Development Policy

Health & Poverty Reduction in Developing Countries

PLENARY DEBATE, 3rd September 2003

Bowis (PPE-DE), rapporteur. - Mr President, today the world's gaze is very much on world trade. However, for millions that is a million miles from their broken, infected and disabled lives, because you can only trade if you can make, grow, sell and distribute. Those tasks are essential to your economic wellbeing and to your country's economic growth. They are tasks which are way beyond you if you are physically or mentally ill or disabled. If they are beyond you, you are in a downward spiral to poverty and, more often than not, to death. Health and wealth, ill-health and poverty are inextricably entwined. Poverty leads to ill-health and ill-health means poverty for nations, families and individuals. Without health you cannot create wealth and without wealth you cannot prevent and cure disease.

We, the countries of the European Union, have accepted the challenge to help the least- and the less-developed countries to overcome poverty and to become partners with us in world trade and development. We have acknowledged the fundamental link between good health and the reduction in poverty and we now need to enhance this priority in our development policies.

The Commission has sent us a good communication, which I welcome. It focuses on the three massive challenges of TB, AIDS and malaria and nothing in my report contradicts that focus. Indeed, I call for more and better investment in these areas.

However, there are other enormous health challenges we must also address. Let me start with the final point in our report.

We, the developed world, are short of doctors. Each and every year we make up our domestic failure by recruiting 63 000 doctors from the developing countries. In return, we send them just 1 300. This is unacceptable.

Then let me re-emphasise the need for a shift in resources to basic health, if our rhetoric is to be translated into effective action. Just 3.4% of our current development budgets go to health. That is simply inadequate. Only 9 of the first 61 country strategy papers had health as a focal area for cooperation. That will not achieve results.

We need resources, but they must be efficiently targeted. Drugs, for example, are wasted if not accompanied by adequate storage, distribution, monitoring and patient education. Nigeria is an example where dramatic improvement was possible in fatal childhood diseases once the programme developed a home-to-home strategy and changed the public perception about immunisation.

Then there are the diseases and disorders beyond the three priorities of TB, AIDS and malaria. By 2020, 80% of the global burden of disease will be non-communicable diseases: cardiovascular, cancer, respiratory, diabetes, depression, epilepsy, etc. Diarrhoea diseases kill 1.5 million children a year. We heard in the last debate about water. Apart from malaria, water-borne diseases that debilitate and destroy include typhoid, dysentery, cholera, hepatitis, trachoma, fluorosis and Japanese encephalitis. Yet 1.1 billion people have no access to clean water and 2.4 billion are without hygienic sanitation. Yet the cost need not be prohibitive, and our report points to examples of inexpensive interventions and changes of local practice which can make a significant difference.

I am grateful to colleagues from all parts of the House who suggested additions or amendments - most of which we were able to incorporate in committee - and a few which I have accepted and put my name on at this plenary stage. I would also like to thank the governments, academics, practitioners and NGOs - not least from the developing countries themselves - for their contributions. They confirmed many of the proposals I had drafted and suggested new areas for me to explore, such as vaccines, maternal health, biomass fuels and palliative care. I hope Parliament will endorse our report and that the Council and the Commission will see it as supportive as well as exhortative. None of us can be satisfied with our efforts to date to defeat poverty by promoting good health. We are all in development mode and our commitment must be to drive our policy forward and faster. It is in all our interests to make real and lasting progress.

Nielson, Commission. - Mr President, I would like to start by thanking Mr Bowis for his good work. While we give support to health directly in many countries, the Commission is increasingly investing in budget support strategies where the linkages to improved health outcomes are ensured.

In this context the follow-up through key input and outcome indicators is crucial and this is a high-priority area of work.

This relates to a long discussion with Parliament and the Committee on Development and Cooperation about the percentages allocated to different sectors.

The Commission is prioritising support for improved health and education outcomes. To reflect this, it is not enough simply to calculate funds for health and education where they appear as focal sectors. All support to related social sectors, such as investment in water and sanitation and budget support linked to improved health and education outcomes, has to be taken into account. Doing this brings us to something that adds up to more than 40% of the programming for the 9th EDF.

It is a matter of the credibility of the link between budget support and outcomes in these sectors, but this is the best way we can do this. We are relying on other donors or partner governments to do more of the substantial work. We are providing a lot of money, but this is also what complementarity is about, what donor coordination is about and what ownership is about.

I am in no way apologetic about these percentages and I will never get tired of arguing like I do here whenever, like tonight, I hear figures - which I feel are wrong - as regards how much we do in these sectors. The Interreg contribution through budget support is real and it has the advantage that it also makes it possible for us to fund and for support to be received for the ongoing recurring costs.

It does not do much to help to build a nurses' training centre if the teaching there cannot be sustained. That is one of the advantages of budget support. This is in no way an excuse, but it is a real, hard-core explanation.

The specific challenges as regards HIV/AIDS, malaria and tuberculosis have been meaningful, leading to our contribution to the global fund. Our engagements at country level mean that we now know better what to do than we did some years ago.

Attempts at solving the HIV/AIDS problem are made more difficult as it involves having to cope with the ideological battle of reproductive health and sexual rights. I do not want to start a discussion tonight on these issues, but it is an added problem on top of all the other existing problems.
As regards financing I am pleased that it was possible to get the United States to accept what everyone else agreed to in December last year in the WTO on TRIPs and the use of generic medicines. The point I want to make here is that it is very nice to see that our decision last year to untangle the procurement of medicine for these diseases adds to the reality and impact of what was agreed in the WTO last weekend. If we still tied procurement to European producers, the WTO agreement that Third World countries should be able to buy generic medicine would not have carried much real importance. So it is the combination of this deal in the WTO and our untying of procurement there that really is dynamic.

I do not want to prolong the discussion ahead. I will end with these remarks and again repeat my appreciation of the input provided by Mr Bowis.