Eduardo Pisani, Incisive Health’s new Strategic Advisor in Brussels, reflects on the commitments to Universal Health Coverage made at this year’s United Nations General Assembly.

Everyone in the world should have affordable access to quality healthcare by 2030. Every country should make appropriate investments to avoid people being at risk of poverty due to health spending. World leaders should “leave no one behind”.

Health for all

There is no doubt that the political declaration on Universal Health Coverage (UHC) adopted during this year’s 74th United Nations General Assembly (UNGA) represents a milestone towards the achievement of the Sustainable Development Goals (SDGs). It has been greeted as “the most comprehensive agreement ever reached on global health” by UN Secretary General Guterres. The World Health Organization’s Director General Tedros Adhanom Ghebreyesus called it a “landmark for global health and development”, stressing the need for a “crucial shift” to protecting health rather than just treating diseases.

“Ultimately health is a political choice. The world we want is one where health is not a cost but an investment. Our vision is not health for some, not health for most. It is health for all.” – Tedros Adhanom Ghebreyesus

The political declaration is a commitment to invest in key areas around primary healthcare. These include mechanisms to provide financial protections for those who need to pay for healthcare out-of-pocket, and implementing strategies to fight diseases and protect the health of women and children. It also commits countries to strengthen their health workforce and governance capacity. Governments will have to report on progress at the UN General Assembly in 2023.

At the same time, twelve multilateral organisations (including WHO, WB, OECD, UNICEF, UNFPA) launched a plan for health and wellbeing for all. The plan will ensure the twelve partners enhance their support to countries to help deliver UHC and achieve the health-related SDG targets.

Time for action

However, despite such progress, there is also widespread agreement that more urgent action is needed. UHC is not on track everywhere, and only roughly half the world population will be covered in 2030 at the current pace. The Universal Health Coverage Global Monitoring Report 2019 calls on governments to redouble the pace of expanding coverage, and commit to spending at least 1% of their GDP on primary health care. According to the report, “progress has been greatest in lower income countries, mainly driven by interventions for infectious diseases and, to less extent, for reproductive, maternal, new-born and child health services. But the poorest countries and those affected by conflict generally lag far behind.”

The focus on primary healthcare (PHC) is critical in low and middle-income countries, as it would potentially increase average life expectancy by 3.7 years by 2030; representing a 5% increase on the US$ 7.5 trillion already spent on health globally each year.

Although the world is getting richer, and overall poverty rates are declining, poverty related to healthcare expenditure is actually increasing. Nearly a billion people spent more than 10% of their household income on health in 2015, and over 200 million spent more than 25%. The controversy around the role of Big Pharma in providing affordable medicines and vaccines is still unresolved, according to Oxfam.

Interestingly, the OECD said that health is lagging behind compared to other sectors of the economy in leveraging data and digital in a way that transforms health systems for better access, more efficiency, and more effective results. Primary healthcare is the pathway to reach UHC, and it is “very exciting”, according to UNICEF, to see the digital innovations that can deliver PHC more effectively.

Accelerating action through partnerships

In sum, the UNGA gave visibility to multiple urgent priorities, but often illustrated challenges rather than presenting solutions. More than 300 side events – many of which on various health-related issues, ranging from AMR to TB and NCDs – showed that the momentum exists to accelerate action and avoid falling short on the ambitious goals. On another positive note, partnerships have been consistently indicated as an accelerator to achieving the Sustainable Development Goals and are now becoming the norm across sectors and stakeholder groups.