[MUSIC] Hello. My name is Petra Lance. And I am the director of the United Nations Development Program or UNDP's representation office here in Geneva. And I'm really happy to be here to talk you today about the relationship between health and development. Even though the United Nations Development program is not a specialized health agency, what we do which includes assisting in reducing poverty, assisting countries in promoting sustainable development, and assisting countries in promoting equality, including gender equality, all have an impact and a bearing on health. My talk today will focus on the very strong and reciprocal relationship and linkage between health and development. I will talk about how health is important for development and how developement is important for health. It will also focus on the importance of having a multi-sectoring approach to health. The conditions in which people live and work clearly have an impact on their well being and on their health, but similarly health can also contribute to development. Let's just look at Asia as an example. It's estimated that between 1965 and 1990 about 30 to 50% of overall economic growth was actually attributable to investments made in the health sector. And we can also then notice that during the decades of structural adjustment in Africa in the 80s where often health budgets were cut we could see that this has negative consequences for economic growth and development. Instinctively, I think we all realize that the healthy and the nourished child has better opportunities in life, has better capacity to learn, and has a better opportunity to contribute to society when he or she grows up. And similarly, a healthy adult is more likely to have a longer education, and a better paying job, than somebody who is not healthy. The strong relationship between health and development can be illustrated by this graph. Using the crude and quite insufficient GDP per capita expressed in purchase power parity and comparing it with life expectancy or some expression of health. We can see a very strong correlation between the two. So I mentioned that GDP is quite a crude and insufficient measure of development. And it was for this reason that the United Nations developed a program in 1990 launched the concept of human development and you can see the definition on this slide here. And the human development concept was inspired by the Nobel Prize Laureate Amartya Sen and also by the late, former finance minister of Pakistan Mahubub ul Haq. They thought that GDP per capita was just too crude a measurement of people's wellbeing. So, they said, let's try to identify a measure that better tells us how people feel, how people live. And they established something that we today call the Human Development Index. And it's got three components and health is at the center. The three components are health, as expressed in life expectancy at birth; the second is educational attainment; and the third is GDP per capita expressed in purchase power, pirating. Let's now go and look at a definition of health, and I think many of you may be familiar with the WHO definition of health which is found in the preamble to the Constitution of WHO from 1946. It defines health as a state of complete mental and social well being and not merely the absence of disease and infirmity. I think by looking at this definition It becomes quite clear that health is influenced by many factors and that health goes far beyond the health sector. And this was also confirmed by the Alma Ata Declaration from 1978, emanating from a WHO conference, this time on universal primary health care. And the Alma Ata Declaration says that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to health. So this all tells us that we need to have a multi-sectorial approach to health. That health goes beyond the health sector. And if we look at the following chart, we can see that there are many determinants to health. I would to these determinants, and I mean the chart is full as it is, but I would add a few. I would, for example, add urbanization. I would add population dynamics such as the aging population. I would add access to water and sanitation. I would add infrastructure and I would also add gender based violence, which is not automatically covered by the social determinant of gender equity. Again, just to show the impact of one of the social determinants of health. Let's look at the next chart, which shows the correlation between education and life expectancy, again, life expectancy at birth and expected years of schooling. You can see that the correlation is very, very strong. Clearly education has an impact on health, but we also know that education has a tremendous impact on development. In the next chart we can also see that in addition to the social determinists of health behavior matters. The chart that I'm showing comes from the United States and it actually shows that behavior patterns matter just as much as genetic predisposition in health care combined when it comes to premature deaths. And behavior is critical when it comes to known communicable diseases, the other side of the coin is of course lust like health promotes development and development promotes health, not investing in health has a negative impact on development. If we look at communicable diseases such as HIV/AIDS, malaria, and tuberculosis, in addition to having very tragic consequences on people's lives and on their families, they also cost a loss of productivity. They increase medical expenses, and they thus increase poverty, and also in instances, they reduce access to food, and they also increase dependency ratios. Normally, the care of the people who are sick also falls, becomes the responsibility of women. And so they also, in a way, contribute to women's opportunities to educate themselves, etc. So they have negative consequences on both families, on individuals, but also on societies and economies. And today also non communicable diseases such as heart disease, diabetes, obesity is also having greater impact on the developing countries and they come at a very, very high cost also to development. So maybe, possibly, to sum up the relationship, we can conclude that good health strengthens development, because it increases productivity. It strengthens people's capabilities. It strengthens the work shop. it increases savings and investments. It's also promotes positive behavior. And it does reduce poverty. In a recent perspective, this was also acknowledged at last year's Rio+20 conference held in Rio de Janeiro in 2012. It was recognized that there is a strong and mutually reinforcing relationship between health and development. And the conference recognized that health Is both an input and indicator and an outcome of development. Let me finalize by making some comments on the millennium development goals that actually also put health at the center of development. There were eight goals. And you can see them in the slide here. And three of them are specifically health-related. But all of them relate to health and, of course, they also relate to development. If we look at the three specific health goals, the fourth goal is to reduce child mortality and the actual target was to reduce by 2 3rds under 5 mortality rates between the period 1990 to 2015. The goal in number five is to improve maternal health. And in fact the concrete target is to reduce by three quarters the maternal mortality ratios between the same period, 1990 to 2015. And goal number six was to halt the specific target of goal number six, which is to combat HIV/AIDS, malaria and other diseases. Among the specific targets were to halt and reverse the spread of HIV/AIDS and also to halt and reverse the incidents of malaria and tuberculosis. And if we look at the progress, as we can do on the next slide, we can see that there's been pretty impressive progress. For example, child survival has increased significantly. 4 out of 5 children today get the vaccinations they need and 3 million, it's estimated at about 3 million children's lives are saved each year because of improved conditions. And we can also note that fewer people are becoming infected by HIV. And many more than previously have access to antiretroviral therapy. And there's been a tremendous growth including in developing countries and here it's interesting to know that this is not only relating to health sector action, it relates also to the fact that genetically produced medicine is now becoming readily available and this was a change in patent laws that made this possible. So I think it's an important factor to talk about and we can also, wanna rejoice in the fact that The global malaria deaths have declined by around one quarter. There's one goal where progress should have been much more important, and that's the goal on maternal mortality. While maternal mortality has almost halved since 1990, the levels are very far from the 2015 target to actually reduce maternal death by 3 quarters. I would like to use the example of the millennium development goal number five, to demonstrate the importance to have a multi-sectorial approach to health. Why we cannot progress in reduction of maternal immortality. The progress is still too inadequate. In fact, it's rather shameful. Maternal deaths are preventable deaths. And yet today around 800 women die every day from giving birth. This shouldn't be the case, and we actually know what to do to prevent these deaths. And clearly the health sector has a lot to contribute to improve maternal health. Including access to family planning, access to sexual and reproductive health services, access to antenatal care. Access to medicines, ensuring that there are skilled birth attendants present when the mothers give birth, etc. And also access to full and emergency obstetric care. But there are factors, there are economic and social factors that play a role in the current scenario of maternal death. And they include girls and women's access to education. They include poverty. They include infrastructure, including access to transport and access to energy. And in order to really do something, to actually, during the 2 and a half years that we have left until 2015, to do something serious about improving maternal death, we need to ensure that development and health actors work together. Because the health sector alone can not achieve the progress that all women so rightly deserve. [MUSIC]
