HEALTH MUST BE CENTRAL TO MACROECONOMIC, SOCIAL POLICY COMMISSION ON SOCIAL DEVELOPMENT TOLD

10 February 1999

Press Release
SOC/4485

HEALTH MUST BE CENTRAL TO MACROECONOMIC, SOCIAL POLICY COMMISSION ON SOCIAL DEVELOPMENT TOLD

19990210 WHO Executive Director Describes Links Between Health Care, Poverty, As Commission Continues Discussion of Priority Theme: Social Services for All

Health must be a central aspect of macroeconomic and social policy, helping to draw them together into one coherent policy for sustainable human development, the Executive Director of the World Health Organization (WHO), Poonam Khetrapal Singh, told the Commission for Social Development this morning, as it continued its discussion on social services for all.

Primary health care remained the core solution to radically improving world health, particularly the health status of the poorest and most needy populations, she continued. Unfortunately, for too long the health debate had remained the domain of the health professionals. "We have given the impression that health is the exclusive business of the health professionals -- that we can achieve health for all on our own". As a consequence, one fifth of humanity remained without access to primary health care, and such denial of access was not only an abuse of basic human rights, it was also a direct cause of poverty itself.

The representative of Guyana, on behalf of the "Group of 77" developing countries and China, said that competing demands on scarce resources predetermined the capacity of governments to provide for all. No amount of political will could replace the purchasing power needed to provide social services for all. It was unrealistic that resources recycled out of limited national budgets could be expanded to meet society's needs. Governments were restricted by national economic circumstances, limited ability to attract foreign investment, declining official development assistance levels, and the debt burden.

The representative of Finland said that, while there were differences between countries, there were a number of choices to be made by all. Would basic social services be provided to all or only to the few? How best could society be involved in such efforts? How could a sustainable funding mix between families, the public sector and market-based institutions be designed to provide basic social services and protection to all in an equitable manner?

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What was the best way to support countries facing constraints in identifying and mobilizing financial and human resources?

Germany's Parliamentary State Secretary at the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, Edith Niehuis, speaking on behalf of the European Union, said the major challenge was defining people's real needs. Special efforts should be made to avoid bypassing the poorest and most vulnerable segments of society who were not able to voice their concerns. Social services were a tool of social policy -- not the only one -- for promoting the well-being of the whole population and improving the situation of disadvantaged groups.

The representative of the Republic of Korea said that countries should be able to maximize the positive impact of globalization for the improvement of social services. It could contribute to achieving the goal of universal coverage of basic social services for all. Moreover, globalization facilitated the global flow of ideas and the exchange of information and experiences among countries, which had played a substantial role in the process of social development.

There was a two-way link between economic growth and social development, said the representative of Jamaica. While the provision of social services enhanced a country's capacity for economic growth and development, without economic growth it was difficult to provide a sustainable basis upon which social services could be supported.

Statements were also made by the State Secretary, Ministry of Health and Social Affairs of Sweden and by the representatives of Canada, China, Poland, Japan, as well as the United Nations Centre for Human Settlements (Habitat) and the World Bank.

The Commission will meet at 3 p.m. today to continue its discussions on social services for all.

Commission Work Programme

The Commission for Social Development met this morning to begin its general discussion on follow-up to the World Summit for Social Development. (For background information on the session, see Press Release SOC/4482 of 8 February.)

Statements

JUNE PERSAUD (Guyana), speaking on behalf of the "Group of 77" developing countries and China, said that developing countries remained committed to improving the welfare of their peoples. Their commitment included an awareness and accommodation of the special needs of vulnerable and under-served groups, such as the disabled and internally displaced persons. While governments bore the primary responsibility for the delivery of social services to all, they should not be solely responsible. Reliable access to information in the planning and delivery of social services had to complement the partnership between governments and other sectors, to create a user- friendly environment where services could be accessed.

Competing demands on scarce resources predetermined the capacity of governments to provide for all groups, she said. No amount of political will could replace the purchasing power needed to provide social services for all. It was unrealistic that resources recycled out of limited national budgets could be expanded in their outreach to meet society's needs. While governments were committed to implementation of Summit commitments, they were restricted by their national economic circumstances, limited ability to attract foreign investment, declining official development assistance (ODA) levels, and the debt burden. The provision of social services for all was a responsibility that developing countries took very seriously. Equitable access by all groups was a goal towards which both developing and developed countries strove.

EDITH NIEHUIS (Germany), Parliamentary States Secretary at the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, speaking on behalf of the European Union, Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, Slovenia, Cyprus and Iceland, said that one of the key messages of the Summit was to call on countries to make efforts towards achieving the goal of coverage of and equal access for all to social services meeting basic human needs. The development and provision of social services was crucial to the overall development of nations and the international community at large. In an enabling environment favourable to social development, social services were an important means to: eradicate poverty; enhance productive employment and reduce unemployment; foster social integration and participation; and advance equality and the status of women.

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Universal access to social services could help ensure access to under- served people who might be given special attention, she continued. There were numerous factors that constituted potential barriers of access for individuals or population groups. Identifying and reducing those barriers were goals crucial to the implementation of the Summit's commitments. The European Union believed that the major challenge was defining the real needs of people. Offering what reflected the real needs of the users could only be achieved in a complex process of decision-making involving all actors as well as targeted individuals and groups. Special efforts should be made to avoid bypassing the poorest and most vulnerable segments of society who were not able to voice their concerns forcefully enough. She stressed that social services were a tool of social policy -- not the only one -- for promoting the well-being of the whole population and improving the situation of disadvantaged groups.

MARTHE ST-LOUIS (Canada) said the fundamental challenge faced by her country was to make its system of social services more responsible and responsive to the public, as it moved into the twenty-first century. The federal-provincial-territorial Social Union Framework Agreement, signed last week in Ottawa, constituted an important step in promoting equality of opportunity for all Canadians. It would also improve the mobility of Canadians and strengthen the accountability of each government to its constituents, by measuring and reporting publicly on the results achieved by social programmes. Overall, the Agreement would make it easier for governments to work together on shared social objectives, while giving provincial and territorial governments the flexibility they needed to respond to local circumstances.

The extensive restructuring of Canada's health care system had caused anxiety amongst Canadians about its present and future state. The Government recognized those concerns and, in collaboration with the provinces and territories, would strive to invest more resources to reinforce the system. In doing so, it would take into account emerging health care issues, and the special health needs of children, women, aboriginal peoples and other valuable populations. Last year, the Federal Government outlined an overall, long-term approach that responded to the conclusions of the Royal Commission on Aboriginal Peoples.

She said that since announcing its Aboriginal Action Plan, the Federal Government, in partnership with aboriginal groups and other levels of government, was linking social assistance to: training and development; developing new training opportunities; improving education; improving health and public safety; and promoting healthy living. Canada was also committed to allocating 25 per cent of its official development assistance (ODA) to meet basic human needs.

FAITH INNERARITY (Jamaica) said given that social services in Jamaica were extensive, the agenda had moved to the more complex issues of how to

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improve the quality and efficiency of social services, given the current fiscal restraints. Government efforts to restore the flow of funds to the social sectors had been affected by macroeconomic constraints, including globalization and problems in the financial sector. There was a two-way link between economic growth and social development. While the provision of social services enhanced a country's capacity for economic growth and development, without economic growth it was difficult to provide a sustainable basis upon which social services could be supported.

She said the reform of Jamaica's education system at the primary and secondary levels was in progress. At the primary level, the major focus was to improve the quality of education and ensure full literacy and numeracy for the entire population. At the secondary level, the reform was designed to achieve greater equity through the implementation of a common-core curriculum. In the area of health, the major thrust in recent years had been to increase funding to primary health care in order to upgrade services. The Government had also decided to implement a National Health Insurance Programme. The two key elements in that scheme were universal coverage and mandatory health insurance for all residents.

SUH DAE-WON (Republic of Korea) said that through concerted efforts of the international community, countries should be able to maximize the positive impacts of globalization on the improvement of social services, while containing its negative impacts. To the extent that globalization facilitated attracting foreign investment, which helped stimulate economic growth and expanded revenue bases, it could contribute to achieving the goal of universal coverage of basic social services for all. Moreover, globalization facilitated the global flow of ideas and the exchange of information and experiences among countries, which had played a substantial role in the process of social development. A rights-based approach should be adopted to ensure social services for all, he stressed. Everyone had an equal right to basic services and to be protected by a social safety net. That approach implied that all actors concerned should be involved in the decision-making process, which would affect their well-being.

His country believed that education was one of the most important social services, he said. The Government had taken every measure to provide better education for all its people, regardless of age, gender or income. Annually, almost 20 per cent of the national budget had been allocated for that purpose. In the wake of the financial crisis, the Republic of Korea now faced one of the most difficult aspects of modern economies, that of unemployment. The number of unemployed had reached 1.5 million last year. To cope with that problem, the Government was not only working to strengthen the social safety net but also to provide more services, such as retraining of workers and access to employment information.

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SUN ZHONGHUA (China) said that to meet services for all, the government had to play an active role of leadership, organization and coordination. It had to formulate practical and feasible social policies to ensure effective management and active participation of the whole population. Secondly, all social undertakings, as vehicles for social development, needed to be based on economic development for their materialization. In the case of developing countries, it was essential that economic development be speeded up to ensure government's inputs into all undertakings, thereby creating the necessary conditions for services for all. As the gap between the North and the South widened, almost one-fifth of the world's population lived in abject poverty. He appealed to developed countries to adopt effective measures to assist developing countries to ensure services for all through common development.

China regarded the equitable provision of primary health care services to all citizens as an important responsibility, he said. In striving to raise the level of medical service, vigorous efforts had been made to promote the reform of medical insurance for the workers in the urban areas and develop the co-operative medical system in the rural areas. The Government also gave high priority to the protection of the rights and interests of social groups such as the elderly, women, youth and the disabled. In addition to the formulation of the relevant rules and regulations, social services had been provided in response to the special needs of various social groups.

POONAM KHETRAPAL SINGH, Executive Director of the World Health Organization (WHO), said that health was a major contributor to both the economic and social dimensions of human development. "It is a message that we in health have been slow to promote", he said. "We are more accustomed to looking at development's contribution to health. It is time now to revise that perspective and refocus our interventions". Since the World Summit on Social Development in Copenhagen, a growing awareness had emerged that health enhanced the capabilities of the poor, built social and human capital and advanced the productivity of poor individuals, communities and societies. That, in turn, led to better health. While the Copenhagen Declaration expressed its commitment in terms of universal access to health services, it did not fully capture the new awareness of health's contribution to poverty elimination and sustainable human development.

She said that, in future, health must make its mark at the core of macroeconomic and social policy, helping to draw them together into one coherent policy for sustainable human development. Primary health care remained the core solution to radically improving world health, particularly the health status of the poorest and most needy populations. The failure, so far, lay in the strategy. For too long the health debate had remained in the domain of the health professions and the health sectors. "We have given the impression that health is the exclusive business of the health professionals -- that we can achieve health for all on our own". As a consequence, one fifth of humanity remained without access to primary health care. Denial of

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access to meaningful care was not only an abuse of basic human rights, it was also a direct cause of poverty itself.

She said that the fight for health must be embedded in both the macroeconomic and social elements of human development. It must aim at ownership by the public rather than health professionals; for complementary operational strategies and plans at national, local and community levels; building the capacities of ministries of health to lead and regulate implementation; and the highest political commitment to health's contribution to eliminating poverty.

IRENA BORUTA (Poland) said it was noteworthy that her country was undertaking work to expand the scope of social services provided. That expansion stemmed from social reforms in Poland in education, health and the social security system. A new pension scheme for retirees, which would guarantee stability of and fairness of pensions, had also been established. There was also a movement towards expanding the scope of education, especially in urban and rural areas. While reforms expanded the catalogue of social services, they also sought to improve the quality of those services. However, while those reforms in social services were moving forward, they were also experiencing some difficulties in certain sectors. She cited health care as one such area. She hoped those difficulties would soon be eliminated.

There was also progress in creating partnerships between the State and other sectors to meet major social needs, she said. In local communities, decentralization and land reform had been enacted. It was also recognized that environmental protection was directly related to the quality of health care. Primary education coverage was 99.7 per cent, while secondary was 87.1 per cent. Life expectancy was 77 years for females and 68.5 years for males. Infant mortality had dropped by 50 per cent, while mortality in children under the age of five years was now 2.2 per 1,000. Poland was also trying to provide access to high quality education. Vocational camps were organized and financed for children of poor families and disabled children. From 1990 to 1997, the number of family diagnostic and consultation centres had increased by about 20 per cent.

TAKESHI KAMITANI (Japan) said that the ultimate purpose of providing social services was to improve living conditions for everyone, and accordingly to focus on enhancing efficiency and effectiveness. The questions were how to respond to social trends, making the most of the resources available, and how to do so effectively, even when economic conditions were unfavourable. For its part, Japan was preparing to launch a new kind of social security system, which strove to ensure that everyone, especially older persons, received needed care. Japanese society was ageing at a rate faster than any other country, and by the year 2015 more than 25 per cent of its population was expected to be 65 years of age or older.

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He said that it was recognized in Copenhagen that the situation in developing countries regarding social services was particularly critical and required special attention. While each government had primary responsibility for ensuring that basic social services were provided to all of its people, the support of the international community extended to those seeking to achieve that goal should be strengthened. While Japan had been increasing that portion of its ODA going to social development and had achieved the goal set by the 20/20 Initiative every year since 1993, it believed that attention should be paid mainly to the output and efficiency of activities funded, rather than the level of resources provided. He hoped that the Initiative would be further promoted with that emphasis.

Lastly, he said that the Second Tokyo International Conference on African Development, held last October in Tokyo, had provided a great impetus to efforts to ensure basic social services in African States. The Tokyo Agenda for Action laid out specific goals and activities, including concrete targets in the field of social development, such as ensuring universal primary education by the year 2015.

EWA PERSSON GORANSSON (Sweden), State Secretary, Ministry of Health and Social Affairs, said that there could be no sustainable economic development without social development. Social development was a base for a stable economic and political society. Poverty eradication, globalization, social and economic development, equality between men and women, and the recognition of the rights of the child could not be treated as separate issues, and required a concerted response. Sustainable poverty reduction could only be achieved with the assistance of a strong civil society. It was important to promote good governance, democracy, human rights and empowerment in the process to strengthen civil society. A key element in the fulfilment of the Copenhagen Programme of Action was the level of ODA with a primary focus on the least developed countries, and Sweden was concerned about the declining trend of ODA.

Policy for the elderly in Sweden was facing several challenges, including rectifying deficiencies in caring services and adjusting the whole society to a new population structure, she said. In a couple of decades, one out of every four inhabitants would be over the age of 65. There was a need for a broad policy for the elderly, and a fundamental concern of that policy was to transform attitudes and to enhance respect for older persons. In that regard, there was a lot to learn from other cultures. A society of solidarity took good care of its older members. Good policy for the elderly was characterized by security, quality and participation, which necessitated a stable pension system and efficient caring services for the elderly. Quality meant ensuring opportunities for active, independent living, but also making sue that the people employed in caring services had good skills and were sufficiently numerous.

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AINO-INKERI HANSSON (Finland) said the Nordic approach to social development was committed to ensuring access to basic social services for all. "We have chosen to equalize access through strong public involvement in the production of those services and a funding structure that is based on taxation and redistribution of income", she said. That policy created a balanced relationship between generations, genders and social groups. For several decades Finland had invested in preventive public health and that had borne fruit. An example of the effectiveness of that method was in the Finnish system of maternity and children's clinics. Infant mortality in Finland had been among the lowest in the world since the 1950s. Other examples included the declining incidence of cardiovascular diseases due to dietary information and the declining incidence of lung cancer due to successful anti-tobacco policies.

She said that universal education had been one of the crucial prerequisites for achieving and sustaining social and economic development. In order to achieve the objective of social services for all, information technology must be utilized. The development of information technology and its utilization in the best possible way would probably be one of the major global challenges at the beginning of the new millennium.

She said that, while there were differences in cultures and economic and social conditions between various countries, there were also a number of choices to be made. Among the questions to be addressed were: would basic social services be provided to all or only to the few; how could the whole society be involved in efforts; how could a sustainable funding mix between families, the public sector and market-based institutions be designed, to provide basic social services and protection to all in an equitable manner; and, finally, how could countries that faced constraints be supported in identifying and mobilizing adequate financial and human resources.

SELMAN ERGUDEN, of the United Nations Centre for Human Settlements (Habitat), said that within the guiding framework of the Habitat Agenda, the Centre had addressed social development and provision of social services through its diverse activities and programmes. Those programmes included urban management, sustainable cities, community development and women and habitat. In addition to those activities -- which aimed to improve management of cities, standards and coverage of social services and addressed specific needs and issues of major population groups -- the Centre had recently intensified its focus on social integration and reduction of exclusion in cities, and devoted the most recent issue of its quarterly journal -- the Habitat Debate -- in 1998 to the topic "inclusive cities". That issue made an in-depth analysis of topics that were related to concepts and policies on how to increase inclusiveness in cities.

The directives of the Habitat Agenda attached great importance to youth issues, he said. In that context, the Centre's work programme for the

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1998-1999 biennium had a specific element on youth entitled, "preparation of three reports at the regional level on the contributions of youth to the implementation of the Habitat Agenda". Those reports would be prepared mainly by inputs from youth organizations and would elaborate on major human settlement issues that impacted youth and future generations, youth activities contributing to improvement of living conditions in human settlements and facilitation of exchange of information and experience. The second important undertaking of the Centre in the field of youth during the current biennium was the organization of the second youth parallel programme to be held during the forthcoming 17th session of the Commission on Human Settlements.

ALFREDO SFEIR-YOUNIS, of the World Bank, said that to make social services for all a reality, societies needed to formulate a new social contract, whereby there was a clearer understanding of who was to benefit from the development process and of how to allocate the scarce financial and human resources in that direction. Providing social services for all was not only a challenge but a moral imperative. To attain that goal, it was crucial that a number of lessons be taken into account and that key elements unique to today's social and economic environment be identified.

He said that the first of the six elements that were unique to the reality faced today was the role that civil society was playing, including organized communities at every level of decision-making. The second element was the changing role of governments and the increasing role of the private sector. Next, for people to really benefit from social services, particularly the poor, it was important that development programmes not only increase coverage, but that they be able to maintain high quality and attain sustainability of expected net benefits. In addition, a powerful link could be seen between economic growth and the provision of social services. Also, an effective provision of social services had to be carried out within a holistic, integrated framework for economic and social development, since the two could not be separated.

Fourthly, in a large number of cases, success in implementation depended on the quantity and quality of the human capital involved and on the level of institutional development, he said. Marrying people with solid institutional arrangements was at the core of providing social services for all. Next, there were a number of social dimensions that had to be taken into account, such as gender. Lastly, for programmes to become an effective instrument of poverty eradication, they required that there be a special effort at both the macro and the micro level.

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