By Rev. Msgr. Robert J. Vitillo, Caritas Internationalis Head of Delegation at the UN in Geneva
The most recent “Substantive Session” of the United Nations Economic and Social Council (ECOSOC), held in Geneva, on 06 – 31 July 2009, had what might seem to be an abstract theme –“ focus on current global and national trends and their impact on social development, including health” – but, in fact, it was one of the more practical meetings I ever attended in the august halls of the United Nations Centre here.
The pragmatic directions came right from the “top” – when United Nations Secretary-General opened the meeting by stating that “he crises of the past 12 months – the energy crisis, the food crisis and the current economic crisis – has caused widespread hardship and grief.” Mr. Ban said that health is the foundation for peace and prosperity. Investments in health are investments in society. They save lives and benefit economies through improved productivity. Prevention efforts could avoid huge future expense.
World Health Organization Director-General, Dr. Margaret Chan, was even more direct – she said quite bluntly that “the world is in a mess”. She included the following points to substantiate her claim: Climate change is a gradual and now inevitable event; the effects of more frequent and more extreme weather events will be abrupt and acutely felt; and the gaps and inequities in development and public health are likely to increase. She insisted that a focus on health is a worthy pursuit for its own sake, is the surest route to that “moral dimension” that is so sadly lacking in international systems of governance as well as the surest route to a value system that puts the welfare of humanity at its heart.
Her Royal Highness Princess Muna Al-Hussein of Jordan noted much progress in realizing the goal that often is touted at the United Nations: “Health for all”. She remarked that, for the first time, childhood deaths had dropped below the 10 million mark. Billion-dollar commitments in official development assistance for health have more than doubled over the past few years. But she also pointed out that progress has stalled. The global maternal mortality rate has barely changed since 1990 – with some 500,000 women dying in childbirth each year. Powerful interventions and the money to purchase them will not buy better health outcomes if we lack stronger health systems based on primary health care. She claimed that the world faces problems beyond those targeted by the Millennium Development Goals. Health in rich and poor countries alike now is threatened by three universal trends: population aging, rapid unplanned urbanization, and the globalization of unhealthy environments and behaviours.
The trends discussed at the opening of this three-week meeting on both international health and development pose some serious challenges for the Confederation of Caritas Internationalis. How many of our member organizations would respond with much certainty to a question about their identity as a development organization but then would deny any expertise or particular interest in health? Can Caritas – and the world community – afford to maintain a dichotomy between health and development by relegating “health” to the world of doctors and nurses and development to the realm of social scientists, humanitarian assistance specialists, community planners, human rights activists, etc., etc.
More than twenty years ago, when the CI Confederation identified HIV and AIDS as one of its priorities, some CI member organizations expressed concern that we were wandering into the realm of “health”.
But now, a quick review of Caritas member organization websites will prove that AIDS has been understood as a development issue by more than 107 member organizations that sponsor or support HIV programming among the poorest and most vulnerable populations in this world. HIV continues to be a major development challenge but increasingly public health and development experts that and AIDS-only approach is insufficient – it must be accompanied by efforts to strengthen both health and community infrastructure among those most in need.
For me, the ECOSOC “Substantive Session” brought into greater focus the inseparable connection between health and development. Indeed, the recently-issued United Nations Report on the Social Determinants of Health points out many causes of poor health are more social than physical in nature, including poor housing, poor sanitation, poor nutrition, and involuntary migration – all problems which Caritas has valiantly struggled to overcome in all parts of the world, but most especially in the most isolated, poverty-stricken, and disaster-prone communities. Health is a cross-cutting factor in many, if not most, of the Caritas priorities, including migration, systemic poverty, natural and human-made disasters, and climate change. Is the Confederation ready to recognize and respond by integration health concerns within our overall development and humanitarian assistance strategies and actions?