Part Two: UNGA 74 – Healthcare as a driver for inclusive development for all

by Maria-Laura Fornella SI Representative to the United Nations New York.

“I attended the Panel on 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 Sanchez, President of the Government of Spain, this panel also featured: Michelle Bachelet, UN High Commissioner for Human Rights and former President of Chile; Maha Taysir Barkat, Board Chair of the RBM Partnership to End Malaria; Winnie Byaniyima, Executive Director of Oxfam International; and Jeffrey Sachs, Professor and Director of the Center for Sustainable Development at Columbia University.

Sheikh Hasina opened the discussion stressing the relevance of inclusive social development and equity for political stability and social cohesion: economic growth alone is not enough. She called for “just and proper” wealth distribution and for securing universal health coverage as a precondition for establishing a righteous and fair society. She cited the UN Declaration of Human Rights, which guarantees all people the right to an adequate standard of living, including health and well-being. She further stated that although progress has been made, half of the world population still lack access to necessary health services and 100 million people fall into extreme poverty every year due to health expenses. She called on all governments to focus on strong primary care systems as a line of first defence against communicable and non-communicable diseases, and she offered the example of Bangladesh that has done this through the creation of fourteen thousand community health clinics in rural areas which receive an average of 10 million visits per month. She concluded that this kind of resource mobilisation remains an unsurmountable obstacle for any nations and requires international support.

President Pedro Sanchez reminded member states that Sustainable Development Goal 3 (SDG3) commits them to provide essential services and universal health coverage (UHC) to all by 2030. He added that UHC is a tool to reduce inequalities, create employment, and promote social and territorial cohesion. Spain adopted it forty years ago, after it transitioned from dictatorship to democracy, and it has brought incalculable benefits to society. Though the 2008-2009 crisis affected the health system and some benefits were rolled back, it quickly became clear that UHC was strongly supported by the population and considered an unalienable right, so his government re-established full coverage.  Spain is today the healthiest country in the world, with the most efficient and accessible public system: not only does it cover citizens but also immigrants regardless of their status. It is also the choice of new biomedical enterprises to develop their high-tech products to the benefit of humanity. Sanchez praised and strongly endorsed the “honest, noble and ambitious challenge to provide Universal (and free, he added) Health Coverage, not only as a question of Social Justice but as the best form to invest in physical, legal security, which are the pillars of institutional order” and the rule of law.

Michelle Bachelet, speaking in her role as United Nations High Commissioner of Human Rights but also as a physician and former President of Chile, observed the enormous progress that has been achieved in health systems all over the world and how this improvement has positively impacted development. Still, she added, a lot remains to be done. Access to health is a universal human right, and as such, UHC must be implemented through laws and policies that uphold the equality and dignity of all members of society. She emphasised that Sexual and Reproductive health care-services to empower women to make their own decisions about their lives remain essential to making UHC a reality.

Following an excellent sequence of speeches about the benefits, commitments and needs of health coverage, Jeffrey Sachs made perhaps the most provocative and intense appeal to rich countries and donors to contribute to make UHC a reality: “This is about Money…there is nothing else to talk about. Every time we tell poor countries “why don’t you do better” we are not doing the right arithmetic…We are missing one tenth of 1 per cent of the income of the rich…to save millions of lives… we are missing a few billion dollars…”. He went on to call out the names of those that could and should contribute, who together have a net worth or $1 trillion. Yet 5 million children will die this year because they do not have access to health care”.

Several interventions from the floor added their support to primary universal health care, and whilst all agreed on UHC as a main instrument to create more equal and more wealthy societies, the main focus of the discussion was on the best way to deliver it:  by states themselves or by private providers. The majority agreed that it is a political decision and that public health care is the preferred mode to fund and implement. There was a very direct exchange on the debate of public vs. private health care between Bachelet and Sachs: Bachelet insisted political decisions determine policy choices and that public health care is the most efficient and equitable as far as providing universal coverage for all regardless of income, gender, and other differences.  “We did it in Chile, Uruguay has done it too, it is a political choice, it is about redistribution, it is about priorities.” Sachs responded that he was demanding international solidarity for the poorest countries where it wasn’t a choice, and where the GDP per capita is $800 (Chad) and not $15,000 (Chile). The representative of France bridged this debate by stating that whilst it is a political choice, and that funds can be found if there is a will. She said that it was important to associate the two: public and private funding but that the government should be in charge through regulation, monitoring and supervision.

Access to women and girls was stressed by Bachelet and by several representatives from the floor, amongst them Gabriela Cuevas, President of the Interparliamentary Union, who stressed that young teen mothers should have full health-care coverage rights, the Health Minister of Uruguay who said that out of all South American countries, Uruguay has the lowest maternal mortality rates and lowest incidence of teen pregnancy.

During closing remarks, Melinda Gates Co-Chair and Trustee of the Bill and Melinda Gates Foundation explained the intricacies and the trade-offs that UHC policies face, and asked the global health community to understand this and not to try to translate “slogans into actionable strategies”. She called on the collection of hard data to make health-care systems effective by measuring performance for accountability. She called on governments, donors and all stakeholders to work together to realise a society of healthy, educated children, and gave her commitment to support such efforts.

Prime Minister Shinzo Abe also made an important closing statement, describing how an affordable quality health care system helped Japan overcome poverty and achieve economic success after World War II. He then described the main steps Japan followed: “National ownership is essential, he said, but there should be cooperation with the private sector as well as oversight by the government of the best way to allocate donor support. He stressed the need for a global monitoring framework and health financing for the most vulnerable countries. In closing, he welcomed the Universal Health Coverage Political Declaration signed on 23 September, 2019 as a major step forward.”

LEAD IMAGE: UN/Amanda Volsard

Read Part One of the report by Maria-Laura Fornella SI Representative to the United Nations New York  HERE

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