11.    The changes in health and survival have been uneven in the region during the last five to ten years. While improvements have continued in western countries and have emerged in parts of central Europe, in many east European countries serious deterioration of health and mortality has taken place. Different age, sex and social groups within the ECE countries have not equally shared in those disparate trends. Progress in the control of cardio-vascular diseases and cancer has been uneven across the region, and this reflects cross-country differences in the capacity of the health systems to respond to these diseases. Challenges arising from the AIDS pandemic and the drug crisis among the youth are continued causes of concern. In many countries with economies in transition, reproductive health remains inadequate. In parts of eastern Europe, the re-emergence of infectious diseases adds to the public health complexities and the pressures on health systems in the countries that are least capable of coping with health problems of the population. It is well recognised that lifestyles are important determinants of health and mortality and that individuals must assume increasing responsibility toward their own health. The inter-relationship between health and environment receives ever-growing attention from the Governments and the general public. Also, as health expenditures represent an important and growing part of social expenditures, concerns are growing over the public financing of the health care system in the future. These trends constitute the context against which the accepted norms of equal access to quality care, efficient use of resources, development of prevention, strengthening of health promotion and education may be considered.

12.    For discussion of these issues, the Meeting will have before it the background paper, "Some features of mortality in the member states of the ECE" by Mr. P. Józan (CES/PAU/1998/7).

13.    The delegations will be provided with an opportunity to debate recent developments in health, including reproductive health, and mortality, and how health and other policies have responded to or influenced those developments. Also, future policies in this field will be considered.

Item 6: Population ageing: issues and policies

14.    Recent declines in fertility and mortality throughout the ECE region have resulted in fundamental changes in the age structure of the national populations. The share of older persons continues to grow and in many instances is expected to approach or surpass one-third in the next century. The numbers and proportions of the oldest old rise at even faster pace, at annual rates ranging between three and four per cent in countries that are enjoying rapid declines in old-age mortality. Although the pace of these changes varies markedly from country to country, they all pose serious policy challenges to many societies. A new form of solidarity between and within the generations will have to be fostered that will ensure that both the young and the elderly receive the support, security and care they need, formally as well as informally. The lifetime experience and skills of the elderly are societal assets which, if put to use, may help to make the new social contract economically sustainable. Housing and labour markets, health care structures and pension schemes will all be affected by these changes. Policy makers in the region thus face a major task of anticipating the realities and exigencies of population ageing before these actually present themselves to their fullest extent, of setting priorities and of acting accordingly.

15.    For discussion of these issues, the Meeting will have before it the background paper, "Population ageing: dynamics, and social and economic implications at family, community and societal levels" by Mr. J. Schmid (CES/PAU/1998/6).

16.    The delegations will be provided with an opportunity to debate recent developments relating to population ageing and how policies have responded to those developments. Also, future policies in this field will be considered.

Item 7: International migration: issues and policies

17.    Over the last five to ten years international migration patterns in the region continued to change in a number of ways. In Europe, due to new restrictive policies adopted in the last five years, the entry of foreign workers remains limited and low compared with previous periods. Also, the numbers of asylum seekers have dropped considerably. However, other forms of regular migration, mainly that resulting from family reunification, are continuing. In North America immigration has continued at a rapid pace, with a shift from family reunification to recruitment of foreign labour based on talent and skills. As the size of regular migration flows declined, the numbers of irregular migrants are believed to have increased considerably. The pressures arising from irregular movements appear to be particularly strong in North America and in central and southern Europe. Despite measures taken in certain host countries to encourage the return of migrants, the repatriation is a slow and difficult process. The various social, economic and political problems relating to the integration of migrants persist in a number of countries. These problems, which are made more difficult by the high unemployment in western Europe, still have to be addressed in a satisfactory way. The profound transformation which has been taking place since around 1990 in central and eastern Europe continues to have a significant impact on migration in that part of Europe. Although the mass emigration from this part of Europe, which was feared in the early 1990s, did not materialise, these countries continue to experience a variety of unprecedented movements.

18.    For discussion of these issues, the Meeting will have before it the background paper, "International migration: patterns, trends and policies" by Mr. J. Salt (CES/PAU/1998/8).

19.    The delegations will be provided with an opportunity to debate recent developments relating to international migration and integration and how migration and other policies have responded to or influenced those developments. Also, future policies in this field will be considered.

Item 8: General debate

20.    The deliberations on fertility and reproductive rights; mortality and health, including reproductive health; population ageing and international migration issues and policies will be followed by a general debate on these issues and policies. The debate will also concern the draft "Conclusions" and the draft "Co-operation Plan."

Item 9: Adoption of the report

21.    The Meeting will adopt the Report of the Meeting (CES/PAU/1998/13), including the two draft annexes: "Conclusions" (CES/PAU/1998/13/Add.1) and "Co-operation Plan" (CES/PAU/1998/13/Add.2). Thereafter, the Meeting will be closed.