Remarks by Ambassador Elizabeth Cousens, U.S. Representative to ECOSOC, for the US and Israel, 4th Session of the SDG Open Working Group, on Health and Population Dynamics

Ambassador Elizabeth Cousens
U.S. Representative to the UN Economic and Social Council 
New York, NY
June 17, 2013


Thank you very much Mr. Co-Chair and I’ll be speaking on behalf of Israel and the United States.

First, let me just express thanks to you, to the secretariat, to all colleagues in the room for such a rich session that we have had this week. The panel discussions have been extremely substantial, the task team papers were excellent and as usual remain very helpful to our work, and we found all of our colleagues’ various contributions extremely thought provoking and valuable.

Let me just offer a few thoughts about health, in particular, and then say a few brief words about demography as well.

There is no question in our minds that global health has to have a central place in the post-2015 agenda. This is a high priority for us that we also hear consistently from absolutely everyone in the room.

We have unfinished MDG business that has to be taken into account, especially around maternal mortality and reproductive health. We have the prospect of making significant new gains against preventable child deaths, including eliminating chronic under-nutrition and stunting. We have a foundation of impressive progress on diseases like HIV/AIDS, Malaria and Tuberculosis on which to build, and we can look to a future in which we can achieve an AIDS-free generation. We have the important challenge of non-communicable disease, especially in relation to aging populations. And we have the potential to advance access to universal health coverage, which is essential to the social protection floors we were discussing earlier. So, we may all eventually end up at the top of Professor Rosling’s chart, but we should only get there after long, healthy, and productive lives.

We can’t imagine a post-2015 development agenda without a top-line health goal, and one that is also inclusive enough to encompass a range of crucial health and health-related targets. We would also reinforce the – perhaps obvious –point that however we define a health goal, health is intimately linked to other goals or targets we will consider. Progress on many communicable diseases depends on access to safe water, sanitation, and hygiene. Maternal and child health depends on gains in gender equality, reproductive rights and access to strengthened health systems and sexual and reproductive health care and services. Access to clean energy is needed to reduce deaths from indoor air pollution. Most health outcomes improve with income and therefore with decent jobs and inclusive growth. And there are many other links – not least, the fundamental fact that health is an essential precondition for virtually everything we care about – the education of our children; their prospects to lead productive, safe, and rewarding lives; and the vibrancy and sustainability of our economies and societies.

This is all to say that it will be important to keep reminding ourselves that any single issue can often be advanced in different ways across the goals and targets we try to set. In this regard, we very much appreciated Dr. Asamoa-Bah’s remarks yesterday and today that health is both a contributor to and an outcome of sustainable development and that health can be an excellent way to measure progress in wider areas.

Let me just offer a few further thoughts about how to think about health goals and some of the questions we’ll need to ask ourselves as our work deepens.

First, the issue of outcomes versus outputs. We will need to think hard, and engage with experts and others about how best to formulate goals and targets to catalyze the actions we seek at different levels. We strongly support universal health coverage, for example. We also heard that when the High-level Panel wrestled with this issue they ended up choosing not to include universal health coverage as a target. They instead chose targets focus on health outcomes on the assumption that universal health coverage was an essential instrument for reaching those outcomes. There is no one right way to decide this kind of issue and we will need to give careful thought to making the most impactful choices as we get later into our process.

Second, the issue of quality. Not just in health, but also in education and jobs and elsewhere. We all recognize that while “access” (to health care, education and so on) is a necessary condition of progress, it is insufficient if we don’t find ways to address quality. Our Colombian colleague posed this question yesterday in relation to universal health coverage, "how do we ensure quality coverage?" Our Tanzanian colleague spoke importantly about quality of life beyond just mortality measures. And our group will need to reflect very deeply on quality throughout our work, including focusing on what we need to do at the international level to provide the right signals and momentum for national and local actions.

Third, the importance of health systems. We have had remarkable success in recent years with disease-specific goals and interventions, and this needs to be sustained. And we need now to ensure greater attention to health systems as well. Strong, well-designed health systems are the front line of defense for healthy, productive societies, and we need to find ways to hard-wire the importance of health systems into our post-2015 agenda.

Fourth, the issue of data. We are impressed, as I imagine most colleagues are, by the recurrent urgent appeals to improve the quantity and quality of data and, in particular, to be able to disaggregate it so that our progress is measured not just in big aggregates. We believe that it will be crucial, particularly given our interest in addressing the needs of the most vulnerable individuals and groups, in getting crucial services to the most under-served or excluded, and in reducing inequalities in general.

I see that my time is fast moving along but let me just say a few brief words about population dynamics. We very much welcomed Professor Rosling’s briefing yesterday so that we could all see empirically the world we are in now and the world that we are moving toward. This is a dynamic perspective that will be important to keep in mind as essential context for our work.

We would just emphasize a couple of brief points:

First, again, the need to use available data and analysis to think ahead about effective strategies. This includes capitalizing on the demographic dividend so many talk about.

Second, the importance of voluntary family planning and need for women to be empowered to decide on the number and timing of their children, which has positive ripple effects across the entire spectrum of development objectives we have.

Third, the need to give more deliberate thought to urbanization.

Fourth, the powerful potential, and wisdom, of youth that we need to recognize and cultivate – and we salute our colleagues from the Netherlands in reminding us of this concretely the other day.

And at the same time, obviously dealing with aging populations and the need to look at everything from across the entire life cycle.

As other colleagues have done, I want to conclude by thanking you again for your leadership and we very much welcome your thoughts about how best to use our summer vacation so we can come back in the fall prepared to embark on further work. So thank you again.