Health, Women's Empowerment, and the MDGs: Cornerstones of Sustainable Development and the Future We Want
Dr. Tony Tan, President of the OGSS
Dr. Tan lay Kok, Vice President of the OGSS
Dr. June Tan, Chairperson of the Organizing Committee,
Ladies and Gentlemen,
It is my great pleasure to be with you tonight, and my great privilege to have been asked to deliver this annual oration.
The ancient Greek physician, Herophilus, believed to be the first anatomist, once wrote that: “When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied.”
In other words, health is the foundation upon which all other achievements depend. Yet today, in the second decade of the 21st century, despite the most advanced science, the most educated population, and the best medicine in human history, it remains largely an accident of birth which determines our life circumstances.
A girl, born today in Hong Kong or France, expects to live to the ripe old age of 85 or beyond. The same girl, born in Timor-Leste, would instead expect to live only to 68 – or 45 in Sierra Leone.
This is a difference of 40 years – four decades of working, learning, loving, and living.
Ours is the last generation which can still tip the scales of health equity, creating a better tomorrow for generations yet unborn.
Ladies and gentlemen,
Acknowledging the Social Determinants of Health
This is not to argue that issues of health policy and health equity alone determine our success or failure as a people – quite the opposite in fact. This is an argument to view health indicators and measures more holistically – to regard them, when they show glaring disparities, as ‘canary-in-the-coalmine’ warning signs of social and developmental risk which run much deeper, and which require much greater coordination and collaboration to address in our societies.
We know that, even in our richer countries, levels of health or ill-health often correspond directly to one’s place in the economic and social order, especially if one happens to also be a woman. Yet for too long, we have regarded illness, disease, and death as challenges which fall primarily to the health sector to remedy. To borrow an image from your work, this is a focus on symptoms without a clear understanding, or treatment, of causes.
In 2005, the World Health Organization established the Commission on Social Determinants of Health to tackle this disconnect. The Commission was tasked to collect and synthesize the global evidence on the social determinants of health, and to make recommendations for action to address these inequalities. In the words of the Commission’s final report: “Social injustice is killing people on a grand scale”.
My good friend, and Nobel Laureate, Professor Amartya Sen, who was also a member of the Commission, had earlier observed that health equity was a critical component of what he called “the justice of social arrangements in general”, and that “[h]ealth equity is most certainly not just about the distribution of health, not to mention the even narrower focus on the distribution of health care”.
This perspective, reflected also in the Report of the Commission, was effectively a new approach to development, which acknowledges that whilst: “health and health equity may not be the aim of all social policies […] they will be a fundamental result. Take the […] policy importance given to economic growth […], growth by itself, without appropriate social policies to ensure […] fairness in the way its benefits are distributed, brings little benefit to health equity”.
To close these development gaps, in order to improve health, the Commission recommended a number of actions based on three principles: improving the conditions of daily life for all; addressing inequalities of power, money, and resources globally, nationally and locally; and doing more to understand and measure the problem and to assess the impact of new action. It was a very simple prescription, but one which should become a key foundation of our post-2015 sustainable development agenda.
Ladies and gentlemen,
Asia-Pacific Progress on the MDGs
In this time of global economic uncertainty, the Asia-Pacific region has become the anchor of financial stability and the new engine of global economic growth. Increasingly, however, the world is also looking to Asia to lead on issues of social development and environmental stewardship – not least because two thirds of humanity lives in our region.
For almost a decade and a half, our agenda to close development gaps has been driven, in Asia-Pacific and around the world, by the eight Millennium Development Goals (MDGs). Asia-Pacific as a whole has had considerable success with the MDGs, particularly in reducing levels of poverty. Nevertheless, the region remains off-track when it comes to hunger, health, and sanitation – and even in areas such as poverty, a number of Asia-Pacific subregions and countries are lagging behind.
Despite remarkable overall regional growth, disparities exist, with more than 740 million people across the region – including in middle-income countries – still vulnerable to extreme poverty. Moreover, more than 60 percent of the world’s people suffering from hunger and undernourishment – 543 million – live in our region.
In terms of health, Asia-Pacific has not performed as well compared to other MDG targets. We have been too slow in efforts to prevent people going hungry, to stop children dying before their fifth birthday, and to extend maternal and child health care services and prevent mothers dying from causes related to childbirth. In 2011, there were around 3 million deaths of children under five, and nearly 20 million births were not attended by skilled health personnel.
As of today, the 11th of December, we have exactly 750 days to the 2015 deadline for achieving the MDG’s. This is two years and 20 days of opportunities to do better – in a big final push to keep the promises our governments made in 2000. Even countries that appear off-track on certain indicators could yet meet their targets. This is evident, for example, in the case of child malnutrition. Of the 14 countries currently of- track in halving their numbers of underweight and stunted children, 12 could still attain their targets by accelerating their rate of progress by less than 2 percentage points per year.
Ladies and gentlemen,
Women’s Empowerment & Development
Our is the region that can achieve the MDGs. Narrowing inequalities – especially gender gaps – holds the key to this development success, both in terms of the MDGs and in the period after 2015. This is especially evident when looking at issues of women’s health in Asia and the Pacific, because one of the most important social determinants of health is gender, and the gender-related health MDGs are the most off-track.
The life experience of too many women in Asia and the Pacific remains vastly different, not only from that of men but also compounded by disparities of ethnicity, caste, economic status, education, and location. The reality is that, even in the same country, many women live in different worlds.
For many Asian women, giving birth is still one of the most life-threatening experiences they can have. In 2008 as many as 140 000 women died in our region from causes related to childbirth – almost 40% of all maternal deaths in developing countries. A very large proportion of these deaths are, as you know so well, preventable.
Take for instance the situation in Mongolia. Between 2000 and 2010, maternal mortality in Mongolia fell from 166 to just 46 deaths per 100 000 live births. This was achieved through a focus on antenatal care and delivery by skilled birth attendants, changes in government priorities, and improving access to health services for mothers in the rural areas. If Mongolia, with its limited resources, can achieve so much, then the challenge for the rest of our region can be addressed successfully.
It is not enough to simply increase development spending or to improve services – we must address the social determinants of health, because social and economic disparities block development progress – especially for women, with implications for their children.
Achieving this, however, is as much about improving household incomes, closing the remaining gender gaps in education, and empowering decision-making autonomy for women, as it is about expanding services. Gender-based inequities in education, employment and income, for example, make women more vulnerable to ill health and premature mortality.
Improving the status of girls and women strengthens overall health security across generations. Education, for example, builds the capacity of mothers to process health-related information and learn about health and nutritional practices that promote child well-being. Violence against women and girls also remains endemic in parts of our region, and must be stopped.
On the Goal of promoting gender equality, the countries of Asia and the Pacific have eliminated almost all of the gender gaps in primary, secondary and tertiary education, but as many as 25 million children of primary-school age remain out of school – the majority of whom are girls. Women are also under-represented in the sciences and engineering. We have to avoid creating another generation of inequality.
Asia has been and remains the anchor of the global economic recovery, but to sustain this growth requires the creation of greater regional economic resilience – and equal access of women to the labour market is one of the best ways to achieve this. Women’s full participation in the Asia-Pacific labor market, not just in the low-skilled and informal sector, for example, would expand the regional economy by an estimated US$89 billion each year. Recognizing women farmers and providing equal access for rural women to agricultural resources would increase annual food yields by about 4 per cent – and lift as many as 150 million people globally out of hunger.
In other words, investment in women and girls is essential for poverty reduction and development. It is a low-risk strategy for inclusive growth. As the United Nations Secretary General, Mr. Ban Ki-moon has said: “The energy, talent and strength of women and girls represent humankind’s most valuable untapped natural resource”.
This is why, in September 2010, the Secretary-General launched the United Nations’ Every Woman Every Child campaign - an unprecedented global movement to mobilize and intensify action by governments, the private sector, and civil society to address the major health challenges facing women and children around the world. Ambitious but achievable, it aims by 2015 to save 16 million lives, prevent 33 million unwanted pregnancies, protect 120 million children from pneumonia and to end the stunted growth of a further 88 million children.
Ladies and gentlemen,
Shaping Post-2015 Sustainable Development
The MDGs have served a valuable purpose – mobilizing global support around common objectives which must now serve as the basis for an even more ambitious and vigorous development effort in the decades ahead.
The next phase of development calls for a new model based on structural changes for equality, inclusiveness, resilience and sustainable development, as a more integrated whole.
This new approach has to be driven by a transformative agenda that is people-centred, cares for our planet, and which generates shared and sustained prosperity. Now is the time for the Asia-Pacific region to lead on sustainable development and the formulation of universal Sustainable Development Goals (SDGs).
We are aware of the social determinants of health now we need greater awareness of the environmental determinants of health. The health of our environment and the integrity of our ecosystems are intertwined with human well-being. The quality of our air, water, food, soil, and extreme weather conditions have a huge impact on our health.
The argument which we are making in Asia and the Pacific is that growth can only be inclusive if it is more sustainable, and it can only ever be sustained in the long-term by ensuring that growth benefits the widest possible number of people, across generations. Our people are asking for a new social contract for sustainable development, between the state and its people, and between the state and the market – one which finally addresses disparities for people and planet, focusing on lower-carbon green growth that is high on poverty reduction and that is employment generating as well.
This social contract has to promote citizens’ engagement, translating growth into productive employment for all. It has to adopt policies for the fairer redistribution of wealth, economic assets and opportunities – where there is better and more efficient natural resource management and effective delivery of quality basic services to everyone. It has to ensure an alliance for greater accountability of both the public and the private sectors, at the local, national, regional, and global levels.
Your role in this alliance for the next development transformation is vital – as the leaders of our health sector, our academic and training organizations, and our institutions of civil society. Unlike the MDG process, the shift to a more sustainable development future has to be universal, consultative, and ultimately based on the power of lasting partnerships which put the health of people and planet at the centre of our choices.
Governments cannot do this alone. We need your help, as advocates and agents for change – to create the understanding, the organizational space, the policy frameworks, the human capacity, and the monitoring systems to drive change – in health, in the economy, and in caring for our planet and our communities throughout the Asia-Pacific region.
Ladies and gentlemen,
In conclusion, as health care professionals your daily work is to wield the best technology, science, and training in the fight to ensure the wellbeing of your patients. As our guardians on the front-lines of medicine, you know that physical and mental health is shaped, in large part, by economic, social, political, and environmental forces.
My message to you tonight is one of opportunity. There is, at this moment, a once-in-a-generation chance to influence the development priorities of our region, our world, and the human future. I urge you to use your skills, your networks, and your energies care for our people and our planet.
Working together we can build the future we want - where the gifts of the earth are no longer taken for granted, where basic needs become basic rights, where all people develop their full potential, and where progress for one is progress for all, across generations.
I thank you.