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 
 
¶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#