Thank you Richard for that very generous introduction. As Richard has said I've had the extraordinary privilege of working closely with Jim Grant and writing the State of the World's Children Report throughout Jim's years at UNICEF. One result is there are a great many names here in Vancouver that I am very familiar with and I would like to take this opportunity to say thank you to the many people at this Congress who have helped me whether they know it or not over those years.
Today I am here to talk about a very different publication. Another fragment of the Jim Grant vision. Again as Richard has said the Progress of Nations 1995 - this looks more cheerful than the version you have on the screen - will be launched next week in Berlin by the President of Germany and the new executive director of UNICEF. I would today like to explain our hopes and aims for this report and to preview some of its main findings. May I also stress that the report is embargoed until June 8th and would also appeal to any media present to respect that embargo.
There are also many in this audience who have helped in this first three years in the Progress of Nations. In the years to come I hope that many more of you will become involved and that together we have a chance of building this genuinely useful international publications for the next decade. I might also add on a practical point that I am very much counting on this week in Vancouver with so many professionals in their fields present here as a unique opportunity to plan in some detail the next edition.
The aim of this publication is stated boldly on the title page. There is says the day will come when the Progress of Nations will be judged not by their military strength nor by their economic power but by the well being of their peoples. By their levels of health, nutrition and education. By the respect that is shown for their civil and political liberties, by the provision that is made for those who are vulnerable and disadvantaged and by the protection that is afforded to the growing minds and bodies of their children. The Progress of Nations published annually by the United Nations Children Fund is a contribution towards that day. To that end it tends to monitor the very basics of development. The very things we have been talking about here this morning, in health, in nutrition, in education, in family planning and in progress for women. It lists and ranks the nations of the world in their regions according to what they are doing and how well they are doing in each of these basic areas. it looks at progress in relation to resources and it looks at progress over time.
This is a necessarily, on occasion a controversial approach. There have been many protests from governments. It is also an approach that I am sure all you here can well anticipate, that is fraught with statistical difficulties. Despite these problems I believe the attempt to do it is justified. The forces of national pride and national shame are still very powerful in this world for good or ill. I would say mostly for ill. This publication is an attempt to help link social progress, people's progress to these great forces. It's an attempt to say that social statistics, the statistics that directly measure people's well being should also be a matter of national pride and national shame for industrialized and developing countries alike. It is an attempt to create what Bill Foege referred to as a missing link. The social norm, the social pressure and expectation that might translate what could be done into what is done.
The Progress of Nations goes out in its different language editions to almost every national newspaper and magazine, radio and television station as well as to universities, government department, major NGO's and so on in all countries. It is a small voice whispering to larger voices. It's main interest is national. It provides information for people to see how their own country is performing and how its progress compares with other countries in the same region or roughly the same economic level. The statistics of each nation tell the story of what is. The international comparisons tell the story of what is possible.
In almost all countries today economic statistics are part and parcel of the political and public debate. I believe the same should be true of social statistics, of changes in the proportions of children who are malnourished, of changes in the proportion of children who drop out of school, changes of proportion of the children who lack clean water or who die or become disabled from easily preventable illnesses. In all countries these and all other social indicators should become the stuff of everyday political debate, media coverage and public concern.
From what I've said so far it may seem that the main purpose of the Progress of Nations is to be critical but I want to correct that impression. The main emphasis of this publication year by year is on achievement. In its pages you will find documented some truly extraordinary achievements in water supply, in child health and education, in family planning, including in many of the largest and poorest countries in the world.
I stress this because in the industrialized world in particular where most information about the developing world comes either in news of its disasters or in appeals for help there is a growing tendency to see the developing world as a stage in which only tragedy is enacted. This I believe does lead to an unjustified pessimism to a faltering of faith in progress. Every issue of the Progress of Nations attempts to remind and record that in only 40 years, average real incomes in the developing world have more than doubled. Child death rates have been more than halved, malnutrition rates have been reduced across the board by at least a third. Life expectancy has increased by a third. Primary school enrollment has risen from a lot less than half to almost three quarters and the percentage of rural families has risen from less than 10% to about 60%. In the meantime the proportion of couples using modern methods of family planning has risen from almost nothing, thirty years ago to more than 50% today. An average family size is falling almost every country in the world. In many of them very steeply.
Such statistics hide great failures and great disparities. Poverty and oppression, injustice and exploitation are alive and well, but however you cut those figures they also represent remarkable progress. It is the kind of progress with which the world must keep faith. More particularly the Progress of Nations monitors progress towards fulfilling the promises that were made as we heard this morning by almost all the world's governments at the 1990 world summit for children. At that summit meeting which is so largely the result of the inspiration and leadership of Jim Grant, the international community agreed on a series of very specific, very measurable goals for protecting the lives, the health and the normal development of children the world over. Too often the commitments made on such occasions are forgotten. Their promises echoing ever more emptily down the years.
We in UNICEF and all our allies were determined on this occasion that those promises would not be forgotten. We were determined that in spite of all the difficulties, all the statistical problems we would somehow keep measuring, keep reminding people, keep monitoring, keep these goals in front of the public eye. The results have not been as so many people thought, a general story of failure. The years since 1990 have in the main, been years of significant and measurable progress towards those specific goals for children in more than half the countries of the world.
In each of the first three editions of the Progress of Nations we have attempted to document that progress or the lack of it in each and every country, progress towards some of these most basic goals for the well being of the world's children.
Let me now give one or two examples from the findings in the 1995 report. You will all receive after this Congress a copy of the publication so I needn't be exhausted in summarizing the contents. This year for example we take up the issue of what nations are doing about the specific problem of Vitamin A deficiency which as you know affects more than 200 million children in the developing world. In his introductory chapter to this issue Al Summer, the dean of Hopkins School of Hygiene Health writes that Vitamin A supplementation could reduce child deaths by a quarter and a third in many countries of the developing world. We know that this is a problem that can relatively, easily, relatively cheaply addressed. We know that most governments of the world promised action in 1990. What has happened in practice.
The Progress of Nations shows the record placing all countries of one or four categories depending on what progress they are making in the Vitamin a program. It lists for example that 35 countries in the world, but with well over half of the developing world's children that have already implemented nation wide Vitamin A programs. It also lists the 41 countries that are known to have a Vitamin A problem but have not as yet taken any large scale action. To take another example we also list all nations of the world according to the action they are taking to eradicate polio. With the cooperation of the World Health Organization the Progress of Nations again places all countries in one of five categories depending on what stage they have reached on the road to polio eradication.
We list the 24 countries in the world where polio eradication has now been certified. We list the 57 nations where polio transmission has probably ceased, but where the cessation has not been certified. We also report that there are 28 countries where levels of polio transmission are very low indeed and where eradication could be achieved with appropriate effort in the very near future. We list also the 25 countries some of them large and some of them poor, in which the transmission of the wild polio virus is still at a significant levels, or for which we believe that to be the case but for which there is little data. Lastly we list the 15 countries in which it is estimated by WHO and UNICEF that eradication of polio by the year 2000 will still be extremely difficult. Many of those countries are countries in a state of instability through war or conflict. The section of polio also carries an introductory article by WHO's doctor in which he expresses a very clear warning about over confidence about this very great goal of polio eradication. Polio can not be eradicated any where until it is eradicated everywhere. That remains a very tall order. I might also mention that he also appeals in that article for more support, financial support from the industrialized nations for the very difficult and really very expensive final stages of polio eradication pointing out the continuing need to immunize all children against polio is currently costing the United States around 270 million dollars a year and currently costing Europe 200 million dollars a year. Expenditures that will no longer be necessary on an annual basis, no longer necessary at all, once polio eradication is achieved. There is therefore a very strong economic argument as well as a strong humanitarian argument for overcoming the difficulties and expenses of this last stage of polio eradication.
Still with immunization we published a list of now the 45 developing nations that have reached a very high level, the target figure of 90% measles vaccination. We also list 18 nations that have achieved a 15 percentage point rise or more since 1990 and unfortunately we have to list those countries where measles immunization levels have been allowed to slide by 20 percentage points or more, including Nigeria, Cameroon, Butan and Papa New Guinea. We point out two with high immunization levels for measles and for other vaccines are not just a matter of resources. Some poor nations are doing very much better than some rich nations. Vietnam for example with a per capita income of only $170 per year is reaching 90% of its children regularly with measles vaccine. A higher proportion than in Japan or Germany or Italy.
To take another example we attempt again with WHO's help to report progress against the acute respiratory infections that are still the single biggest killer of the world's children. Accounting for between three and four million child deaths each year. As most of you know at least 1.5 million of those deaths could be prevented if the relatively simple and inexpensive procedures developed by WHO were to be followed. We list 88 countries where large numbers of children die from pneumonia. We also list the 21 that have launched nation wide programs to combat that problem, the 37 nations that have launched programs in part of the nation, the 14 that have plans of action but no large scale action and the 16 that do not have plans.
I also mention that the new edition documents progress towards another of the specific goals, the eradication of guinea worm disease, down by 90% in the last two years.
We also feature progress against one of the most calamitous and least know problems facing the world's children, the problem of iodine deficiency. Over the years the lack of dietary iodine and most of you know has condemned literally millions to quetenism since birth, tens of millions to mental retardation and hundreds of millions to milder degrees of impairment. The solution as you all know is to iodize salt at a cost of about 5 cents per person per year. A solution that has been deployed in North America and in Europe since the 1920's.
At the 1990 World Summit for Children most of the affected countries agreed to attempt the iodization of at least 90% of all edible salt by the end of 1995. What's happened in practice? The progress relations list the 50 countries that have acted vigorously on this promise and are close to achieving this vital goal. Many others will surpass the 80% mark putting them in a strong position to reach the 2000 target of eliminating iodine deficiency disorders.
The report also covers many other topics, water supply, primary education, progress for women, drawing on the 47 surveys published so far by the DHS, it also tries to monitor progress in a very different, very difficult area. The area of the convention on the rights of the child. As well as publishing what figures we have on specific abuses, child prostitution, child labor, we also tackle a much more difficult issue. The convention on the rights of the child is the first human rights document ever to include basic economic and social rights. All ratifying countries of which there are now 174 have under taken the commitment and I quote, "to diminish infant and child mortality and to combat disease and malnutrition". It is extremely significant that these phrases are included in a human rights document.
The convention also calls upon all nations to make sure that all children have access to education. Now also it is very much easier for richer nations to reach these obligations and the convention caters for this, or attempts to cater for this by saying, "that countries shall undertake such measures to the maximum extent of available resources". This of course is very difficult to measure. How can parents and citizens know if their government is attempting to meet these basic social rights to the best of its resources, to the maximum extent of its available resources. The basis of such judgment can only be international comparison. A country cannot claim that it is meeting those basic needs to the best of its resources if far poorer countries are doing far better. A country with a child death rate of 250 per thousand, a malnutrition rate of 30% can't claim this is entirely due to poverty if lower rates have been achieved in far poorer countries. As you all know that is very often the case. Whether measured by survival and nutrition, education, there are countries that have achieved far higher levels of social statistics than would be implied by the economic level. We are all familiar with the well known examples of Sri Lanka.
The Progress of Nations 1995 attempts to systematize such comparisons so that they can be made relevant, so that they can be used in and for all countries, using the concept of the national performance gap for NPG. By taking economic and social statistics from all countries it is possible to estimate what level of social development whether it is judged by under five mortality rates, primary school completion, malnutrition rates or any other accepted indicator, what level of social development can be expected at any given level of economic development. The national performance gap measures the difference between the actual level of progress that a country has achieved and the average level for that country's per capita GNP. Some countries as you know are doing far better than you would expect for their GNP. They therefore have a positive national performance gap. Other countries are doing much worse than could reasonably be expected for their economic level. They therefore have a negative national performance gap.
So despite the often inadequate statistics, the national performance gap, therefore provides an approximate measure of how well each country is doing for its children in relation to its resources. It is therefore a measure of that vital article four of the convention on the rights of the child, monitoring whether nations are meeting their children's rights for nutrition, survival, education to the maximum extent of their available resources. We believe this will become a useful tool. We welcome your participation in improving and refining this idea.
As I've said, you will all receive a copy of the report so let me just mention one more example from this years. We focused also on the aid record of the industrialized nations. This years chapter is introduced by the Norwegian Premier who describes the present state of the aid giving effort as being in a shameful condition. Our figures confirm this. The latest year for which aid figures are available is 1993. In that year every single industrialized nation, apart from Austria, Ireland and France, reduced its aid budget, many of them steeply. On average in that year the industrialized nations in that year gave only 0.3% of their GNP's in official development assistance. Less than half of the target figure of 0.7% agreed to almost twenty-five years ago. It is indeed a shameful record. Only four countries today meet the 0.7% target, Denmark, the Netherlands, Norway and Sweden. The world's largest donor in absolute terms, the United States has now fallen to bottom place in percentage terms with a contribution of just 0.15% of GNP or half of the average for the industrialized world.
Let me now mention a problem which I'm sure you have all anticipated, the chief problem we face is of course the weakness of statistics. We are trying, as I believe no publication of this kind has done before, to be honest about this weakness. Last year's edition began with the words, "the Progress of Nations is a flawed publication, its statistics are frequently out of date, incomplete and sometimes based on extrapolations and on mathematical models rather than on vital registration systems or on the systematic collection of basic data". The facts and figures that we use are the best and the latest available but they are not nearly good enough.
In the past, the lack of timely social statistics could probably be put down fairly to underdevelopment, but as I mentioned earlier the majority of countries today publish annual, some of them even quarter data on complex things such as GNP growth, inflation, employment, manufacturing output, consumer spending, balance of payments. More and more nations are regularly providing tabulated information on every thing from energy use to television viewing figures. Yet the great majority do not even produce statistics every five or ten years to show what percentage of their children are malnourished or what percentage suffer from preventable illness and disabilities or access to safe water and sanitation or what percentage of women receive anti-natal care or die in child birth or give birth to low birth weight babies.
It is statistics such as these that speak to real human progress and statistics such as these that need to be collected every two or three years if the commitment of social development is to be taken seriously and monitored seriously. Especially I believe we need better statistics about the subject of this Congress in Vancouver this week, the health and the well being of children.
The obvious and profound connection between the mental and physical development of children and the social and economic development of their societies means that the protection that society affords to its children is the very touchstone of development and that most fundamentally is the importance of this Congress in Vancouver. Because the child has only one opportunity for growth and because the process of that growth is so subtle and so susceptible, UNICEF has argued for many years that the child's once chance to grow and develop properly should be shielded from the mistakes, the misfortunes and even the malignancies of the adult world. Whether a child has health care or not, whether a child gets immunized or not, whether a child has a school to go to or not, whether a child grows normally in mind or body. These things should not have to depend on the fluctuations of interest rates or commodity prices or debt rescheduling or even on whether one political party is in power. As I know John Rhode will be speaking with you later this week. With today's know how, the very basic health and development of almost all children could be protected if children are given a first call on societies concerns and capacities and if a commitment is made to maintain that protection both in good times and in bad.
That is the principle of first call to children. It is the great ideal at the heart of social development but it cannot be upheld without a basis of statistical support without knowing and knowing in time how well or how badly our policies to protect children are working.
I would like to end now by returning for a few moments to the relationship between social and economic progress. The Progress of Nations is principally about social development and in particular about closing some of the most obvious, the most shameful and the most damaging gaps between today's knowledge and today's need. There are those who say all this is whistling in the wind. Most of the issues covered in the Progress of Nations, most of the issues we are discussing here in Vancouver this week are symptoms and that the real disease is poverty and that only long term economic development can make any real difference. What can we say in answer to this? First we must answer, I believe, by saying that it is true that specific action against particular problems in child health will not solve the problems of poverty, it will not restructure unequitable economic relationships. It will not eradicate the many causes of poverty and unemployment and low income but I believe those of us working in this field have sometimes treated this argument with more respect than it deserves. I believe we must now answer it by asking a question of our own. That question is, "How much longer must the world's poorest families wait before it is decided that a level of socio-economic development has been reached that a few dollars can be afforded to help them prevent millions of their children from becoming malnourished, blinded, crippled and mentally retarded. We must also answer by saying, frequent illness, malnutrition, poor growth and illiteracy are some of the most fundamental causes, as well as some of the most severe symptoms of poverty. We must answer that the pulse of economic development is weakened when millions of children suffer from poor mental and physical growth. We must answer that the march towards equality of opportunity is slowed where the children are the poorest and drop out of school into a lifetime of illiteracy. We must answer that the productivity of communities is sapped by the hours spent carrying water from unsafe sources and by the time and energy and health that is lost. We must answer that the prospects of finding a job and earning an income are crushed by preventable disability and ill health. We must answer that a families capacity to save and to invest to the future is less when a child is born mentally retarded by iodine deficiency or whatever. We must answer that the contribution of women to economic cannot be liberated if women remain subordinate, chained to long years of childbearing without the option, chained to long days of attendance on illness, long hours devoted to the fetching of water and fuel. In these and many, many other ways the symptoms of poverty helped to crush the potential of the poor. To reduce their control over circumstance, to narrow the choices available to them and to undermine the long term processes of economic development. The struggle for social justice and economic development both within and between nations must continue, just as the poor themselves will continue to struggle as they have always struggled to meet most of their own needs by their own efforts. Those efforts can and must be enhanced by specific actions against disease, disability, malnutrition, illiteracy and drudgery. That is our mission.
At the same time, we who are principally concerned with particular if wide spread problems, especially in health, must also maintain our sense of balance on this issue for in the end economic and social progress must proceed side by side or they would eventually and inevitably hold each other back.
In much of the poor world, as you all know, is now reaching a crisis point in its struggle for economic development. Joblessness, landlessness and an increasingly desperate kind of poverty have been allowed to set up destructive synergisms of rapid population growth, increasing local environmental pressures, rising social tensions and in far too many cases a simply disastrous instability. Unless national governments and the international community renew the quest for new economic policies and relationships to create growth and to ensure its more equitable distribution then there is a very clear danger that these mounting pressures in the years ahead will overwhelm the past progress and the future hopes. While doing all that we can to take action against the specific problems that we will be discussing and learning about here in Vancouver this week, I believe, that we who work in our different specific ways for improved child well being must also raise our voices whenever and wherever we can in the cause of sustainable and equitable, economic development. Thank you all very much.