May 23, 2008
Human Security and a New Vision for Three Major Infectious Diseases
Prime Minister Yasuo Fukuda, Former Prime Minister Yoshiro Mori, Global Fund Executive Director Michel Kazatchkine, and other distinguished guests,
I would first like to congratulate the organizers on convening this international symposium on two major issues that challenge developing countries: infectious disease and human security. This symposium is one of the preparatory events for the Fourth Tokyo International Conference on African Development (TICAD IV).
Infectious disease is a major challenge for the developing world today. HIV/AIDS, malaria, and tuberculosis are rampant in some areas, and other diseases are causing the widespread incidence of pneumonia and diarrhea in children. Infectious disease threatens the health and lives of all people, but especially those living in poverty. It also endangers the overall security of people depriving them opportunities for employment and education.
Combating infectious disease is one of the eight Millennium Development Goals. These goals were adopted at the UN Millennium Summit in the year 2000 as the major challenges that the international community must address.
The Millennium Development Goals (MDGs) include the health-related targets of reducing child and maternal mortality and combating HIV/AIDS, malaria and other categories of infectious disease. Child and maternal mortality can be reduced by expanded immunization programs, providing better continuous care for mothers and children, including perinatal examinations and improved maternal and child nutrition, and more effective emergency obstetric care systems. HIV/AIDS can be managed by information campaigns for the prevention of infection and by proper treatment and care for those already infected. Likewise, malaria is being addressed by programs for promoting the use of mosquito nets and appropriate medication in many countries.
As the UN High Commissioner for Refugees from 1991 through the year 2000, I directly dealt with numerous refugees in many parts of the world. Civil wars and environmental destruction had forced them to leave their homes and suffer extreme deprivation. Adults, old people, and children were living in fear of their lives due to poor water quality and inadequate sanitation, scarce food, disease epidemics, and various forms of violence. Diseases and poor health conditions that would not be fatal in developed countries were actually life-threatening for many of these refugees. Old people, women and children were the most vulnerable.
Needless to say, the factors that seriously threaten the lives and livelihoods of people in developing countries are diverse. The traditional notion of state security that involves protecting the country from external threats had proven to be inadequate and I therefore strongly came to feel the need for a more human-centered security framework that would reach people more directly and reliably and improve the situation in a sustainable manner.
In 2001, the Commission on Human Security was established by the joint initiative of the then Secretary-General Kofi Annan and the Prime Minister Mori of Japan, who is in attendance today. Nobel Laureate Amartya Sen and I co-chaired the Commission, and its report entitled “Human Security Now” is widely known today. To introduce you to a few salient points regarding this report, I wish to emphasize that it takes a holistic approach, encompassing a wide range of sectors composing communities. In pursuing the realization of ‘human Security’, the report advocates two approaches, the “bottom up” and the “top-down”.
The “bottom-up” approach concentrates on empowering people. The purpose is to promote the enhancement of people’s ability to act on their own behalf through various development measures, such as education, access to information, assurance of health care and the provision of social safety nets. The “top-down” approach emphasizes the importance of protecting people and ensuring their safety, basic rights and freedoms through the firm establishment of the rule of law and judicial institutions. JICA has incorporated this human security framework to guide its development activities.
The health care programs which encompass the control of infectious disease and ensuring maternal and child health must also be guided by the framework of human security. No sector requires greater emphasis on the protection and empowerment of people than that which deals with critical coverage of people’s lives.
The “bottom-up” approach should involve empowering local communities to improve health care activities. For this, individuals and communities require a system that enables them to learn about health care and offers the means to organize themselves to meet their respective health care needs. This approach is essential to ensuring the sustainability of any health program. The “top-down” approach should cover health related laws and regulations, obtaining necessary financial and human resources and developing the organizational structures that deliver health care services. The top-down system implies building strong administration at the central national level as well as at intermediate and local levels.
A holistic and cross-sectoral approach for the betterment of people’s health status is essential, especially for those who are living under severe conditions. Any health problem involves social and cultural factors as well as direct issues of health care. The basis for good health includes access to safe water and sanitation, a proper diet, basic education and the availability of gainful employment. It often also requires respect for gender equality and human rights. Thus, integrated programs for social development are important in enhancing health. For example, a community health project may be linked to a participatory community hygiene and sanitation program, which includes literacy program.
Let me here pay tribute to the positive and far reaching impact of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund was created after Former Prime Minister Mori stressed to the world the need for an international initiative to control infectious diseases as the chair of the Kyushu-Okinawa Summit in the year 2000. At that time, the international community had yet to come up with any concrete initiative to control HIV/AIDS. New international strategies to fight malaria and tuberculosis were still in their infancy. Due in part to significant contributions from multilateral organizations, governments, private sector, academia and civil societies, the fund came to develop a clearer course of action to fight each of these three diseases that are unfortunately still prevalent in developing countries.
More recently, the balance between disease-specific vertical approach and health sector holistic approach is being subject to closer scrutiny. This is especially true of countries with inadequate health systems. I understand that the Global Fund is now exploring the widening of its funding scope to cover the strengthening of health systems. These efforts include enhancing human resources to support a wide range of health services and improving the logistics of delivering medicines. I expect that those measures will enable the recipient parties to adopt a more holistic approach to the fight against these diseases.
Undoubtedly, specific approaches to health care are needed to address each of the three major diseases: HIV/AIDS, malaria, and tuberculosis. Each requires highly specialized medical research and treatments. But disease-specific approaches alone will be ineffective in developing countries that are faced with inadequate health systems and harsh social conditions. It is vital for the international community to embrace the concept of human security, to work together, and to realize a holistic approach to health care that addresses local needs and local collaboration.
Next week, Japan will host TICAD IV in Yokohama. The agenda items are boosting economic growth, ensuring human security, addressing environmental issues and global climate change. Health issues will also be discussed. Human security and infectious diseases will also be high on the agenda for the Hokkaido Toyako G8 Summit in July.
Let me conclude by expressing my sincere hope that the series of upcoming events will further promote international cooperation toward infectious disease control and the protection of people’s lives and security in developing countries.