Commission on Population and Development

Forty-third Session

2^nd & 3^rd Meetings* (AM & PM)

Commission on Population and Development Opens Session under Theme

‘Health, Morbidity, Mortality and Development’

 

Life Expectancy Up, Says United Nations Population Fund, but Medical Advances

Not Reaching Huge Swaths of Developing World, People Dying of Preventable Diseases

While life expectancy had risen in all regions over the past 50 years -- one major achievement of the last century -- health improvements and medical advances were not reaching huge swaths of the developing world, mandating the global community to work harder to ensure that people did not die of preventable disease, the Commission on Population and Development heard today as it opened its forty-third session under the theme of “Health, morbidity, mortality and development”.

“Let us make no mistake about it:  health is an integral part of economic and social development,” said Purnima Mane, Deputy Executive Director of the United Nations Population Fund (UNFPA), speaking on behalf of its Executive Director Thoraya Obaid.  Better health was associated with higher incomes and socio-economic status.  However, while funding for global health had soared in the past decade, that for reproductive health had stagnated and declined for family planning.

Pregnancy and childbirth were leading killers for girls aged 15 to 19 years in poor nations, she explained, noting that if every woman had access to reproductive health services, Millennium Development Goal 5 (maternal health) would be achieved.  She said it was time to make universal access to reproductive health an economic, social and political priority.  And only a quantum leap in investments -– and moving from rhetoric to action –- would make a difference.

In a similar vein, Sha Zukang, Under-Secretary-General for Economic and Social Affairs, stressed that “good health is the foundation for human development on all fronts”.  Men and women could not lead their families out of poverty if treatable diseases and injuries caused them untold suffering and shortened their lifespan.

He urged the Commission to address ways to reduce the burden of communicable and non-communicable diseases, especially those non-communicable ailments that were major killers:  cardiovascular disease; chronic respiratory diseases; and cancer among them. It should focus on the linkages between health, development and population dynamics, the most important of which was related to primary health care.  When people had access to doctors and medicine as a fundamental right of citizenship, they were closer to achieving success in all areas.  Their life expectancy increased and societies advanced.

On that point, Hania Zlotnik, Director of the Population Division of the Department of Economic and Social Affairs, said most countries were ill prepared to face looming increases in non-communicable disease prevalence.  A multi-pronged strategy was necessary and must involve concerted public health interventions, improved medical care and the strengthening of health systems.  Ingenuity in creating equitable funding mechanisms to cover the costs was also required.  To reduce inequalities in health outcomes, wide-ranging actions should involve changes in tax and benefit systems, among other efforts.  “People everywhere want choices,” she said.  Giving them control over their lives was essential to improving health.

In a keynote address, Edward Bos, Lead Population Specialist for the World Bank, pointed out that the higher the per capita gross domestic product (GDP), the higher the life expectancy.  Infant mortality showed a similar relationship to GDP as did maternal mortality.  Such associations underscored the idea that “wealthier is healthier”.  However, deaths from non-communicable diseases, as a proportion of total deaths, would increase rapidly for decades.  He asked whether the increased importance of morbidity and mortality from such diseases would merit an indicator in the Millennium Development Goals.

In other business, the Commission designated Agnieszka Klausa (Poland) as Rapporteur for the session.  It also adopted the provisional agenda for its current session (document E/CN.9/2010/1) and approved its organization of work (document E/CN.9/ 2010/L.1).

Four reports were also introduced.  Commission Chairman Daniel Carmon (Israel) introduced the report on the meetings of the Bureau of the Commission on Population and Development (document E/CN.9/2010/2), which summarized the Bureau’s deliberations ahead of the session.

Philip Guest, Assistant Director of the Population Division of the Department of Economic and Social Affairs, introduced the Secretary-General’s report on Health, morbidity, mortality and development (document E/CN.9/2010/3).

Werner Haug, Director of the Technical Division of the United Nations Population Fund, introduced the Secretary-General’s report on the Monitoring of Population Programmes, Focusing on Health, Morbidity, Mortality and Development (document E/CN.9/2010/4); and José Miguel Guzmán, Chief of the Population and Development Branch of the Technical Support Division of the United Nations Population Fund (UNFPA), introduced the Secretary-General’s report on the Flow of Financial Resources for Assisting in the Implementation of the Programme of Action of the International Conference on Population and Development (document E/CN.9/2010/5).

The representatives of Norway, Uganda, Israel, Trinidad and Tobago, Brazil, Mexico and Finland participated in the morning’s interactive discussion with Mr. Bos.

Speaking in general discussion this afternoon were the representatives of Yemen (on behalf of the Group of 77 developing countries and China), Spain (on behalf of the European Union), Nepal (on behalf of the least developed countries), Israel, China, Indonesia, Australia, United States, Belgium, Belarus, Croatia, Sweden, Cape Verde (on behalf of the African Group) and Portugal.

The Observer of the Holy See and representatives of the International Organization for Migration (IOM) and World Youth Alliance also spoke.

The Commission will reconvene at 10 a.m. Tuesday, 13 April to continue its general discussion.

Background

The Commission on Population and Development today began its forty-third session, held from 12 to 16 April, under the special theme of “Health, morbidity, mortality and development”.  For its consideration, the Commission had before it the report on the meetings of the Bureau of the Commission on Population and Development (document E/CN.9/2010/2), which summarized the Bureau’s deliberations ahead of the session. 

In that report, among other things, the Bureau notes the need to establish a multi-year work programme for the Commission and discusses various themes that might be considered in 2012 and beyond.  It recommends that the special theme for 2012 might be “International migration and development”, and that for 2013, “The role of national action, international cooperation and partnerships in the implementation of the Programme of Action of the International Conference on Population and Development”.  The Bureau also recommends that a working group be established at the start of the resumed forty-third session to discuss issues that might result in resolutions or decisions.  That working group should begin its work on the first day of the resumed session. 

The Commission, a functional commission of the Economic and Social Council, monitors, reviews and assesses the implementation of the Programme of Action of the International Conference on Population and Development at the national, regional and international levels and advise the Council thereon.  (For more information on the session, please see Background Press Release POP/979).

Introductory Statements

Opening the forty-third session, Commission Chairman DANIEL CARMON (Israel) expressed his deepest sympathy to the Polish mission, Government and people over the “horrific” tragedy in which the President, his wife and senior Government officials had lost their lives.  Under that cloud of sadness, he warmly welcomed participants, saying that issues to be discussed during the session transcended borders and partisanship.  He looked forward to a constructive week.

Next, the Commission designated AGNIESZKA KLAUSA (Poland) as Rapporteur for the session.

The representative of Spain, speaking on behalf of the European Union, said her delegation had read the report of the Bureau’s intersessional meetings and considered its recommendations.  The review of the International Conference on Population and Development for 2014 deserved greater reflection and it would be premature to include it on the agenda for next year’s session.  Discussion of that matter should take place within the General Assembly.  Also, she believed it was too early to set the Commission’s agenda for 2013.

The Commission then adopted its provisional agenda for the current session (document E/CN.9/2010/1) and approved its organization of work (document E/CN.9/ 2010/L.1).

In an opening address, SHA ZUKANG, Under-Secretary-General for Economic and Social Affairs, emphasized the Commission’s current focus on health, morbidity and mortality, stressing that those complex and far-reaching issues impacted development.

“Health-care systems are not only intricately related to disease and mortality, but to all aspects of development,” he said, underlining that women who lacked basic health services put their very lives in danger when they became pregnant.  “Men and women cannot lead their families out of poverty if treatable diseases and injuries cause them untold suffering and shorten their lifespan.  Good health is the foundation for human development on all fronts,” he said.

He highlighted three core ideas under the Commission’s current theme:  firstly, mortality had been reduced in all countries since 1950, but least developed countries were lagging behind.  Secondly, there was a shifting burden in many countries from communicable to non-communicable diseases.  Thirdly, for health-care systems to be sustainable, they must have comprehensive primary health care at their core.

Calling the decreases in mortality across the world one of humanity’s “major achievements in the last century,” he said the international community must still work harder to support those countries where children started with so many odds against them.  Indeed, one in eight children in the least developed countries died before age five and 41 per cent were likely to die before age 60.

Clearly, health improvements and medical advances were not reaching huge swaths of the developing world, he said.  Even as the miracles of modern science and medicine were celebrated, the most vulnerable people must be connected to those advancements.  Communicable diseases and maternal conditions caused most deaths in the least developed countries, most of which were preventable or treatable with low-cost interventions.

He went on to say that while many aspects of the prevention, control and treatment of major killers like HIV/AIDS, malaria, pneumonia and diarrhoea were addressed in the Millennium Development Goals, other communicable diseases, like tropical diseases, were not.  He asked the Commission to consider how to bring additional attention to the latter and to highlight for Member States the gaps in preventing treating and controlling them.

The Commission’s deliberations, he stressed, must also address ways to reduce the burden of both communicable and non-communicable diseases, especially those non-communicable ailments that were major killers, including cardiovascular disease, chronic respiratory diseases, cancer, diabetes and mental disorders.  Many of those could be prevented or delayed by eliminating risk factors like tobacco use, unhealthy diets and physical inactivity.  Governments could take simple and effective measures to address them, through restricting tobacco use in public places or promulgating healthy eating guidelines.

The collaboration of countries from all rungs of the development ladder was needed to combat non-communicable diseases, he said.  Attention should be brought to those diseases in delicate balance with the communicable diseases outlined in the Millennium Development Goals.  A holistic approach was also needed to address the disparity among social groups, and the Commission should focus on the linkages between health, development and population dynamics.

He asked the Commission to consider the most important linkage, namely, comprehensive primary health care.  Indeed, when people had access to doctors and medicine as a fundamental right of citizenship, they were closer to achieving success on all fronts.  Their life expectancy increased and their societies advanced.  In that light, he drew attention to the recent health-care legislation in the United States, which represented a major step forward towards ensuring that all Americans had access to better health-care coverage.  That historic turning point should inspire other nations to follow suit.

Noting that the Commission had achieved it goals last year, he said that that successful strategy allowed it to cast a wider net this year.  The Commission could also build on the conclusions reached by the annual ministerial review conducted by the Economic and Social Council last year on global public health.  As it reviewed the comprehensive health agenda in relation to population and development trends, the reduction of mortality in the least developed countries, along with the growing problem of non-communicable diseases and the case for comprehensive primary health care, should be a particular focus.

In closing, he said the backdrop for those discussions should be the Millennium Development Goals.  Three of them related directly to health -– child health, maternal health and the fight against HIV/AIDS, tuberculosis and malaria.  The Commission should ask how it could push for change and actions by Member States in achieving the Goals.  Its guidance would further inform and educate the international community ahead of the United Nations high-level plenary on the Millennium Development Goals in September.

PURNIMA MANE, Deputy Executive Director of the United Nations Population Fund (UNFPA), speaking on behalf of Executive Director THORAYA OBAID, said that the fact that people today were living longer than ever before was surely one of humanity’s greatest achievements.  Over the past 50 years, life expectancy had risen in every region, with the largest gains made by developing countries, where average life expectancy had grown from 41 to 66 years.  “This is a success story,” she said.

However, she noted, that increase was not being experienced everywhere, with inequalities persisting between and within countries.  In Africa, average life expectancy was only 54 years, versus 69 years in Asia, 73 years in Latin America and the Caribbean, 75 years in Europe and 79 years in North America.  The greatest challenge was to tackle inequities and meet the health-care needs of all people.

“Let us make no mistake about it:  health is an integral part of economic and social development,” she said, adding that strategies to address health were tied to those to address development.  Better health was associated with higher incomes and better socio-economic status.  Gender discrimination and violence had a severe negative impact on the health of women and girls, particularly evident in cases of sexual and reproductive health, a neglected policy area.

Today, poor reproductive health accounted for a large share of the global disease burden, she said.  Pregnancy and childbirth were the leading killers for girls aged 15 to 19 years in poor nations, and if every woman had access to reproductive health services, including family planning, Millennium Development Goal 5 (maternal health) would be achieved.  Attainment of that “entirely achievable” Goal was lagging, due to insufficient investment.

She said that in the past decade, funding for global health had soared, while that for reproductive health had stagnated.  Maternal deaths in poor countries could be slashed by 70 per cent, and newborn deaths nearly in half, if the world doubled investment in both family planning and pregnancy-related care.

As such, she called on all Governments and development partners to make reproductive health a priority in national budgets, health financing and health system strengthening.  The benefits of investing in sexual and reproductive health included reduced rates of fertility, morbidity and mortality, and helped to achieve development objectives, including higher education levels.  Providing family planning could prevent 53 million unintended pregnancies and 150,000 maternal deaths in less developed countries each year.

For its part, UNFPA fully supported the movement towards harmonized approaches that supported strong national health systems fully equipped to combat diseases like tuberculosis and malaria, she said.  Such systems could increase coverage of antiretroviral treatment for HIV-infected persons and prevent all forms of transmission, including from mother to child.  “Integrated health services save money and lives,” she said.  UNFPA also supported an approach to health that was based on community engagement and human rights, so that people could claim their right to health, including sexual and reproductive health.

To tackle the shortages of health workers, a major barrier to achieving the health-related goals, she said global cooperation was urgently needed to increase investment for training and address health worker migration, which had left some parts of the world depleted of human resources.  Young people should be provided education, skills and health services, including for sexual and reproductive health.  It was especially important to invest in adolescent girls, as doing so would unleash their huge potential for greater progress for all.

Recalling that 2010 had been the date set for achieving universal access to comprehensive HIV-prevention programmes, treatment, care and support, she urged sustained efforts to attain that goal.  Efforts also must be redoubled to promote gender equality and women’s empowerment.  The Programme of Action of the International Conference on Population and Development clearly articulated connections among many factors, including human development, women’s empowerment, health, population and economic growth.  It was time to reaffirm the Programme of Action and ensure its full and effective implementation.

In that context, she said overall funding was not sufficient to meet current needs and escalating costs.  Although donor assistance and domestic expenditures had increased, funding levels were “way below” targets to realize the International Conference’s outcome and the Millennium Development Goals.  The funding gap for reproductive health also must be urgently addressed, especially given the unmet needs for contraception among 215 million women in the developing world.  It was time to make universal access to reproductive health an economic, social and political priority.

“We must not allow the global financial crisis to prevent further investment in health and human well-being,” she asserted, noting that a lack of social investment would be most acutely felt in the poorest countries least able to mobilize resources.  She called on Governments to increase resources for reproductive health and double funding for family planning and pregnancy-related care.  She also urged countries to increase investments in all areas of the Conference’s population package, including data collection and analysis, and their use for development planning.  Only a quantum leap in investments, and moving beyond rhetoric to action, would make a difference for success.

HANIA ZLOTNIK, Director of the Population Division of the Department of Economic and Social Affairs, said the Irish playwright George Bernard Shaw had once said, “I hope to be all used up when I die”.  Living to the “ripe old age” of 94, he had seen his wish realized.  Today, the Commission was meeting to discuss ways of ensuring that everyone died only when they were “all used up” -– that is, they died of old age, rather than disease.

She noted, in that regard, that most regions of the world had achieved impressive longevity gains, with 80 of every 100 children born in regions outside sub-Saharan Africa expected to reach age 60.  Those high chances of reaching age 60 resulted from widespread reductions in mortality from communicable diseases.  Nevertheless, as communicable diseases receded, non-communicable diseases gained ground.  Except in sub-Saharan Africa, those diseases accounted for 68 per cent of the deaths in the rest of the world, home to 88 per cent of the world’s population. 

Non-communicable diseases –- which, she explained, include cardiovascular disease, all forms of cancer, respiratory and digestive diseases, diabetes and other metabolic illnesses, and neuron-psychiatric disorders -- usually struck at older ages, she said.  Their prevalence also increased with age.  The experience of high–income countries showed that improvement in health status among older persons could be more rapid than the increase in longevity, thus producing a “compression of morbidity”, which was the hallmark of healthy aging.

But to achieve healthy aging, it was not sufficient to focus on older people, she said, as growing evidence indicated that health in old age depended on a person’s experience early in life.  Health and mortality also interacted with demography, and fewer deaths meant more people survived. As people aged and developed non-communicable diseases, demand for health care rose.  The rapid aging process meant that a reduction in the risk of becoming ill would prevent projected increases in the burden of non-communicable diseases.

However, most countries were ill prepared to face the looming increases in non-communicable diseases prevalence, she said.  A multi-pronged strategy was necessary and must involve concerted public health interventions, improved medical care, and the strengthening and transformation of health systems.  Ingenuity in developing equitable funding mechanisms to cover the costs was also required.  Reducing inequities in health outcomes was a major challenge -– particularly for those born in sub-Saharan Africa -– and underlined the urgency of achieving the Millennium Development Goals and of fulfilling commitments made to the poor.

Stressing that inequities also existed within countries, she noted that health inequalities were seen, not only between rich and poor, but among all those in between.  Moreover, in all regions, men were more likely to die prematurely than women.  Social conditions that exposed men to greater stress and occupational hazards or that prompted them to adopt unhealthy lifestyles and behaviours were at the root of such striking differences.

Reducing inequalities in health outcomes required more than health interventions, she said.  Relevant actions were wide-ranging and involved changes in tax and benefit systems; education, employment and housing; regulation of transportation systems; and efforts to combat pollution and to promote better nutrition.  Interventions must also address the specific needs of mothers, girls and boys, young people, families, men of working age and older people.  The objective should be to expand human capabilities for embracing healthy lifestyles by increasing autonomy, control and social engagement.

“People everywhere want choices,” she said, stressing that giving people options and control over their lives was essential to improving health outcomes.  In that regard, it was the role of Government to provide those options and to promote the social and economic changes that permitted people to exercise control.

Introduction of Reports

Chairman CARMON (Israel), introducing report E/CN.9/2010/2, said first that the Bureau had decided that three keynote speakers would be invited to address the Commission on the special theme of “Health, morbidity, mortality and development”.  They were Edward Bos, Lead Population Specialist of the World Bank, who would speak on “Population trends, health outcomes and development”; Carissa Etienne, Assistant Director-General for Health Systems and Services at the World Health Organization, who would focus on “Strengthening health systems to address current and future challenges in public health”; and Barry Popkin, Carla Smith Chamblee Distinguished Professor of Global Nutrition at the University of North Carolina, who would speak on “Global Economic and Health Change:  Problems and Solutions”.

Second, the Bureau had considered the Commission’s multi-year work programme, taking account of themes covered by previous sessions, as well as future events like the 2013 High-level Dialogue on International Migration and Development, he said.  It recommended that the Commission adopt “International migration and development” as the special theme for 2012, so that the results of its deliberations could feed into preparations for that event.  It suggested consideration of “The role of national action, international cooperation and partnerships in the implementation of the ICPD Programme of Action”, in 2013.

In sum, the Bureau suggested the Commission consider draft proposals on the following:  provisional agenda for the forty-fourth session; a decision on the themes of future sessions, which should cover at least a theme for 2012 to maintain a multi-year planning horizon; and a resolution on the special theme of the forty-third session.  He said draft proposals on those three items had been distributed to the Commission on 23 March.  Finally, the Bureau had decided to invite the Economic and Social Council President to address the Commission under item 6:  the contribution of population and development issues to the theme of the 2010 Annual Ministerial Review, which would focus on gender equality and women’s empowerment.

The Commission then took note of the report of the Bureau.

When members began consideration of item 3, entitled “Actions in the follow-up to the recommendations of the International Conference on Population and Development”, Ms. ZLOTNIK, in an introductory statement, said that the session’s theme complemented the Commission’s work done last year on the Programme of Action.  While the Commission last year had considered how it could help attain the health-related Millennium Development Goals, this year, it could adopt a more comprehensive approach.  Indeed, the Programme of Action covered more than the health-related Goals; it set goals for reducing maternal and child mortality, as well as targets to improve life expectancy.  It provided a solid foundation to assess efforts to improve health and increase longevity.  Together, reports E/CN.9/2010/3 and E/CN.9/2010/4 provided analysis of such issues.

Speaking next, PHILIP GUEST, Assistant Director of the Population Division of the Department of Economic and Social Affairs, introduced the Secretary-General’s report on Health, morbidity, mortality and development (document E/CN.9/2010/3) which provided an overview of trends in mortality, globally and regionally.  It reviewed knowledge about the disease burden and summarized approaches to understanding the links between health and development.  It also underscored the need to expand the health workforce to achieve a better distribution of health services, and it reviewed ways to treat communicable diseases and reduce the incidence of non-communicable diseases.

Among its conclusions, it found that life expectancy had increased since 1950 in all countries; the fastest in developed countries, he said.  Globally, females were expected to live five years longer than males, and in all regions, their life expectancy exceeded that of males.  On the treatment of non-communicable diseases, which required comprehensive responses of health systems, he said that not all regions had progressed equally.   Africa lagged in reducing mortality, with 64 per cent of all deaths caused by communicable diseases or maternal conditions.

Moreover, most children in low-income countries lost their lives due to preventable causes, even when treatments for communicable diseases were well known:  vaccines, nutritional support, better hygiene, access to antibiotics, bed nets, and access to clean water and sanitation could prevent mortality early in life.  Some 2.7 million new cases of HIV occurred annually and efforts to prevent healthy people from succumbing to it must be strengthened.  Mothers were most affected.  Clearly, achieving health-related Millennium Development Goals was essential to improving health in low- and middle-income countries.

He said the report underscored the need to reduce risk factors for acquiring non-communicable disease, notably tobacco and alcohol use.  Cost-effective measures to achieve those outcomes existed and included better education for children, as well as agricultural policy and regulation of food products.  Other measures involved regulated trade, judicious use of taxation, and measures to reduce traffic accidents, like the use of strict speed limits and seat belts.

Also, increasing the supply of health workers would strengthen health systems, as shortages were severe, and national and global efforts were needed to train health workers.  The report underscored the need to promote equity of health outcomes -- everyone must have access to primary health.  Health disparities were stronger in nations with more inequality.  Education and targeted welfare programmes were needed.  “It is better to prevent than to treat,” he said.

WERNER HAUG, Director of the Technical Division of UNFPA, introduced the Secretary-General’s report on the Monitoring of Population Programmes, Focusing on Health, Morbidity, Mortality and Development (document E/CN.9/2010/4), which, he said, provided an overview of the programmatic work that UNFPA, together with its partners, was undertaking at global, regional and country levels to improve maternal health and reduce morbidity and mortality.

He said two important challenges lay in the way of further advancing the agenda of the International Conference on Population and Development -- weak health systems and gender inequality -– and UNFPA was working to address both of them.  Strengthening health systems called for a “continuum of care” and a “lifecycle” approach that met all the client’s needs in a convenient and affordable way, integrated into an essential primary health care package.  UNFPA recognized that strengthening health systems was especially difficult in funding-constrained environments.  As a result, it was working with partners to align behind national processes and to harmonize support to national health systems.

He highlighted the “Health Four”, which was a partnership between UNFPA, United Nations Children’s Fund (UNICEF), the World Health Organization (WHO) and the World Bank.  It was intensifying in-country work in 25 priority countries, with special attention to the six countries that represented more than half the number of maternal deaths annually, namely, Afghanistan, Bangladesh, India, the Democratic Republic of the Congo, Ethiopia and Nigeria.  UNFPA was also working with countries to build national capacity to increase skilled attendance at birth and to provide emergency obstetric care.  It had launched an “Investing in Midwives” programme and was further addressing weaknesses in procurement systems and the logistics of management, and the delivery of essential drugs and medicines.  However, strengthening health systems did not automatically result in the utilization of better health services and better health outcomes.  Promoting demand at the community level was crucial.

Gender-related attitudes and barriers were major reasons for the persistence of poor sexual and reproductive health outcomes, he said.  Gender-based discrimination often prevented women and girls from accessing much-needed services.  Moreover, sexual violence was often exacerbated in conflict and humanitarian emergencies.  In that light, UNFPA utilized a unique approach that integrated human rights, gender mainstreaming and cultural sensitivity in all its programmes.  It was also mobilizing communities to foster a culture of “zero tolerance” on violence against women and girls.  Through the Joint Programme on Female Genital Mutilation/Cutting, it was working with UNICEF to stop that practice in 12 countries.  In 2009 alone, more than 1,000 public declarations proclaimed villages “FGM/C”-free. 

Introducing the Secretary-General’s report on the Flow of Financial Resources for Assisting in the Implementation of the Programme of Action of the International Conference on Population and Development (document E/CN.9/2010/5), JOSE MIGUEL GUZMAN, also of UNFPA’s Technical Division, said the document responded to the Commission’s request for an annual report on financial flows and complied with General Assembly resolutions 49/128 and 50/124.  The report analyzed international and domestic financial resource flows that were part of the “costed population package” described in paragraph 13.14 of the Programme of Action and included funding in four categories:  family planning services; basic health services; sexually transmitted diseases and HIV/AIDS activities; and basic research, data and population and development policy analysis.

He said revised cost estimates for those four components indicated that total costs of sexual and reproductive health had amounted to $23.5 billion in 2009.  The HIV/AIDS component was estimated at $42 billion.  Costs for the component on basic data research and population and development policy analysis -- which included expenditures for censuses, surveys, civil registration and research and training –- were expected to total $1.6 billion.

Donor assistance had been increasing steadily over the last few years and was expected to reach $10 billion in 2008, he continued.  Meanwhile, an estimated $23.2 billion in resources were mobilized by developing countries.  But as a result of the financial crisis, that strong upward trend was not expected to continue, and the report made clear that the resources mobilized were far lower than what was required in the face of growing needs and costs.  Indeed, if funding for family planning and reproductive health was not increased, it would undermine efforts to prevent unintended pregnancies and to reduce maternal and child mortality, especially in the poorest countries.

Stressing that population and reproductive health were central to development and to the achievement of the Millennium Development Goals, he said higher levels of development assistance were essential in eliminating poverty and improving social conditions.  Women’s rights should also be promoted, while greater investments should be made in education and health. Such investments would give users choices that would, in turn, change the repetitive cycle of poverty and inequality.  While the use of modern contraceptives had increased, an estimated 215 million women who wanted to avoid pregnancy were not using effective contraception.  Fulfilling unmet needs for family planning would help reduce maternal and infant mortality and promote gender equality and women’s empowerment.

Finally, he noted that reliable and timely expenditure data were essential to informing policy, and he encouraged countries to make every effort to systematically monitor financial resources for population activities.

Keynote Speaker

EDWARD BOS, Lead Population Specialist for the World Bank, speaking on “Population trends, health outcomes and development”, said the combined impact of current trends pointed to a world in which people would increasingly live longer. It was a development success story that would require a shift in thinking to ensure that increased life expectancies would continue.  The gap in life expectancy between developed and developing countries had fallen, from 25 years in 1950 to less than half of that in 2010, which showed a great deal of progress.  More people born today were surviving to older ages.  Poverty had declined, even in the poorest regions of sub-Saharan Africa and South Asia.  Data showed that the higher the per capita gross domestic product (GDP), the higher the life expectancy.  Infant mortality showed a similar relationship to GDP, as did maternal mortality.  Such associations pointed to the idea that “wealthier is healthier”.

On the impact of wealth within countries, he said there were dramatic differences between household wealth and health outcomes.  Countries with more equitable income distribution performed better on health outcomes.  Infrastructure like safe water and sanitation services were related to better health outcomes.  Also, better health was related to higher productivity.  Healthier children were more able to attend school.  Health spending increased as nations became wealthier.  In that context, 45 per cent of the population in developing regions lived in urban areas, up from 35 per cent in 1990.  Mortality and disease also changed with development, and lifestyle changes, such as tobacco consumption, often risked obesity, increased blood pressure and abnormal blood lipids.  The major determinant of non-communicable diseases, however, was ageing.

On demographic patterns, he said global population growth had been declining since the 1980s, while that for the elderly population had been increasing.  China, comprising 15 per cent of the global population, deserved special attention.  By 2050, China’s age structure would resemble that of Japan, a country with an ageing population, though with many more people.  Citing two global trends, he said mortality from infectious disease had dropped, and the number of older persons was increasing faster than that of young people.  The combined effect was that the number of deaths from non-communicable diseases, as a proportion of total deaths, would increase rapidly for decades.

Looking ahead, he said reducing the incidence of non-communicable disease would be highly desirable -- and possible -- in high-income countries.  Preventing non-communicable diseases would be an important objective, with healthy ageing as the ultimate goal.  Curative interventions could slow the mortality rate from non-communicable diseases by 1 to 2 per cent annually.  Attention must focus on the increasing numbers of older people.  Health discussions must highlight non-communicable diseases in national priorities; it would be a mistake to tackle them through specific disease programmes.  Finally, he asked whether the growing importance of morbidity and mortality from non-communicable diseases would merit an indicator in the Millennium Development Goals.

Interactive Discussion

In the ensuing discussion, representatives stressed that since declines in the rates of some non-communicable diseases were so expensive, they were not feasible for some countries.  Others, pointing to the development implications of non-communicable diseases, asked why those diseases had not been included thus far in the international development agenda and requested information on how to approach them from that standpoint.  In particular, they wondered what role the United Nations could play. 

One speaker, noting that recent progress involved heavy investments in services and infrastructure, suggested that “balancing” the needs of populations afflicted by communicable diseases with those afflicted by non-communicable diseases posed challenges.  Another speaker noted that as more people reached older ages, an increasing number of other diseases came into play.  That progression seemed endless, and he wondered if the World Bank had a position on whether a plateau could be reached.  Still another speaker highlighted the linkages between lifestyle and non-communicable diseases, and, emphasizing the difficulties of changing tastes, asked if there was any relevant approach for changing tastes in epidemiology.

Responding, Mr. BOS agreed that the decrease in cardiovascular diseases was encouraging, but cautioned that changing lifestyles was not as easy and cost-effective as one might think.  For example, cigarette smoking was highly addictive and difficult to change.  Thus, the cost-effectiveness of such interventions should always be analyzed when considering how to reduce the burden of non-communicable diseases.

He agreed that many countries had a “dual burden” with segments of their populations facing both communicable and non-communicable diseases.  There was a paradox of global health -- the goal was for people to live longer, yet the older they got, the more vulnerable they were to non-communicable diseases.  But the World Bank was focusing on the compression of morbidity and healthy aging.

As an example of that, he said it was preferable for a person to develop diabetes at an advanced age rather than at a young age, when medical treatment would be necessary for many years.  In that respect, the goal was to postpone morbidity to older ages.  Indeed, it should be seen as a positive outcome that people died of non-communicable diseases rather than communicable ones.

Agreeing that non-communicable diseases were important in the development agenda, he cited the need for legislation that addressed such issues as transportation systems as well as non-communicable diseases.  He was not sure what role the United Nations should play, but noted the call by the World Health Organization to focus on non-communicable diseases.

In a second round of questions, representatives asked for more information on the health effects of combating alcohol and tobacco use in both the developed and developing world and on mental health disorders.

Mr. BOS said one finding was that increased taxation of tobacco products had a substantial impact on reducing their use.  High-income countries that reduced smoking indicated there was a significant impact on health –- especially among those, like the United Kingdom, that introduced those campaigns early on.  He contrasted that impact with other countries like France and Germany, which started those campaigns later.

As a demographer, he had no clear answer on mental health disorders.  But as someone had said earlier, the poor were more affected by illnesses, and that was likely true for mental health disorders as well.

General Debate Statements

Concerning the agenda item on actions in follow-up to recommendations of the International Population and Development Conference, AWSAN ABDULLAH AHMED AL-AUD (Yemen), speaking on behalf of the Group of 77 and China (G-77), observed that although there had been huge advances in modern medicine, those advances had benefited just a small percentage of the world’s population and almost exclusively in wealthier settings.  Huge inequalities persisted across and within countries.  The right to the highest attainable standard of physical and mental health was inextricably linked to the accessibility and affordability of medicines and treatment, and he therefore urged that intellectual property rights should not prevent developing countries from taking measures to protect public health.  The international community should also reject the use of “unilateral coercive measures” that affected access to medicines and advanced public health technologies.

He said that the expanding global HIV/AIDS epidemic was erasing decades of social and economic progress and devastating populations in terms of increased morbidity and mortality.  For some countries, the demographic impact of AIDS was enormous, and had serious consequences for their development prospects, as they lost their productive human resources.  At the same time, the international community should pay more attention to the non-communicable diseases, which were responsible for 60 per cent of deaths worldwide and 72 per cent of those in middle-income countries.  Their share of the burden of disease was expected to increase in the future.  Women’s access to health care would increase their productivity and help to reduce maternal as well as child mortality rates, and suppressing the spread of HIV/AIDS, malaria, tuberculosis and other infectious diseases would improve the health of women and girls who were disproportionately affected by those challenges.  The international community should also give priority attention to the plight of people living under foreign occupation.

Noting that resource gaps were especially large in poor countries and that least developed countries depended entirely on official development assistance (ODA), he said the G-77 felt that unless new, additional and sustainable resources were provided to those countries, it was unlikely that most of the goals and targets of the Cairo Programme of Action would be met.  Instead, there would be a worsening of the population and reproductive health situation in many such poor countries.  Estimates for 2009 showed signs that donor countries had reduced the already scarce resources they allocated for ODA.  Any financial contraction by donor countries, under the pretext of the global financial crisis, and continued wavering on their earlier commitments would impede achievement of the health-related targets set at Cairo and to those contained in the Millennium Development Goals.  On the other hand, he stressed the importance of recognizing the contribution of South-South cooperation over the years in the area of health.

JUAN ANTONIO YÁÑEZ-BARNUEVO (Spain), speaking on behalf of the European Union, emphasized that gender equality could not be achieved without guaranteeing women’s sexual and reproductive health and rights, and reaffirmed that expanding access to sexual and reproductive information and health services was essential to achieving the Beijing Platform for Action, the Cairo Programme of Action and the Millennium Development Goals.

He observed that the 2000 decade had seen unprecedented mobilization to combat major communicable diseases, especially HIV/AIDS, malaria and tuberculosis, with HIV/AIDS treatment having reached more than 4 million people in developing countries, or over 40 per cent of those in need.  However positive those particular outcomes, overall progress towards achieving the health-related Millennium Development Goals had been slow, with 50 developing countries off track, especially the least developed countries and nations in sub-Saharan Africa.  Lagging progress in reaching Goals 4 and 5 was particularly distressing.  He, thus, urged increased investment by Governments, the private sector and civil society to strengthen health systems and support mothers and their children from pregnancy into early childhood.

The European Union was determined to assist the achievement of the Goals and other development objectives as agreed at the major United Nations conferences, he said, adding that, in counting down to 2015, it would accelerate action to guarantee universal access to reproductive health and ensure “reproductive health commodity security”.  Given the decline in international assistance for family planning, the Union would do its utmost to increase access to family planning; meeting the needs of some 200 million women who wanted to plan and space their births, but had no access to contraceptives, was a poverty reduction strategy. 

He said that the Union was deeply aware of the multi-sector nature of health and its close links to human rights, gender equality, education, non-discrimination, women and children rights, nutrition, water, sanitation, environmental equality and education, as well as to economic growth and social progress.  It stressed the universal relevance of mainstreaming non-discrimination and gender equality at all levels and in all health-related policies, adopting human rights-based approaches that brought required attention to the situation of women and children. 

GYAN CHANDRA ACHARYA (Nepal), speaking on behalf of the least developed countries and aligning his country with the remarks made on behalf of the Group of 77 and China, said the goals of the International Conference on Population and Development remained as relevant today as when they were adopted in Cairo in 1994.  The least developed countries still faced formidable challenges in delivering population and health-care services, and the mobilization of resources was needed to further enable them to make greater progress towards meeting the Cairo goals and targets.  That mobilization should include, among other things, full market access, full debt relief, increased foreign direct investment, and fairer trade terms.  The United Nations and other international organizations should enhance their support to developing countries for implementing the Programme of Action.

He said that due to the financial and economic and energy crises, as well as the problems posed by food insecurity, the least developed countries were now facing delayed impacts from a reduction of exports, remittances and tourism.  As a result, they had been forced to cut back on public and private spending on social services like health care, education and poverty reduction programmes.  Nevertheless, accessibility to and affordability of medicines and treatment remained crucial in providing better care to the poorer segments of any population.  Women’s access to health care would increase their productivity while helping to reduce both maternal and child mortality rates.

He acknowledged the important role of UNFPA in promoting and ensuring access to and utilization of health services and rights, highlighting, among other things, its voluntary family planning programmes, its promotion of gender equality and women’s empowerment and its efforts to curtail gender-based violence.  The least developed countries were acutely aware of how much more difficult the present global financial crisis made their task of providing better health care to their citizens.  But, unless new, additional and sustained resources were provided, it was unlikely that most of the goals and targets of the Action Programme would be met.

GABRIELA SHALEV (Israel) noted that over the past century the world population had expanded rapidly, while medical science and technology had also grown.  Along with its benefits, that growth posed new and great challenges, and the Commission’s current theme offered an opportunity to take a broad view of health systems throughout the world and to adopt policies that furthered implementation of the Cairo Action Programme.  Today, the birth rate in Israel stood at three children per woman, even as women were increasingly involved in the work force.  Since its inception, the Israeli Government had adopted many programmes and policies to ensure the health and safety of its population. The multifaceted cleavages within its diverse population, which represented many different regions from around the world, required a wide-ranging approach.

She said that in Israel, as in the United States, universal health coverage had been mandated and was supported through a holistic approach that integrated health and education resources.  Among other things, the Government subsidized early childhood education centres, which contributed to the country’s low infant and maternal mortality rates.  Those mother and child health clinics had received such high reviews that they were being studied around the world.  Moreover, much of Israel’s foreign development work focused on Africa, particularly in terms of supporting the achievement of Millennium Development Goal number 5.  Towards that end, Israel was planning a development centre in order to share what it had learned in the areas of maternal and child health.

HU HONGTAO, Deputy Director-General, Department of International Cooperation of the National Population and Family Planning Commission of China, said that health, as an important component of both the Cairo Action Programme and the Millennium Development Goals, was not only the driving force but also the purpose of development.  Noting both “delightful progress” and “frustrating problems” in heath worldwide since Cairo, he called on the international community and national Governments to re-position family planning and inject fresh vitality into it, as that was of critical importance to universal access to health and realization of sustainable development.

He said China also endorsed the view constantly stressed by UNFPA of increased financial input into reproductive health and family planning.  He called for attention to be paid to health status, especially the reproductive health status of vulnerable groups, including migrants, particularly as urbanization accelerated.  To provide the migrant population with equitable medical and health care, including reproductive health and family planning services, was required not only for health improvement of all people but also for safeguarding legitimate rights and interests of all citizens.

Climate change had brought along many uncertainties to health, he said, calling in that regard for enhanced research into the impact of climate change on health and parallel proactive responses.  Developing countries, especially the least developed ones, faced many practical difficulties in realizing the health-related Cairo and internationally-agreed development goals.  To help ease those difficulties, he called on the international community and developed countries to meet their commitments about enhancing assistance to developing countries, especially the least developed ones, so as to help them build capacity, and thus attain universal access to health.  China, as a developing country with the largest population, was fully aware of its profound responsibility and would earnestly fulfil its Cairo commitments and the Millennium Development Goals.  It joined other countries and the international community in striving for universal access to health, including reproductive health.

SUGIRI SYARIEF, Minister and Head of the National Family Planning Coordination Board of Indonesia, underlined the substantial progress made in combating preventable deaths in the past six decades.  But while millions had been saved from deadly communicable and non-communicable diseases, preventable and treatable contagious diseases and pandemics remained the leading killers in developing countries.  International barriers also remained, and had prevented the full penetration of the many benefits of medicine and technology at regional and national levels.

“The fact is, poverty has made health care a luxury item for households in developing countries,” he said, emphasizing how the ongoing economic crisis had severely affected already-low income levels and severely impinged on the ability of individuals and families to access health facilities.  That, in turn, put pressure on the publicly-funded health care system, and the Governments of developing countries should ensure the availability of adequate and sustainable resources.  That meant that those countries that depended on international assistance needed predictability and sustainable funding commitments.

Emphasizing the link between population, health and development and the global economic system, he said reforms of that system must create an inclusive, sustainable and pro-jobs environment around the world, in order to provide better chances for the poor.  ODA commitments should be realized and global emergency funds or reserves to safeguard global health efforts should be established.  The private sector should be encouraged to realize its corporate social responsibility.  Health policies must be coordinated with policies in other sectors, like trade, tax, property rights, agriculture and development.  An effective global aid architecture was also needed.

ANDREW GOLEDZINOWSKI (Australia), urging all Member States to sustain their commitment to implementing the Programme Action and accelerating progress towards achieving the Millennium Development Goals, said it was particularly necessary to recognize the importance of the health-related goals of achieving universal primary education and promoting gender equality and the empowerment of women.  Against that background, Australia had committed to substantially increase its funding for development assistance, including for health, through to 2015.

Working with a range of international and domestic partners to help countries develop and implement better policies and improve health systems and services, he said Australia was committed to supporting country-led national health policies in keeping with the principles of both the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action.  However, everyone should be concerned about the poor progress on maternal, newborn and child heath and the inadequate levels of financing to reach Goals 4 and 5, particularly in Asia and Africa.

“It is unacceptable that over half a million women die annually from pregnancy related conditions, with most of these deaths occurring in developing countries,” he declared, pointing out that more than 200 million women lacked access to modern contraception, which contributed to about 20 million unsafe abortions each year.  Violence against women was another significant cause of injury and ill-health among women worldwide.  Tragically, about 4 million newborn babies died every year.  Noting that the poor health outcomes of women in developing countries were often a reflection of gender inequality, he further observed that the health of the mother and the baby were intrinsically linked during pregnancy and immediately after birth, and that most of those deaths could be prevented or avoided through proven, cost-effective actions.

Debate then turned to item 4, on national experience in population matters:  health, morbidity, mortality and development.

Launching that discussion, MARGARET POLLACK, Director for Multilateral Coordination and External Relations, Senior Advisor on Population Issues, Bureau of Population, Refugees and Migration, United States Department of State, said her Government’s commitment to realizing the shared goals contained in the Cairo Action Programme was central to its foreign policy and foreign assistance.  Recognizing that the improvement of global health outcomes was a shared responsibility, she commended Governments and their civil society partners for bringing the world closer to achieving the Cairo goals.

She said that, although progress had been made, there was considerable distance to travel, notably to dramatically reduce infant and child mortality.  The doors of education must open equally, while more must be done to address maternal mortality and lack of access to reproductive health.  Childbirth was a leading cause of death, with 530,000 women dying each year from preventable causes.  UNFPA research showed that addressing the need for family planning, among other things, would enable most countries to achieve Millennium Development Goals 4 and 5.

For its part, the United States had provided $55 million to UNFPA in 2010 and increased support to combat violence against women, she said.  The President had shown his commitment through the $63 billion Global Health Initiative, which called for more resources to reduce maternal and child mortality, and increased access to family planning.  The President's Emergency Plan for AIDS Relief (PEPFAR) was committed to improving links between reproductive health and HIV care.  It would work to improve access to family planning, help countries improve commodity management systems and expand health-care training initiatives.  The President had requested more than $715.7 million for bilateral and multilateral initiatives for reproductive health, including family planning, representing the single largest contribution in United States history in that area.  To deliver health interventions that reduced maternal and child mortality, the Administration had requested $1.186 billion for 2011, a 48 per cent increase over 2010.  Achieving the Cairo goals required unyielding attention.

Mr. SYARIEF, associating himself with the statement of the Group of 77 and China, underscored Indonesia’s progress in implementing the Cairo Action Programme, saying that the mortality rate in the country had significantly decreased.  At present, 94 per cent of the population could access general health-care facilities.  While the decrease included maternal deaths, it was one of the areas which the nation was still striving to improve, and such efforts included improved access and quality of general health-care facilities.

He said that through the national primary health care initiative, Indonesia had also succeeded in implementing universal child immunization coverage.  That programme, along with other child survival interventions, had helped to mobilize political support for child health programmes and their continuation both at the national and community levels.  However, while it was true the maternal mortality rate had decreased, the current standing at 228 deaths per 100,000 was still considerably high.  If it persisted, the target of 102 deaths per 100,000 could only be expected to be achieved in 2025.  Towards that goal, Indonesia was making every effort to provide the most cost effective and direct intervention to reduce maternal mortality.  That included family planning; having skilled birth attendants during labour; and emergency obstetric care.

Acknowledging that much remained to be done in the areas of public health, he stated that the country still needed to continue its public health insurance scheme to ensure the poor’s access to health-care facilities, including reproductive health and family planning; treatment; and affordable drugs.  Most importantly, in order to guarantee the poor’s affordability on food, health care and drugs as well as education, Indonesia needed to continue to revive its economy and provide decent and stable jobs for its people, he added.

Mr. HU noted that, with one fifth of the global population, his country was the world’s most populous developing country.  Since 1994, it had made remarkable progress in promoting health and realizing universal access to reproductive health by 2015.  It had increased average life expectancy from 69 in 1990 to 73 in 2008, reduced the maternal mortality ratio from 94.7 per 100,00 births in 1990 to 31.9 per 100,000 births today, as well as reduced the infant mortality ratio from 32.9 per cent in 1990 to 13.8 in 2009.  The total fertility rate had declined from 5.8 in 1970 to 1.8 today.

He said that among China’s main approaches for promoting health, particularly reproductive health, was to develop and keep improving its legislation and regulations through the gradual construction of a comprehensive policy and legal framework that included a law on maternal and infant health care, as well as laws on protecting women’s rights and interests, and a population and family planning law.  In 2009, it had earmarked $3 billion for the development of a grass-roots health infrastructure.  The Government also aimed to improve a national service network that covered maternal and infant health care, reproductive health and family planning services in both rural and urban areas.  There was also an 84.6 per cent contraception prevalence rate among married couples.  Meanwhile, the hospital delivery rate had reached 94.5 per cent in 2009.

Equitable health and reproductive services were being gradually provided to migrants, who totalled 211 million in 2009 and represented the largest floating population in the world, he said.  China was also addressing its population issues comprehensively by prioritizing investment in holistic human development.  It was committed to stabilizing a low fertility rate.  Still, it faced a large population and a weak economic foundation, which together severely constrained its chances for sustainable development.  It would, in mid-century, confront the tri-peaks in terms of its overall population, working-age population and elderly population, and in light of those challenges, quality improvement of reproductive health and family planning services remained one of its major tasks.

THOMAS LAMBERT (Belgium) said that more than half a million women died each year from pregnancy and childbirth complications.  “Family planning saves lives,” he said.  Some 200 million women who needed contraception lacked access to it.  When women could space out pregnancies, families were smaller and children enjoyed better health and education.  In Belgium, thousands of family planning centres offered advice and referred doctors.  The country also had evolved programmes to follow children’s development for 16 years, with the goal of ensuring that that development was harmonious.  HIV/AIDS transmission was a major concern and an early testing policy had been created to ensure better treatment.  He noted that a law, adopted in 2000, forbade genital mutilations.

He said that mortality was also due to non-communicable diseases, such as cardiovascular disease and cancer.  The right to health and health-care services was integral to Belgium’s cooperation in the area of gender equality.  The health-care sector, which constituted 10 per cent of the country’s ODA -- or 130 million euros -- was a priority.  Consolidating health-care systems in general offered the best guarantee for health care for all.  Given that, Belgium sent doctors to developing countries.  Likewise, superior education in its three national communities also allowed Belgium to host doctors from developing nations.  The importance of health-care systems and focus on basic health care remained central, notably in reducing maternal and infant mortality.  Reproductive health-care rights must be accessible to all.

IGOR MISHKORUDNY ( Belarus) said his country was giving serious support to improve the reproductive health of its population.  In its efforts to reduce infant and child mortality, birth-assistance institutions were being reformed, with state-of-the-art technology established for the neonatal stages.  In the past decade, child mortality had fallen by half, while maternal mortality rates had declined four-fold.  Further, experts with the World Health Organization had noted a positive trend in all key health indicators in Belarus.  That was due to the Government’s support for the family in terms of childbirth, education, pensions and labour and tax guarantees.  Family benefits currently covered more than 90 per cent of children up to age three.  Material support was also given for housing and other social benefits.  Labour legislation focused on preserving the significance of women’s reproductive capacities, with maternity leave provided until a child reached age three.

He said that since the Chernobyl catastrophe, the Government had implemented a programme of support for those stricken by that event.  His Government was grateful to the support of Ukraine, the Russian Federation and other Member States in calling for the United Nations Decade of Recovery and Sustainable Development of the Affected Regions.  In conclusion, he said Belarus’s leading position among the Commonwealth of Independent States in terms of maternal and child mortality rates attested to the successes of its national plan.  To further that position, the Government was focusing on strengthening its infrastructure and implementing best practices.

VESNA VUKOVIĆ, Head of United Nations Department, Ministry of Foreign Affairs and European Integration of Croatia, aligning herself with the European Union’s statement, said addressing chronic non-communicable diseases, along with efforts to strengthen prevention, were high among public health priorities.  Diseases in that category were leading causes of morbidity and mortality in Croatia.  Malignant diseases were the second-largest category of causes of death.  Among those diseases in the mortality structure of women of fertile age, the most frequent was breast cancer, and national campaigns aimed at early detection of malignant diseases.  Croatia had enjoyed a consistently low maternal mortality rate for several years, which had been achieved and maintained through existing antenatal and post-natal care mechanisms centred on protection standards.

She said the legal basis for safe motherhood had been defined through various Government sectors and the national implementation of both the Millennium Development Goals and the Cairo recommendations.  Women’s health care was fully covered by a mandatory health insurance system, as was health care for infants and small children.  The Government adopted a national plan of activities for the rights and interests of children for the 2006-2012 period, which urged increasing the number of physicians and nurses per capita to bring Croatia closer to the European Union average.  Croatia would remain fully committed to monitoring implementation and incorporation of the Cairo agenda into its national health policies, strategies, programmes and budgets.

ANDERS LIDEN (Sweden), aligning his country with the remarks made on behalf of the European Union, said the close connection between health and economic and social well-being was well documented.  Attaining the highest standard of health, including sexual and reproductive health, was a basic human right and a prerequisite for achieving the Millennium Development Goals.  Given the commitments that had been made, it was worrying that progress in the health-related Goals –- particularly Goal 5 -- was lagging.  More than half a million women died each year because of pregnancy-related complications.  Indeed, nearly 20 million women resorted to unsafe abortions every year, and maternal mortality related to such unsafe practices was generally high where abortion was severely restricted.

He said that recent studies indicated that the most cost-effective way to reduce maternal mortality was to invest in maternal health and preventive measures, like family planning and skilled obstetric health workers.  Investments in sexual and reproductive health and rights would also lead to fewer unintended pregnancies, fewer maternal and newborn deaths and healthier mothers and children.  It would also result in higher levels of education, social equity, economic growth and productivity.  Stressing that political will and leadership, as well as additional resources, were needed to come to grips with that major global health problem and human rights emergency, he said Sweden was organizing special training sessions to allow its ambassadors to exchange experiences and views on sexual and reproductive health and rights issues.  It would also continue to focus on Goal 5.  Strengthened respect for human rights, sexual and reproductive health and rights and gender equality promotion were key priorities in Sweden’s HIV/AIDS efforts.

ANTONIO PEDRO MONTEIRO LIMA (Cape Verde), speaking on behalf of the African Group and endorsing the statement made on behalf of the Group of 77 and China, said mortality in children under age 5 had fallen in developing countries in 2008.  However, in sub-Saharan African countries, there had been little if any progress.  In 2007, one in seven children had died before his or her fifth birthday.  Sub-Saharan Africa deplored such deaths.  Today, some 536,000 women died in pregnancy or delivery, with about 265,000 of those occurring in sub-Saharan Africa. The HIV/AIDS pandemic had shortened life expectancy in Africa among the young and productive population, and support was needed to complement African Government actions.

Indeed, 35 per cent of national budget resources were used for health each year, he explained, noting that the supply of quality vaccines must be encouraged to save lives, and financing for hospitals was also needed.  The African Group requested experts to help meet those challenges. Such efforts should not be based only on Government action; a global partnership among the private sector, civil society and non-Governmental organizations was also needed.  The promotion of health and long-term treatment of disease required international support.  “Our hearts in Africa suffer,” he said.  “Our youth deserves more.”  It was time to look for financing.  He anticipated taking part in fruitful debate during the session.

PEDRO ABECASSIS COSTA PEREIRA (Portugal) acknowledged that many important steps had been taken since Cairo, but noted that several gaps and challenges had yet to be met if the Conference goals were to become a reality.  That would require further common efforts by Governments, the private sector and civil society.  Portugal was ready to do its share. 

Regarding health, morbidity, mortality and development, he reported that substantial improvements in the health status of the country’s population over the past 25 years had been made possible through careful planning and enforcement of internal coherence policies, promotion of inter-linkages between actions taken by different sectoral departments, and the full use of existing synergies.  The results of those efforts involving all national relevant authorities were now starting to show in two key areas of the Cairo outcome: rising life expectancy and a reduction in child mortality.

Encouraged by the progress, Portuguese authorities were aware, however, that much remained to be done in several other areas, starting from health inequalities between genders, regions and socio-economic groups.  One important area that was receiving the authorities’ full attention was that of education.  Progress made in that field, enhanced by social policies, favoured not only greater knowledge of health issues, especially the prevention and fight against HIV/AIDS, the reduction of fertility, morbidity and mortality rates, and improvements of the quality of the working population, but also family planning and women’s empowerment.  Concluding, he said the crucial issue of the suffering of AIDS orphans in Africa deserved the immediate attention of all; methods of intervention must be devised to help the affected population to cope with that reality, which burdened caregivers, who themselves become vulnerable.

CELESTINO MIGLIORE, Permanent Observer of the Holy See, said sadly, the half-million maternal deaths recorded annually, of which approximately 90 per cent occurred in developing countries, represented only the tip of the iceberg.  It was estimated that for every mortality, 30 more women suffered long-term damage to their health, such as from obstetric fistulae.  The physical devastation caused by fistulae made them complete outcasts, isolated by family and society.  Such women suffered pain, humiliation, and lifelong disability if not treated.  Worldwide, perhaps 2 million of those poor, young and forgotten mothers were living with the problem, most of them in Africa.

“These deaths of mothers and babies are all the more shameful especially since they are readily preventable and treatable,” he asserted.  The consensus of the obstetric community was that mothers needed essential prenatal care, skilled attendants at all deliveries and specialist care for life-threatening complications.  And yet, programmes focused on providing the services that ensured that mothers and their babies survived pregnancy were badly underfunded.

In his view, investments in education and long-term development programmes could provide communities with the means for improving their own health, he said.  However, the emigration of individuals with medical knowledge and skills from developing countries resulted in the loss of the very expertise and people necessary to improve the health-care systems in those countries.  Governments should address the urgent health needs of children around the world.  In 2008 alone, there had been more than 243 million cases of malaria leading to more than 800 deaths.  Similarly, treatable and avoidable respiratory infections, digestive diseases and illnesses resulting from inadequate nutrition remained the main causes of death among children in the developing world.  Diseases which had long been eliminated in developed countries continued to devastate children in the developing world.  Global solidarity was necessary to ensure that poor children had access to much-needed medication and nutrition, he added.

LUCA DALL’OGLIO, Permanent Observer of the International Organization for Migration (IOM), said the spike in the world’s population had seen growing numbers of migrants and increasingly complex patterns of human mobility that comprised a heterogeneous group of individuals with different health determinants, needs and vulnerabilities.  Risk factors –- including poverty, stigma, discrimination, social exclusion, language and cultural differences, family separation and administrative hurdles and legal status -- often determined the level of access migrants had to health and social services.

He said that with the WHO and the Government of Spain, the IOM had organized a Global Consultation on Migrant Health in Madrid in 2010.  Consensus had been reached on several strategies for improving migrants’ health.  First, migrants’ health should be monitored through standardized, comparable aggregated and disaggregated data to better capture the status of those populations.  Second, policies and legal frameworks affecting migrants’ health must adopt and implement relevant international standards on the protection of migrants and respect for their rights to health in national law and practices.  Third, it was important to deliver health services to migrants in a culturally and linguistically appropriate manner.  Finally, there was a need to broaden and strengthen partnerships, networks and multi-country frameworks in ongoing migration health dialogues.

IOM, he noted, was setting up a clearinghouse on migration health information, international minimum standards on health for migrants, best practices and global advocacy efforts that aimed to put migrant health on the agendas of relevant organizations.  It was also working with several “champion” countries that had made great progress in addressing migrants’ health.

Returning to agenda item 3, a representative of the World Youth Alliance, said “people are the most important drivers of development.  That human creativity is a critical resource.”  Development required promotion of a social, political and economic environment that allowed people to reach their full physical, spiritual, mental and emotional potential.  Ensuring access to health care that addressed communicable and non-communicable disease prevention and treatment was critical to those efforts.  Comprehensive primary health care informed by local priorities must become the focus of international efforts. For too long, health priorities had been donor-driven and focused on investment efficiency.  Where acute health issues associated with malnutrition, clean water and sanitation and vector-borne disease were addressed, health systems must be flexible to address disease prevention.

With that, she called for renewed commitment to achieving Millennium Development Goal 5, as too many women lacked access to adequate pre-natal care, skilled birth attendants and adequate post-natal care.  She urged the Commission to address maternal health distinctly from reproductive health and rights, as a combination of those issues led to investments that made it easier for women in poor countries to avoid pregnancy than to have a healthy pregnancy and delivery.  Finally, she called on all nations, in partnership with families and communities, to promote to the fullest extent the health, well-being and potential of all children, adolescents and youth.

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*     The 1^st Meeting was covered in Press Release POP/975 of 3 April 2009.

For information media • not an official record