Speech by H.E. Mr. Anand Panyarachun
for the International Conference

“Global Public Health Perspective:
Where Do We Go from Here?”

Siam International Hotel, Bangkok
November 16-18, 1998

A quest for a new world order:
A place for women and children

Honoured Guests, Ladies and Gentlemen,

I am pleased and honoured to have the opportunity to address a conference that celebrates the 50^th anniversary of two institutions, the world Health Organization and Mahidol University, both committed since their origin to the ideals of scientific advancement and equal opportunities for every human being to secure the fruits of technological progress.

The most difficult period of history to understand for us is always the present in which we live. It is, therefore, a tricky undertaking to guess the features of a new order that human kind is forging, consciously or not consciously. For sure, the suddenness and scale of changes in the last twenty years suggest that we are living through a sequence of revolutions.

Probably the unprecedented development in communication technology is the main common determinant behind tremendous recent changes that ranges from the end of Apartheid to the narrowing of ideological divides, from the collapse of many dictatorships to the end of state economic monopolies and from the boom to the recent fall of Asian economies.

Here we will not examine detailed aspects of each of these changes with their explanations. The theme assigned to me has a clear assumption: to be worthy of its times and capable of meeting the challenges of the future, any new world order has to be propitious for children and women to develop their full potential. I accept this assumption when I discuss here the quest for a distinct place for women and children in a new world order. I strongly and sincerely believe that this requirement, although especially important for the third poorest part of the world, has a strategic importance for the whole planet.

The quest for a place for women and children in a new world order requires a conjunction of wills, hearts, minds and hands. To support this quest with consistent actions we have to refer not only to our values and ethical principles, but also to some lessons learned from the collective experience.

Most key elements that we want to see in the new order are already explicit in the Charter of the United Nations and in the national constitutions that during the past century have guided dozens of countries around the world. Moreover, some new sound elements have been widely accepted and endorsed, particularly in the last two decades, in a series of international conferences on development, population, environment, women and children among others. I would like to propose here six ethical principles and lessons learned that constitute, in my view, “imperatives” for a new world order that favour women and children. These are:

With the highest priority – a first call for children. Essential needs of all children should be given high priority in the allocation of resources, in bad times as well as in good times, at the national, international as well as at family levels.

Second, a new order should oppose the apartheid of gender as vigorously as the apartheid of race. To discriminate girls in the educational opportunities is an unacceptable mistake. Employment rights, social security rights, property rights and even civil and political liberties should not depend on one, unfortunate little chromosome.

Third, if the issues of malnutrition, preventable disease, widespread illiteracy and poverty are not confronted as a new world order evolves, it will be so much more difficult to reduce the rate of population growth and make the transition to a form of development that is environmentally sustainable.

Fourthly, the growing consensus around the importance of market economy policies should be accompanied by a corresponding consensus on the responsibility of governments to ensure and promote basic investments in people.

Firth, the international action on debt, aid and trade should create an environment in which economic reforms in developing countries can succeed in allowing ordinary people to earn a decent living.

Last but not least, is democracy in a broad sense of the world, political freedom, decentralization, transparency in government action, and participation of women in politics? These are not just desirable and suitable for certain countries: in the Four Corners of the world these have proven to be clear paths to economic and social development.

Too many times in history have experienced economists failed to predict economic trends, no matter how much was invested in preparing those predictions and how many mathematical calculations were used. But here, I am not afraid to say that the imperatives above, if put in practice, will serve to strengthen social and economic development, not just in the long run, but also in the short and medium term as well.

These paths are not without their pitfalls and every country must proceed at their own pace. Government endorsement and general awareness on child rights and non-discrimination against women have grown tremendously in most parts of the world. However, in places like South Asia and Africa, millions of children die of preventable diseases, and hundreds of millions of women still suffer gross discrimination. AIDs and economic stagnation are threatening remarkable achievements in women and child health that were obtained in the last few decades. Global military expenditures are on a downward trend, but today there are more civil wars going on than two decades ago. Awareness on environment protection has grown substantially, and sustainable development proposals prevail in the discourse, but, in practice, the risk of major ecological crisis is growing a bit every day.

Still, we feel that these causes are far from being hopeless. The principles I have just outlined are based on solid arguments and extensive experience. The special vulnerability of children is well known: in their first three years both survival and future development are constantly at risk. Every child, boy and girl, if well educated, will be able to give his or her unique and valuable contribution to humanity, including in the economic sphere. Contrary to a somewhat current opinion, improvements in child survival have never accentuated population growth: families that are more knowledgeable in the care of children and confident in their survival are more motivated to avoid unwanted pregnancies.

In a desirable new order, it may be appropriate in most cases to reduce the involvement of the government in the production and delivery of certain services. But women and children will still need a competent public sector to promote prevention and care, and provide accessible quality schools and other institutions dedicated to education. Many of our countries stagger under the burden of external debt. Yet we continue to deny that the bulk of these debts have to be paid by the masses – the most humble labourers and their families. This will definitely not produce lasting growth, and furthermore, will not prevent the repetition of similar situations in the future. Democracy and decentralization have a special reason to be regarded as crucial factors to produce a new order: they are much more compatible with the unstoppable growth of free communication than other ways to run a government.

The rationale of the six imperatives that I proposed appears clear from the considerations above. Let us look now at ways each country can ensure that these six imperatives will influence the lives of real people. A new international order will, of course, be made of a sum of facts that happen in individual countries.

We have to see the Convention of the Rights of the Child (CRC) and the Convention on the Elimination of all forms of Discrimination against Women (CEDAW) as key instruments. These particular conventions not only produced declarations, but were also followed by official treaties with mechanisms for international monitoring. The process of reporting on the national compliance to the international bodies may be, in itself, a powerful tool for change if the discussion on the articles of these conventions is popularized. This is beginning to happen in various countries, including Thailand, and we hope that this practice will extend until it is the norm, rather than the exception.

In many countries, free elected governments ratified these conventions. It is then democracy that will support the enforcement of regulations that emanates from them, while the dissemination of information by the many new formal and informal networks will in turn support democracy in this process.

Still, we must be aware that international treaties, national laws and regulations and international monitoring of indicators are not sufficient to guarantee these rights. Even wide, intensive and popular discussions on the compliance with these treaties will not be sufficient. We need comprehensive government plans that are adequately funded within the limits of national budgets. Also, these plans have to be carefully administered and monitored.

Participation of key non-government stakeholders in the preparation and implementation of the plans will contribute to better define the objectives, to find out the most appropriate ways to achieve these objectives and to monitor, evaluate and readjust strategies. Diversity of perspectives has to be valued as an asset and no more as a problem. Each country might find out its own way to get meaningful and effective participation: some have created effective commissions for women’s affairs, some have proposed integrated special committees and task forces for children, or even a special Ministry for children. Some others, instead, did a serious job in putting the specific concerns with women and children needs and rights into the routine work of a variety of institutions.

I see that some major objectives, such as AIDS prevention and care, or ending of trafficking of women and children, also deserve specific national or even regional plans, endorsed at the highest political level. Special challenges for these objective oriented plans being:

• to break down the barriers among sectors;
• to harmonize the contribution of government, private sector and NGOs; and
• to specify objectives and strategies for the short, medium and long term

We regard these challenges above, together, as an additional imperative that arises from decades of experience in working for and with women and children. They remind us, for example, that physical, mental and emotional health, development, education and special protection have to be addressed simultaneously, in a balanced fashion; that independent women’s organizations have a lot to contribute to the effectiveness of programmes for AIDS control, for a safe motherhood, for sanitation or for poverty alleviation; that children have to be prepared for the future in a fast changing world, but their future is also decided today, because today an avoidable disease might impair forever this future.

Now different actors have their roles to play, and different responsibilities in providing a place for women and children in the new world order, I would like to look at two of them, namely the governments and the scientific community.

A pivotal role of the governments is to provide universal and equal opportunities at least for survival, and to promote early childhood development and elementary education. Besides this typical mandate in the sphere of well-known basic services, children and women need to have access, systematically, to channels and services that deal with abuse and other gross violations of rights. All this is valid for all countries and, especially in the poorest, requires careful prioritization among different alternatives.

Changing the balance of existing expenditures in favor of the poor majority is necessary in many cases. Some countries have succeeded in this, but not without huge difficulties. It is not easy, for example, to shift the priority from national airlines to domestic bus routes. Where democracy is strong it may be easier, but in general this is more like to happen if overall resources are expanding rather than contracting. This brings the discourse to economic development, to access to international aid and, of course, to the adjustments that, in periods of crisis, are supposed to restore development.

An interesting approach is that, even in a market economy context, targets for development plans should be first expressed in terms of basic human needs, and only subsequently translated into physical targets for production and consumption.

Too much international aid goes to unconnected projects rather than in support of a set of policies and strategies agreed upon in recipient line ministries, coordinated with plan and finance, and approved at the political level. As a consequence, too often requests and responses to aid tend to favor expensive and even unsustainable capital-intensive efforts likely to benefit the higher income brackets in society.

Although the aim of adjustment programmes is to help restore financial stability to accelerate growth, these should always include strategies to alleviate the negative effects on the income of the poorest. Employment and, particularly, programmes in education, health and natural resource protection should be protected.

We insist, in other words, in a better targeting on the part of the recipients as well as on the part of the donors. A recent initiative, called “20/20” pursues this objective. This was launched in 1992 by UNICEF and UNDP, and proposes that at least 20% of the national government expenditure has to go to health, education, water supply and sanitation, while at the same time at least 20% of external aid also has to go for these same areas. So far no developing country and no donor have complied with this target.

As for the scientific community, represented in this room with many exponents in the area of public health, certainly has a role to play to ensure a place for women and children in a new world order. Representing 80% of the World population, developing countries account for 90% of the world’s burden of illness and disability. Yet, excluding research on AIDS, only 5% of the global expenditures on health research is devoted to the health problems of developing countries.

In the area of basic research, in order to explain the mechanisms of diseases and for technology development, we see the need to increase allocation to respond, for example, to the unanswered questions related to respiratory infections and malaria, with high impact on poor children all over the world. Such researches are better carried out through international collaboration and exchange, and should involve institutions in both the developing and industrialized nations.

Even more emphasis should be given to support with additional resources, the better understanding of the most suitable ways to ensure the successful application of existing knowledge, as well as the efforts to improve surveillance of behaviors and diseases. This type of study, to be strengthened in developing countries, includes epidemiological field studies, health communication surveys, studies on drug suppliers and demand, health services financing and information systems in support of management. This knowledge will enable planners and managers to better establish priorities and design programmes that might channel limited resources to benefit more people.

Similar considerations have to be made on the research on education and on selected social issues, especially related to women and children, such as violence and other behavior-related fields. In developing countries, an increase in the support for good quality studies on service supply and demand. Management, communication and cultural aspects involved in these fields would have a great return for women and children.

In conclusion, I would like to declare my optimism for a new order, or, more simply, for the new times ahead.

Like the Universal Declaration of Human Rights that emerged in 1948, the Convention on the Elimination of all forms of Discrimination against Women (CEDAW) from 1981, and the Convention on the Rights of the Child (CRC) from 1992, were conceived to last for centuries, such is the strength of the principles that sustain the articles of these documents.

This strength suggests that their survival, with growing enforcement, for one millennium or more is not pure Utopia. We can look at these human rights as proposals and aspirations. We needed thousand of years of suffering, struggle and, of course, improvement in communications among nations and people to reach a consensus on this comprehensive spectrum of proposals. Many of these aspirations are rooted in most traditional cultures. We don’t need to contradict the principles of any religion or culture to affirm the validity of the CRC and the CEDAW.

These treaties are typical products of a new era, where no nation and no village live any more in absolute isolation. Although knowledge of the treaties still eludes perhaps half of mankind today, they are nevertheless known and valued by millions of individuals all over the planet.

We feel that these millions of people may make a difference, by helping to accelerate the compliance with established rights, also by disseminating the new ideas to others. Many organizations too, much more than ever, are exercising their creativity to preserve and uphold women’s and children’s rights. They form a critical mass that share the mission of upholding these rights. Their members and leaders are professionals or volunteers who operate in the public sector as well as in NGOs. Diverse in culture and backgrounds, they are involved in delivering services at the grass-roots level as well as in discussing solutions with some degree of abstraction. Their power is growing, allied to the well-known rapid improvement in communications.

Peter Senge, a known thinker of modern management, said that the organizations that will prosper will be those capable of recognizing the value of the “many leaders” within them. The same applies to the world as a whole. The hope of a worthy order, with a place for women and children, resides in the strength of the “many leaders” that will put their hearts, brains and hands at work for this ideal.