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Chairman, Colleagues,
Thank you for creating this opportunity in a busy Barcelona
programme to think ahead to the World Summit on Sustainable
Development in Johannesburg.
In about six weeks from now, world leaders will be gathering in
South Africa to review what has happened since the Summit in Rio ten
years ago. Looking back over the last decade, there has been progress
in all three pillars of sustainable development - the economic, social
and environmental. But there is a great deal more to be done.
Especially if we are to bring about an approach to development which
genuinely integrates the three pillars - and which meets the needs and
aspirations of countries both north and south.
Those leaders meeting in Johannesburg face a broad and complex
agenda. It is no secret that the preparations for the Summit have been
difficult. Reaching consensus on such a wide and inter-linked range of
topics will not be easy.
But there is much that can be done, if we maintain a focus - a
focus that keeps people, and their needs, at the centre of the frame.
At a global level, this means agreements between rich and poor
countries that can benefit both. On the ground, it means recognizing
that we are not dealing with a zero-sum game. Environmental
degradation, for example, is not an inevitable consequence of economic
growth. Rather, better environmental management can be a key to
poverty reduction - through more secure livelihoods, reduced
vulnerability and better health.
The key point I want to make today is that we cannot achieve the
goals of sustainable development in the face of widespread ill health,
particularly among poor people. To talk about sustainable development
when decades of progress are being eroded by a single epidemic simply
does not make any sense.
Healthy life is of course an outcome of sustainable development,
but what we have to realize, is that it is also a powerful and
undervalued means of achieving it. We need to see health both as a
precious asset in itself, and as a means of stimulating economic
growth and reducing poverty. Ten years ago, health was seen primarily
in terms of providing social services: as consumption rather than
investment. Fortunately, the world is now beginning to accept that
health is central to the whole concept of sustainable development. It
is a key element in securing our common future.
Chair,
In preparing for the Summit, we need to present health in the
following ways:
First, we can make the case for investment in health with much
greater precision, based on the work of the Commission on
Macroeconomics and Health. The outlays suggested in the Commissioners'
report are large, but so is the potential return. An aggregate annual
additional investment of around $66 billion, with about half coming
from donors, could save eight million lives a year and generate around
$360 billion from improved productivity and greater levels of domestic
and foreign investment. This means a six-fold return on investment.
Second, we can demonstrate clearly what can be achieved with
additional resources. We can track progress and measure results.
And we have clear and quantifiable goals on which donors and
developing countries have agreed. The relationship between better
health and poverty reduction is well reflected in the Millennium
Development Goals, where more than a third of the 48 indicators are
related to peoples' health. Achieving the targets in health will
significantly contribute to the overarching goal of reducing by half
the proportion of people living on less than $1 a day.
Thirdly, some of the greatest risks to health are associated
with the physical environment. Diarrhoeal and respiratory diseases
have an intimate, but preventable, link with poor living conditions,
inadequate and contaminated water, dirty household fuels and unsafe
food and water. Poor children particularly, face a range of dangers to
health from the physical conditions in which they live. In addition to
contaminated food, these include domestic accidents, road traffic
injuries, and exposure to lead, pesticides and other poisons.
There are also important indirect links between the environment and
health: as natural resources are depleted or degraded, so are peoples'
livelihoods affected. This vicious cycle has to be broken.
Finally, we cannot discuss sustainable development without focusing
on globalization and health. A globalising world has brought many
benefits to the health of the world's poor, but it can also add to the
risks - be it through the increase use in tobacco, sedentary
lifestyles or changing dietary habits.
Colleagues,
In presenting the case for investment in health, we also need to
review how we work. The Johannesburg Summit will stress the importance
of partnerships.
In the health field we already know what can be achieved through
well-managed partnerships and alliances between governments, civil
society and the private sector. In the field of research and
development - we are stimulating the development of new drugs for
malaria and TB, and vaccines for AIDS. We have seen how the Global
Alliance for Vaccines and Immunizations (GAVI) can harness private and
public finance both to increase coverage through stronger health
systems and create markets for new vaccines. And we have played an
active role in developing the Global Fund to fight AIDS, TB and
Malaria.
We have also seen the results that can be achieved on the ground
when governments work creatively with voluntary and private
organizations. Several countries are now actively considering how they
will respond to the recommendations of the Commission for
Macroeconomics and Health but using the report as a stimulus to ensure
that health is fully reflected in national poverty reduction
strategies.
Johannesburg also offers an opportunity to consider areas where new
partnerships are needed. I have already touched on the issue of how
poor children face a wide range of dangers to their health from the
environments in which they live. Many groups have appreciated this
reality and have developed multi-sectoral initiatives to promote
children's' environmental health - particularly in poorer communities.
The UN system - specifically WHO, UNICEF, UNEP UN Habitat and the
World Bank - is well placed to build on the current momentum and
encourage an international movement to create Healthier
Environments for Children. We plan to accelerate that movement
through a launch event at the Johannesburg Summit
In summary, we have a strong case to make for placing health at the
heart of the sustainable development agenda.
We cannot maintain current levels of spending. We have to be
realistic about the costs of what we are trying to achieve. The level
of spending in most low-income countries is insufficient to address
the challenges they face. The minimum level of financing needed to
cover essential health interventions, including HIV/AIDS, of between
$30-$40 contrasts with actual levels in the order of $13 per person in
the least developed countries. Increases in domestic resource
mobilization are possible, but in most cases a huge gap will remain.
To address this gap requires a significant and sustained increase in
the levels of aid for health from the current total of around $6
billion per annum. And the increase needs to start now.
But money alone is not the whole story. We have to innovate. The
system of development finance we see today is still characterized by
fragmentation, high transaction costs and islands of excellence.
Systemic problems require systemic approaches. We have to strengthen -
and in many cases build - the infrastructure and health systems
necessary to implement proven interventions. And we have to scale up
research and development that is focused on the health of poor people
and poor countries.
We begin to understand the linkages between sectors - between
health and the environment, between the environment and the economy,
between the many causes that make people sick and poor - but in too
many countries we lack the structures and institutions that can help
us act on these insights.
Colleagues,
Sustainable development is about the relationship between human
society and the planet on which we live. There are health conditions -
of which HIV/AIDS is the most prominent - and serious risks to health,
that threaten our very future. A sustained effort, a quantum leap,
scaling up - all these terms have been used in the discussions
surrounding WSSD. The key point is this: It is time to act, and no
more time to lose!
Thank you.
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