The document summarizes the key discussions and outcomes from the PMAC 2017 conference on addressing health issues for vulnerable populations in the context of achieving the UN Sustainable Development Goals. The conference included presentations on various vulnerable groups such as people with disabilities, refugees, migrants, ethnic/sexual minorities, and those affected by HIV/AIDS. Barriers these groups face include stigma, discrimination, lack of access to services, poverty and human rights violations. Solutions discussed involved strengthening state policies and programs, improving health sector responses, increasing understanding through scientific research, and empowering civil society advocacy. Achieving meaningful social inclusion requires collaborative efforts across government, health, education, and community organizations.

1. Summary
Ministers,Secretaries,distinguishedguest,LadiesandGentlemen
I am speakingonbehalf of the rapporteurteam.
It isan opportune time forPMAC2017 to addressthe healthof vulnerable populations,inthe
contextof the SDGs whichfocuson social inclusion—leavingnoone behind.
The PMAC 2017 has been arrangedbetween29Januaryand 3 February2017. Duringthe pre-
conference,there have been 34side meetingsand6fieldtrips.Duringthe mainconference,
there have been 3 keynote addresses,4plenarysessions,19parallel sessionsandmanylaunch
events,posterpresentationand anart contest.There are a total of 888 registeredparticipants
from73 countries.Half of participantsare male.
We have a total of 134 personswho tooka role as chair,moderator,speakeror panelist.The
graph at the upperrightof thisslide clearlyindicatesthat more malesthanfemalesare onthe
stage of the PMAC 2017. I am gladthat NGOsand Civil SocietyOrganizationsare the majorityon
the stage,44 out of 134.
1. Who are the vulnerable population and socially excluded?
The conference hasidentifiedanumberof typesof individualsand groupswhoare vulnerable
and sociallyexcluded.
Individuals andgroupsof people are excludeddue to various attributes:gender,race,caste,
indigenous origin,ethnicity,religion,disease,disability,migrationanddisplacementstatus.
Theyinclude:
• The poor and those with very limitedfinancial means
• People withdisabilities
• People livingwith HIV/AIDS
• People fromamongsexual minorities
• People wholive inremoteareasandare isolated
• Membersof minoritygroups,religions andcertaincastes
• The elderlyandinsome cases,widows

2. The co-existence of multiple attributes createsextremevulnerability amongstsuch individuals,
as seeninthisfigure.Forexample,adisabledyounggirl belongingtoa disadvantaged caste
livinginatribal area of Indiais categorized asthe mostvulnerable of the vulnerablepeople. We
oftenrefertothisas “intersectionality”
The consequencesof social exclusionare enormous.The vulnerable are ofteninvisible inthe
society inwhichthey live, andtheirsocial exclusion isassociatedwith low social standing,
poverty, low humancapital endowments, restricted accesstoemploymentandservices,and
lack of voice.
2. The pain and suffering of refugees
In 2015, IOM estimated that65 millionpersonsare forciblydisplaceddue toconflicts;21 million
are refugees,34million are internaldisplaced personsand 10 million are statelesspeople whose
existence isnotacknowledgedby anynationstate. Natural disastersresultin anadditional 19
millionbeingdisplaced.
Religious andpolitical conflictsare majordriversof refugeeflight.
Evidence clearlyshowsthe grave healthconsequencesof refugee status:physical assault,
mental breakdown,anddepression.In some settings refugees are sexuallyabusedand their
humanrights violated, asinmanyof the detentioncenters forasylumseekers.
Despite the contributionsby UNHCR, MSF and otherhumanitarian actors,the increasing
numbersof refugeesanddisplacedpersonsdue toarmedconflicts farexceedtheirresources,
limitingtheirabilitytoprovide effective supporttoall.
Humanitarianactionaimsto preserve life andrelievesuffering,protecthumandignityand
restore people’sabilitytomake theirowndecisions. Humanitarianaction isnotdevelopmentor
peace building,state-building,orlongtermsupportto human rights.

3. As statedbyJamesOrbinski,MSFInternational President,atthe Acceptance Speechforthe
Nobel Peace Prize in1999:
Humanitarianismisnota tool to end waror to create peace.It is a citizens' responseto
political failure. It is an immediate,short-termactthatcannoterasethe long-term
necessityof political responsibility.
3. The plight of migrants
IOMestimates thatthere are around1 billionmigrantsworldwide, of whomthree quartersare
internal migrantsanda quarterinternational migrants. Economicdisparityacrossrichand poor
countries, anddemographicimbalancesbetweenthe global north withalow fertilityrate and
labourshortage and the global south withlaboursurplus,are the maindriversof migration.
The stereotypingand publicdiscoursewhichdiscriminate againstalarge numberof migrantsis
the maindriverof xenophobiaandviolence againstthisgroup.
Evidence showsthatthe migrantfriendlypolicytowardsSyrianrefugeesinTurkeycontributesto
improvedeconomicwellbeingof boththe migrantsandthe hostcountry.
Poormigrant workersface high costswhensendingmoney home totheirfamilies.The feeson
average amountto 7.5% of total remittances.
In 2015 the worldwide remittance flowsfrom the UnitedStates toothercountrieswas134
billionUS$. Itis estimatedthatcuttingtransfercharges byat least5 percentage pointscansave
up to $16 billionayear, improvingthe economiclivelihoodof these migrants andtheirfamilies.
The SDG target10.c aims to reduce tolessthan3% the transactioncostsof migrantremittances
and eliminateremittance corridorswithcostshigherthan5%.The profits benefitprivate
enterprisessuchasWesternUnion, andMoneyGram.
4. Persons with disability
Disabilityisnotcaused only byphysical,mental andotherimpairments, butfamilyand social
attitudesandstigmaare additional burdens.The UN Conventionon the Rightsof Personswith
Disability(UNCRPD)hasshiftedthe paradigmfrommedico-charitytoasocial model of disability.
National lawsare requiredtobe inline with the principlesof the UNCRPD. Country experiences
demonstrate aneedforharmonization withotherconventions suchasthe ConventiononChild
Rights, the Convention onthe Eliminationof All Formsof DiscriminationagainstWomen
(CEDAW), andotherinternational humanrightsinstruments toaddressthe challenges of
multiple vulnerabilities.
Despite the twoConventionsratifiedbyState Parties,the UNCRPDand the CEDAW,
governments lackcapacitytoimplementthe national laws,leavinghuge roomformajor
improvementnotonlyinlowandmiddle income countries,butalsoinhighincome countries.

4. Supportto ensure full social participationbypersonswithdisabilityare grosslylacking,for
example there are linguisticbarriers affectingthe deaf, andphysical environment challenges for
the blind.
Eugenicsterilizationof people whoare eithermentallyill ormentallydefective,withouttheir
consent,isnotuncommonly practicedincountries whichhave ratifiedUNCRPDandCEDAW.
A surveyin2010 by the DisabledPeople'sInternational(DPI) Women'sNetworkJapan,has
uncovered the traumainthe livesof womenwithdisability.One physicallydisabledwomenin
herthirtiesreportedasfollows:
I wassexually molested by my mom’sboyfriend.Whilehewasassisting me during my
bathtime, he touched my breastsand otherpartsof my body.Itwashorrible.I told my
mombutshe did notbelieve me. Thatwaseven worse.
Anothersaid:
I somehowmanagedto geta job,butmy bossasked me to go outfor a drink. I gotdrunk
and fell asleep. He then tookme to a hotel and raped me.Afterwards,herepeatedly
forced me to havesex with him.
5. Ethnic minorities
Ethnicminoritiesworldwide are violatedof theirhumanrights,theirrightstotheirlands,their
culture,theirreligiousandritual practices.Theyare oftennotrecognizedbytheirstates,asthey
were notrecognizedbytheirformercolonial masters.
The StolenGenerations history exemplifiesthe abuse of ethnicminorities.They are the
generationsof Aboriginal childrentakenawayfromtheirfamiliesbygovernments,churchesand
welfare bodiestobe broughtupin institutionsorfosteredouttowhite families.
Thiswas official governmentpolicyinAustraliauntil 1969, butthe practice hadbeguninthe
earliestdaysof Europeansettlement,whenchildrenwereusedasguides,servantsandfarm
labour.
AlmosteveryAboriginal familyhasbeenaffected insome waybythe policyof childremoval.
Takingchildrenfromtheirfamilieswasone of the mostdevastatingpracticessince white
settlersarrived, andhas continuingprofoundrepercussionsforall Aboriginal peopletoday.
In 1995, the CommonwealthAttorneyGeneral establishedaNational Inquiryintothe Separation
of Aboriginal andTorresStraitIslanderChildrenfromtheirFamilies.The Inquiryreport, Bringing
themhome,was tabledinthe CommonwealthParliamenton26 May 1997, the day before the
openingof the National ReconciliationConvention.Bringingthemhome made 54
recommendations.

5. FormerHighCourt Judge,SirRonaldWilson,chairedthe HREOCInquiry.After Bringing them
homewas released,he toldanaudience inCanberrathat:
Children were removed becausetheAboriginalrace wasseen asan embarrassmentto
white Australia.Theaim wasto strip the children of their Aboriginality,and accustom
themto live in a whiteAustralia.The tragedy wascompoundedwhen thechildren,as
they grew up,encountered theracismwhich shaped thepolicy,and found themselves
rejected by the very society forwhich they were being prepared.
The Inquiryfoundthatbetweenone inthree andone intenIndigenouschildrenwere removed
fromtheirfamiliesunderpastgovernmentpolicies,butcouldnotbe more precise due tothe
poor state of records.
AcrossAsiaand Latin America“tribal peoples”and“indigenouspeoples”have lowersocial
status,limitedvoice andpoorhealthoutcomes.Theylive inremoteforestedareas,withlimited
control overtheirlivesandlands. While povertyhasreducedandhumandevelopment
outcomeshave improvedacrossthe board,yetimprovementsamongindigenouspeopleshave
not beenasdramatic as those amongthe general population. Thishasoftenledtoincreased
inequalitybetweenindigenousandnon-indigenouspopulations.
6. Stigma and violence stemming from sexual orientation and
HIV/AIDS
Those whoare Lesbian,Gay, Bisexual andTransgender(LGBT),andthose affectedbyHIV/AIDS
and TB, are the classicpresentationof multiple vulnerabilities.
Social attitudesandcriminalizationincertainstates exacerbatethe exclusionof LGBT, andthose
affectedbyHIV/AIDSand TB.In particular,theyresultinviolence,andphysical andmental
assaultsof LGBT people.
HIV-relatedstigmaispervasiveinthe livesof those livingwiththe disease.Stigmamarkspeople
as differentandasdisgraced.Itdeniesindividuals theirdignity,respectandrighttofully
participate intheircommunity.
Stigmamanifestsindiscriminatoryandsometimesviolenttreatmentof people livingwithHIV,
theirfamiliesandothersaffectedbyHIV.Stigmaandsocial exclusiontakesplace infamilies,
communities,employmentopportunities,andeducationandhealthcare settings.
The negative attitudestowardspersonswithHIV/AIDSresultinextremestatementsthat
majoritygroupsfindnohesitationinvoicing,suchas:
Peoplewith HIV should be jailed and peoplewith HIV are immoral.
The negative consequencesforthe individual are clear,butsuchresponsestointernalized
stigmaalsoundermine familial andcommunitynetworksandrepresentagreatwaste of states’
social capital.

6. Effortsto increase publicawareness andencourage the properunderstandingof HIV/AIDS,
throughcampaignsby UNAIDS,Civil SocietyOrganisationsandotherpartners,have contributed
greatlyto minimizingthe stigmatizationof HIV/AIDS,thoughunevenprogress isapparent.
7. The solution stream: a long march towardssocial inclusion
Social Inclusioncanbe definedintwo ways. The firstisa broad sweepdefinition,whichframes
social inclusionas:
the processof improvingthe termsforindividualsandgroupstotake part insociety.
A second,sharperdefinitiontakesintoaccounthow the termsof social inclusioncanbe
improvedandforwhom.It articulatessocial inclusionas:
the processof improvingthe ability,opportunity,anddignityof people disadvantagedonthe
basisof theiridentitytotake part insociety.
The Conference hasdiscussedandproposedvarioussolutionsinsupportof social inclusion.
7.1 The role of state actors
Firstand foremost,ispoliticalcommitment.Statesmustdoanumberof things.
First,theymustrecognise the issuesandstrengthentheircapacitiestoidentifythe socially
excludedintheircountries,capacitiestodeviseeffective inter-sectoral policiesandactionsto
progressivelyrealize socialinclusion,andcapacitiestomonitorprogressandreformulate
effectiveactions.These state responsesmustbe framedwithinhumanrightprinciples.
Second,theymustincrease opportunitiesforinclusioninmarkets,services,andspaces,forthe
sociallyexcluded.
Third,theyshouldstrengthenandsustaininstitutionalcapacitiestoimplementthe various
Conventionsandotherinternational humanrightinstruments,inordertoprogresstowards
social inclusion.
Fourth,theyshouldstrengthenpolicyandpractice toreduce all typesof stigmaand
discriminationinall settings, - labourandemployment,education,andhealth-care settings.
Fifth,theymustimprove legal andpolicyresponses,andcrackdown on all typesof violence
relatedtostigmaand discrimination.
Sixth,theyneedtorecognize the intersectionsof multiple vulnerabilityattributesanddevise
effectiveintersectoralactionsforsocial inclusion.
7.2 The role of health sector

7. The healthsectorhas a veryimportantrole to playto ensure the healthof the vulnerable
populationisprotected.Toname some keyactions:
Demandside financing,suchasthe use of conditional cashtransfersforhealthservicesfor
certainvulnerable groups, hasbeenapositive experience inseveral countriesthoughthere are
challengesonmonitoringandensuringsustainability. However,demandhastogo handin hand
withwell regulatedsupplyof services
Progresscan be made in ensuingthe provisionof dignifiedandrespectful services
Anti-stigmainterventionsshouldbe embeddedincohesive national HIV policyandprogram
responses.
The use of a communityscore card, local assemblies,andcreationof effectivedialogues
betweencommunityandhealthcare providerscanencourage “collaborative governance for
health”andenhancesthe accountabilityof providersandthe state tocitizens
Healthprofessional educationshouldbe transformedinbothinstitutional andinstructional
dimensionstowardsa“sociallyaccountable healthworkforce”,byprovidinggreater
opportunitiesforstudentsfromsociallyexcludedgroupstotrainas healthprofessionalsandbe
locatedintheirhome communities.Thiscanensure more dignifiedandrespectful servicesto
theirlocal populations.
7.3 The role of scientific communities
Scientificcommunitieshave importantrolestoplay.Forexample,theyshould:
 Developgreaterunderstandingof stigmaanddiscriminationbasedonsocial identity.
 Understandthe social dimensionof andsolutionsto“stereotyping”whichgeneratesstigma
and social exclusion
 Devise innovationsforeffective reductionof stigmaanddiscrimination.
7.4 The role of non State Actors
Experiencesof non-state actorsdemonstrate the contributionsthey canmake:
 The Culture Centre of the Deaf in Mongoliahasgoodexperiencesinadvocatingfor
awarenessof UNCRPD,ithas alsocontributedtothe CRPD shadow report.
 The DisabledPeople'sInternational(DPI) Women'sNetworkinJapanhasaddressedthe
multiple discriminationstowardwomenwithdisabilities,disabilityreform, andlinkages
betweenCRPDandthe CEDAW.
 The creationof the TunawezaChildren's CentreinUganda,whichempowerschildrenwith
special needstoreachtheirfull potential,wastriggeredbythe “noddingsyndrome”,
diagnosedsince 1970s, whichisendemicincertaincountriesinAfricaaffectedbythe Black
Fliesandonchocerchiasis.
 More broadly,Civil SocietyOrganisationshave acritical role toplayinholdingState Actors
accountable,asintheirparallel reportof the UNCRPD.
8. Conclusion

8. Finally,the conference concludesthataddressingsocial inclusionrequiresatopdownapproach
fromresponsive andaccountable governments,andabottomup approachthroughan active
citizenship. Social inclusionisoftennotaboutdoingmore,asmuch as itis aboutdoingthings
differently.
This slide showsyou the name of the Rapporteur Team. Thissynthesispresentationcan
happenbecause ofhuge effortsof the whole team consistingof 70 sessionrapporteurs, 5
Lead Rapporteur and 2 Rapporteur Coordinators.The Rapporteur Team in this room, could
you stand up? All participants please joinme giving the big hands to all Rapporteur.
(applause)
That is all of the presentation.Thank you very much for your attention