Women’s health key to national prosperity

Health has to be seen as a central part of a complex picture facing decision-makers and political leaders today, in which health policy and foreign policy have become intertwined. This is the reason why foreign ministers from France, Thailand, Indonesia, South Africa, Senegal, Brazil and Norway adopted the Oslo Declaration on foreign policy and global health in 2007.

Through this initiative, new bridges and links between countries with different experiences have been established, helping to forge new consensus when this is needed in broader international contexts. Other foreign ministers are becoming increasingly aware of these issues.

A few years ago, Norway decided to focus considerable diplomatic attention and development assistance resources on improving women’s and children’s health globally. This decision was based on a simple but important lesson from our own history. 

A hundred years ago, Norway was among Europe’s poorest nations. Our transition to becoming one of the richest has several explanations. One of the main factors is the mobilisation of all our human resources, in particular through the empowerment and participation of women in the labour market.

Every time our country has enacted a major piece of legislation to empower women, a long-term benefit to the economy has followed. This was true when universal suffrage was introduced a century ago, it was true when we ensured universal access to day care for children, and we also see it today, a few years after we introduced a requirement that corporate boards should be made up of at least 40 % women. And it has been true for dozens of similar collective decisions over this past century.

Today, three out of four women are employed in the formal labour market in Norway. Since the 1970s women have doubled the pool of human resources in the workforce. They have created value and additional jobs, and they have generated tax revenue, enabling us to continue to invest in welfare and opportunities for all.

The key political lesson is this: strengthening women’s empowerment is a high-return investment for society as a whole.

In large parts of the world, we are still at square one and will have to begin by investing in the basics. That means simply investing in the survival of women and their children.

More than 270 000 women die giving birth every year. More than 20 000 children die every day from preventable causes. More than 200 million women do not have access to the family planning services they need in order to live meaningful, productive and fulfilling lives. Only when a society ensures that a woman can give birth safely, feel confident that her children will survive and control how many children she wants and when to have them, can it release the full potential of all its citizens to create collective wealth and social cohesion.

In the international community’s concerted efforts to improve global health over the last 15 years, maternal and child health has been the missing piece. We have seen enormous progress in fighting AIDS, tuberculosis, malaria and vaccine-preventable diseases. These efforts mean that millions of lives are now saved each year.

Maternal and child health, however, lagged behind for a long time. It is only in the past three or four years that we have seen significant progress.

This progress has finally inspired many to make a major push for women’s and children’s health. Over the past two years, we have seen an unprecedented increase in the focus on women and children. Two years ago, the UN Secretary-General launched the Every Woman Every Child movement, demonstrating the priority he gives to this issue. Every Woman Every Child aims to mobilise and intensify international and national action by governments, multilateral organisations, the private sector and civil society to address the major health challenges facing women and children around the world.

Rising to this challenge, the US Government initiated a new partnership, Saving Mothers, Giving Life, together with the Norwegian Government, the American Congress of Obstetricians and Gynecologists, Every Mother Counts and the pharmaceutical company Merck. Saving Mothers, Giving Life aims to save the lives of mothers and their newborn children, focusing on the critical period during labour, delivery, and the first 24 hours postpartum. During her speech at the conference “A World in Transition: Charting a New Path in Global Health” in Oslo in June, Secretary of State Hillary Clinton strongly reiterated US commitment in this area.

The Government of the UK and the Bill and Melinda Gates Foundation have both recently strengthened their commitment to family planning. Meanwhile, UNICEF has launched a new initiative, together with Ethiopia, India and the United States: Committing to Child Survival – A Promise Renewed.

Norway is involved in or strongly supports all of these initiatives and is playing a leading role in the UN Secretary-General’s initiative and global strategy for women’s and children’s health.

I am encouraged by the many examples of innovation and creative thinking to find unorthodox solutions to long-term problems. In several countries, innovative solutions of this kind are already in use. For example, women can get reminders and advice on their mobile phones concerning their pregnancy and medications, and community health workers can order medicines and lab tests the same way.

The UN Commission on Life-Saving Commodities for Women and Children, which is co-chaired by Norway’s Prime Minister Jens Stoltenberg and President Goodluck Jonathan of Nigeria, sees great potential in these initiatives and emphasises the use of new technology and innovation. The Commission is also encouraging wider use of advance market commitments and other procurement guarantees that give private companies the assurance that there will be a market for products they develop or invest in. Such market-shaping activities have been highly effective in bringing new vaccines to the market and reducing the price of existing ones. There is no reason why this should not also work for other health commodities.

What we are now witnessing at long last is a massive effort to give women and children the chance of a healthy and safe life, regardless of income or geography. The challenge, of course, is to make sure all of these initiatives are coordinated and complement one another. There must be collaboration between North and South and between the public and private sectors. Here I am optimistic; we have learned a lot about coordination and collaboration over the past decade or so.

However, donor initiatives and coordination can only encourage action; the main effort must be made by the countries that are facing the highest rates of disease and mortality. To an increasing extent, this is what is happening. The focus must be on results, and on tangible, measurable results. In the simplest terms, we are talking about a sustainable, measurable and significant reduction in deaths before the Millennium Development Goals’ target date of 2015.

Our world is changing rapidly. Gone are the days when we could roughly separate the world into two parts: the mainly rich nations in the North and the largely poor nations in the South. By 2020, only 17 nations will still be considered “poor”. The rest will be “middle-income” or “high-income” countries.  Despite this growth, the number of people living in poverty will not have fallen very much. Rather, they will be living in nations that are somewhat richer overall.

This change will have a number of consequences for how we as nations work together to improve health.  Development assistance will play a smaller role than it does today, and the assistance will need to be smarter and more focused. As countries become less reliant on assistance, the donors will have to ensure that they complement national efforts and that they align their aid with national strategies. 

Nevertheless, there needs to be continued vigilance to ensure that aid does not replace domestic investments and that the most vulnerable groups – including women and children – do not lose out when national priorities are set and aid is distributed.

Health diplomacy will therefore come to the fore. As global health discussions increasingly become a dialogue of equals rather than asymmetric negotiations between donors and recipients, we will need to be clear about the intrinsic value as well as the economic and social benefits of investing in women’s and children’s health.

We know that the sustainability and healthy development of any society is increasingly a question of ensuring equality, good governance and national priorities that protect all citizens and provide for their basic needs. Norway will continue to promote these insights and to use its resources and influence to further this cause globally. 

***

See also: GHDnews.com