Identifier
Created
Classification
Origin
09GENEVA582
2009-07-14 16:40:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
Mission Geneva
Cable title:  

ECOSOC 2009 GENEVA HIGH-LEVEL SEGMENT

Tags:  ECON EAID ECIN PHUM UN 
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VZCZCXYZ0010
RR RUEHWEB

DE RUEHGV #0582/01 1951640
ZNR UUUUU ZZH
R 141640Z JUL 09
FM USMISSION GENEVA
TO RUEHC/SECSTATE WASHDC 8847
RUCNDT/USMISSION USUN NEW YORK 3066
UNCLAS GENEVA 000582 

SIPDIS
SENSITIVE

DEPT FOR IO/EDA AND IO/T
USAID FOR OFDA AND ODP

E.O. 12958: N/A
TAGS: ECON EAID ECIN PHUM UN
SUBJECT: ECOSOC 2009 GENEVA HIGH-LEVEL SEGMENT

SENSITIVE BUT UNCLASSIFIED

UNCLAS GENEVA 000582

SIPDIS
SENSITIVE

DEPT FOR IO/EDA AND IO/T
USAID FOR OFDA AND ODP

E.O. 12958: N/A
TAGS: ECON EAID ECIN PHUM UN
SUBJECT: ECOSOC 2009 GENEVA HIGH-LEVEL SEGMENT

SENSITIVE BUT UNCLASSIFIED


1. (SBU) Summary: The 2009 High-Level segment of the United Nations
Economic and Social Council (ECOSOC) was held in Geneva from July
6-9 and focused on current global and national trends and their
impact on social development, including public health. As such the
meeting examined the current financial crisis and its impact on
global health, as well as on progress towards the heath-related
millennium development goals (MDGs). There was general consensus
that the crisis was harming both the health sector of many
developing countries, and the resources they could devote to it, due
to a variety of factors including lower fiscal revenues and trade
levels, higher unemployment and demands on social safety nets as
well as lower assistance levels by some donors. There was also
consensus that substantially more needs to be done to address
unacceptable levels of maternal mortality in most developing
countries, and particularly in Africa. Many delegations voiced the
need for action on rising levels of non-communicable diseases (NCDs)
(hypertension, diabetes, etc.) with some calling for a new MDG and a
summit on this issue.


2. (SBU) A number of countries presented high-quality voluntary
national reports on health developments in their countries, although
unfortunately the crowded agenda provided little time for useful
interaction on these reports. The U.S. statement is available at
http://www.us-mission.ch/ and www.usunnewyork.usmission.gov . After
difficult negotiations, the Council adopted by consensus a
38-paragraph Ministerial Declaration. Agreement on this document
(and conclusion of the session) was delayed until late on the final
night due to Japanese dissatisfaction that the term "human security"
was absent from the text. After accepting a US-brokered compromise,
Japan joined consensus without the term, in return for explanations
of positions by the United States, the European Union and Sudan (for
the G-77 and China.) END SUMMARY.

High-Level Segment
--------------

3. (U) The High-Level Segment is the first of five segments of the
ECOSOC 2009 Substantive Session held in Geneva from July 6-31. The
other four (Operational Activities, Coordination, Humanitarian
Affairs and General) will be reported septel. The High-Level

segment has four components: a High-level policy dialogue with
international financial and trade institutions; an Annual
Ministerial Review (AMR),thematic discussions and a Ministerial
Declaration. There were no other formal decisions at this segment.



4. (U) At the opening of the High-Level Segment UN Secretary
General Ban Ki-moon emphasized that the global community "Must not
let the financial crisis be an excuse for inaction." Margaret Chan,
the Director General of WHO, discussed "unfair consequences of
flawed policies," and urged ECOSOC to maintain the momentum in
efforts to reach the MDGs. Michael Marmot, Chair of the Commission
on Social Determinants of Health, focused on the unfairness of
current status of global health citing the 50 year difference in
life expectancy between Japan (86) and Zimbabwe (40). Cherie Blair,
speaking on behalf of the Cherie Blair Foundation for Women, urged
progress against fistula and NCDs, saying that it is time to give
women their voices. She was followed by Sarah Omega Kidangasi, a
maternal health and fistula advocate from Kenya, who spoke
eloquently about her experience in suffering from fistula for 12
years before receiving treatment in May 2007.


5. (U) The policy dialogue with the international financial and
trade institutions consisted of similar messages from the moderator,
Sha Zukang, Under-Secretary of UNDESA, and the four panelists, the
WTO Director General, the UNCTAD Secretary General, the IMF Deputy
Managing Director, and the World Bank's Vice President for Human
Development. All urged that stimulus measures be continued and not
ended prematurely. WTO chief Pascal Lamy stated that trade has been
a stabilizing factor in the past, and thus far no intense
protectionism has arisen. The World Bank representative urged the
global community to do more to support growth and protect the poor.
The projected economic growth for developing countries has dropped
by one third, making achievement of the first MDG, the halving of
poverty by 2015, according to her, all but impossible.

Annual Ministerial Review (AMR)
--------------

6. (U) The theme of this year's AMR was "implementing the
internationally agreed goals and commitments in regard to public
health". In opening this segment, UN Under-Secretary-General (DESA)
Sha Zukang noted the declining fiscal revenues, falling household
income, and rising unemployment of low income countries due to the
current financial crisis and said these and other factors will harm
already over-stressed developing country health systems, and provide
such countries less resources to devote to this sector. He urged
the international community to take a global and long-term vision in
addressing these and other challenges of development. He also
emphasized the need for donor coordination. Most interventions
discussed the financial crisis as often as they did health issues or
the MDGs.


7. (SBU) There was general consensus the current international
financial crisis is making it more difficult for many developing
countries to continue to make progress in improving their health
systems and in reaching the health related MDGs by 2015. The
representative of Barbados made one of the strongest interventions,
noting the need for improved international cooperation, monitoring
and donor cooperation. Most developing country interventions
expressed thanks for donor support but requested more resources on
an urgent basis. Several countries, including Jamaica, noted that
high levels of domestic violence and crime were harming efforts to
improve health. India complained (at length) about EU seizures of
Indian generic drugs bound for Africa. The Russian delegation
emphasized the importance of improving road safety as a health issue
and indicated they were going to hold an international conference on
this issue.


8. (U) There was also strong consensus that insufficient progress
was being made to counter maternal mortality rates, particularly in
Africa. A variety of reasons were given for the "unacceptably" high
rates of essentially preventable deaths; all the delegations that
intervened, without exception, noted this was an area that further
focus and progress has to be made.


9. (U) A key element of the AMR was the presentation of relatively
high quality and frank voluntary national presentations by China,
Dominican Republic, Jamaica, Japan, Mali, Sri Lanka, and Sudan. The
Chinese presentation was perhaps the most optimistic, noting China's
strong progress on health and also its aggressive counter-cyclical
package focused on the financial crisis. Even China noted it needed
to make more progress countering maternal mortality rates. A
notable exception to the balanced discussions of the problems,
progress and challenges of the different health systems was the
presentation of Bolivia which was a more political document that
only tangentially focused on health.


10. (U) Many delegations also called for more work on
non-communicable diseases (NCDs) such as hypertension and diabetes.
Several delegations, including Barbados, called for a new MDG on
NCDs as well as a summit to discuss them.


11. (U) The High-Level Segment Thematic Debate on "Trends in aid and
aid effectiveness in the health sector" was the last scheduled
activity in the High-Level Ministerial Review in this ECOSOC
Session. Moderated by the ECOSOC President, Sylvie Lucas, the panel
included the Minister of Planning from DROC; Anders Nordstrum,
Director-General of Swedish International Development Agency;
Eckhard Deutscher, Chair of the Development Assistance Committee,
OECD; Helen Evans, Deputy Chief Executive Office GAVI, the former
Minister of Health from Mozambique and the Director for Development
Policy, European Commission. The Congo Minister of Planning
discussed the current state of health and health financing in the
Congo, and described measures his government has taken to
rationalize assistance to the health sector and increase its impact.
The Government's health strategy suffers from inadequate financing,
receiving less than 3.5 percent of the national budget in 2007 and
2008, representing less than one percent of the GNP for this period.
In a recent National Forum on the Effectiveness of AID in Kinshasa
in June 2009, the Ministry of Plan announced a plan for the
Integrated Development of the Health Sector, to end the vertical and
fragmented approach of assistance. COMMENT: The Congo Minister's
presentation underscored the need for country-specific approaches to
health-related aid measures. While external aid is often a
necessary adjunct of developing nations' health policies,
country-specific approaches should allow countries to better manage
their own finances and direct aid efforts more efficiently. END
COMMENT.


12. (U) Anders Nordstrum brought new perspective to the often
repeated exhortation on the importance of "keeping commitments,"
noting that in the 2001 Abuja Declaration, African leaders pledged
to allocate at least 15 percent to improving health status. He
discussed the need to simplify the aid landscape, saying that even
if the multiple streams of funding can be managed, the transactional
costs are greatly reducing the impact of the huge sums available. He
noted the importance of mutual accountability, "to taxpayers in
Tanzania as well as to those in Sweden" and thus of reducing
corruption, and tax evasion, now estimated at USD 160 billion,
greatly complicating governments' abilities to provide services. In
response to the panel, many delegations expressed impatience with
the speed of implementation of the Paris Declaration and Accra
Agenda; with the lack of recognition of country ownership,
especially in the broader form advocated by several panel members;
and requested greater levels of aid with less conditionality.
Unfortunately, time for discussion or response was minimal.

Ministerial Declaration
--------------

13. (SBU) Late on the evening of July 9 ECOSOC adopted by consensus
a ministerial declaration that highlights the need for stronger
health systems, improvement on maternal mortality, attention both to
infectious diseases and non-communicable diseases, enforcement of
intellectual property rights (IPR),the importance of sexual and
reproductive health, and the link between health and poverty, among
other issues. The U.S. delegation played a helpful role on
developing most paragraphs, often proposing language that bridged
differences between the G77 and the EU. This was due to the
comprehensive and flexible guidance provided by Washington and the
non-controversial nature of most of the issues. The lengthy and
often difficult debate over TRIPS and access to medicine was an
exception, but in the end we reached agreement on IPR language on
IPR that was acceptable to the United States and actually appears
more critical of European policies.


14. (SBU) During the final stages of negotiation, the G77 mobilized
the Arab delegations in Geneva to demand inclusion of a earlier
reference to foreign occupation. Israel had previously proposed a
paragraph on terrorism to balance the G77's proposal on foreign
occupation. USDel and facilitator worked on a watered-down package
proposal that gained approval from the Palestinians and G77,
focusing on the need for a functioning health system in situations
of armed conflict and foreign occupation, as well as the physical
and mental health needs of victims of terrorism. Agreement on this,
the TRIPs language, and a couple of other issues allowed the
document to be closed early on the morning of the final day.


15. (U) However, an unexpected twist came late on the final day
when, contrary to expectations, the Japanese delegation refused to
join consensus without the inclusion of the phrase "human security"
in the text. They had unsuccessfully argued for its inclusion
during the negotiations. This term refers to a Japanese concept
that has been struggling to gain traction for several years. Their
proposal to include this phrase in the text had support from the
delegations of the US, EU, Mexico and Kazakhstan, but unyielding
opposition from the G77, who possibly wrongly suspect that the
ill-defined term may eventually be used to justify humanitarian
interventions to protect civilians. Only after three rounds of
formal meetings at the ambassadorial level on this point,
interspersed with private conversations between the Japanese and the
President of ECOSOC; the heads of the US, Swedish, Sudanese and
Russian delegations; and PermReps in New York, did the Japanese
agree to a USDel suggested compromise to join consensus on the
declaration, with Explanations of Position (EOPs) issued by each of
the delegations (Japan, US, EU and G-77) above regarding "human
security." The G-77 EOP noted that the failure of the text to
include "the issue" at this time did not preclude the ability of the
delegation (Japan) to raise it at another time or in other fora.
The text of the US EOP may be found on the USUN/NY and USMission
Geneva websites at http://www.us-mission.ch/ and
www.usunnewyork.usmission.gov

GRIFFITHS#