News and Events

printer friendly version

"Promoting Cross-Sectoral Actions to Achieve the Health MDGs"

Opening Remarks by
Khempeng Pholsena

Asian Development Bank

At the High-level Forum on Health MDGs

21 June 2005
Tokyo, Japan

Excellencies, distinguished participants, ladies and gentlemen:

On behalf of the Asian Development Bank, I am delighted to welcome you to this session on "Promoting Cross-Sectoral Actions to Achieve the Health MDGs."

As we all know, the Asia and Pacific region has made good progress in reducing poverty, but a huge challenge remains. Some 690 million people in the region still struggle to survive on less than one dollar a day. Nevertheless, it is likely that the Region as a whole will meet the Income MDG.

But the prospects for achieving the non-income MDGs - particularly in relation to hunger, nutrition, maternal and child health, water and sanitation, and environmental sustainability are far less encouraging.

The UN Millennium Project has estimated that today Asia and the Pacific is home to 71% of those without access to improved sanitation, 58% of those without access to safe water, 56% of the undernourished and 54% of those living in slums. There is no doubt that this explains, at least in part, why the region accounts for 43% of the world's child mortality and an estimated 47.2% of the world's maternal mortality - a full 25.7% of global maternal mortality in India alone.

Ladies and Gentlemen,

Our topic today is one of utmost importance. Health is clearly a cross-cutting issue throughout all sectors of the economy. Achieving the Health MDGs is essential because they account for a full 75% of the overall Goals. Available data suggests that healthier populations are more inclined to invest in higher levels of skills training for themselves and education for their children leading to higher permanent incomes. Improvements in health set in motion a virtuous cycle of rising incomes and poverty reduction.

If we are to achieve all health-related MDGs, concerted and timely action by all of us will be required - both within our own organizations and countries and in mutually supportive partnerships at the global level and within the Region as a whole. And there is ample evidence that cross-sectoral interventions can improve efficiency and accelerate effective achievement of the Health MDGs.

It is interesting to note that, of the health-related "Quick Wins" recommended in the United Nations' recent "Millennium Project Report," more than half identify actions that require collaboration among some combination of different sectors that have a powerful influence on health - including Agriculture, Communications, Education, Energy, Environment, Health, Public Works, and/or Water and Sanitation.

In addition, there is a need to duly reflect the impact of cross-cutting issues such as - poverty reduction, gender equality, and governance.

The Background Paper for this Forum suggests that - all other factors held constant - child mortality declines by:

• 3 - 4% if access to drinking water improves by 10%;
• 3% if years of schooling among women rise by 10%;
• .8 - 1.5% if direct government spending on the health sector rises by 10%; and
• 1 - 1.5% if the density of paved roads rises by 10%, in part because of the easier access such roads provide to health and other related services.

With those statistics in mind, it is worth noting a few examples of various non-Health sector projects and programs that contribute directly to achievement of the health-related MDGs. Such examples include:

• The Punjab Community Water Supply and Sanitation Project that illustrates the cross-sectoral integration of Hygiene Education with capacity building and water supply and drainage infrastructure in order to, among other things, reduce the incidence of water borne diseases contracted especially by poor individuals and households and
• Various projects supported under the Education for All Program illustrate the importance of integrating health-related school policies with the provision of safe water and sanitation in schools, skills based health education, and school based health and nutrition services -- including health check-ups, immunization, de-worming and iron supplementation and school feeding programs.

Issues and opportunities in the road sector also well illustrate both cross-sectoral problems and opportunities with respect to Health MDGs. Thus, even as an increase in the density of paved roads can make a significant contribution to reductions in maternal and child mortality -- in part because of the easier access such roads provide to health and other related services -- ADB studies have found that:

• About half a million people die prematurely every year in Asia from air pollution that is - to a substantial degree - caused by the increased density of vehicles that result from road improvements,
• Another 3.8 million suffer from asthma and other breathing problems, and
• About 44% of the world's road deaths also occur in our Region.

It is also clear that the spread of HIV/AIDs and communicable diseases is also facilitated by the improvement and expansion of road networks. Taken together, the estimated financial burden of road-related effects on health range from US 392 million dollars to US 2.6 billion dollars a year in the Region.

Recent examples of responses to such issues include, for example, the Metro Manila Air Quality Improvement Sector Development Program and China's Preventing HIV/AIDs in Road Projects in Yunnan Province.

• The program in Manila integrates activities in a wide range of sectors such as transport, energy, industry, and health. Components include -- among other actions -- a vehicle inspection system, production of clean fuels, introduction of anti-pollution devices, monitoring both air quality and public health results.
• The China Project finances 5 components - advocacy, information and education, comprehensive medical packages for treatment of HIV/AIDs and other Sexually transmitted diseases, condom distribution during the first year, benefit monitoring and evaluation - to reduce the most important health risk at the road construction stage of the Baoshan-Longlin Expressway.

Finally, examples of cross-sectoral support from agro-industrial partnerships include -

• On-going efforts to identify and select natural rice seeds with higher iron, zinc, and Vitamin A content for fighting micro-nutrient deficiencies.
• Regional technical assistance that has resulted in National Investment Plans for fortifying essential staples in 5 countries with involvement of the private sector; and
• A sub-regional initiative for Central Asia and Mongolia focusing on iron fortification of wheat flour and salt, as will be described more fully during the presentation of the Kyrgyz Republic.

Nevertheless, before concluding I would like to note that the Background Paper also indicates that child mortality declines by 2 - 3% if per capita incomes rise by 10%. That suggests that the quality of micro-level project and program decisions with respect to the health-related MDGs is not enough - such decisions must be made in the context of an overall strategy that gives appropriate attention to economic growth with equity.

Later on in our session, we will have an opportunity to discuss how cross-sectoral approaches can be established and integrated into an overall strategy for growth and poverty reduction.

But now, I would like to introduce you to two distinguished presenters who will address two of the main cross-sectoral organizational issues affecting achievement of the health-related MDGs:

• First, Her Excellency Mrs. Boldjurova will present the Kyrgyz Republic's experience with establishing an effective partnership among government, commercial private producers and other interested parties to address common objectives with respect to health and improved nutrition.
• Second, Mr. Arum Atmawikarta will share Indonesia's experience with integrating government's health and non-health sector activities directed to achievement of the Health MDGs in an increasingly decentralized system.