Joint Statement on the C5+1 Virtual Ministerial

Office of the Spokesperson

The text of the following statement was released by the Governments of the United States of America, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Tajikistan, Turkmenistan, and the Republic of Uzbekistan on the occasion of the C5+1 Virtual Ministerial.

Begin Text:

The U.S. Secretary of State and the Ministers of Foreign Affairs of the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Tajikistan, Turkmenistan, and the Republic of Uzbekistan met April 23, 2021 virtually in the C5+1 format.

Participants celebrated the five-year anniversary of the C5+1 format, inaugurated in November 2015, noting the success of the platform in enhancing regional dialogue, cooperation, and partnership among the participating countries. The format has contributed to increasing economic and energy connectivity and trade, mitigating environmental and health challenges, jointly addressing security threats, and advocating for the full participation of women in all aspects of the political, economic, and social life of member countries.

Participants recommitted to addressing common challenges collaboratively in pursuit of a prosperous and secure Central Asia free to pursue its interests with a variety of partners, including the United States.

In the April 23 Ministerial Dialogue, participants addressed a range of shared challenges as they:

  • Discussed the situation in Afghanistan and the continuing need for all countries in the region and the broader international community to support the Afghan-led, Afghan-owned peace negotiations for a united, sovereign, stable, democratic, and self-reliant Afghanistan that is free of terrorism and at peace with itself and its neighbors;
  • Called on all parties to the conflict in Afghanistan to reduce the level of violence in the country and on the Taliban not to pursue a Spring offensive, so as to avoid further casualties and to create an environment conducive to reaching a negotiated political settlement;
  • Welcomed the Central Asian countries’ important contributions to regional stability and Afghanistan within the framework of international and multilateral mechanisms and dialogues and through their cooperation with Afghanistan across energy, economic, cultural, trade, human rights, and security lines of effort;
  • Supported efforts to preserve the economic, social, political, and development achievements of the last two decades in Afghanistan, and agreed to build upon those gains by upholding human rights, especially women’s rights;
  • Agreed to the continued development of security cooperation between the United States and the countries of Central Asia as a means of promoting stability and regional security and countering cross-border threats emanating from Afghanistan;
  • Emphasized the importance of continued law enforcement cooperation and information sharing at national, regional, and international levels to counter the problem of drug trafficking in Central Asia;
  • Reaffirmed the importance engaging in greater joint cooperation in support of economic growth, business-to-business connections, climate change action, infrastructure development, and people-to-people exchanges in Central Asia;
  • Supported the continuation of regional energy infrastructure and connectivity projects as a means to enhance electrical connectivity and energy integration, promote regional cooperation, and provide transit revenues and reliable energy to Afghanistan and countries in Central Asia;
  • Affirmed their commitment to integrate more renewable sources of electricity as a driver of clean and affordable energy;
  • Reaffirmed the importance of projects that promote regional connectivity and transit trade through the extension of transportation networks connecting Central Asia to South Asia via Afghanistan;
  • Agreed to continue support for high quality institutions of higher learning in Central Asia that serve students from across Central Asia and Afghanistan as a means of increasing regional connectivity and understanding;
  • Agreed to deepen cooperation in prevention of trafficking in persons and to support rule of law and good governance;
  • Appreciated the United States’ continued commitment to development and investment projects in Central Asia in cooperation with national development and development finance agencies, as well as the U.S. intention to support women’s business associations across the region;
  • Recognized the impacts of climate change on C5+1 countries and agreed to work together to protect those who are most vulnerable, and to raise global ambition on the road to COP 26 to be held in Glasgow in November 2021.

Next Steps

The Participants:

  • Welcome the United States’ proposal for a future C5+1 meeting between the Special Presidential Envoy for Climate John Kerry and representatives of the Central Asian countries;
  • Noted the importance of the C5+1 working groups on economic issues, environment and energy, and security, and agreed the C5+1 working groups will continue to meet regularly, including later in 2021, at the expert level to prepare decisions for future high-level dialogue meetings;
  • Agreed the next C5+1 High-Level Dialogue expected on the margins of the Government of Uzbekistan-hosted regional connectivity conference in July 2021, will review the program of work adopted in 2020 and adjust it as necessary;
  • Agreed Ministers will seek an opportunity to meet again by the end of 2021.

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Evidence collected during the pandemic suggests the prevalence of behavioral health conditions has increased, while access to in-person behavioral health services has decreased: Centers for Disease Control and Prevention (CDC) survey data collected from April 2020 through February 2021 found that the percentage of adults reporting symptoms of anxiety or depression averaged 38 percent. In comparison, using similar questions, CDC found that about 11 percent of U.S. adults reported experiencing these symptoms from January to June 2019. An analysis of CDC data found that the share of emergency department visits for drug overdoses and suicide attempts were 36 and 26 percent higher, respectively, for the period of mid-March through mid-October 2020 compared to the same time period in 2019. In a February 2021 survey of its members, NCBH found that in the 3 months preceding the survey, about two-thirds of the member organizations surveyed reported demand for their services increasing and having to cancel or reschedule patient appointments or turn patients away. The survey also found that during the pandemic, 27 percent of member organizations reported laying off employees, 45 percent reported closing some programs, and 35 percent decreased the hours for staff. Officials GAO interviewed from provider organizations offered anecdotal examples of problems with payments for behavioral health services, including examples suggesting that denials and delays were more common for these services than they were for medical/surgical services. However, most officials were not aware of published data that could confirm their concerns, and data from reports from two states on claims denials either did not support their concerns or were inconclusive. In addition, a report in one state that examined mental health parity—requirements that behavioral health benefits are not more restrictive than medical/surgical benefits—found that the rate of complaints associated with behavioral health services was notably lower than those for medical/surgical services. The lack of available data confirming stakeholder concerns could be related to potential challenges consumers and providers face in identifying and reporting mental health parity violations, as previously reported by GAO. Specifically, in 2019, GAO found that complaints were not a reliable indicator of such violations, because consumers may not know about parity requirements or may have privacy concerns related to submitting a complaint. GAO recommended that the federal agencies involved in the oversight of mental health parity requirements evaluate the effectiveness of their oversight efforts. As of March 2021, the agencies had not yet implemented this recommendation. Why GAO Did This Study Behavioral health conditions, which include mental health and substance use disorders, affect a substantial number of adults in the United States. For example, in 2019, an estimated 52 million adults in the United States were reported to have a mental, behavioral, or emotional disorder, and 20 million people aged 12 or older had a substance use disorder. Experts have expressed concerns that the incidence of behavioral health conditions would increase as a result of stressors associated with the COVID-19 pandemic. Even before the pandemic, longstanding questions have been raised about whether coverage or claims for behavioral health services are denied or delayed at higher rates than those for other health services. GAO was asked to examine several issues about the demand for behavioral health services, as well as coverage and payment for these services. GAO examined (1) what is known about the need for and availability of behavioral health services, and how these have changed during the COVID-19 pandemic; and (2) what issues selected stakeholders identified regarding the payment of claims for behavioral health services. GAO reviewed survey data and other relevant analyses focused on the need for and availability of behavioral health services prior to and during the COVID-19 pandemic. GAO also reviewed reports from two states that compared claims for behavioral health services with those of other health services; interviewed officials from NCBH; and interviewed officials from hospital associations and insurance regulators in Oregon, Pennsylvania, Texas, and Virginia. For more information, contact John E. Dicken at 202-512-7114 or dickenj@gao.gov.
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