PERSONAL health and wellbeing is the baseline Indicator for sustainable development. An integrated approach to social development is essential for achieving universal health: goals in one area of social development can be reached only by parallel action towards all goals.
One of the major challenges of the 21st century, therefore is to meet the social and economic needs of a rapidly growing population in such a way as to reduce inequities between developed and developing countries, and to Improve the quality of life in developing countries in a sustainable fashion.
To face this challenge, more resources are needed, not only in the form of public expenditure but also by forming partnerships with the private sector. non-governmental organisations and international agencies. It is also critical for industrialised ‘ fou^ifries" io recognise that aLtwSthi/iati of aid and technical expertise to developing co'iintries. fd .the area of healthcare is crucial for sustainable development and a more equitable world.
By United Nations projections. world population is likely to grow from the current 5.9 billion to between 7.7 billion and 11.1 billion people by the year 2050, with the most likely protection considered to be 9.4 billion. The overwhelming majority of this growth will occur fn the developing countries. Countries which today are strapped for resources to deal with the problems of providing adequate healthcare, food, housing, water and sanitation for the poor and marginalised, are going to find It even more difficult to cope with the demands in the future.
Bangladesh, with a population of 121 million ana a GDP per person of only 8226, has shown how political will and individual tenacity can bring about positive change in the lives of everyday people. Twenty years ago outsiders saw very little achieved in Bangladesh. However, a collaboration between the government, non-governmental organisations and international donors has given Bangladesh a second chance.
By implementing educational and developmental programmes. the government has managed to curb population growth. Twenty-five years ago
the contraceptive prevalence rate was only 7 percent, today it Is 50 per cent, the fertility rate has dropped from 7 to 3.3. Bangladesh has also succeeded in lowering the death rate.
Despite many calls on scarce resources, the country has been able to increase access to reproductive health and family planning information and services. Innovative educational programmes have enable girls ana women to escape from Illiteracy and find alternatives to early marriage and constant childbearing. Educational expenditures in Bangladesh have increased from 9.4 per cent of government spending during 1973-78 to 13.6 per cent during 1990-1995.
Another important form of partnership is technical coop-
tbe^terecoufitrieS-fi^a^Pprinefs in Population and Development initiative launched in . 1994 tai promote the exchange of experiences and the development of regional training Institutions.
As someone who has spent
an entire life dedicated to public health. I cannot emphasise enough the value of human-cen-ired development which has been recognised by the world community as the single most important factor in a country’s drive to achieve sustained economic growth and prosperity.
I was Secretary General of the International Conference on Population and Development (ICPD) 1994. and I am proud of the firm consensus of 179 nations on population and development that the conference produced. The ICPD was the only international conference of the 1990s to agree on the resources necessary to achieve its goal.
The ICPD Programme of Action includes a set of specific objectives for all countries:
Universal access to reproductive healthcare including fam Uy planning and-sexflrt-neallh by the year 2015.
Universal access td primary education by 2015; countries should try to close the gender gap in primary and secondary education by 2005.
Infant mortality rate below 35 per 1000 live births and an unclerfive mortality rate below 45 per 1000 by 2015.
Reducing maternal mortality rates by one half of the 1990 levels by the year 2000 and halve it again by 2015.
Increasing life expectancy at birth to 75 years or more bv the ve.u 2015
International agencies will continue to play a vital role in helping countries to meet their objectives in people-centred development. In the area of health, the World Health Organisation has the mandate to be the leading agency.
Health for all is the institutional goal of the World Health Organisation. WHO must equip itself to perform its intended function as the international leader In health issues, stressing its comparative advantage as an active partner, first in a reformed and responsive United .Nations system: and second among health related orgarusanoTf§"frr buttr public and private sectors.
The World Health Organisation s unique structure should enable it to respond to regional needs and capacities while maintaining a global perspective. There must be a close and dynamic partnership between the regions and the centre, driving from a common purpose and with due attention to regional and national priorities.
Determination to achieve the highest qualily with the greatest economy of human and financial resources will be the hallmark of this approach. WHO must examine its structure and operations with this objective in mind. Ute process of self-examination has already begun. Some of the resulting proposals have already produced movement towards reform.
In a world where nations have been brought closer together through trade and technology. human suffering from disease and poverty cannot be ignored. Clearly more has to be done to make basic health services available to all. Only a concerted effort by al! the part tiers: governments, international agencies, non govern mental organisations, healthcare personnel and the private sector can guarantee health for all in the 21st century.
The author is Executive Director of the United Nations Population Fund.