UHC Political Advisory Panel Op-Ed in Lancet Global Health

Realising the right to health for all people—UHC is the umbrella to deliver health for all

Authors: Maria Fernanda Espinosa, Vytenis Povilas Andriukaitis, Ilona Kickbusch, Sania Nishtar, Emilia Saiz, Keizo Takemi, Gabriela Cuevas Barron, Justin Koonin, Akihito Watabe on behalf of UHC2030

This article was first published in The Lancet Global Health.

The COVID-19 pandemic has devastated population health, gender equality, and sustainable development, and has increased inequalities within and among countries.¹

With multiple ongoing crises, we risk further fragmenting the global health architecture. In 2023, our approach to global health cannot be a continuation of the past. The COVID-19 pandemic showed us that countries, regions, and the multilateral system must better prepare to respond to emerging health threats, including climate change and humanitarian crises.

This year, the G7 Hiroshima Summit and World Health Assembly (WHA) in May and the G20 New Delhi Summit and UN high-level meetings (HLMs) on health in September will be key moments for governments to take action and make a fundamental shift a reality. The focus on health is a unique opportunity to invest in resilient, equitable, and sustainable health systems that will set us on track to achieve the sustainable development goals (SDGs), set by the United Nations General Assembly in 2015, by 2030.²

However, achieving our globally agreed-upon goals will require strong collaboration and a better understanding of how modern crises are intertwined.

Strong health systems can better absorb and recover from shocks. During the COVID-19 pandemic, countries with equitable systems focused on primary health care could scale up services for patients with COVID-19 while continuing to ensure other essential health care needs were met.³

At the three HLMs on health occurring in September, 2023, we can build on these lessons from the COVID-19 pandemic, acknowledging that health emergency preparedness and universal health coverage (UHC) are intertwined goals that we achieve through the same health system. Towards 2030, UHC2030 will accelerate sustainable progress towards UHC, focusing on building equitable and resilient health systems, leaving no one behind, and providing protection from global health emergencies.

This March, the UHC Movement launched an Action Agenda,⁴ which provides countries with concrete actions to advance progress on UHC. This Action Agenda will inform the 2023 Political Declaration on UHC and other health-related processes in 2023 and beyond. As the UHC Movement Political Advisory Panel and co-chairs of the UHC2030 Steering Committee, we urge countries and global health leaders to unite behind this agenda and use its eight action areas as a blueprint for what cannot be neglected: (1) champion political leadership for UHC; (2) leave no one behind; (3) adopt enabling laws and regulations; (4) strengthen the health and care workforce to deliver quality health care; (5) invest more and invest better; (6) move together towards UHC; (7) guarantee gender equality in health; and (8) connect UHC and health security. This sense of urgency is why, ahead of the WHA, we call on Health Ministers to mobilise their Heads of State to engage in all three HLMs and escalate health at the UN SDG Summit in September, 2023, with ambitious and actionable commitments to ensure that UHC is recognised as the umbrella to deliver health for all.

World leaders must champion UHC and governments are responsible for realising people's right to health. Doing so requires political will and policy cohesion with adequate resources backed by Heads of State, health and finance ministers, local and regional governments, and parliamentarians. The political declaration on UHC is essential for everyone. In 2023, political leaders will have a unique opportunity to restructure the global health architecture to achieve SDG 3—good health and wellbeing.

World leaders must acknowledge that gender equality is crucial to achieve UHC. In many countries, health is still a privilege and not a recognised human right, particularly for women and girls. All governments must commit to equal rights, access to services, and representation of all genders in health and political leadership through gender-sensitive policies. Gender equality drives health, and women are the foundation of health systems because they make up almost 70% of the health care workforce, yet only 25% of leadership roles.⁵

World leaders must take urgent action to realise the right to health and anchor this right in implementation. National health policies and strategies must be underpinned by sound legal and regulatory frameworks and an institutional capacity to be responsive to people's needs, consistent with international agreements, and leave no one behind. Policy makers must ensure that frameworks are human-centred, sustainable, and independent of national political cycles by working with opposition political parties and prioritising population health across party lines.

World leaders must institutionalise mechanisms for inclusive health governance. Governments, including local and regional governments, are primarily responsible for ensuring people's health, but they alone cannot achieve UHC. Governments need to establish a whole-of-society approach in their processes and include front-line community health workers in all decision-making mechanisms. Social participation and systemic coordination of all stakeholders ensure that policies respond to all people's needs, create the basis for trust in policies, and make health systems more transparent and accountable.

In this upcoming WHA, all health ministers must champion UHC, further commit to gender equality, and anchor health for all in their country implementations. Governments must include civil society and communities in all processes and they must act and be accountable for their commitment.

Placing health on the highest agenda is not having multiple processes, but unifying behind health for all and building a more coherent global health architecture. Leaders must recognise that we cannot address emerging health threats without climate-resilient and equitable health systems. In 2023, a continuation of the past is not an option.⁶

The convergence of crises we face is too grave and millions of lives are on the line.

We declare no competing interests. We thank Neena Joshi and Katri Bertram for their support in drafting and editing this commentary.

References

1. Paremoer L, Nandi S, Serag H, Baum F. Covid-19 pandemic and the social determinants of health. BMJ. 2021; 372: n129.
2. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. https://sdgs.un.org/2030agenda. Date: Aug 10, 2015. Date accessed: April 25, 2023. 
3. Sachs JD, Abdool Karim SS, Aknin L, et al. The Lancet Commission on lessons for the future from the COVID-19 pandemic. Lancet. 2022; 400: 1224-1280.
4. UHC2030. Taking action for universal health coverage. https://www.uhc2030.org/un-hlm-2023/. Date: 2023. Date accessed: April 6, 2023.
5. WHO. Closing the leadership gap: gender equity and leadership in the global health and care workforce. World Health Organization, Geneva 2021.
6. United Nations. Fast facts on climate and health. https://www.un.org/sites/un2.un.org/files/2021/08/fastfacts-health.pdf. Date: Aug 10, 2021. Date accessed: April 6, 2023