World leaders gathering at the United Nations Headquarters today approved an action‑oriented political declaration on universal health coverage, committing themselves to achieving that objective by 2030.
By the terms of the declaration, which was forwarded to the General Assembly for formal adoption at a later date, world leaders reaffirmed the right of every human being, without distinction of any kind, to the enjoyment of the highest attainable standard of physical and mental health, committing to accelerate efforts towards the achievement of universal health coverage.
“Shockingly, half the world’s people are still waiting to exercise that right, with serious consequences for us all,” with some 100 million people worldwide impoverished by catastrophic health‑care expenses, said United Nations Secretary‑General António Guterres in his opening remarks to the high‑level meeting, held under the theme of “Universal health coverage: Moving together to build a healthier world”.
The declaration approved today is the most comprehensive agreement ever reached on global health — a vision for universal health coverage by 2030, Mr. Guterres said, describing it as a “significant achievement” that will drive progress over the next decade on communicable diseases including HIV/AIDS, tuberculosis and malaria, while addressing non‑communicable disease and antimicrobial resistance through robust and resilient primary health‑care systems.
The United Nations stands ready to assist Member States in these endeavours, but “making universal health coverage a reality by 2030 depends first and foremost on bold national leadership,” he stressed.
Also addressing the opening segment of the meeting was Tijjani Muhammad-Bande, President of the seventy‑fourth session of the General Assembly, who said that genuine universal health care can only be realized through continued cooperation to improve infrastructure, especially for transport, allowing people to easily reach medical centres, and through seizing the opportunities created by technology advances and the information revolution. Indeed, he said, the old medical adage that prevention is better than cure holds true today and he called for continued investment in research to better equip countries in preventing disease.
Tedros Adhanom Ghebreyesus, Director‑General of the World Health Organization, said that lack of access to affordable primary health care is a problem not only in low‑income countries, but also in high‑income ones, where cancer patients often choose death due to the financial disaster treatment would bring to their families. No one should have to make such a choice, he stressed, calling on countries to spend an additional 1 per cent of gross domestic product (GDP) on primary health care and make a crucial shift to people‑centred quality services. Investing an additional $200 billion a year on scaling up such services across low‑ and middle‑income countries would potentially save 60 million lives and increase average life expectancy by 3.7 years by 2030. “Ultimately, health is a political choice,” he emphasized, adding that the declaration approved today is a powerful statement.
David R. Malpass, President of the World Bank Group, noted that the financing gap in the world’s 54 poorest countries — representing 1.5 billion people — is $176 billion annually. Closing it requires delivering good outcomes in four priority areas, including greater investments in affordable primary health care, engaging the private sector, supporting communities through education and job creation, and mobilization of domestic resources. If leaders commit to building smarter, data‑driven health systems, they can deliver quality health care and the World Bank will be a committed partner in those efforts, he added.
Gro Brundtland, eminent high‑level champion of universal health coverage and member of The Elders, said that health cannot be left to the free market, as only the wealthy will access services, while the poor are plunged further into poverty. She said that universal health coverage can only be achieved through public financing, recalling that 30 years ago, development agencies and Western Governments pressured developing countries into cutting health budgets and pushing the burden onto households. “This was a huge mistake,” she said, warning that the situation persists today in countries dominated by out‑of‑pocket payment models and calling on all States to “ban this practice immediately”.
In the ensuing panel discussion, titled “Universal Health Coverage as a Driver of Equity, Inclusive Development and Prosperity for All”, participants explored ways to operationalize the commitments made in the political declaration at the national level.
In another panel discussion, titled “Accelerating multi‑sectoral and multi‑stakeholder action and investments for achieving universal health coverage”, participants tackled questions such as how to effectively and efficiently finance universal health coverage strategies through additional domestic revenue, budgetary reallocation, multisectoral policies and partnerships.
In closing remarks, Mr. Ghebreyesus of the World Health Organization said history was made today, with Governments committing to a world in which no one misses out on quality health services simply because they lack access or cannot afford them. Noting that Japan began its journey to universal health coverage not when it was prosperous, but rather when it was weak after the Second World War, he said universal health coverage laid the foundation for it to become the economic powerhouse it is today. “No country can flourish if its people are trapped in cycles of diseases and poverty” he said.
Japan Prime Minister Shinzo Abe expressed hope that every country attains universal coverage, as health is the cornerstone of human security, describing that national ownership and health financing for the vulnerable are key to achieving such services for all.
Melinda Gates, Co-Chair and Trustee of the Bill and Melinda Gates Foundation, said that prioritizing primary health care requires hard trade-offs, urging Governments to regard primary health care as the most effective investment for their countries.
TIJJANI MUHAMMAD-BANDE, President of the General Assembly, said access to quality health services must be a universal right, not a privilege. “That investment in health will deliver significant economic benefits to individuals and societies,” he said, calling for collective efforts to ensure that nations around the world can benefit from each other in medical training and the provision of medical infrastructure in order to meet the Sustainable Development Goals. The objective of universal coverage is to strengthen health systems, beginning with primary care, ensuring that people can access affordable preventive, curative and rehabilitative health services.
While each nation has its own priorities, needs are better met with strong international cooperation, he said, stressing that the World Health Organization (WHO) has delivered outstanding results. Governments must also encourage local organizations working to bring health-care benefits to the populace, with an important focus on quality and financing to ensure that care services delivered lead to healthier societies. “This is essential to bolstering the economy, particularly through the healthier human capital it guarantees,” he emphasized. Member States must continue to support each other to attain quality health services to integrated, efficient, safe and people-centred care.
He pointed to the eradication of smallpox as among humankind’s greatest triumphs, citing campaigns to immunize children in developing nations against diphtheria, tetanus, whooping cough and poliomyelitis as outstanding achievements. Perhaps the biggest impact has been the influence on public health medicine, particularly the emphasis on community solutions, which afford greater flexibility than — but also support — hospital-based care, efforts that have revolutionized the design of health services worldwide, he explained.
Among the challenges are demographic shifts, he said: the ageing population accompanied by a massive rise in the number of infants, along with pollution, poor housing and medicine provision. The effect of climate change and its implications for health provision are massive and must receive attention, as must increasing resistance to antibiotics and the emergence of “super bugs”. Genuine universal health care can only be realized through continued cooperation to improve infrastructure, especially for transport, allowing people to easily reach medical centres, and through seizing the opportunities created by technology advances and the information revolution. Indeed, the old medical adage that prevention is better than cure holds true today and he called for continued investment in research to better equip countries in preventing disease.
ANTÓNIO GUTERRES, Secretary-General of the United Nations, said that all have the right to accessible, high-quality, affordable care that promotes physical and mental health, including during conflict and humanitarian crises. “Shockingly, half the world’s people are still waiting to exercise that right, with serious consequences for us all,” he said, noting that every year, some 100 million people around the world are impoverished by catastrophic health-care expenses. Even when health care is available, it often fails to cover the full spectrum of human suffering, including those with mental health conditions.
Warning that weak health-care systems pose a risk that goes far beyond national borders, he stressed that health for all is an investment in people, in their well-being, and in healthy and prosperous societies. Universal health coverage has proven to be a catalyst for economic growth that benefits individuals, families, communities, businesses and economies. “Good health is both an outcome and a driver of economic and social progress,” he said, explaining the reason why universal health coverage is at the centre of the 2030 Agenda for Sustainable Development, which is a generational opportunity to address the social drivers that lead to good health and well-being, and a global call for transport policies that reduce pollution, and for strengthened governance that enables the efficient delivery of health services to people.
The political declaration approved today is the most comprehensive agreement ever reached on global health — a vision for universal health coverage by 2030, he said, describing it as “a significant achievement” that will drive progress over the next decade on communicable diseases including HIV/AIDS, tuberculosis and malaria, while addressing non-communicable disease and antimicrobial resistance through robust and resilient primary health-care systems. Recalling his recent trip to the Democratic Republic of the Congo, he said he saw first-hand the vital need for such systems when he met health workers and patients affected by the Ebola outbreak. The political declaration also states the need to ensure universal access to sexual and reproductive health-care services and reproductive rights.
Noting that many countries are on the path towards achieving health for all by 2030, he also drew attention to others that will need to accelerate their efforts so that no country, community or person is left behind. He emphasized the urgent need to change the financing paradigm and step up the pace of investment in health for all, expressing the United Nations readiness to support Member States with its convening power, knowledge and expertise. Multi-stakeholder partnerships and innovative cross-sectorial investments will be essential to success. “But making universal health coverage a reality by 2030 depends first and foremost on bold national leadership.”
TEDROS ADHANOM GHEBREYESUS, Director‑General of the World Health Organization, said that when he visited the Democratic Republic of the Congo in the past year to address the Ebola outbreak there, he was embarrassed to talk only about that epidemic because measles and malaria kill more people, stressing the urgent need to strengthen the overall health‑care system. The world spends $7.5 trillion on health globally each year. Lack of access to affordable primary health‑care services is a problem not only in low‑income countries, but also in high‑income countries. In a high‑income country, a cancer patient chose death instead of seeking treatment that would bring his family to a financial disaster. No one should have to make such a choice, but the reality is that millions of people face such a dilemma.
Costly health care puts families into poverty, which in turn saps productivity, he said, declaring that universal health coverage is not just a health imperative, but “an economic imperative”. Calling on countries to spend an additional 1 per cent of gross domestic product (GDP) on primary health care and make a crucial shift to people‑centred quality services, he said that investing an additional $200 billion a year on scaling up such services across low and middle‑income countries would potentially save 60 million lives and increase average life expectancy by 3.7 years by 2030.
“Ultimately, health is a political choice,” he emphasized, adding that the political declaration approved today is a powerful statement. “Our vision is not health for some, health for most, but health for all,” he said, describing health as “a fundamental right” and “a means to achieve prosperity”.
DAVID R. MALPASS, President of the World Bank Group, described the financial institution’s focus on achieving better health access and outcomes. In those efforts, “words are not sufficient”. Improved funding and health systems are vital. Drawing attention to the International Development Association through which the Bank finances health care in lower income countries, he said it has provided $13.5 billion to fund essential health interventions for more than 700 million people. While critical, its funding is not nearly enough. The financing gap in the world’s 54 poorest countries — representing 1.5 billion people — is $176 billion annually. Closing it requires delivering good outcomes in four priority areas where more can be done.
He first recommended increasing investments in affordable primary health care, as resources are needed to detect and treat conditions early. “This will save lives and reduce health-care costs”, he assured, noting that in the Democratic Republic of the Congo, the Bank has committed more than $350 million to fight Ebola. Five years on, countries hardest hit by the epidemic are still feeling the effects of the epidemic. He called Nigeria’s recent announcement that it is polio free a remarkable achievement.
It is also important to engage the private sector, he said, drawing attention to various World Bank projects, first in Afghanistan, where basic services are being contracted to health providers. Given the changing nature of work, the World Bank and International Finance Corporation (IFC) are also supporting the rollout of mobile health insurance platforms. In Kenya, for example, the platform reaches 4.5 million people and is projected to reach 10 million over the next three years.
He said communities must be supported through a focus on education and job creation, underscoring the importance of addressing childhood stunting, girls’ education and weak social safety nets. Finally, it is essential to change the way health is financed, achieving better outcomes for the money spent. Domestic resources must be catalysed and country leadership is critical in that regard. If leaders commit to building smarter, data-driven health systems, they can deliver quality health care and the World Bank will be a committed partner in those efforts.
GRO BRUNDTLAND, eminent high-level champion of universal health care and member of The Elders, said universal health care is the best way to fulfil the right to health. “Health cannot be a question of income; it is a fundamental human right,” she said, quoting Nelson Mandela. Nor can health be left to the free market, as only the wealthy will access services, while the poor are plunged further into poverty trying to pay for them. She drew attention to a recent report by the Global Preparedness Monitoring Board, which found alarming gaps in global preparedness against global emergencies, such as the Ebola epidemic in western and central Africa.
She said that universal health coverage can only be achieved through public financing, recalling that 30 years ago, development agencies and Western Governments pressured developing countries into cutting health budgets and pushing the burden onto households. “This was a huge mistake,” she said, denouncing that in some cases, poor people were imprisoned in health facilities because they simply could not pay their health-care bills. The situation persists today in countries dominated by out-of-pocket payment models. “I call on all States to ban this practice immediately,” she asserted.
Highlighting a successful universal health-care pilot in Kenya whereby financing is increased and user fees are eliminated, she stressed that South Africa learned that universal health coverage cannot be attained through private voluntary insurance, which is extremely inefficient. Raising health financing efficiently and fairly is not enough; resources must be allocated equitably. She drew attention to successful primary care-led universal health-care reforms, notably Ethiopia’s health workers programme, and welcomed that after decades of such achievements, the global health community has come together to champion universal health care — and importantly agrees on how to achieve it. With that in mind, she called on political leaders to legislate, invest and collaborate to make universal health coverage a reality.
This morning, the Assembly convened a panel discussion on the theme, “Universal health care as a driver of equity, inclusive development and prosperity for all”. Co‑chaired by Sheikh Hasina, Prime Minister of Bangladesh, and Pedro Sánchez, Prime Minister of Spain, it featured four panellists: Michelle Bachelet, United Nations High Commissioner for Human Rights; Maha Taysir Barakat, Board Chair of the RBM Partnership to End Malaria; Winnie Byanyima, Executive Director of Oxfam International; and Jeffrey Sachs, Professor and Director, Center for Sustainable Development, Columbia University, United States.
Ms. HASINA, opening the discussion, said inclusive development and prosperity means that everyone — irrespective of his or her social background — must get equal opportunity. It also means that everyone must enjoy equal access to the common benefit and resources. “Lack of equity and absence of inclusive development may bring political instability and serious erosion of social cohesion,” she stressed, adding: “We now see that only generating growth and creating wealth is not enough,” she stressed, calling for “just and proper” access to and distribution of wealth. “Securing universal health coverage is one of the preconditions for establishing a righteous and fair society,” she said, emphasizing that the Universal Declaration of Human Rights guarantees all people the right to a standard of living adequate for his or her health and well‑being. In adopting the 2030 Agenda, countries committed to ensuring that all individuals and communities are able to receive essential health services and that none should be left behind.
While some progress has been made to those ends, she emphasized that half the world’s population still lacks access to necessary health services and about 100 million people are pushed into extreme poverty every year due to health expenses. She called on Governments to tackle those challenges by introducing models of equitable health financing with strong social protection measures for all, pointing out that 90 per cent of health needs can be met at the primary level. Indeed, strong primary health‑care systems can be the first line of defence against communicable and non‑communicable diseases and should be a priority for all countries working to deliver on Sustainable Development Goal 3. In Bangladesh, some 14,000 community health clinics were established to provide care to rural areas “so that the last one in line can be reached”. Noting that those clinics receive more than 10 million visits on average each month, she said resource mobilization to ensure universal health coverage remains a fundamental obstacle in many nations and requires international support.
Mr. SANCHEZ said Sustainable Development Goal 3 commits Member States to provide universal health coverage to all their people by 2030. “Health is a fundamental human right,” he stressed, as well as a fundamental means to move forward on the other Goals. It is also a major social equalizer and lays the foundation for growth, social cohesion and a driver for employment, innovation and research in all countries. While the path is not an easy one, he said Spain has drawn many “immeasurable” benefits from its decision to set up a universal health‑care system in 1986. While the recent global financial crises seriously impacted its health‑care system, broad public awareness of their “inalienable right” to health care was so great as to ensure the continuation of coverage.
Today, he said, Spain is among the healthiest countries in the world and has one of the highest quality and most accessible and efficient health systems. Its health‑care professionals are leaders in their field and all people living in Spain — including migrants — have access to care. Describing Goal 3 on universal health care as both noble and ambitious, he said that it is also feasible. Investing in health benefits a country’s physical and legal security, supports the rule of law and promotes inclusion in every sense of the word. “This goal is worth achieving,” he stressed.
Ms. BACHELET, speaking also as a physician and a former Head of State, said one of the most inspiring and far‑reaching achievements in recent decades has been the improvement of health. “People are living longer, they are living better, and this progress in achieving the right to health for millions of people has helped to generate broader and deeper development,” she said. Healthy societies are the key to unlocking sustainable development, while poor health outcomes severely restrict their capacity to flourish and build resilience. More than half of people alive today have little or no access to life‑saving services such as prenatal care and basic treatment for malaria, tuberculosis or HIV/AIDS. Instead of thriving, individuals and communities are forced to struggle simply to survive. They are vulnerable to outbreaks of communicable diseases, as has been clearly seen in the case of recent Ebola epidemics.
Describing cost as a significant barrier, she said WHO estimates that some 930 million people spend more than 10 per cent of their annual household income on health care and about 210 million spend more than 25 per cent. However, socioeconomic determinants of health — such as inequality, discrimination and poverty — are also major reasons why millions lack access to good quality health care and services. Underlining the importance of the right to health as the essential basis for the advancement of universal health care, she said both health services and the underlying determinants of health should be tackled to ensure that no one is left behind. Laws and policies must uphold the equality and dignity of all members of society — “and they need to be implemented”. Moreover, she said, sexual and reproductive health‑care services are essential to empowering women to make their own decisions about their lives and remain central to establishing universal health coverage. Recalling that many countries with universal care systems established them “not when they were wealthy, but when they were financially on their knees” in the aftermath of the Second World War, she urged those on that path today to “pick up the pace”.
Ms. BARAKAT stressed the importance of everyone everywhere having access to the health services they need. Tackling malaria will be a critical component to achieving universal health coverage. “Every two minutes a child dies of malaria and that is simply unacceptable,” she stressed. Access to health services from “cradle to grave” is vital. “The lack of sufficient genuine drugs for treatment causes patients, particularly women and children, to die,” she stressed. Medical and nursing schools need to be supported to keep up with the demand of health-care workers per capita. She noted that malaria continues to remain a concerning disease, underscoring that during the recent Ebola crisis, many more women and children died from malaria than from Ebola. Preventing these deaths requires political will, financing and a coordinated multisectoral approach. Strong governance is essential to coordinating all the necessary elements as well as to prevent and fight corruption. “With all the critical pledges made by world leaders today, we believe we can achieve global health coverage by 2030,” she emphasized. Achieving global health coverage will help achieve other Sustainable Development Goals, including the one to end to malaria — one of the oldest and deadliest diseases known to humankind.
Ms. BYANYIMA said that that today 10,000 people will die because they cannot access health care. Rich people live 25 years longer than poor people. The 1 billion people who lack access to health care are not being “left behind”, they are being pushed behind, she stressed. Universal free public health care is possible and essential to close the gap between the rich and the poor and between men and women. Governments should focus on raising more money from corporations and taxing the wealthy. Thailand introduced universal health coverage in 2002, a case which demonstrates that it is possible for wealthier countries to successfully do the same. She cautioned against the lack of regulation of pharmaceutical companies, welcoming the commitment to price transparencies mentioned in the declaration. Governments have a choice between privatized health care, which benefits the rich, and public health coverage, which will close the gap between the rich and poor and the haves and the have‑nots. “I urge you to reject the failed ideas and broken solutions,” she emphasized.
Mr. SACHS said “this is about money and about rich people in rich countries paying for poor people to stay alive”. At a minimum it costs $100 per person per year for a rudimentary primary health‑care system. There is nothing else to talk about,” he stressed. “Every time we tell poor countries ‘why don’t you do better’ we are not doing the right arithmetic,” he emphasized. The money is in rich countries. Every time more money has gone into public health, lives have been saved by the millions. “We are missing one tenth of the 1 per cent of the income of the rich around the world to save millions of lives,” he continued, also adding: “We are missing a few billion dollars.” Jeff Bezos, Bill Gates, Sergey Brin, Larry Page and just a few others have a net worth of $1 trillion. Yet 5 million children will die this year because they do not have access to health care. The Pentagon spends $2 billion in a weekend. If it took one weekend off the world could eliminate malaria. When money is applied it is successful, and the technology is there. There are no mysteries to this, he said, urging: “Please tell the rich countries enough is enough.”
As the floor was opened for an interactive discussion, many speakers welcomed today’s meeting as a demonstration that the world’s focus is shifting towards universal health coverage as a common goal. Ministers for Health from around the globe outlined their countries’ strides in the provision of quality care — as well as challenges in ensuring access — with many also spotlighting the social and economic benefits gained since their Governments instituted universal health-care systems.
The Minister for Health of the Russian Federation, agreeing with the panellists that health coverage is a matter of social justice as well as a precondition for the achievement of the Sustainable Development Goals, said his country’s Constitution enshrines the right to timely and quality health care. The State covers more than 90 per cent of health-care costs and health insurance is both obligatory and compulsory. From the highest levels, the Government is also committed to improving the quality of health care and has successfully increased the average lifespan while decreasing maternal mortality by a factor of five, he said.
The Minister for Health of Uruguay said that, in his country, individuals pay for health care according to their ability and receive services according to their needs. Noting that public spending on health care has increased from about 4.5 per cent of the country’s GDP to over 6 per cent, he said inequality has dropped as a result. Today, no one in Uruguay dies from abortions and the country enjoys one of South America’s lowest maternal mortality rates, lowest incidences of teen pregnancy and has seen a reduction in non-communicable diseases, he said.
The Minister for Health of Brazil agreed that health coverage is the responsibility of the State. Recalling that his country instituted a universal health-care system in 1988, when the economy was at one of its lowest points, he agreed with other speakers that it enjoyed a great reduction in inequality as a result. Brazil has made significant strides on many health outcomes and now aims to become the first tobacco-free country in the world, he said, describing it as unimaginable that New York — one of the riches cities in the world — is currently experiencing a resurgent measles outbreak.
The Minister for Health of Slovakia said his country is focused on fulfilling the health goals and aims presented by WHO, including by improving hospital access for all as well as the working conditions of doctors and nurses. Further, he noted that a newly created WHO centre is implementing tuberculosis education programmes for Roma communities.
The Deputy Minister for International Cooperation of Italy said that it is a moral, social and economic imperative for Governments to provide health care to all citizens. Universal health coverage allows full human development and is at the core of peaceful and prosperous societies. As a G7 and G20 country, Italy consistently advocates for global health coverage. Italy’s Agency for Development Cooperation provides financing to help deliver essential services to those most in need, she said, stressing that effective multilateralism is needed to tackle global health emergencies. Italy is a major donor to HIV, tuberculosis and malaria programmes working to save lives and will continue to scale up international awareness on child diarrhoea, which is recognized by WHO as a global killer and is the second cause of death in children under five in low-income countries. Governments must take urgent action to end this mortal disease through appropriate funding and political will.
The Deputy Minister for Health of Canada said his country believes that universal health care is the cornerstone of a healthy society. “We recognize that an effective health-care system must be equitable, respect human rights and foster gender equality,” he added. However, building a universal health-care system is a challenge. Canada is dedicated to continuing to support global efforts to realize such a system and remains determined to building healthy and inclusive societies.
The Minister for Foreign Affairs of Iceland said that his Government in June approved an ambitious health-care plan in line with the 2030 Agenda. He drew attention to neurological spinal disorders that affect 1 billion people worldwide and highlighted the importance of promoting sexual and reproductive rights, which are not just crucial for women and girls but societies as a whole.
The President of the Inter-Parliamentary Union said it is currently working on a global resolution on health care. Universal health care is a human right, she stressed, underscoring that young teen mothers should have full health-care coverage rights.
Mr. SACHS, responding to those comments, said that while many countries have come forward with generous support to the Global Fund the world’s wealthiest people have not. “This is the difference between solving these diseases and not,” he stressed, adding that “it doesn’t have to come from Governments.” The Fund still has a $17 billion shortfall over the next three years, which is needed during the current replenishment round.
Ms. BACHELET echoed some of those points, while underscoring the need for “solidarity systems” in which a country’s richest people work hand-in-hand with the rest of society.
Ms. BYANYIMA also agreed, while also warning against further privatizing health care. “Poor people are already paying,” she stressed, urging countries to instead adopt more progressive taxation plans. It is well known that the world’s wealthiest people are currently hiding some $7.6 trillion from tax authorities and the world’s largest companies are hardly taxed at all.
Ms. BARAKT, meanwhile, emphasized the need to use funds effectively and reduce corruption.
The Minister for Health of Nigeria said the only way to truly invest in the world’s people is to ensure universal access to health care. However, many countries, including Nigeria, are struggling to develop their primary health systems, especially in rural areas. By increasing its value added tax and other taxes on luxury goods and services, the Government established a Basic Health Care Provision Fund to ensure free care to those who cannot afford services. Nigeria is also working on the issue through the lens of education, environment, prevention and by risk pooling, he said.
The Minister for Health of Singapore described the specific elements of his country’s health-care system, known as MediShield. That system employs means-tested subsidies and a scheme which covers co-pays for those unable to pay. Meanwhile, he said, Singapore is introducing a higher-payout insurance scheme for older persons in the context of an ageing society.
The representative of France said that universal health coverage is a critical political issue as it dictates division of resources and wealth and determines “whether people live or die”. Many speakers today have demonstrated the willingness of their Governments to invest in health care, she emphasized, also stressing that profit should never determine people’s access to health care. France President Emmanuel Macron has focused his term on combating inequality caused by health-care costs. “It is absolutely possible to find the funds,” she said.
The representative of the Major Group for Children and Youth stressed that every person can realize their right to health and well-being. “We owe it to the most vulnerable and marginalized in our communities whose voice is not heard today,” she added, emphasizing the need to invest and partner with young people.
Also speaking were members of the health community and non-governmental organizations.
In the afternoon, the Assembly held a panel on the theme, “Accelerating multi‑sectoral and multi‑stakeholder action and investments for achieving universal health coverage”. Co‑chaired by Adolfo Rubinstein, Secretary of Government for Health of Argentina, and Don Pramudwinai, Foreign Minister of Thailand, it featured four panellists: Helen Clark, Board Chair of the Partnership for Maternal, Newborn and Child Health; Omar Ishrak, Chairman and CEO of Medtronic; Ngozi Okonjo-Iweala, Board Chair of GAVI; and Keizo Takemi, Member of the Japanese House of Councillors and World Health Organization Universal Health Coverage Goodwill Ambassador.
Mr. RUBINSTEIN, noting that the United Nations work on universal health coverage will follow the precedents set by previous related meetings and resolutions, said the health sector has the potential to deliver large returns in economic gains and equality. However, Member States must work to mobilize more resources, make care more effective and efficient and accelerate and institutionalize quality care for all. Noting that poverty causes ill health, he stressed that the burdens associated with ill health also drive poverty in many contexts. Many low‑ and middle‑income countries have set universal health care as a priority in their reform programmes, as discussed by leaders of the Group of 20 (G20) at a recent summit. Drawing attention to the importance of budgetary impacts, he said universal health coverage typically results in a strong return on investment — namely, a 5‑to‑1 cost‑to‑benefit ratio in health terms, or 10‑to‑1 ratio if social benefits are considered.
In Argentina, he said, all people have access to health care, but those benefits are often “more nominal than real”. Indeed, like many countries in the region, gaping health and social disparities exist. To tackle those challenges, the Government decided to expand health coverage to all people by focusing on primary, family‑ and community‑based care. It is also working to grow digital connectivity among and between health centres, prioritize the prevention of chronic diseases and support mental health‑care coverage. Over the next five years, Argentina intends to invest about $650 million, funded in part by the World Bank, he said.
Mr. PRAMUDWINAI stressed that universal health coverage is not only about the health sector. Indeed, a key element of ensuring its sustainability is to encourage the participation of all stakeholders and the public, thereby instilling a “real sense of ownership and engagement”. The success of Thailand’s health‑care system, for example, owes much to public engagement and community empowerment, infrastructure development and public and private investment in health facilities.
Stressing that an investment in universal health coverage is an investment in a secure future, he said a healthy population will be a key force in driving countries towards stability, prosperity and sustainability. Sustained financing is therefore critical to universal health coverage. In Thailand, a “sin tax” from cigarettes and alcohol helps to fund universal health coverage. In addition, he said, a local health security fund was established to enable local governments and communities to manage their own health funds, allowing them to meet current and future needs.
Ms. CLARK echoed the importance of primary health care, recalling that the Alma‑Ata Declaration declared primary care as the key to providing health services to all. It is estimated that more and better investments can scale up 150 high‑impact interventions in all countries, help save around 60 million lives and tackle health inequities. “Multi-stakeholderism” is another critical component, she said, stressing that “it is at the very heart” of the universal health coverage agenda. Outlining lessons learned in that regard, she said health coverage connects directly to other sectors and development goals. For example, climate change will impact on people’s health and contribute to the costs of achieving universal coverage. Women, children and young people must have a say in the design of services they need, she stressed, while multi-stakeholder engagement will help to ensure independent accountability.
Mr. ISHRAK, describing Medtronic as a medical technology company with operations in more than 150 countries, said its mission is to use technology to alleviate pain, restore health and extend life. Recalling the United Nations foundational idea that all people should have access to the health services they need without risk of financial ruin or impoverishment, he said a sustainable health‑care system requires a comprehensive infrastructure consisting of a referral chain, well‑equipped hospitals and trained physicians to provide access and appropriate care. Most health‑care systems today are based around a “fee” for a product or service, meaning there is no financial accountability for actual health outcomes, potentially leading to billions of dollars in waste. “This system is simply not sustainable,” he stressed, warning that “if we don’t create payment models based on accountability for outcomes, universal coverage will never be affordable”.
To create sustainable universal health coverage, he said, a system is needed in which fees are based on the value provided to the patient. Quantifying the value delivered is a challenge requiring clearly defined and measurable outcomes, as well as an understanding of their related costs. Calling for strong data collection, he said Medtronic and other private sector companies are ready to work with Governments to help leverage diverse thinking and global perspectives that are not possible through one group alone. Specifically, he said, Medtronic and the private sector can contribute by providing innovation, expanding access to care and putting the “full power of our technologies and people toward improving care efficiency”. In 2018, Medtronic therapies improved the lives of more than 75 million people — two patients every second — and it is ready to contribute to a spirit of partnership to push universal health coverage forward.
Ms. OKONJO-IWEALA, speaking also as the former Minister for Finance of Nigeria, said the first step towards achieving universal health coverage is to “build an investment case” as to why it should be a priority for all countries. Not only is health care a human right, but it also makes sound economic sense, she said, noting that improved health care results in an average growth rate in middle-income countries of 1.1 per cent annually, and over 5 per cent annually in Africa. Immunization alone brings in about $54 for every dollar spent.
Turing to GAVI’s own funding, she said $3.6 billion — or 41 per cent of its support in the coming years — will come from countries. “But this is not enough,” she stressed, urging both Governments and civil society members to further scale up and expand coverage. In that context, she proposed a new acronym — “ERDU” — which stands for “efficient domestic resource use”. In addition, she called for greater political will; stronger coherence between ministries of health and economy; and more domestic resource mobilization. All those will help countries and their populations take greater ownership of their health-care systems, she stressed.
Mr. TAKEMI recalled serious health challenges that plagued Japan following the end of the Second World War. Significant pre-emptive investments in health care at that time allowed the Government to expand coverage, ultimately making it universal, and thereby improving living standards and building up the country’s economy. Underlining the importance of driving universal health care through domestic resources where possible, he spotlighted a programme currently in place in Bangladesh which efficiently combines domestic funding with funds provided by international development assistance sources. Calling for a new financial mechanism much like that one to be created at the global level, he also encouraged greater regulatory harmonization and improved access to health-care services for vulnerable people, including refugees and persons with disabilities.
As the floor was opened for comments and questions, many speakers agreed with the panellists that expanded health coverage is not only crucial to improve living standards but also constitutes an important economic investment. Several delegates emphasized the need for public-private-partnerships to ensure that health coverage is made truly universal — reaching the most remote areas — while also underlining the need to boost efficiency and reign in administrative costs.
The Secretary of State for International Development of the United Kingdom described his country’s universal health-care system, while voicing concern that some 800 million women around the globe die needlessly each year from pregnancy complications or related illnesses due to a lack of health care. Underlining the need for universal sexual and reproductive health care, he announced a new commitment of £600 million to fund reproductive health services, based on the United Kingdom’s longstanding commitment to gender equality.
The representative of the United States, echoing the importance of multi-stakeholder partnerships, said his country’s actions in the health-care arena are both value-based and people-centred. Spotlighting investments in the treatment of sickle cell disease as one tangible example of effective investment, he said integrating treatment into local primary health systems requires the engagement of a variety of sectors and entities.
The representative of Sweden, meanwhile, said a shift towards effective and efficient universal coverage will require reprioritization in many countries around the world. In Sweden, she said, work is under way to contain administrative costs and combat corruption, while also increasing knowledge and transparency about how funds are spent.
The Minister for Foreign Affairs of Estonia said that technological development and innovation can help support the universalization of global health coverage. Improving the health of women, newborns and adolescents is a prerequisite to achieving the Sustainable Development Goals, he noted, also adding that abortion should not be considered as a family planning issue.
The Minister for Health and Sanitation of Sierra Leone stressed the need to establish mechanisms and adapt technologies that would prevent populations from being exposed to communicable diseases. He highlighted the link between agriculture, the environment and health and stressed that maternal and newborn childcare is critical, especially as the bulk of the maternal deaths affect teen girls exposed to child marriage. Transporting women who go into labour to hospitals and medical facilities as soon as possible remains essential. He also said that during health emergencies brain drain becomes a concern as rebuilding and retraining personnel is timely and requires resources.
A representative of the Global Fund to Fight AIDS, Tuberculosis and Malaria said the organization can help by simply ending the scourge of those diseases and in turn creating the capacity of Governments to meet all the myriad health needs communities have. The Global Fund invests about $1 billion a year on the building blocks of the global health system, she added.
The Deputy Minister for Health of Thailand said that his country investing in universal health coverage has proved to garner a 20 per cent return. Active participation of all stakeholders ensures good governance and helps promote and uphold the rule of law.
Responding to questions and comments posed, Ms. CLARK said from Sweden to Sierra Leone there is agreement that the health of women and children must be a top priority. There are still 800 maternal deaths every day and these can be prevented. “We really have some basic business to do for women, newborns, children and adolescents,” she emphasized, stressing the need to keep girls in school so that they are better able to determine their futures.
Ms. OKONJO-IWEALA said it is gratifying to hear that countries are moving towards universal health care and “that it is not just about human rights but also good for the economy and for economics”.
Mr. TAKEMI said that universal health coverage is not the final goal but rather a target. The final goal should be a more healthy society and a healthy world. “We always have to think about the most socially vulnerable people — the disabled, immigrants and refugees,” he added.
Mr. ISHRAK underscored the need to focus on proving primary care in the most structured manner. As data systems are being built in developing countries, it is important to link some kind of family history to the databases so that primary care vigilance can be more effective. It is vital to think how information technology systems can better serve people.
The representative of Turkmenistan welcomed the focus on health care and said that policy in his country aims to harness human potential. Nobody should be refused access to the health-care services they need because they are unable to afford them. Turkmenistan is investing in its health infrastructure and is focused on building hospitals and clinics, combating tuberculosis and improving maternal and adolescent health. Much work has been done in controlling HIV/AIDS as well. Public health is a key condition for improving the well-being of the population.
The representative of Burkina Faso said that his country has committed to allocating domestic resources to fund basic health care for women and children under age five. “This costs money and is being funded by State resources,” he said, adding that Burkina Faso is looking at the universal health care system model so it can further reduce the direct cost of care. In that regard, implementation of an effective management system is critical, he continued, noting also the link between the environment, agriculture and stock breeding, and health.
The representative of Indonesia said his Government is promoting a public health programme to encourage healthy lifestyles as it continues to improve the standard of primary health care. “It is imperative to have strong cooperation between the Government and the private sector,” she emphasized.
The representative of Nicaragua said that families in her country receive free health care, universal vaccination coverage, examinations and diagnoses “even when there are very complicated measures required”. Vulnerable populations such as indigenous people and those of African descent cannot be left behind. Nicaragua has vaccinated against 16 diseases, including polio, tetanus and German measles.
The representative of Spain said universal health-care coverage remains a challenge which his Government is firmly committed to, adding that primary care is fundamental to ensuring equity among all populations. The pricing of medicine must be transparent, he stressed.
The representative of the Philippines underscored the importance of aligning health initiatives of local communities with national legislation. Various legislative measures, including raising taxes on alcohol, tobacco and cigarettes, are currently being considered. Universal health-care coverage is based on the idea that people need to be protected from the extreme financial burden that often overwhelmingly affects vulnerable populations.
A representative of United Nations Children’s Fund (UNICEF) said that without universal health coverage the promise of human rights and equality for all will go unrealized. While life expectancy has improved and fewer children are dying than ever before, immunization and malnutrition rates have plateaued. Failing to tackle the root causes of poor health is a huge missed opportunity for entire societies, she said, expressing concern over the unequal distribution of power, money and resources. “All people, no matter whom they are or where they live, must have access to good affordable health care,” she emphasized.
The representative of the International Organization for Migration (IOM) said that universal health coverage must also include migrants. It is essential to empower those left behind within and across borders.
Mr. ISHRAK, responding to the participants, emphasized that the unique social conditions and factors of patients must be taken into account. This could be addressed through having multiple sectors collaborating to ensure the best possible health care to patients.
Ms. OKONJO-IWEALA said that sometimes investing in water and sanitation can do far more for infant and child mortality than investing purely in the health sector alone. “It is important to get away from this silos way of thinking about it,” she added. Turning to the point made by the representative of the Philippines on taxing goods detrimental to health, she said that this could be an effective way to help curb the availability of alcohol, tobacco and cigarettes.
Mr. TAKEMI said it is important to consider how to finance universal health coverage but simultaneously to discuss and implement ways to improve access to all people.
Also speaking today was a representative of the World Economic Forum.
MELINDA GATES, Co-Chair and Trustee of the Bill and Melinda Gates Foundation, said that universal health coverage is a big idea, but the global health community is not to be ambitious and translate slogans into actionable strategies. Citing the experience of a woman with malaria who spent all her money in two days visiting a doctor and a local drugstore but was still unable to receive proper medication for herself and have her son vaccinated, she said this health-care system failed her and her family. Sadly, her experience represents those of millions of women and children. Things do not have to be this way.
Primary health care is a step towards universal health coverage, but prioritizing primary health care requires hard trade-offs, she said. Yet, primary health care is the most effective investment. For the health-care system to be effective, there is a need for collecting data and measuring performance for accountability. Stressing the need for a national health-care package, she urged donors, Governments and other stakeholders to work together to realize a society, where children are healthy and educated and can realize their potential and thrive. Her Foundation stands ready to support such efforts.
Mr. GHEBREYESUS, Director-General of the World Health Organization, said history was made today, with Governments committing to a world in which no one misses out on quality health services simply because they lack access or cannot afford them. Noting that Japan began its journey to universal health coverage not when it was prosperous, but rather when it was weak after the Second World War, he said universal health coverage laid the foundation for it to become the economic powerhouse it is today. While Governments do not agree on every issue, all agree that health is not an outcome of development; it is a prerequisite. “No country can flourish if its people are trapped in cycles of diseases and poverty” he said, pointing to expanded service access and reduced out-of-pocket spending as major successes. For all countries, primary health care must be the foundation, and today’s declaration calls for a 1 to 2 per cent increase in public spending.
More broadly, he said promoting health and preventing disease requires cooperation among all sectors, from energy, transport and trade to agriculture, environment and more. While there are numerous legal, fiscal and regulatory measures countries can take to advance universal coverage, the journey starts with a political choice. “Health is a political choice,” he said. “Health is a fundamental human right — an end in itself — and it is a means to development.” However, no one’s health is improved, nor is disease prevented, by a declaration. Government’s strong commitment will mean nothing unless it becomes a reality in the lives of those they are here to serve. “We must move with a sense of urgency, but not of desperation, so that progress can be sustained,” he said, underscoring WHO’s commitment to helping every country with technical know-how. The challenge is great, but so is the reward: a healthier, safer world for everyone, everywhere.
SHINZO ABE, Prime Minister of Japan, said that his country leads the Group of Friends of Universal Health Coverage, highlighting the momentum the Group created to advance universal coverage. Japan established universal health coverage in 1961, when it was still struggling to overcome poverty after the end of the Second World War. Affordable quality health services helped Japan overcome poverty and achieve economic success, he said, expressing hope that every country attains universal coverage, as health is the cornerstone of human security.
At the summit of the Group of Seven (G7) industrialized nations Japan hosted, his Government shared how to achieve universal health coverage, he said. First, national ownership is essential, he stressed, presenting how Japan adopted consistent policy, made best use of donor support and cooperated with the private sector, among other measures. Secondly, resource allocation and health financing for the most vulnerable is vital. Stressing the need for a monitoring framework, he highlighted Japan’s support for countries suffering heavy tolls from the outbreak of infectious diseases. Welcoming the issuance of the political declaration today, he said it is “a major step forward”.