Troika (Italy, Spain and Turkey)

   
 
FOURTH SESSION OF THE OPEN WORKING GROUP ON
SUSTAINABLE DEVELOPMENT GOALS OF THE GENERAL ASSEMBLY
New York, 17-19 June 2013
Statement by the Secretary General of International Cooperation for Development of the Government of Spain
Mr Gonzalo Robles
Ministry of Foreign Affairs and Cooperation of Spain
Check against delivery
Interactive exchange of views on:
Health & population dynamics
We have the honour to make this intervention also on behalf of Italy and Turkey, with whom we are pleased to share the membership of this Open Working Group.
Both Health and Population dynamics are central issues to the three dimensions of sustainable development and must play a prominent role in the development of the future post 2015 Development Agenda.
Both issues have been also discussed during the recent thematic Consultations organized by the UN system. In this regard, we would like to reiterate that, in order to ensure the highest coherence between the different processes that will contribute to a comprehensive overarching post 2015 framework, it is important to use the elements and conclusions of these debates in our deliberations here.
Although both elements are highly interconnected, let me outline some relevant points for each one of them independently. Due to time constraints, I will now concentrate on answering the guiding questions you have presented to organize the debates; we will post the full statement of our team on the Group’s website.
Health is a basic and fundamental human right. A comprehensive, rights-based post 2015 framework must state the enjoyment of the highest standards of health as one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic or social condition. The full enjoyment of the right to health is also critical for the enjoyment of other human rights.
But besides that, health is inextricably linked to the three dimensions of Sustainable Development, and it can be approached under different perspectives: Health as a result
of development, Health as a contributor to development and Health as an indicator of development. Health is also discussed prominently in the recent final report of the High Level panel of Eminent Persons on the post 2015 Development Agenda, where it is listed, under the heading of Ensure Healthy Lives, as one of the possible main goals in the future framework, including different health related targets, although the proposals are mainly diseased-centered and there is not any cross sectoral approach.
Three of the eight MDGs are focused on Health and all the rest are highly connected with this theme. The experience of the MDGs has shown us that the definition of clear objectives has greatly pushed the development agenda, and in many low and middle income countries health progress over the past decade has been impressive. However, the improvements have been highly asymmetrical and unbalanced, and it is certain that many countries will not meet the MDG targets and much remains to be done beyond 2015, particularly in the lowest income countries.
Of all the MDGs, the least progress has been made on the maternal health goal-worldwide. In this regard, priority should be given to women’s wider access to effective and functioning health systems, with skilled and motivated health workers. In addition family planning programs, nutrition initiatives, facility-based deliveries, disease prevention, and new and innovative methods to provide more help to mothers and empowering women to space births and choose family size should be developed.
Besides that, there are important health determinants that were not taken up in the MDG framework and have contributed to persistent inequities. The unfinished health MDGs must remain health priorities in the post 2015 period.
Regarding your first question, the post-2015 should address some of the neglected and unachieved elements of the MDGs such as the social determinants of health, including girls’ education, health equity and gender equality. Greater emphasis should be placed on human rights and human dignity.
It is crucial to reaffirm the importance of investing in child and maternal mortality, sexual and reproductive health and rights, as well as the fight against HIV, TB, malaria and neglected tropical diseases under a more comprehensive framework. For instance, comprehensive and cost effective sexual and reproductive health services would necessitate centres that provide services from a holistic approach, including information, contraceptive services, maternal health services, prevention of STI’s, HIV/AIDS and non-communicable diseases that affect women, such as breast and cervical cancers.
Additionally, preventive health policy must be enlarged and improved through family medicine, mother and child care and vaccination programs, especially in least developed areas.
There are also emerging challenges, such as: interlinkages with environmental considerations, like climate change, demographical changes, including ageing in certain countries, existence of new diseases or the growing importance of non communicable diseases.
The poorest people tend to suffer most from the health effects from aforesaid challenges. In turn, disease and disability slows development.
Ensuring financial access to health services is one of the most critical challenges poor countries face. The countries need to allocate an important amount of financial resource to the health sector. In addition, they need to strengthen existing structures and mechanisms for sustainable, effective and efficient mobilization and utilization of internal and external resources.
Under these circumstances, it is clear that a fragmented agenda based in the current health MDGs would not be enough.
Against this backdrop, and also responding to your question number 2, on the experiences and views in regard to the best strategies to reduce inequality and inequity in health coverage and access, we consider that there is enough evidence to support a more comprehensive approach to health issues and policies.
The right to be healthy and access to basic health services is important regardless of living location, gender, age or socio-economic status.
We must make steady progress in ensuring Universal Health Coverage and access to quality essential health services. That means reaching more people, broadening the range of integrated, essential services available to every person, and ensuring that services are affordable for all.
In this regard, we see merit in the proposal coming from the WHO, and the health sector, to explore the idea of ensuring universal health coverage and access to achieve health goals and targets.
The universal health coverage and access has two interrelated components: coverage with high-quality health services in the context of disease prevention, health promotion, treatment, care, and support and coverage with financial risk protection, for everyone, to ensure that the more vulnerable and marginalized populations are not affected.
We consider that such an overarching objective could be both universally applicable and at the same time, adapted to national circumstances.
Health implications should be also considered in connection with other possible areas under the post 2015 framework, such as agriculture, food security and nutrition, water and sanitation, energy, employment, sustainable cities and transportation or sustainable consumption and production. These sector targets should have strong link and causality with health outcomes and life quality, such as sanitation and food safety.
In any case, and answering your third question we consider that besides this over-arching health goal, a hierarchy of more sector and programme specific goals, targets and indicators can be developed to reflect existing agreements (including the current
MDGs) and emerging elements of the new health agenda, under a broader approach that measures health equity.
The inevitable rise of non-communicable diseases is one of the biggest health challenges in front of countries.
The causes of this spread should be understood well and preventive measures should be taken to adress this problem. For example environmental hazards, such as air and water pollution, toxic chemicals, and built environments that discourage physical activity are among these causes.
In addition to its toll on human suffering, illnesses carry a significant financial burden in the form of healthcare expenditures and losses on productivity and some economic activities, such as tourism, trade etc. The cost of inaction to non-communicable diseases can cause an important load to the economy. So, investing in health should be considered as means for accelerating development.
Coming to your last question, the challenge is how to frame an overarching health goal and targets in a way that drives change that is relevant for all countries; that acknowledges health as a global concern and at the same time recognizes the specificities at country level and places special emphasis on the more vulnerable groups, in addition to taking into account the social gradient.
On the other hand, the variation in the achievement levels of MDGs among countries and regions revealed that there should be differentiated goals for each country. Countries’ priorities may vary according to the demographic profile and health circumstances of each country.
In this regard, investing in the health of women, children, and youth, especially of the more disadvantaged, and putting emphasis on health systems and services as well as the determinants of health, will produce significant progress toward achieving health outcomes.
Combining this with a cross cutting approach on inequality would give a strong message to ensure all people, irrespective of income, education, gender, age, or sexual orientation, can improve their health.
Also, it is important to encourage Health Impact Assessment as a way to analyse the impact that policies from health and other sectors (as food, water and sanitation, urbanisation, transport, employment, etc.) may have in health and in health equity.
In conclusion the SDGs should:
- take a holistic, life-course approach to people’s health with an emphasis on health promotion and disease prevention,
- include specific health-related targets as part of other development sector goals,
- accelerate progress where MDG targets have not been achieved and set more ambitious targets for the period to come,
- address the growing burden of NCDs, mental illness, violence, and other emerging health challenges,
- sexual and reproductive health and rights must be addressed, and young people require special attention,
- promote healthy lifestyles,
- provide more affordable, appropriate, effective and efficient health services,
- investment in human capital considering demographic developments and new occupation which might be required in the long term,
- ensuring broad public benefit, particularly for the poor and vulnerable,
The issues related to Population Dynamics are broad and complex and are clearly linked to Sustainable Development affecting all its three dimensions. This importance was highlighted in the Río+20 final document.
Continued rapid population growth and high mobility, linked with unsustainable patterns of production and consumption will clearly pose important challenges on sustainable development. On the other hand, the complexity of population dynamics and related issues such as continued rapid population growth, ageing, urbanization and migration patterns make the design of development goals and targets more difficult. However, it is clear that these issues must be considered in the post 2015 agenda.
How population dynamics unfold over the next decades, and whether they compound developmental challenges or help facilitate solution, depends on whether effective policies are put in place. Therefore, countries must pro-actively address, rather than merely react to, population dynamics with well defined policies, respecting human rights. Policies that are also evidence- informed and gender responsive.
Coming to your first question, our answer will be to promote a rights-based and gender responsive approach, that strengthens citizenship, social participation and the empowerment of people, including sexual and reproductive health rights, as well as investment in human capital throughout the life course of individuals. Population trends are not inevitable and can be guided through policies that expand individual’s opportunities. In this regard, we are committed to the full and effective implementation of the Beijing Platform for Action and the Programme of Action of the International Conference on Population and development.
We also consider very important to complement these policies, with addressing other social determinants, such as access to basic needs, quality education at all levels, youth employment, support income security through generation of productive and remunerative employment opportunities, and ensure that adequate social protection nets are in place. This would also help to realize the potential demographic dividend.
While high population growth is still a concern mostly in the least developed countries, in many other parts of the world, countries are facing with population ageing, that will
eventually have to be addressed by all countries in the future. Against this backdrop, it is important to also consider the promotion of active policies targeted to older people.
Promoting active ageing, providing age friendly environments, fighting against age discrimination and increasing intergenerational solidarity are some of the important issues that should be addressed in the next development agendas.
Coming to your third question, urbanization and migration are two key issues related to population dynamics and in both cases it is important to focus on the development benefits they may have.
We understand migration can have important effects for both sending and receiving areas. Migration and the resources it generates in the form of investments, remittances, and knowledge and skills transfers can enhance individual capabilities and human development at different levels. However, it can also involve trade-offs and costs generating new inequalities and vulnerabilities. It may also cause economic and social problems such as lack of manpower in sending areas and social integration problems in the receiving areas.
Despite progress in dialogue and cooperation at the global level, there are still divergent visions on this issue, migration and mobility remain inadequately mainstreamed into development frameworks and sectoral policies, and there is still a persistent negative image of migration.
Reflecting on the negative and positive aspects of migration at a global level is crucial to adequately manage it, and to facilitate bilateral, regional or multilateral partnerships on migration, with a focus on the benefits of migration for development. Especially vulnerable groups of migrants, such as women, children, older people, or adolescents should be the primary focus of the more inclusive policies. On urbanization, nowadays, half of the population lives in cities and by 2030 more than 60% of the population will be living in urban areas, according to some projections.
Urban areas are potential for sustainable development but one of the reasons behind high urbanization is migration from rural areas. Therefore it has social and economic dimensions that are reflected in cities like environmental problems. The living areas of migrants or new comers are usually the most fragile parts of the cities.
Well planned and managed urbanization will be a critical component of sustainable development.
Regarding question 4 in relation with 2, on the possible goals and indicators, it would be difficult to find overall goals related to population dynamics that can be applicable to all contexts. However, independently of the final form that the new post 2015 development agenda takes, it will need to address and integrate the complex demographic challenges.
The collection, analysis and use of population data and projections are essential for forward-looking and people-centered development strategies, and we are committed to explore the development of adequate targets in this regard.
Having better information will provide the ability to change unnecessary policies, to adjust priorities and to manage funds in the most required areas for policy makers.
To sum up, the SDGs should aim to:
- improve life quality of the population.
- support a migration structure fostering sustainable development,
- ensure healthy living conditions and consider the needs of emerging age groups, in particular youth and older people.
Cuarto período de sesiones del grupo de trabajo abierto sobre objetivos de desarrollo sostenible de la asamblea general
Nueva York, 17-19 de junio de 2013
Intervención del Secretario General de Cooperación Internacional para el Desarrollo del Gobierno de España,
Sr. Gonzalo Robles
Ministerio de Asuntos Exteriores y de Cooperación, España
Cotejar con la intervención oral
Intercambio de opiniones sobre:
Salud y dinámicas de población
Señor Co Presidente,
Tengo el honor de intervenir también en nombre de Italia y Turquía, con quienes compartimos la pertenencia a este Grupo de Trabajo Abierto para los ODS.
Tanto la salud como las dinámicas de población son cuestiones esenciales para las tres dimensiones del desarrollo sostenible.
Ambas cuestiones han sido también debatidas durante las recientes consultas temáticas organizadas por el sistema de Naciones Unidas. En este sentido, nos gustaría reiterar que, con el fin de garantizar la máxima coherencia entre los diferentes procesos que están contribuyendo a definir el marco global post 2015, es importante tener en cuenta las conclusiones de esos debates en nuestras deliberaciones.
Por razones de tiempo voy a centrarme en dar respuesta a las preguntas orientativas de los co presidentes: pondremos a su disposición la intervención completa del equipo en la página web del Grupo.
La salud es un derecho humano básico y fundamental. El pleno disfrute del derecho a la salud es también fundamental para el ejercicio de otros derechos humanos.
Pero, además, la salud es un componente esencial de las tres dimensiones del Desarrollo Sostenible, desde diferentes perspectivas: la salud como resultado del desarrollo, la salud como factor de desarrollo y la salud como indicador del nivel de desarrollo.
También ocupa un lugar destacado en el reciente informe Panel de alto nivel Post 2015, como posible objetivo principal en la futura agenda.
El post-2015 debería abordar algunos de los elementos rezagados en la agenda del milenio, como los componentes sociales de la salud, incluyendo la educación de las niñas, la equidad en la salud y la igualdad de género. Se debería hacer más hincapié en los derechos y la dignidad humana.
También hay que insistir en la importancia de invertir en aspectos relacionados con la mortalidad infantil y materna, la salud y los derechos sexuales y reproductivos, así como la lucha contra el VIH, la tuberculosis, la malaria y las enfermedades tropicales olvidadas, desde un enfoque más amplio.
Asimismo, convendría ampliar y mejorar la política sanitaria preventiva, a través de la medicina familiar y de los programas de vacunación materno-infantil, especialmente en las áreas más desfavorecidas.
Han surgido nuevos desafíos, como son las cuestiones medioambientales, incluido el cambio climático, los nuevos patrones demográficos – incluido el envejecimiento en algunos países - la existencia de nuevas enfermedades o la importancia creciente de las enfermedades no contagiosas.
Por todo ello, está claro que una agenda fragmentada, basada en los actuales ODM, no es suficiente.
En este contexto, en respuesta a su pregunta número 2, acerca de las experiencias y puntos de vista sobre las mejores estrategias para reducir la desigualdad y la inequidad en la cobertura sanitaria, consideramos que hay argumentos suficientes para apoyar un enfoque más integral de las políticas de salud.
Tenemos que progresar gradualmente hacia una cobertura sanitaria universal, con acceso a servicios esenciales de calidad. Esto implica acceder a más gente, ampliando la gama de servicios integrados esenciales disponibles para cada persona y asegurando que sean asequibles para todos.
En este sentido, vemos interesante la propuesta de la OMS y del sector sanitario, que consiste en explorar la idea de asegurar una cobertura y un acceso sanitario universales para la consecución de objetivos y metas en este ámbito. Este planteamiento tiene dos componentes relacionados entre sí: una cobertura con servicios sanitarios de alta calidad, es decir, prevención de enfermedades, promoción de la salud, tratamiento, atención y una protección del riesgo financiero, para todo el mundo, asegurando la inclusión de los más vulnerables y las personas marginadas.
Consideramos que este objetivo global podría ser a la vez universalmente aplicable y adaptable a las circunstancias de cada país.
En todo caso, y respondiendo a su tercera pregunta, consideramos que además de este objetivo global se puede establecer una jerarquía de objetivos específicos, metas e indicadores de sectores y programas para reflejar los acuerdos existentes (incluidos los
ODM) y los elementos emergentes de la nueva agenda de la salud, bajo un enfoque más amplio que mida la equidad sanitaria.
Llegando ya a su última pregunta, la inversión en la salud de las mujeres, los niños y jóvenes, especialmente los más desfavorecidos, haciendo hincapié tanto en los sistemas sanitarios como en los factores que inciden en la salud, supondrá un progreso importante hacia las metas que debemos alcanzar.
Además, es importante fomentar la Evaluación del Impacto en la Salud como método para analizar el impacto de las políticas en éste y otros sectores (como el urbanismo, el transporte, el empleo, etc) sobre la salud y la equidad de la salud.
En conclusión, los ODS deberían:
- Partir de un enfoque holístico, que abarque todo el ciclo vital, con énfasis en la promoción de la salud y la prevención de enfermedades.
- Incorporar metas sanitarias específicas, como parte de otros objetivos de desarrollo
- Acelerar el progreso para la consecución de los ODM y establecer metas más ambiciosas de cara al futuro
- Hacer frente al coste creciente de las enfermedades no contagiosas, las enfermedades mentales, la violencia y otros desafíos emergentes
- Abordar la salud y los derechos sexuales y reproductivos, con especial atención a los jóvenes
Sr. Co Presidente,
En relación a las dinámicas de población, estas están claramente vinculadas con el desarrollo sostenible en sus tres dimensiones. Los países deben abordar de forma activa y no meramente reactiva estas cuestiones.
En cuanto a la primera pregunta, nuestra respuesta es promover un enfoque basado en derechos y en la igualdad de género, capaz de fortalecer la ciudadanía, la participación social y el empoderamiento de las personas, incluyendo los derechos sexuales y reproductivos e invirtiendo en capital humano durante todo el ciclo vital. En este sentido, nos comprometemos a la aplicación plena y eficaz de la Plataforma de Acción y el Programa de Acción de la Conferencia Internacional sobre Población y Desarrollo de Beijing.
En cuanto a la tercera pregunta, la urbanización y la migración son dos cuestiones clave; en ambos casos, es importante centrarse en los beneficios para el desarrollo que puedan tener.
Entendemos que la migración puede tener efectos importantes, tanto en las zonas emisoras como en las receptoras. A pesar de los avances en el diálogo y la cooperación a nivel global, todavía existen visiones divergentes. La migración y la movilidad siguen estando insuficientemente integradas en los marcos del desarrollo y de las políticas sectoriales, y aún persiste una imagen negativa de la migración.
Asimismo, hay que tener en cuenta la migración medioambiental, abordando el complejo nexo entre cambio climático y medio ambiente.
Los grupos más vulnerables de migrantes, como las mujeres, los niños o los adolescentes deben ser el foco principal de unas políticas más inclusivas.
En cuando a la urbanización, en la actualidad, la mitad de la población vive en ciudades, y hacia el año 2030 más del 60% de la población vivirá en zonas urbanas, según algunas estimaciones. Una urbanización bien planificada y gestionada será un componente fundamental del desarrollo sostenible.
En cuanto a las preguntas 2 y 4, acerca de las posibles metas e indicadores, sería difícil encontrar objetivos generales relacionados con las dinámicas de la población que puedan ser aplicables a todos los contextos. Sin embargo, independientemente de la forma definitiva que adopte la nueva agenda de desarrollo post 2015, tendrá que abordar e integrar los complejos desafíos demográficos.
La recopilación, el análisis y el uso de los datos y proyecciones de población son también esenciales, para elaborar estrategias de desarrollo orientadas al futuro y centradas en las personas.
En resumen, los ODS deberían contribuir a:
- mejorar la calidad de vida de la población
- dar cabida a una estructura migratoria que pueda fomentar el desarrollo sostenible
- asegurar condiciones de vida saludables y tener en cuenta las necesidades de los grupos de edad emergentes, en particular los jóvenes y los mayores.