Time for action on Health for All: We need to deliver on renewed global commitments to Universal Health Coverage

Tuesday 12 December, 2023

If there was ever a time that we needed to focus on Universal Health Coverage (UHC), it’s now.

As of 2021, at least 4.5 billion people (more than half of the world’s population) were not covered by essential health services. Two billion people experienced financial hardship due to healthcare costs, and more than 1.3 billion people were pushed or further pushed into poverty when trying to access basic healthcare.

These staggering figures of human suffering are likely to have worsened in a year marked by conflict and environmental disasters.

While these statistics may seem disheartening, there are opportunities to act. On Universal Health Coverage Day, we shine a light on those opportunities, and how we can work together to make the most of them.

In 2019, the UN Political Declaration on UHC was adopted to ensure that all people have access to the health services they need, when and where they need it, without experiencing financial hardship. But most of the world is falling behind on that commitment, with countries still reeling from the COVID-19 pandemic and its ongoing impacts.

In September 2023, leaders had an opportunity to address these issues, at the second UN High Level Meeting on UHC. This was a critical moment to course-correct and accelerate efforts towards achieving UHC by 2030 under the Sustainable Development Goals through a renewed political declaration.

Fortunately, a global commitment to achieve UHC was reaffirmed by world leaders with the 2023 Political Declaration on Universal health coverage: expanding our ambition for health and well-being in a post-COVID world adopted by the UN General Assembly.

And although the 2023 Political Declaration on UHC was not as ambitious and action oriented as many had hoped for, the Declaration has several positives.

Notably, noncommunicable diseases (NCDs) received greater recognition than its 2019 counterpart, reflecting the understanding that UHC cannot be realised without addressing the NCD burden.

There was a strong focus on equity, strengthening primary healthcare, multisectoral engagement and collaboration. Further, there was a recognition that most healthcare workers are women and that they need better leadership opportunities, fair and safe employment practices and equal pay for equal work. There was also acknowledgement of the need to address the impacts of misinformation and disinformation on public health, an issue absent in the 2019 Political Declaration on UHC.

There was also greater acceptance of the impact of climate change on public health. It was pleasing to see the interrelationships between planetary and people health reflected in the 2023 Declaration. This growing understanding of the need to address health in a holistic way was also recognised at the recent COP28 UN Climate Summit which dedicated an entire day to climate and health issues and saw world leaders once again commit to work to achieve UHC.

The McCabe Centre was also pleased to see recognition of the critical role of law and regulatory frameworks reaffirmed in the 2023 Political Declaration as many UHC commitments can only be achieved by using law.

The 2023 Declaration sets a clear expectation that countries strengthen legislative and regulatory frameworks to advance UHC, including using law and regulation to address NCD risk factors such as those contained in the WHO Global Action Plan on NCDs known as the NCD ‘best buys’, and to support equitable access to quality health service delivery, including through engagement with people affected by conditions such as NCDs.

With the current lack of UHC described by the UN Secretary General as a ‘human rights tragedy on a massive scale’, it is now up to leaders in all nations to build on the momentum of the second High-Level Meeting on UHC and fulfil the promises made to their citizens of health for all by 2030.

Countries must action their promises to foster coordinated efforts within and between countries together with other global health actors to comprehensively address the social, economic, environmental, and other determinants of health by working across all sectors through health-in-all-policies approach. This must occur in a way that ensures effective participation of citizens who need the realisation of UHC to improve their lives and livelihoods.

The fourth UN High-Level Meeting on the Prevention and Control of NCDs in 2025 and the third UN High-Level Meeting on UHC in 2027 serve as further impetus to implement actions that will see tangible progress towards advancing UHC and reducing the NCD burden if the world is to achieve commitments made under the Sustainable Development Goals by 2030.

Health is a fundamental human right. UHC is ultimately a political choice. On this International Universal Health Coverage Day, the time to act is now.

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