“A better future for all: why meeting the Millennium Development Goals matters”

24 Aug 2010

Statement by Helen Clark, Administrator of the United Nations Development Programme on the occasion of the Head of School Seminar Series at the School of Population Health, University of Auckland, New Zealand.

Thank you for inviting me to address you this afternoon on “A better future for all: why meeting the Millennium Development Goals matters”.

It is always good to be back at the University of Auckland. It was here I studied and then taught at the Political Studies Department, before being elected to Parliament. And it is here Peter works to this day – maintaining a very personal connection to the institution.

While the School of Population Health in its current form is a fairly recent addition to the University, it is already well known for its impressive work addressing a longstanding question of concern to us all: how can we best improve the health and wellbeing of entire populations?

This is a question which has long been of interest to me, both during my time in public life in New Zealand, including as Minister of Health, and now at the United Nations Development Programme. As a young Health Minister two decades ago I was greatly influenced by the Alma Ata Declaration which emerged from the 1978 International Conference on Primary Health Care.

That Declaration stated that “…health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.”

It proceeded to call for everyone by the year 2000 to enjoy a level of health which would permit them to lead socially and economically productive lives – an objective popularized as “Health for All by the Year 2000”.

The truth is, however, that for very great numbers of people around the world that goal was not realised.

In 2000 I travelled to New York as New Zealand Prime Minister to the Millennium Summit of the United Nations, convened by Secretary-General Kofi Annan, to sign the Millennium Declaration, which encapsulated the Millennium Development Goals. A very large number of other Heads of Government and Heads of State were there.

My recollection is that the dawn of the new millennium was seen as a time of hope – backed by a desire to do better for humanity than had been possible hitherto.

In that context, the eight MDGs stood out as the international community’s pledge to create a better and healthier future for billions of people in developing countries by 2015.

They were, and still are, the most comprehensive and universally agreed development goals. They set out to tackle poverty across its many dimensions. Achieving the goals would take the world a considerable way towards realizing the vision of the Alma Ata Declaration.

The MDGs are about substantially reducing poverty and hunger; empowering women; increasing access to the essential services of education, healthcare, clean water and sanitation; reducing the incidence of specified deadly diseases; protecting the environment; and forging strong global partnerships for development.

For the poorest and most vulnerable of the world’s people, the significance of the MDGs was that they were not just another list of noble intentions loudly proclaimed by the international community – there’s been rather a lot of those before and since.

Rather, the MDGs represented time-bound and specific commitments by leaders of rich and poor countries alike to make a difference for the better for those denied the basics of a decent life.

A decade after the MDGs were launched, we can see that the focused effort to achieve them has yielded results – although progress has been uneven across the goals, and across and within regions and nations.

The theme of my comments today, therefore, will be that the MDGs can be achieved – but that to do so against the background of the multiple crises our world has been experiencing will require a stepped-up effort and clear prioritisation around what, on the evidence to date, is most likely to work.

It is also true that achieving the MDGs does not deliver nirvana – there would still be very large numbers of extremely poor and hungry people denied many of the basics of life in 2015. I do not believe that our world can be at peace with itself while that sorry situation persists.

The MDG scorecard to date shows that the world is on track to meet the target of reducing by half the numbers living in extreme poverty from the 1990 baseline figure by 2015. That has been hugely influenced by the remarkable progress of China, where hundreds of millions of people have been lifted out of poverty, pulling up the global average numbers. In many countries, however, little progress has been seen.

Enrolment in primary education has continued to rise, reaching 89 per cent in the developing world. But the pace of progress is not yet fast enough to ensure that all girls and boys complete a full course of primary schooling by 2015 as MDG Two envisaged. Concerted action could see this goal achieved.

There has been progress towards gender parity in education. This is so important, as the education of girls yields some of the highest returns of all development investments. The benefits are intergenerational, as a mother’s education is a significant variable affecting children’s educational attainment and opportunities.

The flow-on effects of girls’ education will include reduction of child and maternal mortality, better child nutrition, a boost to economies, and greater ability to protect women and girls from HIV/AIDS, abuse, and exploitation.

For the MDG targets on drinking water, sanitation and nutrition, progress to date has been uneven.

Based on the current trajectory, the world will meet or even exceed the drinking water target by 2015. By then, around 86 per cent of the population in developing regions will have gained access to improved sources of drinking water.

The same is not true for efforts to halve the proportion of people without access to basic sanitation. Steps towards this target – so important for good health – are far too slow. In 2008, 48 per cent of the population in developing regions still had no basic sanitation, compared to 59 per cent in 1990.

Ensuring proper nutrition is vital for people’s health and wellbeing. Unfortunately, there have been setbacks in this area. In 2009, for the first time in history, more than a billion people are estimated to have suffered from chronic hunger – that is around 130 million more than before the combined impact of the food, fuel and economic crises.

The MDGs are all inter-linked – achievements in one can spur progress on others

If we can reduce child mortality, improve maternal health, and turn the tide on HIV/AIDS, malaria and tuberculosis, that is positive over time for poverty reduction, school enrolment, and gender empowerment.

The good news is that new global partnerships have increased the uptake of immunization, the distribution of anti-malarial bed nets, and the availability of anti-retroviral drugs for people living with HIV/AIDS.

Between 1990 and 2008, the mortality rate for children under age five in developing countries dropped by 28 per cent. In absolute terms that reduced the number of children under five dying - from 12.5 million to 8.8 million.

That is a massive achievement, especially measured against a rising population. But progress will need to be faster still to meet the target of reducing those deaths by two-thirds by 2015. Most of those who died could have been saved through low-cost prevention and treatment measures.

It is worth noting here the specific inter-linkages between the health MDGs.

Intensive efforts to control malaria have enabled many African countries to make steep inroads into reducing child mortality; as has reducing mother-to-child HIV/AIDS transmission.

Alas, the MDG which is struggling the most is that on maternal health. Preliminary new data do show some signs of progress in reducing maternal deaths. Nonetheless, the advances are nowhere near enough to meet the MDG target of cutting the maternal mortality ratio by three-quarters between 1990 and 2015.

That so many women die as a result of complications from pregnancy or childbirth in the 21st century is a shocking indictment of the low priority given to women’s needs and status in many societies.

As Minister of Health in New Zealand in 1990, I was responsible for the passage of new legislation providing for the independent practice of midwifery. I strongly believe that empowered midwives will play a critical role in improving maternal health.

It is not for lack of knowledge about maternal death in our world that for so many women giving life is so often linked to death. It is about poverty in all its manifestations – including a lack of access to basic services.

In Sweden, a woman’s risk of dying from pregnancy-related causes is about one in more than 17,000. In Niger, in West Africa, it is one in seven.

Statistics like these speak for themselves, and should be a clarion call to action to address the underlying causes of the tragedy of maternal death.

The MDG on maternal health also calls for universal access to sexual and reproductive health services. In many societies, there is huge unmet need for these – yet, if provided, they increase the choices available to women. When women are healthy and empowered, their newborns are more likely to survive and their children to thrive. These benefits carry through to the next generation – creating virtuous cycles. 

Fortunately, much needed momentum is building to reduce child and maternal mortality rates.

In June, G8 leaders, meeting in Canada, pledged to mobilize an additional $5 billion over the next five years to significantly reduce the number of maternal, newborn and under-five child deaths in developing countries. 

African Heads of State and Government in Kampala, meeting that same month, made maternal, infant and child health and development a key focus of their African Union Summit. 

And this September UN Secretary-General Ban Ki-moon will launch a Joint Action Plan to Improve the Health of Women and Children.

Over the past three decades, the HIV/AIDS epidemic has reminded us of the fundamental linkages between health and development more broadly.

It has shown us that, to tackle this deadly virus and its impact, it takes both the best that science and medicine can offer and attention to the basic conditions which shape vulnerability – be they poverty, gender inequalities, or discrimination against marginalized groups.

The spread of HIV appears to have stabilized in most regions, and there has been a significant expansion in the provision of anti-retroviral treatment and programmes to prevent mother-to-child transmission.

Yet, AIDS remains a serious development challenge. For every two people starting anti-retroviral treatment, five more are believed to be newly infected. The AIDS epidemic is continuing to take a heavy toll on men, women, and children around our world.

In all societies, including our own, we must remain vigilant in our response to HIV/AIDS, and step up and support both prevention and treatment measures. There are still high mountains to climb before we can declare “mission accomplished” in halting and reversing the spread of HIV.

Consistent with UNDP’s focus on tackling the underlying issues which surround development challenges, we have established a Global Commission on HIV/AIDS and the Law. We have challenged our Commissioners including Australia’s Justice Michael Kirby and New Zealand’s Charles Chauvel, to take a forensic look at areas of the law which inhibit effective HIV/AIDS response, and we have challenged them to be bold in their recommendations.

Clearly, meeting the MDGs is making - and can make - a tremendous improvement to the overall well-being of individuals, families, their communities, and nations.

That on its own is a good enough reason to accelerate progress in order to meet the Goals by the 2015 target date.

But the MDGs are not only of concern to those living in developing countries.

The MDGs are everyone’s business. In a country like New Zealand, a recognition of our common humanity and a sense of moral obligation have long led us to support others less fortunate than we ourselves are.

Now in the interconnected world in which we live, we are all neighbours. What happens far away to others can impact on us. In this broader sense, if our neighbours are poor and struggling, our prospects are affected too.

In recent years, the food and fuel price crises, the global recession, and major climatic events and other natural disasters have been felt sharply around the globe.

Sadly, it is all too often those least responsible for causing the problems that have suffered the brunt of the impacts, and have the least resilience to deal with them.

We certainly see the impact of climate change affecting the poorest and most vulnerable the most.

We see how the global recession, which began in a few markets in the North, has pushed tens of millions of people in the developing world into extreme poverty. The World Bank estimates that the global recession will push an additional 64 million people into extreme poverty by the end of this year, relative to what the numbers would have been without the recession.

We see high food prices going beyond squeezing family budgets hard, as they do in New Zealand, to causing families to go without adequate food and nutrition in poor countries and communities – to the extent of causing malnutrition, and the stunting and wasting of children.

Failure to meet the MDGs cannot be blamed on the world lacking the resources and know-how to do so. There is a wide range of proven policies which, adapted to national context, can ensure progress - where there is strong political leadership, sufficient capacity, and adequate and predictable funding to implement them.

Next month there will be an MDG summit at the UN in New York to review advances made towards the Goals ten years after world leaders agreed on them.

It is important that Member States agree on a clear MDG action agenda for the next five years.

In preparing for that summit, UNDP has been compiling the evidence from a large number of countries of what factors drive achievement of the Goals. With extra funding from donors, we were able to support the preparation of more than thirty specially-commissioned national MDG reports, and then analyse them and other recent MDG reports to produce an international assessment of what it would take to achieve the MDGs.

While any action agenda must always be adapted to each country’s unique context, we do highlight eight priority areas for attention:

The need to support country-led development and effective governance to get results.

There is no “one size fits all” template for development success. To accelerate and sustain progress, development strategies must be locally owned and based on a broad consensus in society. We do see development as being more likely to thrive when a country’s institutions are responsive and accountable, and it is essential for there to be an institutional capacity to deliver services.
Work on governance issues related to development effectiveness is actually the largest component of UNDP’s portfolio of activity around the world. We assemble expertise to support governments to build their capacity to strategise, plan, and deliver, and to support parliaments, electoral commissions, human rights commissions, and other institutions which work on transparency and accountability to do their job of scrutiny and monitoring.

Inclusive economic growth is required. Growth needs to be job-rich, especially to offer opportunity to the world’s largest-ever generation of young people coming onto the labour market. As well, in those countries where a significant proportion of people live on the land, agricultural and rural sector development is vital.

2.5 billion people in developing countries depend on agriculture for their living. As New Zealand well knows from its own experience, increasing agricultural output and productivity can be a path to prosperity – and in developing countries it improves local food security too.

To be more productive, farmers need access to quality fertilizers, seeds, extension services, and credit. They need secure land rights, better access to markets, and improvements in local infrastructure.

A fairer distribution of income, assets, and opportunities is also essential for poverty reduction, and so would be a global trade deal which works for poor people and countries. The current gridlock in the WTO negotiations does nothing for development.

Expanding opportunities for women and girls is essential, and must be a key part of the MDG breakthrough strategy the world needs. The multiplier effects of women’s empowerment, education, and improved education are profound for development.

To lift whole societies out of poverty, women too have to be able to be full beneficiaries of and contributors to that process. If women are sidelined in development, countries will struggle to reach development goals.

I believe that women always have the capacity to be tremendous agents of change and forces for peace and development. Interventions to support them must include measures to reduce the burden of domestic activities and which facilitate broader economic and political empowerment and the attainment of equal rights and status.

We need to target investments in health and education, in clean water and sanitation, and in the professionals and systems running these services.

That saves lives, and it lays the foundations for inclusive growth and poverty reduction. Healthy and educated people are better able to improve their own lives.

Sustaining improvements in these essential services requires long term commitments to developing effective systems and institutions, as well as to skills and professional development.

We need to increase the reach and scope of social protection to build resilience to the shocks which inevitably occur. Without social safety nets, development gains can be quickly lost when crises hit - if, for example, children are pulled out of school and there’s not enough income in the family for sufficient food.

We have also seen social protection and cash transfer programmes expand access to nutritional supplements and immunisation, increase the frequency of health check-ups, and keep children in school.

Rather than being seen as a drain on a nation’s budget, social protection needs to be seen as a critical investment in building the resilience to cope with present and future shocks.

Expanding access to energy is critical, not least in saving women many hours each day spent on back-breaking chores. It increases productivity, and it brings power to homes, schools, and health clinics.

In West Africa, as I saw for myself on a visit earlier this year, UNDP has worked with partners to bring basic generators to villages. The impact, particularly for women has been profound.

But globally, the way we generate energy has huge implications for our future. Sustainable development will not be achieved if the ability of tomorrow’s generations to live and grow is undermined by the way we choose to live and grow today. So we need to support lower carbon paths to development. To achieve that, a climate deal which generates significant funding for poor countries to support adaptation and mitigation is essential – but remains elusive.

Supporting domestic resource mobilization is critical. That means having effective tax systems. Most of the resources needed to achieve the MDGs have to be raised within developing countries themselves, and limited resources need to be spent well. Where great wealth is being generated by the extractive industries, it also needs to be tapped for the public good.

In line with commitments under MDG 8 - that concerned with global partnerships for development - the developed world should deliver on its ODA commitments, and make its ODA more effective and predictable.

Unfortunately, adjusted for growth, ODA delivery by the end of 2010 is projected by OECD to be 38 per cent short of the increase promised at the G8 Summit in Gleneagles in 2005. The commitment made by the G8 was to double development spending from 2004 levels by 2010. Closing that gap now would cost around half of one per cent of developed countries’ combined GDP – hardly a vast sum.

Yet as the donor countries grapple with recovery from recession, a number are seeing their ODA budgets as easy targets for cuts. That is not only affecting the ability of poor countries to develop, but it is also affecting the ability of multilateral organizations like the one I lead to help.

Developed countries also need to look at how their other policy settings affect development. Unfair world trade rules, the failure to strike a new climate agreement, and short-sighted policies on migration all thwart development.

Looking ahead, one thing is clear – the world has sufficient tools and resources at its disposal to meet the Millennium Development Goals. The real question is: do we have the determination and the resolve to do so?

The series of crises of recent years hasn’t make the task any easier - but nor has it made it impossible.

The MDG Summit in September could be a real turning point in the fight against poverty – if there is a collective will and political leadership behind it.

We have the opportunity to make 2015 a milestone in our efforts to make the world a truly better place for all.

Whether it is combating the spread of disease, preventing environmental degradation or helping countries to grow and provide health and education for their citizens, advancing the MDGs is an important part of making our world a more just, secure, and peaceful place.