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Mr President, Honorable
Fidel Castro,
Minister of Health,
Ladies and Gentlemen,
My message today is that together we can break the
cycle of poverty and deprivation throughout our world. And we can do
so by investing in the health and development of our children.
You are pediatricians, and most of you are already
convinced. But I am committed to bringing the message to political
decision-makers everywhere. I want to see health at the centre of the
global development agenda.
The Government and people of Cuba have shown that
investing in health is vital. Now we are seeing similar trends in the
rest of the world.
Investing in health is a well documented strategy
for lifting populations out of poverty.
Investing in health during early childhood is
cost-effective and a sound example of healthy public policies.
We know which diseases cause the greatest burden
throughout our world. Respiratory infections, diarrhoea, and
birth-related conditions are the leading causes of mortality or
disability.
The same three killers were there in 1995; they
would have been on top had we looked at disease burdens in 1965 or
even earlier. But even if the levels for most of them have dropped
significantly, in most countries these top causes of child mortality
remain the same.
In addition we have seen an increase in deaths from
malaria. The vast majority of the one million malaria deaths each year
occur among young children in Africa, especially in remote rural areas
with poor access to health services.
The global HIV/AIDS epidemic is also affecting children. There is a
significant risk that the virus moves from mother to child during
delivery or as a result of breast feeding. Children suffer, too, when
they lose their parents, teachers and health workers to the epidemic.
In the Caribbean and in Africa in particular, HIV/AIDS must influence
all strategies aimed at improving the lives of infants and children.
Child mortality rates tell us what is happening in
society. It is children from poor households, whose parents are unable
to access essential health services, that are most at risk. High child
mortality rates are a sign of social inequity.
More than 10 million children under five years of
age died in 1999; 99% of them were in developing countries. This age
group accounts for more than half of the global mortality gap between
the poorest and richest populations of the world.
In Cuba you have shown that if all households are
able to access essential child health care, the main causes of child
mortality can be tackled. You have also given priority to ensuring
that children access basic needs - promoting good nutrition and
improving access to water and sanitation. The statistics show what
these policies have achieved.
We have seen vast improvements in other countries,
too. Worldwide, child mortality rates and life expectancies have
greatly improved. More children survive the first five years than ever
before. But these opportunities for a better life have not been shared
by all the world's children.
The children who survive risks to their health have
other needs. This means additional responsibilities for our societies.
Ensuring that children can enjoy a healthy and stimulating childhood.
Helping to prepare them for later challenges; to make contributions to
the well-being of their communities and to national development.
Colleagues,
People who suffer repeated attacks of illness find
it hard to escape from poverty. They are unable to earn a decent wage.
Children who are sick do not well at school. Mothers who are ill are
less well able to care for their young ones. Illness perpetuates
poverty. It is at the root of the poverty cycle.
And clearly, one way to break the poverty cycle is
to focus on the well-being of the world's children.
As health professionals, we are making headway.
Our goal is that each child has a chance to achieve
her, or his, full potential. This means preventing - and treating -
episodes of serious disease.
We have strong and cost-effective tools to improve
the lives of the very young.
We have developed integrated ways to respond to
children’s needs. They promote child survival, growth and
development through responsive care in early childhood.
We now recognise the need for cognitive stimulation
and psycho-social factors in child development.
We understand how nutrition influences cognitive
and social development as well as growth, physical development and
vulnerability to illness. Good nutrition - especially during the first
three years of life - is critical for the child's future physical and
mental well-being.
WHO has helped countries develop integrated
approaches to the Management of Childhood Illness. Countries draw on
each other's experiences - recognizing that children do better if
their needs are addressed together rather than through separate
programmes. Fewer opportunities are missed. Resources are used more
efficiently. Parents benefit because services respond to a range of
child illnesses and offer guidance that will be useful in future.
These integrated approaches focus on the youngest
children - from birth to five years - who have often been hardest to
reach. They use existing health services as a starting point.
Paediatricians have played a major role in training health workers to
provide a quality service.
A child brought to a clinic with diarrhoea is
treated for her presenting symptom. At the same time she is checked
for acute respiratory infections and other diseases. Her nutritional
status is assessed. She is vaccinated, and the mother is advised on
breastfeeding, family planning, malaria prevention or nutrition.
In some parts of the world, the advice extends to
the promotion of psychosocial development, particularly in situations
where children are affected by the stress of conflict or natural
disaster.
These integrated approaches to childhood illness
focus on health worker skills, and on their being able to have the
medicines and other goods essential for providing a quality service.
This may also mean improvements in the health infrastructure, as well
as community-wide support for better child care practices in the home.
The results of integrated approaches are evident in
Cuba. They have been applied elsewhere to good effect. We know what is
happening in the towns and villages. One baffled mother coming out of
a health station in a small African village recently asked
suspiciously whether there had been a major pay rise among nurses,
since the health workers now actually talked to her at length and
showed unusual concern for her child. The challenge is to take these
approaches to scale, throughout the world, so that millions of
children benefit. We need to show what can be achieved, so that those
who make decisions ensure that sufficient resources are invested in
the health and well-being of children.
In December 1999, the Director of the Pan American
Health Organization launched the "Healthy Children Goal
2002". The goal was to prevent 100,000 children from dying under
the age of five within the Region of the Americas by the year 2002.
The goal is being achieved through the wider application of integrated
approaches to managing children's illness - or IMCI. Heads of State,
First Ladies, Ministers of Health, and senior officials of UNICEF and
other UN agencies and nongovernmental organizations took part in the
launch. They are now working to implement it, and to make a real
difference.
Positive results have already been reported. Better
nutrition through improved support to mothers during weaning. Improved
immunization rates. Reduced mortality due to infections.
Colleagues,
Improving levels of childhood immunization is a WHO
priority. You can be proud of your achievements in Cuba. The results
from other parts of the world are good, too. The proportion of the
world’s children who are vaccinated has risen from less than 5% in
the 1970s to around 80% today. But it is not easy to maintain these
coverage levels. And many children in poor countries do not have
access to the new vaccines being introduced in wealthy countries. We
are helping countries to find new funds so that they can improve
immunization services.
The Global Alliance for Vaccines and Immunization,
GAVI, has shown us a way forward. Last year we invited the poorest 74
countries to submit proposals to the GAVI Secretariat. Before the end
of last year, financial support started to flow. Vaccines started to
reach countries early this year. To date 54 countries have
responded and the Fund has commitments amounting to
US$ 375 million.
GAVI is reversing the decline in immunization
coverage reported over the past few years. It brings new vaccines to
millions of children who until now have not been able to benefit from
them. It also shows how - working together - we can enable millions of
people to access health interventions they need. It shows us how to
scale up our efforts.
First - we need a shared understanding of the tasks
that need to be done. Then we need team-work that brings together
different professional disciplines, agencies and countries. And we
must all focus on results.
Our shared understanding, now, is that economic
development is impossible if people do not enjoy good health. Our team
work is achieved through partnerships, in which people with vastly
different backgrounds work together with shared purpose. This results
in commitment, creativity and innovation. The shared purpose means a
focus on results.
One promising new partnership is the planned Global
AIDS and Health Fund. Many countries and organizations have helped
bring the plans to where they are today, and the UN Secretary-General
has personally undertaken to oversee the creation of the Fund and
ensure that it is operational by the end of this year.
Many of us are hopeful that this Fund will make a
major difference. Our enthusiasm is tempered by the recognition that
much has to be done to make it work. But once it is operational, by
the end of this year, it will change the way in which development
agencies work together.
The Fund is a sign of ways in which health
interventions are being implemented on a large scale, based on science
and best practices, with developing country governments squarely in
the driving seat, and with development agencies working together in a
well coordinated manner.
Colleagues,
When Prime Ministers and Finance Ministers
recognize that early childhood development is also their business -
that wise investments yield real results - then we will see real
change.
The expertise is there. Cost-effective strategies
exist. We know what it takes to improve conditions for the children of
the Americas and the rest of the world.
We can do it.
We are now working hard to secure new and
additional funding for major diseases linked to poverty. We are
engaged in a debate about solidarity: about the steps needed to create
a better world. As we move towards a future that is more prosperous,
just and secure, children are at the center of our concern.
Thank you. |
