HEALTH: GLOBAL TRENDS, POLICIES, ISSUES, ADVANCES, THREATS
from

Global Issues of the Twenty-First Century
and United Nations Challenges
A GUIDE TO FACTS AND VIEWS ON MAJOR OR FUTURE TRENDS

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by Christopher Spencer
Former Senior Advisor International Organizations,
Canadian Department of Foreign Affairs and International Trade
Updated: 13 SEP 08


ACCESS TO HIV PREVENTION: CLOSING THE GAP, A 40 page Report by Global HIV Prevention Working Group, (distributed after May 03 as Supplement to Foreign Affairs):-brief statement of Working Group's accomplishment states that it is region-by-region analysis of gaps in access to HIV prevention interventions; it examines current spending levels versus projected need; and it recommends funding and programmatic activities to avert 29m of 45m new HIV infections projected between 2002 and 2010.Worldwide comments; then analyses regarding regions: Sub-Saharan Africa, Asia/Pacific, Eastern Europe/Central Asia, Caribbean/Latin America, North Africa/Middle East. Conclusions: HIV Prevention Resource Gap; RECOMMENDATIONS. Latter(each followed by argumentation) are: Global spending on HIV prevention activities from all sources should increase three-fold by 2005 to $5.7b, and to $6.6b by 2007. Because prevention efforts currently fall short of what is needed in every region of developing world, prevention scale-up must be central priority in each region. In immediate future, prevention efforts should aggressively focus on bringing to scale especially cost-effective, high-impact interventions. As both prevention and treatment programs are brought to scale, these initiatives should be carefully integrated to create singlecontinuum of services. In addition to funding prevention interventions themselves, donors should, in collaboration with multilateral agencies, provide extensive additional support to build long-term human capacity and infrastructure. Development assistance and policy reforms should address social and economicconditions that increase vulnerability to, and facilitate rapid spread of HIV/AIDS. Research into newprevention strategies and technologies should be strengthened and accelerated. Substantial and sustained efforts by all donors should focus on improving data collection regarding magnitude and nature of HIV/AIDS spending in low- and middle-income countries.

 

Diane Ackerman et al., The New Age of Discovery: A Celebration of Mankind's Exploration of the Unknown (Toronto: Time Canada 97):-although"popular"in format, purpose/content are serious: 17 thoughtful essays contributed by leading scientists and academics. Aim is to survey where scientific discovery now stands, and where it is taking us. Many topics are or will be global and/or UN issues: health/ageing; defence against asteroids; DNA/climatic discoveries and implications; "Third World" -relevant technology; genderdifferences; care of global commons and indigenous peoples; extraterrestrial life; new energy forms; ethical computing; "homogenization" of world; special global challenges. Relatively easy place to start looking at trends and prospects- particularly if your background not in science. Survey is just example ofvaluable collections of what are in fact 21st-Century global issues, put together by good general periodicals(dailies, weeklies, monthlies),often to mark occasions like anniversaries or new years/decades. Those fitting our purposes here would be forward-looking, deal with subjects global in scope or importance, be written by top impartial authorities, and preferably offer reading lists.

 

AFRICA: CURRENT PROBLEMS, SOURCES, AND SUGGESTED CURES: MEDIA SELECTION

John Grimond "Africa's Great Black Hope: Survey of South Africa" (1-16); "Africa's Elusive Dawn" (Edit 17-8); "Aid to Africa" (59); "South African Governance: The End of Minority Rule" (Bus.66)The Economist 24 Feb 01:-these four pieces complement each other. Even if two concentrate on South Africa, its leading economic/political roles make it continent's bell-wether - in success or failure. Editorial bitter: "Africa's parlous condition dreadful condemnation of mankind's collective efforts to end poverty and promote freedom...[While]Millennium African Renaissance Programme[made South Africa's president Mbeki call firstfor]'critical examination of Africa's post-independence experience, and acceptance that things have to be done differently'" ,editor chastises rich world for its tariffs, quotas, farm subsidies, unfavourable terms of trade, weapons sales, debt inducement, tied/declining ODA - and for supporting corrupt Africanregimes/prohibitive drug prices. Africa deserves both more support/better leaders. ODA article stressesincreased British interest in helping poorest countries, i.e. mostly African which received about 1b poundsin bilateral/multilateral aid in 99-00. UK will concentrate on getting new technology/skills to students and would-be teachers, on debt relief, on police training and on peacekeeping. Business item notes although,when South Africa's present rulers still rebels threatened to nationalize big business; in power they have brought better corporate governance through greater efficiency and transparency. "Break-up of old conglomerates coincided with attempts to create new class of black businessmen" .Survey's analyses, whileconcentrating on South African economic, social and political situation, have much relevance for whole of Sub-Saharan Africa - and whole Third World. Two over-riding realities are:(1)elimination of very rich, long-entrenched and well-armed racist regime, in refined/orderly way, and without expected bloodbath(in continent only too experienced with ethnic dominations/bloodbaths);but(2) apartheid's replacement by equal or worse horror: AIDS(now threatening all Third World).In addition, relatively high (for Africa)average per capita income disguises "extremes of wealth and poverty rivalled only in Brazil: South Africa really both first world and third world country...Fortunately, long wait for freedom...provided time...to see how other countries coped with self-government. And it brought goodwill, not least because South Africa blessed with leadership of statesman of heroic proportions...Spirit of generosity seemed to characterise not just Mandela but new South Africa as a whole" .Survey discusses:(1)Land(Re)Distribution: with apartheid,white 15% of population effectively owned 87% of land, including all best;(2)Education: takes 21% of budget/5.7% of GNP, but still mixes some of best and worst schools in world;(3)Violent Crime: "threatensnot just South Africans' security but very basis of their society" mainly for socio-historic reasons;(4)HIV/AIDS: "makes most other problems seem trivial" with UNAIDS estimating 4.2m people HIV-positive; life expectancy expected to fall from 60 to 40 years by 08; social custom/ government policy at fault;(5)Racial Equality: affirmative action and "black economic empowerment" encouraged by law, butracial gaps are probably diminishing mainly through constitutional ban on discrimination;(6)Employment and Investment: both face major shortfalls, although policy aims at" growth, employment and redistribution" ;" only40% of economically active population employed in formal" sectors;(7)Justice: made much apparent progress: Constitution aims high, but partly unenforceable; independent Supreme Court; Human Rights Commission against discrimination; novel Truth and Reconciliation Commission provided neither, butoffered "day in court" ;(8)Non-Blacks: about 250,000 whites(officially or unofficially)emigrated since majority rule, but those staying generally do not suffer: Afrikaners have adapted well; Indians have lost economically, and Coloureds complain they are "not black enough" ; Appraisal: is generally good, considering where things started and African comparisons; biggest problems social: continuing dominance of racial concerns and income gaps; catastrophe of AIDS and its socio-economic impact.

 

AIDS: THIRD WORLD: COST-PATENT DILEMMA; GLOBAL ASSISTANCE

AIDS: THIRD WORLD: INFECTION RATES AND SOCIAL-ECONOMIC ISSUES

AIDS: THIRD WORLD: MEDICAL DEVELOPMENTS AND CHALLENGES

AIDS: THIRD WORLD: POLICY ISSUES AND CONFERENCES

The HIV/AIDS pandemic is viewed increasingly as the most serious challenge facing global society. Almost all material on this subject is found in the media and is included in RECENT DEVELOPMENTS. To reach all media selections relating to AIDS, click on AIDS Third World.

 

Lawrence K.Altman "Study Finds Drop in H.I.V. Cases in South India"NYT 31 Mar 06:-"Prevalence of new HIV infections has fallen significantly in southern India, region of that country where the disease hasoccurred most often, scientists reported. Many health officials have predicted major increases in HIV in India, which has world's second highest number of infected people, after South Africa. But new infections among young aduts declined by more than a third from 2000 through 2004, according to astatistical study. [Article contains selected statistics from study and varied information about sources.]Authors attributed favorable trend to an increasing use of condoms by men and an insistence by prostitutes that their partners use them. That decline, in turn, reduced transmission of HIV to spouses.Experts cautioned against drawing too firm a conclusion from one study and added that the new findingsdid not mean India's HIV epidemic was over. Still, the study has two key implications, researchers said.One is that strategies that emphasize education about how HIV can be transmitted and the use of condoms offer the best hope for reducing the spread of the virus in India. Second is that routine monitoring of HIV and other sexually transmitted diseases are powerful and cost-effective ways to control AIDS in India. But experts urged constant vigilance for signs of a reversal of the favorable trend...Reductions were more modest in 14 northern states, where prevalence of HIV infections is about one-fifth that in the four southern states".

 

Lawrence K.Altman "Chimp Virus Is Linked to H.I.V." New York Times 26 May 06:- "By studying chimpanzee droppings in remote African jungles, scientists reported [25 May] they have found direct evidence of amissing link between a chimpanzee virus and the one that causes human AIDS. Scientists have long suspected that chimpanzees are the source of the human AIDS pandemic because at least one subspecies carries a simian immune deficiency virus closely related to HIV, the virus that causes AIDS... The genetic and immunologic tests were developed in stages over the past seven years to help tracethe evolution of HIV and solve the mysterious origins of AIDS. [S]tudy combined genetics and epidemiology... Team's findings show 'for the first time a clear picture of the origin of HIV-1 and theseeds of the AIDS pandemic'. HIV-1 is the virus that causes the vast majority of AIDS cases in the world... Studies estimate that the human AIDS virus jumped species 50 to 75 years ago. But no one knowswho the first infected person was or how that person acquired HIV. The earliest HIV infection wasdocumented in 1959 in an unidentified man in Kinshasa[, Congo]. Team theorized that HIV was first transmitted locally somewhere in west-central Africa. Because the subspecies of chimpanzees... livesin the wild in Cameroon, Gabon and Congo Republic, the first infection could have been in any of those areas... The communities with a high prevalence of infected chimpanees were located south of theSangha River, which flows into the Congo river and on to Kinshasa. That led... to the theory that someinfected person carried HIV from a remote area to Kinshasa, where it was then passed on. It is not known whether chimpanzees infected with SIVcpz become ill... More collections were needed in other vast areas of Africa to provide a clearer picture of the evolution of AIDS and to determine if there wereother viruses that could cause epidemics like AIDS" .

 

Lawrence K.Altman "Report Shows AIDS Epidemic Slowdown in 2005"New York Times 30 May 06:- "Newsurveys suggest that global AIDS epidemic has begun to slow, with decline in new HIV infections in about 10 countries, leader of UNAID program said. Outside of those countries,.. number of new AIDS infections continues to rise or hover at its current pace. Meanwhile, public health efforts are reaching only a small proportion of people at risk, Dr.Peter Piot, executive director of UNAIDS, said at news conference in UN NYC ...India has 5.7m infected people and South Africa 5.5m, but India's population far greater. Showing no sign of decline, South Africa has a prevalence rate of about 19% of 47m people.In India, rate is less than 1% of its population of 1.1b. Progress against AIDS in some regions represents dividends from a surge in financing since 2001, when UN pledged its commitment to stem epidemic by 2010. Declaration called for countries to report regularly on their responses to AIDS. This week, UNGAwill receive the progress that 126 countries have said they have made. Report(op.cit.), most comprehensive survey ever compiled from country data, pointed to the 2001 UN meeting as a turning point for AIDS financing. In 2005,.. world spent $8.3b on AIDS, compared with $1.6b in 2001. 'We areseeing the impact', Piot said. He cited increased condom use, a rise in postponement of sexual intercourse and a decrease in number of sex partners as factors in slowing of epidemic. Summarizing report's findings, Piot said '2005 was least bad year in the history of the AIDS epidemic'... Despite thepositive trends, Piot reported grim findings from China, Indonesia, Papua New Guinea, Russia andVietnam(op.cit.), with signs of outbreaks in Bangladesh and Pakistan. Ending the pandemic will depend largely on changing social norms like empowering women, reducing stigma of the disease andencouraging a greater reduction in the number of sex partners, report said. Most countries have strong foundations for building an effective response against AIDS, report said, but systems to carry out plansremain inconsistent. Thoroughness of the individual national reports varied, and many countries did not provide data for all categories... Still, replies identified significant weaknesses, he said. Fewer than 50%of young people achieved comprehensive knowledge levels about HIV, far fewer than the 90% goal. Only9% of gay men and fewer than 20% of intravenous drug users received any kind of HIV prevention help in 2005. Services to prevent HIV infections in infants have not scaled up as rapidly as programs to provide antiretroviral therapy. Just 9% of pregnant women were covered... Report shows that epicenterof the epidemic remains in sub-Saharan Africa. There epidemic has reached peak, but incidence remains unacceptably high, Piot said. Across most of Africa, HIV prevalence among pregnant women attendingclinics has remained roughly level for several years. UN disputed contentions by some observers thatthe leveling off showed a turning point in the AIDS epidemic in Africa... Piot said, 'actual number of people infected continues to rise because of population growth'" ; Reuters "25 Years On, Anti-AIDS Drive Still Falling Short" NYT 30 May 06:- "Twenty-five years after AIDS first recognized, world still falling shortin its battle against the disease with severe gaps in prevention and treatment, UN said [30 May].'Response to AIDS epidemic to date has been nowhere near adequate', said UNAIDS... Since...1981,AIDS and HIV virus that causes it have spread relentlessly from a few widely scattered hot spots to virtually every country in the world, infecting 65m and killing 25m, UNAIDS said in 630p report... Anti-AIDS initiatives and their results vary widely from country to country, and many are falling short of benchmarks set in a landmark high-level UNGA session in 2001, UNAIDS said... Dr. Peter Piot of UNAIDS... expected long-term commitments at this week's meeting...and hoped for $20m annually by 2010... Global AIDS incidence rate is believed to have peaked in 1990s. About 1.3m in developing world now on life-extending antiretroviral medicines, which saved about 300,000 lives last year alone. Still, some 4.1m were newly infected and 2.8m died in 2005... Global supply of condoms was less than 50% of what was needed, and antiretroviral drugs, while more widely available, remained costly and hard to get. Ignored in many countries are prostitutes, said... ex-dir of UN Population Fund... However, final statement by governments at conference this week not expected to refer to prostitutes, drug users orhomosexuals, due to objections from Islamic nations, some Catholic countries and US, which fear thatmerely mentioning these groups would endorse their behaviour. Infected individuals still suffer fromostracism and discrimination, while vast majority of world's 40m infected have never been tested for HIVand are unaware of their status, report said. While $8.9b expected available in 2006, $14.9b will be needed, UNAIDS said. By 2008, it predicted $22.1b would be needed, including $11.4b for prevention plans alone. Report called for more and better-targeted education and prevention strategies, more treatment opportunities, and more drug research, particularly on drugs for children, whose needs 'have been largely left out of the research agenda'" ; Lawrence K.Altman "U.N. Urges Tripling of Funds by '08 to Halt AIDS" NYT 01 Jun 06:- "Stopping epidemic of AIDS will require $22b/year by 2008 and possibly more in following years, officials of UNAIDS program said. The $22b is nearly triple the $8.3b spent 05 by all sources, including governments and private sector. Urging that countries spend more, UNSG Kofi Annan said a costlier and more sustained effort needed because AIDS 'has spread further, faster and with more catastrophic long-term effects than any other disease'... Of projected figure, half is needed for prevention and a quarter for treatment and care of infected people. Remainder is for care of orphans,children at risk of becoming infected and program costs. UNSG and Piot of UNAIDS spoke as UNGAbegan meeting aimed at renewing political commitment and setting new goals for expenditures and formeasuring progress... Annan urged delegates to challenge countries trying to avoid goals that mention gay people, prostitutes, intravenous-drug users and others at high risk of becoming infected.'Governments concerned need to be realistic and responsible', UNSG said. He also said that 'if we are here to try to end the epidemic, we will not succeed by putting our head in the sand and pretending thatthese people do not exist or they do not need help'... Report cards showed that most countries missed more goals than they met. More than 20m have become infected since 2001 meeting. Now countriesmust fundamentally change the way they think and deal with epidemic, moving from crisis managementto 'sustained attention and the kind of "anything it takes" resolve that member states apply to preventing global financial meltdowns or wars' , Piot said... Global Business Coalition on HIV/AIDS released a study showing that private companies have become more likely to provide treatment for employees as cost of antiretroviral drugs has fallen over last six years, to $140-$300/year, from $10,000. In African countries with a high prevalence, more than 70% of companies surveyed are fully subsidizing access to HIV treatment, coalition said. Study...found increasing trend to expand such treatment to employees' dependents. Companies also offering access to voluntary testing/counseling" ; Lawrence K.Altman & Elisabeth Rosenthal "U.N. Strengthens Call for a Global Battle Against AIDS" NYT 02 Jun 06:- "[UNGA]adopted strongly worded declaration [02 Jun] aimed at pressing nations of the world to strengthen theirbattle against AIDS, global pandemic [UNSG] called 'greatest challenge of our generation'. Language of document surprised even anti-AIDS groups, which said that while it did not satisfy all their objectives, they had feared it would be watered down... Nonbinding declaration reaffirms commitments made in 01,when UN defined AIDS as far more than a medical issue, framing it in terms of political/human rights/ economic survival... New document is political blueprint, not plan of action. Calls for strong commitment to bolster the rights of women/girls so they can protect themselves from infection with HIV... Declarationcalls on countries to: use scientifically documented prevention strategies, including condoms;make clean needles accessible to drug users; take steps to provide universal access to prevention programs/ care/antiretroviral drugs. Includes politically charged terms like 'condoms' /'vulnerable groups' , thoughthose groups not specified... Countries expected to measure their progress over next 5 years against targets to be determined by UN... Said world will need to spend up to $23b/year by 2010... Earlier in day,UNSG Annan delivered a gloomy assessment, saying world was losing the battle. 'The epidemic continues to outpace us' , he told packed UNGA. 'There are more new infections than ever before; more deaths than ever before; more women/girls infected than ever before'... [US' s] Mrs.Bush speech steered away from many of the criticisms that have been labled against administration, notably that it promotes sexual abstinence over scientifically proven strategies, particularly condom use. Indeed, she said, 'ABC'model - initials stand for abstain, be faithful and use condoms - had brought sharp declines in infections in Africa. Britain's international development [minister] said in interview: abstinence alone did not work...Dr. Peter Piot [UNAIDS] said: while no document could make anyone '100% happy', final version was 'a major advance'and far stronger than weaker drafts circulating earlier in week" ; Reuters "Nations Resist New Financial Commitments on AIDS" NYT 02 Jun 06:- "A major UN meeting on AIDS strategy fellshort of concrete financial commitments but recognized the growing spread of the disease among women and their right to protect themselves. Last day of 3-day meeting brought together heads of state, PMs and health officials from 151 countries... 'I know that none of you got all you wanted in this declaration', UNGA President Eliasson said in closing session. But he said thanks to advocacy groups,'the draft got stronger - not weaker'... Document says $23b will be needed annually by 2010 to fight AIDS...Nations agreed to search for additional resources to ensure universal access to treatment by 2010.But delegations did not commit themselves to a timetable for raising the funds as they did in 2001 whenthe financial target was met... Squeamishness over sex was evident.,. with Islamic groups and conservative Roman Catholic countries using the term 'vulnerable groups' rather than referring toprostitutes, homosexuals and drug addicts... Yet the document, in addition to abstinence, advocated male and female condoms and 'harm reduction'efforts related to drug use, a euphemism for needle exchange programs for addicts... Declaration called for sex education, reproductive health services andcondemned 'abuse, rape and other forms of sexual violence'as well as 'trafficking in women and girls' " .

 

Kofi A. Annan, "Preventing War and Disaster: A Growing Global Challenge" , Annual Report on the Work of the Organization 1999, by the Secretary-General of the United Nations(New York: DPI/2058; Sales No: E.99.1.29-Sep 1999):-after a convincing plea for more cost-saving global efforts to foresee, prevent, or reduce human and natural crises, Annan summarizes all major UN activities over year to Sep 99, and selected plans and problems(in 130pp). Chapters address: peace and security; development; humanitarian issues; globalization; legal order; human rights; administration. Overall impression: hard-won progress implementing UN obligations/reforms/savings are frustrated by Members' selfishness/lack of political will/financial irresponsibility. HEALTH ISSUES are covered in several contexts in the Report. The most interesting/important relate to: the global HIV/AIDS pandemic,"now the most deadly infectious disease in the world" with over 30m infected by the end of 1998(55);the foci of WHO health assistance including: disaster-related needs, health-sector aid, priority areas(mental health, epidemics, immunization, malaria, pharmaceuticals, nutrition, polio, malaria)(69); biosafety(84); environment/health(85); drugtreatment/database(87).

 

Kofi A. Annan, "UN Committed to Ensuring World Water Security and 'Blue Revolution', Says Secretary-General, in Message to World Water Forum" in UN Press Release SG/SM/7334 21 Mar 00:-urgent global problem is finding huge additional quantities of affordable water to meet increasing needs of population growth/concentration and rising agricultural/industrial demand, and to make up for global pollution andfalling water tables(see Worldwatch Institute: Lester R. Brown, "Water: Emerging Constraint on Growth" (123-5)in State of the World(1999)op.cit.). Hence "world's impending water crisis" was theme of UNSG's text. He reported that "every year, more than 5 million people[over 50% children]die as a result of poor water quality - 10 times the number killed in wars...[W]ithin 25 years two out of every three people on Earth will live in water-stressed conditions. Indeed, the declining state of the world's freshwater resources, in terms of quantity and quality, may well prove to be the dominant issue on the environment and development agenda of the new century" . UN Newservice 21 Mar 00: Klaus Toepfer, UNEP head, at the Forum: "The battle for the conservation of water will be won or lost in the mega-cities of the world" .[Technology can help:]Douglas Jehl, "Tampa Bay Looks to the Sea to Quench Its Thirst" in New York Times12 Mar 00:-US appears to be just reaching the stage when many high-density areas need, or find it economic, to desalinate sea or brackish water. Tampa Bay(2.3m residents)will be the first large urban areato do so, planning the largest(25m gallons/day)desalinization plant outside Saudi Arabia(whose economics are totally different). As of writing, five states(cheaply)desalinate brackish water, while two cities which built sea-water plants decades ago, now use them for backup due to cost. But Tampa cost estimates have fallen from $4-6 per 1,000 gallons to $2.08. With several cities planning desalinization, and many more facing the need, economics/technology may now produce a global cost breakthrough. [World FDI and ODA may soon include large expenditures on desalination.]

 

Kofi A. Annan, "We the Peoples: The Role of the United Nations in the 21st Century" Millennium Report of S-G presented 03 Apr 00 to UNGA in preparation for the Millennial Summit 6-8 Sep 00:- Executive Summary, Key Proposals, Full Report, Fact Sheet, Press Releases, SG UNGA Statement, SG Press Conference Transcript: all under http://www.un.org/millennium/sg/report/. Annan said report "attempts to present a comprehensive account of the challenges facing humanity as we enter the twenty-first century, combined with a plan of action for dealing with them" . Section titles with(very tight)summaries: I. New Century, New Challenges: New millennium-Summit offers unique occasion to reflect on world's common destiny, since interconnected as never before. UN can help meet challenges ahead and be reshaped now to make a real difference. II. Globalization and Governance: Globalization unequally distributed and lacks shared social objectives. More people(plus crime, drugs, terrorism, pollution, disease, weapons, migrants, refugees)interact across frontiers faster, and feel more threatened/ horrified by distant events/conditions. New technologies enable common understanding/action, so must learn to govern better, together. States need mutual help via common institutions, from non-state actors, and informal policy networks. The unequal/unstable/unsustainable world development model needs agreed remedial measures. III. Freedom From Want: .5b live on less than $1 a day, so must reduce extreme poverty by half before 2015. Priorities: sustained growth; all children complete primary school by 2015 and all youth finddecent work; by 2010 HIV infection rate in young cut by 25% -one result of more LDC-relevant research; improve lives of 100m slum dwellers by 2020; experts/charities to tackle low agricultural productivity in Africa, as governments give higher priority to poverty; maximize LDC access to infonets to speed development; rich states open markets to LDCs, offer more debt relief, and focus increased ODA. IV.Freedom From Fear: internal wars killed 5m in decade; WMD remain threat; security protects people, not territory. Tackle conflict by: prevention, more balanced development, human/minority rights, exposingweapons/money/resource smuggling; protect the vulnerable by enforcing international/human rights law; using UNSC for armed intervention when rights and lives are massively violated; consider peace operations review panel proposals; target "smart" sanctions more; improve control of small arms transfers, and reduce dangers of existing nuclear arms and proliferation. V. Sustaining Our Future: Most planet-sustaining actions are too few, little, and late. Before 2002, must: cope with climate change: reduce emissions 60% by efficient/renewable energy, implementing Kyoto Protocol; meet water crisis: accept 2015 target of 50% reduction in those without safe/affordable water, raise agricultural productivity per unit of water, improve management; defend soil: biotechnology may be best hope for sufficient food production, so debate must be resolved globally; preserve forests, fisheries, biodiversity with joint government/private sector conservation; build new stewardship ethic: public education, integration ofenvironment into economic policy, regulations/ incentives, accurate scientific data. VI. Renewing the UN: Must find consensus solutions among governments, private sector, NGOs, and IOs, with UN as catalyst. Build on core UN strengths(norm-setting, global actions, humanitarian trust)to press rule of law, adapt UNSC, and work with NGOs, private sector and foundations, including through informal policy networks; work with industry to exploit information technology; improve UN management throughstructural/agenda reform, priority-setting, more flexibility, results-based budgeting. VII. For Consideration by the Summit: Act on basis of shared Charter values: Freedom, Equity and Solidarity, Tolerance, Non-Violence, Respect for Nature, Shared Responsibility. Adopt resolutions drawn from Report as evidence.Reviews: Barbara Crossette, "Annan Urges High-Tech Aid for Poor Countries" in New York Times 4 Apr;The Economist 8 Apr: "Kofi Annan's Words to the World: Bouncing to a Fairer World" (51).

 

Kofi A. Annan, "Common Destiny, New Resolve" , Annual Report on the Work of the Organization 2000, by the Secretary-General of the United Nations(New York: DPI/2153;Sales No.E.00.1.22-Sep 99):-UNSG begins by noting report to Millennium Summit, "We the Peoples: The Role of the United Nations in the 21st Century" (op.cit.), includes his assessment of humanity's progress and challenges at turn of millennium,and suggests ways in which international community can work together to" better lives of people still left behind" .Introduction, summarizing 130-page report on major UN activities over year to Sep 00, highlights: (1)Demands on UN humanitarian agencies far exceeded worst-case predictions; (2)Living standards in sub-Saharan Africa still declining; (3)AIDS pandemic spreads with frightening rapidity; needs stronger commitment to action; (4)Three new peace missions were created, straining UNHQ resources. (5)Reviewsanalysed UN failures in Srebrenica and Rwanda; offered recommendations. (6) controversial economicbenefits of globalization must be more inclusive/equitably shared. (7)Must be cooperative management ofglobal economic affairs through more effective governance. (8)Informal global policy networks involving governments, international institutions, civil society and private sector have great potential. Chapters: Peace/Security; Humanitarian Commitments; Development; International Legal Order/Human Rights; UNManagement.

 

Kofi A. Annan "Courage To Fulfil Our Responsibilities" The Economist 04 Dec 04(23-5):-UNSG offers global action-urging essay built on his immediate reaction to report of the High-Level Panel on Threats, Challenges and Change. Following his urgent introduction is a brief summary of Annan's alreadyconcentrated and rearranged version of the panel report's many concerns/proposals. Its value is less to summarize the panel's views than to identify subjects they and/or he discuss. "We face a world of extraordinary challenges - and of extraordinary interconnectedness. We are all vulnerable to new security threats, and to old threats that are evolving in complex and unpredictable ways. Either we allow this array of threats, and our responses to them, to divide us, or we come together to take effective action to meet all of them on basis of a shared commitment to collective security. I asked the 16 members of [panel]- eminent people representing many nations and points of view - to analyse the threats to peaceand security our world faces; to evaluate how well our existing policies and institutions are meeting them; and to recommend changes to those policies and institutions, so as to ensure an effective collective response to those threats. Their report...makes 101 far-sighted but realistic recommendations. If acted on, they would address the security concerns of all states, ensure that UN works better, strengtheninternational rule of law and make all people safer" . First: threats. Event/process leading to deaths on large scale/lessening life chances or undermines states, should be viewed as threat to innatl peace/security.Clusters: economic/social, including poverty/disease; inter-state conflict/rivalry; internal violence: civil war/state collapse/genocide; nuclear/radiological/chemical/ biological weapons; terrorism; innatl crime.Threats interconnected to unprecedented degree; no state alone can defeat. Highly enriched uranium at size of 6 milk cartons could level medium-sized city as nuclear device. Such attack in US/Europe isstaggering cost for world economy. Security of developed states only as strong as ability of poor statesto respond to/contain new deadly infectious disease. Incubation period for most is longer than most air flights, so any one of 700m who travel airlines in year could unwittingly carry lethal virus to unsuspecting state. Today, virus similar to 1918 influenza could kill tens of millions in fraction of a year. In today's worldany threat to one is truly threat to all; applies to all categories of threats. Since real limits on self-protection,all states need collective-security system, committing all to act cooperatively against dangers. Givengravity/interconnectedness of threats, world needs more active prevention. Prevention can be highly effective(Nuclear Non-Proliferation Treaty);WHO helped halt SARS. Best prevention agents: capable states, acting/cooperating with others. Best preventive strategy: is development support. Millennium Development Goals to halve poverty/hunger by 2015 states' best security investment. It will save lives/reduce violentconflict and radicalism/bolster state ability against threats before real harm. HIV/AIDS shows danger ofinadequate prevention. Slow/ineffective global response allowed 20m killed/20 years; spread continues andworst to come. Ultimate cost will include shattered societies. Still not taking all needed steps to bring under control. Also need public-health facilities built in poor world. Not only poorer states benefit diseasetreatment/local prevention; whole world has better defence against bio-terrorism/large-scale naturalepidemics. UNSC should work with WHO to strengthen biological security via prompt, effective responses.Equal: greater environmental collective action, including beyond Kyoto protocol to better resources management in states at risk. Prevention also vital to protect against terrorism. New isrange/scale/intensity of threat(al-Qaeda can kill around world/has struck in 10+ UN members).Could acquire instruments of massive destruction: unprecedented danger. UN must better use assets in fight against terrorists: articulate a strategy respectful of laws/human rights. Definition of terrorism offered: any action intended to kill/seriously harm civilians/non-combatants, with purpose of intimidatingpopulation/compelling action by government/innatl organization. States should use to build consensus andstrengthen UN response to deadly scourge. Also urgent recommendations on non-proliferation/disarmament/curbing supply of materials to reduce risk of nuclear/chemical/biological attacks by states/terrorist groups. States encouraged to end development of domestic uranium enrichment and urgedto voluntary time-limited moratorium on reprocessing plant construction. IAEA ability to monitor compliance with Non-Proliferation Treaty strengthened by standards in protocol for safeguards inspections. Since Cold War, UN far more engaged in preventing/ending civil wars; ended more through negotiation since 90 than in previous 200 years; developed expertise/learned hard lessons. As demand for UN blue helmets grows, need to boost peacekeeper supply/avoid 90s worst failures. Rich states should hasten efforts transforming existing forces for UN peace operations. UN must invest in mediation/support peace agreementimplementation. Demobilize combatants/reintegrate into civil life; otherwise civil wars not successfully ended/other goals(democracy/justice/ development)remain unmet. Often innatl community lost focus if crisishigh point past/peacekeepers left. Propose UNSC create Peacekeeping Commission; to give strategicfocus for work in states under stress/emerging from conflict. If prevention/peaceful resolution fails, UN must be able to rely on force. Whatever reason: all states/UNSC should bear in mind basic guidelines/ questions: (1)Seriousness of threat: does it justify force?(2)Proper purpose: does proposed force halt/ avert threat?(3)Last resort: all non-military options explored/exhausted? (4) Proportional means: force proposed minimum necessary?(5)Balance of consequences: clear action not worse than inaction? No need to amend Art.51 of UN Charter: any state's right of self-defence against armed attack/pre-emptive action against imminent threat. However if states fear threats, neither imminent nor proximate, but which could culminate in horrific violence if left to fester, UNSC already powered to act/must be prepared to take action earlier than past, when asked/reliable evidence. Protection of civilians inside states long fraught with controversy. Yet recognized more widely that question better framed, not as intervene-right butprotection-responsibility - borne first/foremost by states. Panel agreed principle of non-intervention in internal affairs cannot protect committing genocide/large-scale ethnic cleansing/other comparableatrocities. I hope UN members agree/UNSC will act. UN(now nearly 60)born in very different time/world, so has under-appreciated record of adapting to new dangers, e.g. peacekeeping in world's civil wars/response to attack of Sep 01. Clearly needs far-reaching reform to prevent/respond to all current threats. Some propose via-UN collective response too difficult/not necessary. But all anti-threat actions impact beyond immediate context/all states benefit from shared global framework. Not mean UN needs to do everything. It must learn of share burdens/welcome help from others/work with them. Already does so; report recommends strengthened UN partnerships with regional organs/individual states. Great attention: UNSC reform. Objectives: make UNSC more effective/authoritative. Permanent membership devised(1945)to ensure active engagement of big powers to maintain peace/security. New permanent members matter of controversy/debate. Two suggestions, both expanding membership to 24; aim at: add those who contribute most to UN financially/militarily/diplomatically; ensure UNSC represents UN as whole;not expand veto, which would render decisions more difficult. Proposals offer chance breakthrough in year ahead. If acted on, UNSC more representative/better equipped for decisive action. Need strengthened UN secretariat that can support Peacebuilding Commission; implement UNSC/ committee decisions better on peacekeeping/mediating civil wars. Report envisages more concerted-action secretariat, with UNSGmore responsible for management/accountability. Equally important: ECOSOC overhaul to strengthen role in social development/improving knowledge on economic-social dimensions of security threats. Also, recommends Human Rights Commission better defender of rights of all. After 60 years, once again findworld mired in disillusionment and all too imperfect. Easy to stand at sidelines and criticise/talk endlessly about UN reform, but world no longer has that luxury. Time to adapt collective security system so it works efficiently/effectively/ equitably. Next year UN states reviewing progress on Millennium Declaration; world leaders' summit in Sep. Appropriate moment to act on some of most important recommendations in report.I will indicate which call for decisions at that level. Fervently hope world leaders will rise to challenge. Have all lived through period of deep division and sombre reflection. Must make 05 year of bold decision; all share responsibility for each other's security. Let's summon courage to fulfil responsibility." Complete text of "A More Secure World: Our Shared Responsibility" Report of the High-level Panel on Threats, Challenges and Change, plus initial comments by requester/addressee, UNSG Kofi Annan, can be read and even copied(99pp Acrobat Reader)from Secretary General's part of UN file (www.un.org). Executive Summary(8pp Acrobat)also available at same address. Capturing the 21st Century Security: Prospects for Collective Responses(Oct 04)collects reports from six Stanley Foundation conferences in 04 that dealt with UNSG panel. Report at http://reports.stanleyfoundation.org. Council on Foreign Relations "Q&A: Reforming the United Nations" 01 Dec 04:-originally available either by NYT>CFR>International>[title] or via CFR directly. This is expert interview with Lee Feinstein who" has spearheaded Council work on the United Nations" and studied the important UN report and its UNGA prospects.

 

Associated Press"U. N. Names Family Planning Official"New York Times 11 Oct 99:-reports UN Population Fund has appointed European Parliament member and 1997 runner-up in Ireland's presidential election, Mary Banotti, to be its goodwill ambassador and spokeswoman for UNFPA's "Face to Face" campaign. As such she will publicize plight of women and girls denied access to reproductive health care and family planning services.

 

Associated Press "Earth is Menaced by Fewer Killer Asteroids Than Previously Thought" New York Times12 Jan 00:-deals with real and major danger from space, not only to entire cities but to all life on earth, that is far from infinitesimal. Scientists have been estimating that 1-2,000 mountain-sized asteroidsperiodically cross the earth's orbit. This number produces about a 1% chance of one hitting the earth per millennium. Since asteroids are lumps of rock, iron and other material believed left over from the formation of the solar system, and those being counted have diameters between two-thirds of a mile to six miles, they are big enough to "wreak global disaster" . NASA has just lowered the estimated number of such killersto about 700, or by half. New technology may find 90% within the next 20 years, but there are also lots of smaller asteroids able to destroy cities. Britain has just set up a risk assessment committee. AP, "Experts Mull Asteroid Risk" NYT 18 Sep 00:-committee mentioned above is reported to have urged British government to seek international partners to fund a powerful new telescope to be stationed in southern hemisphere and governments should launch joint studies to assess how to destroy an object on a collision course with the planet. Committee estimated that a "wide object" crashes into our planet every 10,000 years with the force of a 100-megaton nuclear bomb. Government reacted:" it's sensible to put justa little[money]into making certain we know if there is a danger of an object hitting our very fragile planet" .

 

Associated Press"Researchers Produce a Healthier Rice"New York Times 14 Jan 00:-reports " scientists have genetically engineered a type of rice that could end vitamin A deficiency in the developing world" . About 14m children worldwide are deficient; so besides reducing widespread blindness, raising vitamin A levels could prevent 1-2m deaths a year. Swiss researchers successfully spliced three genes into rice to make it rich in beta carotene, a source of vitamin A. While tests are ensuring the original nutritional valueis maintained, the famous International Rice Research Institute(IRRI) is working to breed the trait into popular rice varieties. New developments reported in David Barboza"AstraZeneca to Sell a Genetically Engineered Strain of Rice"NYT 16 May(Note to Anthony DePalma"Super Seeds Sweeping Major Markets...").

 

Associated Press"Dolly Creators Claim Cloning Pigs"New York Times 14 Mar 00:-reports research groupwhich created Dolly the sheep, the world's first clone of an adult mammal, has produced the first cloned pigs. Since pigs are physiologically one of the closest animals to humans, it is hoped they could be" genetically engineered so that their organs or cells would be more readily accepted by the human body, making them more easily transplantable" . It is believed that transplantation of genetically altered pig organscould be tested on humans in four years. Although such "xeno transplantation" is controversial because of major concern that diseases could be transferred from pigs to humans (see The Economist 21 Aug 99 op.cit.), it is claimed that genetically altered pig organs "are the only near term solution to solving the worldwide organ shortage crisis" . Many people die awaiting a transplant, or having one rejected.

 

Associated Press "Number of Refugees Grows Worldwide" New York Times 13 Jun 00:-World Refugee Survey 2000, issued by prestigious US Committee for Refugees, claims that at end of 20th Century there were35m people worldwide "uprooted and in need of protection." Conflict contributed 7m to this in 99 alone, and despite UN success in ending some long-term disputes following end of Cold War, this estimated total had risen from 29m in 90. Moreover, of these, 13.7m are found in Africa(4.4m in Sudan alone).Another trend has been continually growing number of refugees that for various reasons remain in their own countries:Internally Displaced Persons. Identified IDPs now number at least 4m, and clearly demand higher priority from UN-UNHCR since they are not afforded same legal protections and care as" international" refugeesunder Geneva Conventions. On other hand, there is hope that some sources of refugees and IDPs may bein sight of permanent solution. Elizabeth Rosenthal, "Famine in North Korea Creates Steady Human Flow into China" NYT 10 Jun:-report on motives and stratagems of North Korean refugees within/outside their country. Any moves towards Korean reconciliation could have major and rapid effect on this crisis. For evenlonger-term look at issue of unwilling migration, AP reports "Conference Addresses Migration" NYT 10 Jun:-experts Paris meeting organized by Universal Academy of Cultures concluded "globalization demands greater moral responsibility and intervening in sovereign nations is plausible response to misery that drives populations beyond their borders." Those seeking political asylum increased from 250,000 in 87 to 900,000 in 92, but then declined to 388,000 in 98,perhaps reflecting growing influence of such perceptionin UN. Meanwhile, if Europe's population falls 100m by 50, migration waves may become beneficial.

 

Associated Press "Nations Vow to Fight Urban Blight" New York Times 09 Jun 01:-results of five-year-review of progress in meeting UN Habitat Agenda, agreed upon at 96 global summit on urban issues in Istanbul. New York review conference produced UN Declaration on Cities and Other Human Settlements in the New Millennium which reaffirmed commitment to Agenda principles regarding "adequate housing for all and sustainable development of world's cities" -no easy task since many countries" openly admit they have made little progress since Istanbul meeting. More than 1b...still lack adequate housing[out of 3b(50%)global urban population, and since f]ast-growing slums are common on outskirts of Asian, Africa and Latin American cities" .Textual crises overcome involved Palestinian proposal to criticize Israel, and US refusal to reaffirm adequate housing as "human right" .

 

Associated Press"Ugandans Report Mixed Messages on AIDS Plan"New York Times 18 Mar 06:-"Question of why Ugandans didn't use a condom is at the heart of a dispute between some health activists and US government. Activists, as well as some Ugandan officials, accuse US of blunting the condom message in favor of abstinence, while the Americans say they are victims of misinformation and have actually increased nearly tenfold the number of condoms they supply to this African nation of 26 million...Billboards urging condom use have disappeared from the capital, Kampala. In their place are posters, some funded by US government, urging youth to delay sex until marriage... HIV prevalence crept up to 7.1% in 2004-5, after stagnating at around 6% preceding three years, according to government figures";

 

Associated Press"AIDS Said Orphaned 1.5M Asia - Pacific Kids"NYT 22 Mar 06:-"AIDS has orphaned an estimated 1.5m children in Asia-Pacific region, but they are often overlooked in the mix of other issues surrounding a disease that has historically focused on adults, officials told a regional conference...About 121,000 children in the region have been infected by the disease, according to UNAIDS figures from2004. Another 35,000 also need anti-retroviral drug treatment to survive. Three-day meeting has drawnsome 250 delegates from UN agencies, governments and NGOs to Hanoi to discuss what can be done to limit spread of the disease among youth and how to help children already infected or orphaned by it... UNICEF regional director... said there needs to be increased prevention efforts targeting youth, more focus on prevention of mother to child transmission, provision of drugs to children suffering from the disease, and creation of support groups for kids infected with the virus or orphaned by it... A Save the Children survey... found that many children cannot go to school because someone in their family is sickwith the disease, they are commonly ridiculed and ostracized by society and are sometimes forced to work as slaves or sex workers after becoming orphans"; AP"Group Warns of More Child AIDS Deaths"NYT24 Mar 06:-"Number of children orphaned by AIDS in East Asia-Pacific region could grow from 450,000 to 1.7m in less than a decade if resources aren't increased for prevention and treatment, UNICEF official said... Also said number of child deaths could reach nearly 20,000 a year during that time if more isn't done... It would take up to $5.5b annually until 2015 to lessen effects of HIV/AIDS on children in the region, in increasing to an estimated $6b a year after that, he said... [UNICEF epidemiologist also said] there are an estimated 450,000 children in the region who have lost one or both parents to the disease, and thatcould grow to 1.7m by 2015 without more funding... A document released at end of conference called for reducing the stigma and discrimination associated with HIV, boosting steps to prevent mother-to-child transmission, and enhansing care and protection for children. Other provisions included more pediatric HIV testing and greater access to anti-retroviral drugs for children. HIV/AIDS epidemic is growing faster in East Asia than anywhere else in the world. In many countries epidemic still largely concentrated in high-risk groups; AP"Gilead AIDS Drugs Show Prevention Promise"NYT 27 Mar 06:- substantial articlediscusses current global hopes in seeking action both against and avoiding HIV/AIDS. Begins: "Twenty-five years after the first AIDS cases jolted the world, scientists think they soon may have a pill that people could take to keep from getting the virus that causes the global killer. Two drugs already used to treat HIV infection have shown such promise at preventing it in monkeys that officials last week said they would expand early tests in healthy high-risk men and women around the world...'If it works, it could be distributed quickly and could blunt the epidemic'. Condoms/ counseling alone have not been enough -HIV spreads to 10 people every minute, 5 million every year. A vaccine remains the best hope but none is in sight. If larger tests show the drugs work, they could be given to people at highest risk of HIV - fromgay men in US cities to women in Africa who catch the virus from their partners... The drugs are tenofovir(Viread) and emtricitabine, or FTC (Emtrive), sold in combination as Truvada by Gilead Sciences Inc."AP"Bid to Give AIDS Drugs to Poor Nations Lag"NYT 28 Mar 06:-"UN's attempt to put 3m HIV-infected people around the world on antiretroviral drugs by last year fell far short of its goal, but it saved hundreds of thousands of lives nonetheless, [WHO] said. So-called '3 by 5 program'- 3m people on antiretroviral drugs by end of 05 - was launched in Dec 03. However, a progress report issued by WHO said only 1.3m people in poorer countries were being treated at end of 05... Program helped lay groundwork for more ambitious goal of achieving nearly universal access to medicine by 2010, set by leaders of G8 nations in 05... Some 3m people die of AIDS each year, [Global AIDS Alliance exec.dir.] said, and WHO believes program averted between 250,-350,000 deaths in 05... WHO report said world spent $8.3b on AIDS 05, up from $4.7b in 03... Treatment in southern Africa, a focus of program, has risen sharply... Other regions also of concern, such as India where large number of people infected and treatment access still very low.A general goal is to expand testing because most people who are HIV-positive don't know it. Testing for children in particular needs to be more widespread so that infected youngsters can be identified quickly and started on treatment, WHO AIDS director said. Health workers have to act quickly becauseabout half of AIDS-infected children die before age of 2".

 

Associated Press"EU Agency: Gypsies Suffer Discrimination"New York Times 07 Apr 06:-"Gypsies[henceforth Roma] remain among Europe's most discriminated-against people, European Union's racism watchdog agency said [07 Apr]... Roma routinely denied jobs/ housing/education/health care, saidVienna-based EU Monitoring Center on Racism and Xenophobia. Center's director... said Roma living in many of EU's 25 member states suffer 'systematic discrimination', and called for more intensive effort/greater political will to eliminate the bias and help lift Roma communities out of poverty. Estimated 6.2m Roma live in Europe - 4.6m in central/eastern Europe - according to estimates by UN-affiliatedInternational Organization for Migration. Last year... EU monitoring center said unemployment ran as high as 90% among Roma in some new EU members such as Czech Republic, Hungary and Slovakia, and that worst discrimination happened when Roma tried to rent/buy property. ['T]erritorial segregationis particularly acute', report said. Roma also tended to receive substandard medical care... A globalconference of Prague-based International Romani Union - coalition of organizations working to easethe plight of Roma - designated 08 Apr as International Day of Roma in 1990"

 

 Associated Press"AIDS Conference Ends With Appeals"New York Times 26 Apr 06:-"International AIDS conference [in Cape Town, of 1,000 scientists/researchers,] ended [26 Apr] with impassioned appeals to political/pharmaceutical industry leaders to fund development of a virus-killing [vaginal] gel to protect women from the disease and so save millions of lives. Peter Piot, head of UNAIDS,.. said safe/effective microbicides could be ready in 5-7 years, with only minimal additional funding, and thus turn the dream of saving millions of lives into reality... In the hard hit African countries, women account for nearly 60% of infections. Most are infected through heterosexual intercourse... UNAIDS/WHO have long promotedmicrobicides as a potentially valuable weapon in fight against the epidemic, not least because it allows women to protect themselves without having to rely on partners who refuse to wear a condom or befaithful. Yet despite this, research has proceeded slowly. [Piot] said investment in microbicide development should be doubled - and even then would still only reach about US$150m per year...Microbicides can take the form of a gel, cream, sponge or ring that releases an ingredient that can kill or deactivate HIV during intercourse. There are currently five different products being tested[, mainly in Africa on thousand of women]. Dozens of agents that could interrupt HIV transmission have so far beenidentified. There are also hopes that the microbicides could be used to prevent other sexually transmitteddiseases and unwanted pregnancies. One of the products, cellulose sulphate, has the potential to bea contraceptive and shield against HIV... Another microbicide, Carragard, coats vaginal cells and preventsthe virus from entering...Much of funding for research comes from Gates Foundation and US government... Trying to dismiss fears that microbicides would mainly be used in developing countries and therefore offer only low profit margins, [WHO] cited their potential for use in contraception in wealthy countries".

 

Associated Press