Ladies and gentlemen,

It's a great pleasure and honor for me to welcome you all to Norway and to this meeting of experts which we hope will help us to plan the health agenda for the World Summit on Sustainable Development in Johannesburg next year.

You don’t realize this yet, but you’re in a hazardous position. You’re about to listen to an un-seasoned State Secretary who has already performed three speeches today. I’ve covered legal issues relating to the management and development of international waters. I’ve talked about Information and Communications Technology and more specifically debated the highly interesting question: Can you, or can you not, eat computers? I’ve presented the Government’s position on the gender dimension when it comes to HIV/AIDS. And now, health and sustainable development. I cannot guarantee for your health and safety when this is all over. Now you’re warned.

But in a way, my day today—with all these speeches—is in some ways a good metaphor for what sustainable development is all about. It’s about a broad and dispersed number of agendas that are interlinked in multi-layered and multi-dimensional ways. Whoever came up with the concept of sustainable development—actually we all know very well who did that, don’t we?—did a great service to conference organizers and speech writers. In a way, it opens up for putting just about anything on the agenda for some kind of conference or meeting. A good way to keep politicians busy on the speaking tour.. Which of course we love even on a day like today although pretending to be exhausted..

Jokes aside, what I really am trying to say is that the concept of "sustainable development" is useful and powerful precisely because it forces us to think holistically and comprehensively about challenges such as poverty and environmental degradation. What meaning would sustainable development have for policymaking if we ignored freshwater—a fundamental source for all lifeforms we know of? What meaning if we did not connect sustainable development to human health, including the HIV/AIDS disaster? What meaning if we did not utilize powerful technologies to build and disseminate knowledge and enhance our response capacity?

So as long as we can somehow act on, and not be paralyzed by, all the "holisticity" or comprehensiveness of sustainable development rhetoric there is some hope. I hope this meeting will result in some progress in terms of leading to some real action.

The adoption of Agenda 21 at the UN Conference on Environment and Development in Rio in 1992 was greeted with high hopes. Never before had so many heads of state and government been assembled, and never had the topics under discussion been so important. The documents that were adopted were an agenda for the 21st century – a plan of action. The aim was to ensure a common future for the world that was economically, socially and environmentally sustainable.

We have made progress since Rio. The implementation of Local Agenda 21s has been particularly successful. They serve today as practical guidelines for the development of urban and rural communities in many regions across the world. But we have to admit that in general, efforts to follow up Agenda 21 have not fulfilled the hopes we entertained in 1992. We should therefore review our main achievements and the lessons we have learned so far, and identify the major constraints. When we have done this, we should decide on specific commitments and targets that will enable us to progressively implement Agenda 21.

It is governments that are responsible for ensuring that the principles of sustainable development are included at all levels in political decision-making processes. They should invite major groups and stakeholders to contribute to the process of evaluating what has been done since 1992 as closely as possible, to make sure that their conclusions have a broad and relevant basis. Only in this way can we be sure that the ground has been properly prepared for revitalizing the implementation of the Agenda, and avoid another implementation gap. Only through action, not words, will Agenda 21 serve its real purpose.

Sustainable development means integrating economic, environmental and social concerns and its ultimate goal is to create a better quality of life for everyone. The UN Millennium Declaration reaffirms support for the principles of sustainable development as set out in Agenda 21 and stresses that special measures will be taken to address the challenges of poverty eradication and sustainable development in Africa.

If the Johannesburg Summit is to succeed, it must address the main challenges we are facing in our efforts to promote sustainable development. We must mobilize political will and commitment to make a positive change in the policies and practices of all stakeholders.

Safeguarding health is high on the agenda in Norwegian development cooperation policy. Since the publication of the Brundtland report of the World Commission on Environment and Development, the world has become sensitized to the links between environmental change, health and development. Good health is clearly essential to human well-being and is a human right in itself. But it is also a means to increased productivity and poverty reduction. We are thus looking forward to the publication of the report from the Commission on Macroeconomics and Health, which will demonstrate how investment in health pays in terms of economic development. The Nobel Laurate Amartya Sen has already done groundbreaking work in this area, demonstrating the positive synergy between sound investments in improving health services and poverty reduction and improved quality of life beyond the improvement of health as such.

Investment in health and the provision of health services for the poor has been a priority area for Norwegian development cooperation for many years. This will continue to be so because we are convinced that good health is absolutely vital if people are to make their way out of poverty. Ill health arrests economic activity and income earning, which are the very basis for development. Health is, therefore, a condition for sustainable development.

I view poverty as the principal moral and political challenge of our times. Poverty is the number one ‘killer’ in the world today, and poor people around the world carry a disproportionate part of the global burden of health problems. Even though WHO has shown that the gap in life expectancy between rich and poor countries has been reduced from 25 years in 1955 to 13.3 years in 1995, it is obvious that not all populations in the world have benefited from this improvement in health. Furthermore, discrepancies within some countries – even wealthy ones – have increased in the same period. WHO has estimated that among the poorest families in the world one in five children will never reach their 5 ^th> birthday. According to the World Resources Institute this unacceptable fact is mainly due to environmental problems. The health of poor children is directly affected by unfavorable environmental conditions and by polluted air and water in particular.

Environmental changes at the global level as well as changes at the micro level have an impact on health and economic development. At the same time, changes in livelihoods and lifestyles have an impact on the environment and may in turn adversely affect human health and productivity. Environment-related health problems are becoming more and more widespread, and we must strengthen the social, political and institutional mechanisms needed to cope with them and to reverse negative trends. This is why the Norwegian government has great hopes for the World Summit on Sustainable Development. Politicians and decision-makers around the world should make use of the opportunity offered by the 10-year follow-up to the Rio Summit next year. We must take concrete steps to implement the objective set out in the first principle of the Rio Declaration, which states that "Human beings are at the center of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature". This principle is based on an understanding of the strong links between health, environment and development and the fundamental role of health for the success of global development efforts and the resulting eradication of poverty.

Much disease and ill health is directly related to environmental factors and a lack of basic health services. And this invariably characterizes the habitats of the world's poor. Health hazards such as inadequate and unsafe food and water, poor sanitation and environmental hygiene have been with us for far too long. Some of the big killers of our time, such as diarrhea, thrive in these conditions, and have not been eradicated by conventional development efforts. For this reason, clean water is a priority area for the Norwegian government. Water is essential to human development: it is needed for domestic use, agriculture and industry. In the year 2000, 508 million people were estimated to be living in 31 water-stressed or water-scarce countries. This is why we believe sound water management is so crucial.

The world is changing fast. Rapid globalization will have both positive and negative impacts on health. Apart from the globalization of unhealthy lifestyles, we are likely to see the emergence of new threats to human health associated with global climate change, depletion of the ozone layer, changes in the biosphere and environmental degradation, such as deforestation, desertification and pollution of freshwater and oceans. Adverse environmental change and pollution may spread far from the source of the problem. For example, the persistent organic pollutants, or POPs, that are used in many countries may accumulate in food chains in the Arctic, where they endanger the health of indigenous peoples and the wild game they hunt for food. Global warming, caused by consumption of fossil fuels all over the world may threaten the livelihoods of people in the Small Island Developing States. The increased prevalence of storms and floods jeopardizes human lives in low-lying coastal areas.

The examples are many, but the causal connections are sometimes uncertain. Here, the precautionary principle as set out in Agenda 21 provides a basis for agreement. This principle states that where there are threats of serious or irreversible damage, lack of full scientific uncertainty should not be used as a reason for delaying precautionary action. We would like to see the precautionary principle used to safeguard human health against environmental problems.

More fundamentally, we may need to change our perception of the relationship between the environment and ourselves. The environment is not something apart from ourselves: we are in the environment, but it is equally true that the environment is in us - in a cultural, psychological, chemical—and I would add spiritual—sense. We shape the environment and are simultaneously shaped by it.

Over the last few years there has been growing recognition of the fact that efforts to combat global epidemics and disease problems have not received enough attention and financing. As always, the poorer countries have suffered the most. Many have national health strategies and plans but lack the resources to implemen them properly. As a result, diseases continue to spread, sometimes even accellerating. When that's the case, development is certainly not sustainable.

In this light the initiative to establish a global fund to combat AIDS, Tuberculosis and Malaria is truly of significance. The aim is to have an operational fund by the beginning of 2002. Total pledged amounts are already in the area of US$750 million. We hope--it is indeed intended--that the private sector will contribute strongly. It is really a public-private partnership that we are talking about. Nongovernmental organizations will also have an important role to play at the country level. I'd like to stress that we really need this fund to be established and to succeed. In our approach to this process we have stressed the following:

• The new fund should be a financial mechanism and not a new organization.
• It should make use of existing mechanisms and draw on existing resources wherever possible.
• Special emphasis should be given to coordination at the country level to strengthen country ownership and accountability, and to encourage new partnerships between the public sector, the private sector, civil society and the donor community. The fund should be structured so that it can support, even strengthen, and not burden, the health care systems already in place and struggling in so many countries.

The Norwegian government regards poverty eradication as essential to the realization of the objectives set out in Agenda 21. Poverty eradication is also the primary objective of Norwegian development policy. By hosting and actively participating in this important meeting we hope to bring together the health, environment and poverty-reduction agendas. Communication and exchange of knowledge and experience from these different fields is an objective in itself. Furthermore, we wish to support national strategies for health and poverty reduction. In the context of the World Summit in Johannesburg, we want to promote a concerted effort at the global and national levels based on our shared understanding of the links between health and sustainable development.

Thank you.