development; and tomorrow's population was not the concern of today.
The relatively rapid growth of the world's population was not over, he said. At present, the population of the world was 5.9 billion, and by the middle of 1999, it would reach 6 billion. During the next 50 years, the world's population was expected to pass 9 billion and was not likely to stop there. According to a United Nations study of long-range population projections up to the twenty-third century, under the medium-fertility scenario, which assumed fertility would reach replacement levels of slightly above two children per woman in the coming decades, the world population would reach 10 billion by 2100, 10.8 billion by 2150, and will stabilize at slightly under 11 billion people around 2200.
It was misleading to say that the population debate was over, he continued. Not only did the population debate continue, but it was multifaceted, addressing issues other than growth and size. In addition to being far more complex, it included, among other things, the determinants and consequences of fertility, mortality, morbidity, international migration, urbanization, internal distribution and age structure. Other critical issues that needed to be faced were questions of equity and equality among various social and economic subgroups within a population. Such issues as the provision of adequate health care for the poorest segments of societies or how to allocate resources equitably among the young and old needed to be acknowledged, debated and adequately addressed in national, regional and international forums.
He went on to say that population growth did not necessarily bring about progress and development, as was believed. The indefinite growth of population was unsustainable in the long run. Populations could not be isolated by State borders because population phenomena were increasingly becoming interdependent and global in nature. Misery, conflicts and social unrest, for example, often generated large flows of migrants, displaced persons, asylum-seekers and refugees. Those human movements impacted greatly on neighbouring countries, as well as distant nations. In the area of health, for example, international
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borders or administrative boundaries could not contain disease, viruses, germs, epidemics, and pollutants. No country could assume that it could isolate itself from HIV/AIDS.
On the issue of financial resources, he said that, although such resources were necessary, more money in itself was not sufficient to ensure progress in resolving population and development problems. To resolve those issues, account would have to be taken of political, social and cultural considerations. Research had shown that while income had a significant impact, health depended on more than simply income. For instance, despite the constraints imposed by low levels of income, it had been demonstrated that some low-income countries could achieve low mortality levels. Life expectancy approximated that of developed countries in countries such as China, Cuba, Costa Rica, the State of Kerala in India, Jamaica and Sri Lanka.
He said that understanding population and development dynamics was incomplete and remained inadequate in many important substantive areas. While a great amount of data and information were readily available for many countries, there were, unfortunately, substantial gaps of data and information for a large number of countries around the world, especially among the least developed countries and newly independent States. Although action on population issues was needed, without a sound knowledge base and a solid understanding of the relevant dynamics involved, programmes and services ran the risk of being misdirected, ineffective and costly.
Furthermore, he added, what was decided today would dramatically affect the quality of life and living conditions of future generations. Citing a number of fertility scenarios based on projections, he said the range of potential demographic outcomes underscored the critical importance of today's policies and actions for the long-range future of world population.
RUDOLFO TUIRAN, former Chairman of the Commission, and Chairman of the intersessional bureau that met on 12-13 September 1997, introduced his bureau's report. He said its 16 recommendations included: designating a special discussant to launch the debate on the Commission's main report, world population monitoring, focusing on health and mortality; the convening of a panel of experts to discuss the special theme of health and mortality; and the establishment of a working group at the current session to discuss issues that might result in resolutions and decisions, which would report to the plenary.
He said the bureau had emphasized that the quinquennial review and appraisal would not involve existing agreements contained in the Cairo Programme of Action and that the review should be undertaken through a system- wide approach, involving all relevant United Nations bodies. The bureau requested the Director of the Population Division to present a draft outline for the quinquennial review and appraisal to the current session. It also
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recommended that the review and appraisal focus on the special themes of 1996 (reproductive rights and reproductive health), 1997 (international migration), 1998 (health and mortality), and 1999 (population growth, structure and distribution). The quinquennial review and appraisal should consider the achievement of the goals and targets of the Cairo Programme of Action, he said.
The bureau also recommended the themes and agenda for the Commission's future sessions, to be held between the year 2000 and 2004, he said. For the year 2000 the theme proposed was "population, gender and development". For the years 2001, 2002 and 2003, a number of themes were suggested, as follows, without regard to priority: international migration and urbanization; reproductive health, with emphasis on family planning; population and the environment; the family and intergenerational support; socio-economic differentials, disadvantaged and vulnerable groups, and population and development; basic social services; fertility levels and trends; and population ageing. In the year 2004, the Commission should concentrate on the next quinquennial review and appraisal and not a special theme, he said.
Follow-up Actions to ICPD Recommendations
Mr. CHAMIE, Director of the Population Division of the Department of Economic and Social Affairs, referred to the following five reports prepared by the Division: world population monitoring focusing on health and mortality, with special emphasis on the linkages between health and development and on gender and age; population programmes in the area of health and mortality; the report of the Administrative Committee on Coordination (ACC) Task Force on Basic Social Services for All; the flow of financial resources for assisting in the implementation of the Cairo Programme of Action; and an updated version of intergovernmental and non-governmental organizations implementation of the Programme of Action in the area of reproductive health and reproductive rights.
He said health and mortality continued to be an extremely important issue for the Commission. It was an area where there was universal consensus. Virtually everyone desired good health and long life and, accordingly, it was a priority issue for individual governments and intergovernmental bodies. During the past 50 years, enormous strides had been made in the area of health and mortality. Mortality rates had dropped and life expectancy had risen in every region of the world. Nevertheless, unacceptable differentials persisted among countries, as well as among subgroups within countries.
Concerns with those differentials had led to the setting of goals or targets in the Cairo Programme of Action, including goals for infant, child and maternal mortality, as well as life expectancy at birth. One of the critical challenges in the coming decades was to reduce those relatively high mortality rates and to provide basic health care for all. Furthermore, in the area of health and mortality, he said it was essential that the relevant bodies
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of the United Nations system continued their ongoing collaboration. Everyone would benefit from the productive cooperation among United Nations agencies, programmes and funds, as well as relevant non-governmental organizations.
BIRGITTA BUCHT, Assistant Director of the Population Division, introduced the Concise Report in World Population Monitoring, 1998: Health and Mortality (document E/CN.9/1998/2). She stressed the remarkable progress made in the reduction of mortality since the Second World War. Life expectancy had risen more rapidly in less developed regions, resulting in a narrowing of the gap between the more and the less developed regions. In most developed countries, mortality had continued to decline. For countries with economies in transition, however, the trends had been different in recent decades, with life expectancy in eastern Europe being lower than in many developing regions such as East Asia, the Caribbean and Central America. The most recent data, however, showed slight improvements.
In the less developed regions, progress had been uneven, she said. Many countries had achieved very rapid mortality reductions. China, for example, had one of the most rapid mortality declines in the world. In contrast, the least developed countries, most of which were in Africa, continued to lag behind. The spread of HIV/AIDS had been particularly devastating in sub-Saharan Africa. According to recent estimates, more than 30 million people currently had the disease, and the majority, around 21 million, were in Africa.
She went on to highlight other developments discussed in the report, including: the impact of complications related to pregnancy and childbirth on mortality for women in many parts of the developing world; the shift in the many causes of death from predominantly infectious and parasitic diseases to chronic degenerative diseases of adulthood; and the important relationship between health and development.
SHIRO HORIUCHI, of Rockefeller University, said that the report had described the remarkable progress in mortality since the Second World War. Mankind could be proud of the progress made towards a longer, healthier, life. The average length of human life had increased from about 20 to 30 years in the prehistoric era to nearly 65 years today, and it approached 80 years in some countries. Most of that progress occurred during the current century. The progress in the early and middle periods of the century was due mainly to the reduction of mortality from infectious and parasitic disease, as well as maternal and perinatal disorders. Substantial declines were observed in mortality at young ages, but not at very old ages, leading to the view that further significant increases in life expectancy would be difficult.
The first type of mortality transition, called the epidemiological transition, was currently supposed to be under way in developing countries, he continued. That, however, was only an educated guess, as national-level data available for adult mortality in developing countries was limited. Governmental
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efforts and international collaboration should be strengthened for improving the quantity and quality of adult mortality data, particularly because an increasing proportion of death and disease in developing countries was estimated to be occurring at higher ages.
Concerning degenerative diseases, he said that a cumulative amount of research indicated the substantial effects of lifestyle factors on a wide-range of diseases, noting that no smoking, moderate alcohol, exercise and proper diet were effective and low-cost methods for health promotion. Smoking had been shown to raise mortality and morbidity considerably for a wide variety of diseases. He urged the international community to discourage the international trade of manufactured cigarettes and unmanufactured tobacco. Together, some findings of the report suggested that life expectancy could be notably affected by the extent to which people, particularly the relatively underprivileged, felt there was meaning in their lives. For a life to be fully lived, he added, the life should be worth living.
R. CLIQUET (Belgium) said that, at the thirtieth session, his delegation announced the willingness of the Population and Family Study Centre, a Flemish Scientific Institute, to host the Technical Symposium proposed by the Commission. It was eventually held in Brussels in November 1997 under the auspices of, and with the financial support of, the Government of Flanders and the Government of Belgium.
Presenting the substantial matters dealt with in the report of the meeting, he said the meeting considered the meaning and relevance of the mortality, epidemiological and health transitions. The meeting then addressed the question of the measurement of mortality and health status, especially in countries of the developing world, which often lacked the data that would allow the estimation of adult mortality and an appraisal of health status. As far as the measurement of health status was concerned, it recommended the use of surveys, stressing the need for internationally accepted guidelines for the design and implementation of such surveys in developing countries, in order to enhance comparability.
Concerning trends in health and mortality, he said that developed countries were characterized by having attained already fairly low mortality levels, as well as significant declines of mortality. In relation to the low levels of mortality reached in the most advanced regions of the world, certain questions, such as the re-emergence of infections and the appearance of new diseases were also discussed. The prevalence of high-risk behaviuors and the high-fat content of the diet typical of countries with economies in transition were described as major factors underlying the trends observed. As far as the developing countries were concerned, the report cited several reasons to be pessimistic about the future evolution of mortality in the region, such as economic difficulties, AIDS and the prevalence of internal conflict or war.
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He said that an important issue discussed throughout the symposium was the question of individual choice versus societal responsibility. In its conclusions, the panel underlined the importance of comparative research and of disseminating the findings, so that countries could learn from each other's experience. The report further noted that funds for improving health were scarce. In addition, a key element in improving health and reducing mortality consisted of empowering people and, through that, allowing them to opt for behaviours that could reduce the risk of illness and death.
S. ARI WARDHANA (Indonesia), on behalf of the "Group of 77" developing countries, said he would focus on the theme of health and mortality. He said the quest, since the 1960s, to better integrate social and economic factors into development had given renewed impetus to a strategy emphasizing health, family planning, nutrition, education, safe drinking water, sanitation, shelter, poverty eradication and sustainable economic growth. In that context, the pursuit of health was central to the achievement of all social and economic goals by individuals, families, communities and societies. The primary health-care approach had provided a blueprint for health policies at the national and international levels. Virtually all countries had adopted primary health-care policies, he said.
Such strategies had been instrumental in putting health at the very centre of the development agenda, which was reaffirmed at the Cairo Conference. Such strategies were central for reducing mortality and morbidity in most developing countries. However, despite the considerable progress made in increasing life expectancy, in reality there was no acceptable level of mortality. No government considered the level of mortality in its country to be fully satisfactory. However, the levels were characterized as "acceptable", given such concerns as the amount of resources available for reducing mortality.
That the level of mortality in any country influenced the type of health concerns expressed by the government, he said. In the developing countries, infant and child survival and maternal mortality were the principal concerns of governments. The main problem now being faced by most developing countries in coping with those social phenomena was the lack of adequate resources at both the national and international levels.
BETTY KING (United States) said her country's commitment to the goals and principles of the Cairo Conference remained strong and unwavering. The United States appreciated the excellent collaborative efforts within the United Nations system to provide developing countries with the information and the technical and financial assistance they needed to address the major challenges of implementing the Cairo Programme of Action.
She said her Government had played a major role in supporting both bilateral and multilateral programmes. United States bilateral assistance to developing countries and countries in transition in population, health and
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nutrition sectors, from 1994 to 1997, totalled more than $4 billion. In the same period, additional amounts were contributed to the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA) and UNAIDS, in addition to the United States' portion of the United Nations and World Bank spending in the population, health and nutrition sectors.
Turning to the report on world population monitoring on health and mortality, she said the threat posed by infectious diseases, including the re- emergence of such diseases as malaria and tuberculosis, had led the United States to develop a new strategy for international cooperation in combating those diseases and to increase attention to them in the country's development assistance programmes. The major components of the strategy included: implementing effective tuberculosis control programmes; preventing and treating malaria and other diseases of major public health importance; and improving the capacity of developing countries and transition countries to obtain and use good quality surveillance information for responding to infectious diseases. In 1998, the United States would be committing an additional $50 million under its bilateral assistance programme to initiate that focused effort.
On the issue of the health of women and children, she said the inter- agency meeting held recently in Sri Lanka had injected a new dynamism into international efforts to tackle preventable deaths among women. A key concern was whether it was possible to improve the measurement of levels, trends and causes of maternal mortality and morbidity with sufficient precision to evaluate the impact of programme interventions. She proposed an interdisciplinary expert group to give further consideration to maternal health and mortality measurement issues.
She stressed the need to produce large-scale improvements in health and mortality. To that end, consideration should be given to using education and the media, religious organizations, private businesses and other influential organizations to assist adolescents and young adults in adopting behaviour that would improve their chances of becoming health and productive adults. Other issues of importance were increased food security for vulnerable groups and new approaches for involving the private non-profit sector and community resources in financing and providing health services. The role of non- governmental organizations in advancing reproductive health at all levels was fully appreciated, she added.
PHILIP MASON (United Kingdom), speaking on behalf of the European Union, and Bulgaria, Estonia, Hungary, Lithuania, Romania, Slovakia, Slovenia, as well as the associated countries of Cyprus and Norway, said this year's theme was one that touched every person, personally and directly. The report on health and mortality was setting the scene in view of the international community's increasing emphasis on mortality figures within the context of
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international development targets, many of which the Cairo Conference played a crucial role in developing.
Commenting further on the contents of the report, he said it was descriptive rather than analytical. Little was done to analyse the link between poverty and mortality. Such realities as the burden of disease on the poor needed to be explored and the policy implications demonstrated, if there was to be progress in reducing the proportion of people living in extreme poverty. Also, the report only touched on the links between development and mortality. It was surprising that the issue of resources had not been addressed, nor were attempts made to analyse expenditures against the health gains recorded.
Taking up the issue of women's health, he said it was horrific and unacceptable that women living in poverty in Africa and Asia were some 250 times more likely to die of causes related to pregnancy than women in Europe and North America. Regarding HIV/ AIDS, he said it was important to be clearer about the extent that the disease contributed to changes in mortality patterns by furthering poverty, particularly in the rural areas. In addition, Health sector reform should focus greater attention on the benefits of health care and the success of non-governmental organizations in providing health care.
LI HUNGGUI (China) said that, despite the efforts of the international community, enormous gaps still existed in mortality and life expectancy, and many developing countries had been left far behind by their developed counterparts. Many countries would not be able to reach the goal of increasing life expectancy, as set forth by the Cairo Conference. United Nations agencies should collaborate to put in place a holistic strategy, both regionally and globally, that attached importance to health care, family planning, nutrition, education, safe drinking water, sanitation, housing, poverty alleviation and sustainable development.
He said that effective prevention and control of HIV/AIDS was one of the most important strategic approaches to realizing the health and mortality goals set by the Cairo Conference, noting the efforts of the UNAIDS programme, which was jointly sponsored by six agencies. He hoped that the United Nations could sum up in a timely manner the experiences accumulated in the performance of UNAIDS over the past two years, so that the programme could really live up to expectations.
Although disease patterns had changed in many countries, he said that the developing countries were still subjected to the double burden of both infectious and chronic, non-infectious diseases. However, experiences from many developed countries had attested to the fact that health promotion was an effective means of preventing and controlling such diseases. The majority of developing countries, however, lacked the experience to do health promotion. He hoped United Nations agencies could actively promote cooperation between the developed and developing countries in that regard.
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TAHA MOHAMED (Sudan) noted that with reports such as the one on health and mortality, incremental data always provided incremental policies. Environmental degradation, for instance, was afflicting sub-Saharan Africa, but it was not helpful to aggregate all of Africa in such analysis. In future research, it would be preferable to desegregate countries with similar problems. Offering another example, he noted massive displacement in sub-Saharan Africa as a significant problem affecting health and mortality issues. Globalization also affected countries differently. Structural adjustment, as executed by various governments, had affected various countries in different ways.
IGOR A. ZLOKAZOV (Russian Federation) said the report had described clearly problems that were of key concern to his country and other economies in transition. There was a certain dynamism in the various causes of mortality, from chronic to infectious diseases. For example, among men, there were various problems and, in recent years, such problems as syphilis and AIDS had become prevalent. Factors that contributed to increases in mortality and morbidity included the decline in living standards and environmental degradation, as well as the increase in the abuse of alcohol. That had led to a major government policy to raise awareness and allocation of funding to help cover activity in that area. The Government was doing everything it could to enhance the effectiveness of health care, he went on, drawing attention to trends in preventive medicine and private medical care on a commercial basis.
EASTON WILLIAMS (Jamaica) said he was concerned about the quality of data on infant mortality. He expressed caution on the rates of infant mortality quoted for his country. In 1993, an infant mortality rate study conducted by the Ministry of Health indicated 24.5 per 1,000 live births, a significant difference from the picture painted of Jamaica in the report.
SAMIRA YENER (Turkey) suggested that corrections brought to the attention of delegates be inserted into the report as a separate chapter.
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