Address at the Opening Ceremony of the 11th Commonwealth Health Ministers Meeting

This is a momentous occasion and one which I hope will be the first of many such gatherings. We meet in South Africa as a Commonwealth family for the first time in its history: with the 'prodigal son', in reverse of the parable, welcoming the family to its bosom.

Mr Vice President, we are honoured that you are able to be with us today. On behalf of all of us, I greet you most warmly. Your friends throughout the Commonwealth have rejoiced on the return of a democratic South Africa to our association and accordingly reserved a special warmth of reception for President Nelson Mandela when he attended the recently concluded Auckland CHOGM. The Commonwealth offers its support to South Africa in the enormous work which your government is doing for your country, for Africa and for the world at large.

I welcome, too, all Ministers, delegates and observers to this triennial Commonwealth Health Ministers Meeting. I offer particular greetings to the delegations from Cameroon and Mozambique, the two newest and respectively 52nd and 53rd members of the Commonwealth. I trust you will find your first Commonwealth ministerial meeting a rewarding experience.

This meeting celebrates an act of partnership within the Commonwealth in addressing the theme of Women and Health. We are glad to have as observers our colleagues from other inter-governmental organisations — the World Health Organisation, the United Nations Children's Fund and the International Planned Parenthood Federation. We greatly value our close collaboration with our colleagues from international organisations. We also extend a warm welcome to representatives of the Commonwealth non-governmental organisations with whom we look forward to working further for the health of the Commonwealth.

We are indeed fortunate to be visiting South Africa and to enjoy the beautiful surroundings of the Cape in early summer. But the greatest pleasure comes from sharing in a Commonwealth event in the new South Africa. In the area of health, the government and people of South Africa face major challenges. Innovative approaches to health needs have already been adopted. In particular, South Africa is promoting an active partnership between women and men for development.

South Africa already has much to teach us. She is developing an integrated approach to restructuring her health system to ensure universal access to primary health care. Member countries will gladly share their experience with those developing new policies here. No doubt delegates will use the planned field trips to learn how a range of health services, treatment and care is being delivered in widely different communities.

The theme for this meeting was aptly chosen. Both committees at the October 1992 meeting of health ministers proposed it independently. Since then, there have been three major international meetings at which matters concerning women and health have been debated. Indeed, some men at Commonwealth pre-World Health Assembly meetings have even been heard to complain that the male was becoming an endangered species. They asked when appropriate action would be taken to redress the balance!

Joking aside, there are two good reasons for this recurring preoccupation. The first is that statistics demonstrate the enormous burden of preventable disease which affects women, a product in part of the disadvantaged situation of women, who are over-represented in the lowest socio-economic levels of society.

The second is the tremendous, usually unrecognised contribution women make to the health of men, children and other women, often at the expense of their own health and welfare, and the extent to which women provide unpaid health care for their families and communities. Thus, improving women's health, and giving attention to their work for health, will benefit women and men, and of course their children.

The Commonwealth has not overlooked the position of women. Commonwealth Heads of Government, at their meeting in New Zealand last month, endorsed the Commonwealth Plan of Action on Gender and Development and addressed issues which bear directly on women and on health, as well as other priorities which will have a significant effect on both. Our challenge here is to move beyond words to deeds.

Our agenda divides neatly into two sections: 'women for health', covered in the first item, and, secondly, 'health for women' which includes their experiences of health and how it could be improved. Taken together they have the potential to improve the health of all.

'Women for health' describes what women do for the health of their families and communities. For example, women have traditionally been responsible for nutrition, much of the agricultural work, and the treatment of sickness and injuries, as well as care of the disabled or dependent and much, much more. In a world which does not yet count what women do at home and in the local community as 'work', the real contribution of women is not recognised.

Women also make a measurable contribution in health professions and in their input through other sectors which affect health. Yet there is an imbalance: men are over-represented at the executive, policy-making and power-holding levels of health and other sectors. Women predominate in less conspicuous 'people-centred' activities. We still have to tackle the challenge of developing real partnership between women and men in all aspects of the health system.

The 1995 Commonwealth Plan of Action on Gender and Development will promote this: it signifies a change of focus from women to gender. It addresses the needs, understandings, skills, rights and responsibilities of all members of society and looks at the differential impact of policies on women and men. Within such a framework of values, women and men will work together for sustainable economic and social development for all nations.

But health ministers face a special problem. The health status of children, women and men is influenced more directly by poverty, education and employment than by any action which lies within the power of the health sector. The limited budgets of health ministers are committed to the provision of health services. Their work needs to be buttressed by their ministerial colleagues, not face their competition. At the tenth Commonwealth Health Ministers Meeting, ministers recognised that influencing environmental factors of most importance to health required effective advocacy and intersectoral collaboration. This is precisely the issue identified in the Pitroda report Foundation for the Future, which the Commonwealth Secretariat is currently seeking to address.