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APPENDIX C
Selected provisions from the Draft Ministerial Declaration


20 June 2009


Paragraph 8: We recognize that social determinants play a central role in health outcomes and call for action to address the underlying causes of health (EU) inequities. (G77: delete)

We recognize the role of social determinants in health outcomes and give due consideration of the conclusions and recommendations formulated by the from the WHO Commission on Social Determinants of Health, as approved by the World Health Assembly (WHA) 2009, which aim to improve living conditions, tackle the inequitable distribution of resources, and measure, understand and assess their impact. We call for international cooperation to support States in their efforts to strengthen their public policies aimed at fostering full access to health and social protection for, inter alia, the most vulnerable sectors of society including through, as appropriate, action plans to promote risk-pooling and pro-poor social protection schemes.

(G77: compromise para on Social Determinant of health to merge G77 8alt, EU 6alt, and Facilitators 8)

8 alt We recognize the role of social determinants in health outcomes and the need to strengthen the public policies aimed at fostering full access to health and social protection for, inter alia, the most vulnerable sectors of society including through, as appropriate, action plans to promote risk-pooling and pro-poor social protection schemes. (G77: delete)

8 bis We stress that health literacy is an important factor in ensuring significant health outcomes and in this regard call for the development of appropriate action plans to promote health literacy. (previously OP26) AGREED

8 ter We reaffirm the values and principles of primary health care, inter alia, equity, social justice, [universal access, multi and inter sectoral approach/coordination, inclusive leadership, people-centered care, universal coverage, health in all policies, transparency, accountability, referral system (EU)] and community empowerment and participation as the basis for strengthening health systems and that [improved (US)] [public health public policies are is (US)] better achieved through supportive policies that stress better nutrition, safe drinking water, hygiene, sanitation and urbanization which is sustainable. (G77: to replace OP11, 12, and 16) EU: OK, with addition of referral system, transparency and accountability for the health system, ...[four elements of the health system]. Health in all policies (WHA, Res 62/12)

Paragraph 9bis: While noting the progress made in the past decade in advancing global health, we express concern at the lack of progress in improving global health, with across the board inequities in health persisting among and within countries. In particular, we are deeply concerned at the slow progress in achieving MDGs 4 and 5 on improving maternal and child health. In this context, we reaffirm our commitment to tackle maternal and child mortality, including through: (G77)

  1. Increased accessibility, availability, acceptability and affordability of health care services and facilities to all people in accordance with national commitments and to promote maternal and child health, nutrition and survival to achieve a rapid and substantial reduction in maternal morbidity and mortality and to reduce disparities between and within developed and developing countries as quickly as possible, with particular attention to eliminating the pattern of excess and preventable mortality among infants and children. (G77)
  2. [Achieving universal access to reproductive health by 2015, through increased political leadership at all levels, allocation of domestic and donor resources and emerging innovative financing and by strengthening public health systems, basic infrastructure, and specific health interventions (G77)]
  3. Increased commitment to address the problem of malaria and diabetes during pregnancy; a condition that impairs maternal health, and which can negatively affect their offspring
  4. Calling for an integrated approach to reverse this negative trend, including actions to tackle childhood illness (G77) (To replace Op 31 32)

Paragraph 10: We stress the [importance of attitudinal shifts, necessity to [change eliminate (US)] discriminatory practices based on religion, cultural or customary traditions, (EU, US, G77: not acceptable: see alt)] especially towards women and girls, and the development of multisectoral health policies and programmes that address their special needs [, inducing concerted efforts to counteract violence against women, which constitutes a severe threat to physical and mental health as well as to women's empowerment. [, and violence against children (EU)] (EU)

10alt We stress the importance of addressing stereotypes which constrain the achievement of gender equality and empowerment of women, as well as eliminating discriminatory attitudes and practices towards women and girls, and integrating them in the decision-making process and development of gender-sensitive multisectoral health policies and programmes in order to address their needs. (G77)

10 alt alt We stress the importance of developing gender-sensitive multisectoral health policies and programmes that address the special needs of women and girls (Kazakhstan)

Paragraph 29: We recognize the fast growing threat of non-communicable diseases (NCDs) representing more than 60 percent of the global burden of disease, including mental disorders, (EU) and their grave social and economic consequences, which place a serious [financial (US)] burden on societies. Tackling [it them (US)] constitutes one of the major challenges for development in the twenty-first century. We call for urgent action to implement the WHO (US) global strategy for the prevention and control of NCDs and its related action plan as well as recognize the potential of the Framework Convention for Tobacco Control. (EU)

Comment EU: Move up e.g. OP4

29bis We recognize that diabetes is a chronic, debilitating and costly disease associated with severe complications, that poses serious challenges to the achievement of internationally agreed development goals, including the Millennium Development Goals, (G77)

Comment: US: Treat all NCDs in one para

29 ter We also acknowledge the importance of the UNECE/WHO "protocol on water and health" as a means of fighting water related diseases such as cholera, dysentery, coli, viral hepatitis A and typhoid. (Israel)

Comment: Israel: flexible on placement

Paragraph 31: [While welcoming the progress made in the past decade in advancing global health, (Israel) While welcoming the gains made the past decade in advancing global health (Kazakhstan) we express concern on the lack of progress on [some goals, particularly (Israel)] [MDG 4 and 5 the goal to reduce by two-thirds the under-five mortality rate and by three-quarters the maternal mortality rate, and to achieve universal access to reproductive health (MDG 4 and 5) (US)]. We are deeply concerned at the slow progress in improving maternal and newborn health, and that maternal death remains the largest inequity in health in the world and call for health system strengthening as a key component of (EU) an integrated approach to reverse this trend, including for actions to prevent and cure (EU) childhood and maternal (EU) illness.


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