Mr. Chairman, Wah Jun Tze, ladies and gentlemen, Jim Grant placed children first. He devoted the best part of his life and energy to them. He thus became one of those rare individuals of whom it can be said they have helped to create a better world and given us hope for a better future for the whole of humanity. Exercising his conscionable examination and imagination Jim Grant was able to create a corridor of peace for immunization in time of war. He managed to convince both the pauper and the poor that premature death and a stronger future for children were neither.... nor....and through reckless and personal efforts he was able to give them social mobilization a new meaning inspiring a whole nation to harness their resources and their energy on behalf of children. Working for so many years in close association with Jim Grant has been a great privilege for me. Jim Grant was never content with words only. He wanted action and always made sure that there was follow up in the field. He made the reason be know to powerful people and parties alike in major cities and in remote villages of the world.
In 1981 Jim Grant was involved with UNICEF in an international seminar which a kind of first activity for other Asian countries, in central provinces of China with the joint participation of WHO, UNDP and world banks. I was there, WHO regional director, for the western parts and he and I spent several days traveling together across the province up to Yenti. It was memorable experience during which we discovered we made an excellent team since he could speak Chinese but not read while I could read it but not speak it. I always like to think of that long journey when Jim Grant used to talk. In later years sometimes it was difficult but in this sociable partnership which bind UNICEF and World Health Organization together, I am grateful for the apprenticeship that Jim Grant extended to me and shall always remember these many years of courage with him as a deeply valuable experience. It will be impossible to review the list of all his achievements ranging from the campaign he launched for the child survival and the development of the world summit for children.
We didn't expand the program of immunization, the child vaccination, the various health programs and intervention for eradication of poliomyelitis, measles, the control of acute respiratory infections and diarrhea disease among children, the protection and promotion of breast feeding, micronutrient deficiency we at WHO knew that we could always rely on Jim Grant for his love and support of UNICEF universal importance. On our own we would not do justice to his life. His ceaseless struggle against indifference, and injustice is the biggest education to international service. His fifteen years of passionate commitment to the children of the world, their survival, their well-being and their happiness. The best and only worthy tribute we can pay Jim Grant's life and memory is to humbly to continue to do his work, to try to follow in his footsteps and to remain true to his example to the spirit in which he himself always lived and worked.
Much of the international attention for child health in this last decade has been directed at simple intervention to prevent more than 12 million deaths each year among children under five. These simple measures include child immunization, the control of diarrhea, acute respiratory disease and the promotion of infant and young nutrition, particularly breast feeding. I will show in this transparency infant mortality and children under five mortality has decreased significantly and we will achieve our child summit goal by the year 2000. Still we need great effort but we hope that we will do it.
In 1985 our friend and colleague Jim Grant launched the initiative called child survival which over the years has saved the lives of millions of children with the support of UNICEF, UNDP and with the support of many other agencies and non governmental organizations. WHO remained committed to preventing children's death and enhancing their quality of life. WHO set for itself a number of intermediate targets for the year 2000. Among which the eradication by more than two million of the total number of annual deaths of children under five. The first one is the report which I told to the 48th assembly earlier this month report that simple intervention WHO has been planning and implementing it also provides an assessment of their impact on the lower mortality, morbidity and disability among children. This is a overview of how UNICEF, WHO and world community has been achieved in the first ten years.
We have the significant degrees but still many, many diseases in the developing countries are not yet controlled or eliminated. Today we are on the verge of elimination of poliomyelitis and the prospects are good that we will be able to eliminate both neonatal tetanus, iodine and Vitamin A deficiency by the year 2000. All these goals are within our reach. In 1993 there are 40,000 fewer deaths from measles than 1985. Even so, the remaining 1.2 million deaths from measles and the other 2.4 million deaths from vaccine preventable disease during childhood should not be accepted by us. They can and therefore should be prevented. There has been growing international recognition that health, nutrition, and well being of women and mother's lay the foundation of child health and health for future generations.
This combination inspired the declaration and plan of action from the world summit of children, international convention on the life of the child and the program of action of the international conference on population, implementation and development. In terms of health the most striking and unacceptable gap be raised between maternal and child survival. It is true that between 1960 and 1993 the gap in infant mortality was narrowed by 50% as you see here between developing and developed countries. But during the same period the gap between the least livable and the developing countries actually widened. In the developing world, maternal mortality rate can be high as 700 per 100,000 live births and nearly half of the births are unattended by a trained person. There are many obstacles which impede for the progress in child health and there are various forces and circumstances that are eroding the progress already made while historic gains have been made in immunization still many groups have not been reached. For example, deprived and marginalized population of the inner cities in the third world and much of Africa where immunization levels are around 50%. Diphtheria is raging in the country of the former Soviet Union where quality control and vaccine production, have deteriorated because of the period of transition of market technology. Tuberculosis is surging up in developing and developed countries alike. Malaria has an annual two million death toll of which half are children. HIV, AIDS is a growing problem in all countries and continents and of concern for future generations as well as today's development. Prevention and health education related to sexually transmitted diseases and HIV, AIDS must be among our priority as we are intent on preserving the health and the future of our youth.
Countries which have made enormous strides in making health care accessible to all women and children are now beginning to see cracks in and even the cracks of parts of their health system. Failure to invest now in healthy infrastructure and simple technology for child health and reproductive health will erode human productivity and creativity for the next generation. This is a fact which we can't afford ignore and which be recognized by all leaders. Many social pressures contribute to the urgency of addressing child health care issues in their broadest context. By the year 2000 48% of the world population will be living in urban areas. Some 15% of them in the city of 5 million or more. Larger numbers of women are entering the formal and informal labor force often resulting in inadequate maternity registration that would provide them protection and the support during the pregnancy and the period of breast feeding. The support traditionally insure by the extended family is declining and the number of single parent households usually under the responsibility of women is rising. In both developed and developing countries many young women continue to have children before having reached social and biological maturity. This pattern takes its toll in excessively higher rate of maternal and new born mortality and life long morbidity. The health and well being require that we advocate healthy lifestyles and promote responsible parenthood. A parent who smokes increases the child's chance of respiratory disease and other diseases and contributes to a small but significant impairment of the child's growth. Children born of adolescent parents are at higher risk of prenatal and infant morbidity and mortality. Statistics tend to show that they are also more likely to suffer child abuse and neglect. When left to themselves or separated from their families at an early age, children are more likely to acquire health damaging lifestyles such as substance abuse under peer pressure and external influence.
Survival is but one dimension of infant and child health in primary health care. Health whole is our common goal and is jointly defined by all WHO member states. It requires that we focus on infancy and childhood are crucial stages in the health development process of any individual. This is when we can work on focusing on optimum physical growth and psycho social development and identify and control the prerequisites of a dark disease. The future of any society depends on the health growth and development of its children and adolescents. Every child who has underdevelopment is affected by the subtle interaction of its genetic trait and the various inferences at play in its physical and social and family environment. Nutrition and health education both have a crucial role to play in enhancing children's health. Child growth and development can be seen as a series of steps, each of them requiring a combination of crucial nutrients, psychological stimuli and social interaction in order for the child to pass successfully to the next step. If started the process results in an increasing, natural, well nourished and healthy individual able to function in a family community and why that social setting at any stage destruction of the development process may occur at the medical, biological, immunological, psychological, socio-economic levels. Some transitional period are more critical than others constituting key points of the abilities of that child. The impact of the infection, injury or inadequate nutrient intake may be immediately apparent or may not be manifested until adult life. Poverty is a major obstacle to healthy development of each individual and to realize the overall goal of health care. Poverty is often caused or perpetrated by ill health. Poverty is the world's deadliest disease and wields its destructive influence at every stage of human life. All children are born with a flame of hope in their heads. For millions and especially for the girls that flame is too soon extinguished by poverty and discrimination. WHO's vision of health for all remains a generous and much needed ideal that can be pursued with a strong sense of solidarity.