Mr. Chair, please allow me to congratulate you and the other members of the bureau on your election. We are confident that you will ably guide us through this year's meeting.
This debate is about national experience in health, morbidity, mortality and development. Although in Norway most of the population has good health, we also have several challenges in these areas. Among these are regional and social disparities in life expectancy, and rapidly growing health care costs related to the ageing of the population. However, these challenges are minute compared to the problems faced by the poor countries of the world.
This year's theme reminds us of the self-evident: Under-development leads to bad health, and health problems of poor and deprived people often lead to catastrophic expenses, with further detrimental consequences for development. This vicious circle is well known. What the world still grapples is how to break this vicious circle.
Sometimes we need radically new approaches, but at other times we can learn from the past. It is encouraging that there is a renewed interest in Primary Health Care, exemplified in the World Health Report of WHO in 2008. The Alma Ata Declaration adopted in 1978 is again brought into the open; WHO and others are revitalizing it. When this is done more than 30 years after the declaration was launched we have the advantage of building on experience gained, and framing it in today's language and thinking.
Primary Health Care is a level of health services. But it is also a philosophy and an approach. At the time of Alma Ata the slogan was “for the people, by the people“. Health care should be accessible, acceptable, affordable, and of good quality. Health care should be empowering. It should take into account, people's own knowledge and skills.
Today we frame this in a rhetoric of strengthening health systems, continuum of care, and of Human Rights. The Human Rights deal with the right to health care, the quality of care, and with the underlying determinants of health.
A truly people-centred approach to health care must take into account not just what is fashionable or where new technological inventions can be put to use, but what people see as their health problems. There is not much excuse to continue to neglect what is rightly called neglected diseases. These are debilitating diseases that continue to haunt millions. Often they do not require new inventions but dedicated health staff and creative use of well-known technologies and approaches. Another example of a health problem that has experienced fading interest is nutrition. Despite the fact than in many countries with high child mortality about half of the deaths have malnutrition or under- nutrition as an underlying cause of death.
Many countries have larger numbers of adolescents than ever before. They need skills and means to live a life with good health. They need sexuality education and access to affordable methods to protect against infections and unwanted pregnancies. We cannot support an ostrich policy of denying sexually active adolescents the right to information and access to such methods.
The MDGs take a prominent place in the global debates. MDG 4 sets a goal for reduction of child mortality. The importance of considering nutrition has been mentioned. Also the needs of newborns should be considered. What is needed is often not so much new and sophisticated technology in order to save the lives of newborn, but better observation and care by all involved, including health staff. A change of attitude is often required, especially for babies in the first hours of life. At times a high level of sophistication is necessary, but often it is a matter of attentive staff that adheres to professional and ethical standards. The staff needs to be motivated, which is a huge challenge when the surroundings are anything but motivating.
The ICPD Programme of Action is central to CPD. The Human Rights principles of health services and the principles from Alma Ata are in turn at the core of the ICPD. And since ICPD deals with health issues that are so intimately linked with existential, cultural and religious values, knowledge and rigorous science are essential if the best results are to be achieved.
Fortunately we are now much better equipped with knowledge on what works in the area of sexual and reproductive health and rights than we were at the time of the Cairo conference. Research has been carried out across the globe. The Human Rights reporting system and courts have gained experience on issues linked to sexuality and reproduction. In 2009 WHO published the report “Women and Health”. WHO describes in this report a clear relationship between the strictness of abortion legislation and mortality from abortion complications. What was said during the Cairo conference, namely that abortions do not disappear if they are banned, but they become much more dangerous for women, has now been proven with data from all over the world. And reduction of abortion deaths is necessary for the achievement of MDG 5.
The ICPD saw health services linked to sexuality and reproduction as a cluster of interlinked activities. We are particularly concerned that Family Planning, which is an important component, has received too little funding in recent years, as documented in the report of the secretariat for this meeting.
A topic that the ICPD did not deal with was sexual orientation. Attempts were made, but no consensus was reached. Also in this area we are being equipped with more knowledge. Increasingly scientific studies are revealing the nature and development of sexual identity and orientation.
Mr. Chair,
At the heart of Human Rights lies non-discrimination. Denial of freedoms and rights in the area of sexuality and reproduction affects the poor disproportionally. Norway shares the view of the first UN rapporteur on health and Human Rights, Prof. Paul Hunt that time is ripe to acknowledge the term Sexual Rights. This would include the right to safe, legal abortion for women with unwanted pregnancies, and the right to non-discrimination based on sexual orientation.
The ICPD Programme of Action was forward-looking in the sense that it embraced Human Rights and was technically sound. Many countries changed their policies, and we welcome the changes that followed the adoption of the Programme at national and global level. But the foreseen results are still not in place. All the three MDGs on health are related to the Programme of Action, and MDG number 3 deals with gender equality and women's empowerment, which is an important underlying determinant for sexual and reproductive health.
2015 is the deadline for reaching the goals of ICPD. But the principles of ICPD are not time bound. The consensus in Cairo came after a long, elaborate and democratic process. The process that is to be put in place to look beyond 2015 should not change the values and the principles of the ICPD Programme of Action. We would suggest a process similar to the one that took place at ICPD+5 in 1999, where we took stock of the situation and discussed how to move the process forward.
Thank you for your attention.