From promise to practice: Finalizing a Pact for the Future that delivers health for all

In today's times of unpredictability and uncertainty, it is inspiring to see countries come together to create a Pact that delivers a better future for all. To protect the current and safeguard our next generations, governments must ensure they are healthy, resilient and better prepared for tomorrow. 

When we look through the latest draft of the Pact for the Future, we see that governments have recognized and promised to alleviate the inequality and suffering that too many face. We see their wish to provide opportunities and give hope. They have called for global transformation and promised to work together with resolve, "striving for a world that is safe, sustainable, peaceful, inclusive, just, equal, orderly, and resilient for a sustainable future." We applaud this resolve as it resonates with us. 

In the Pact, the importance of physical and mental health is recognized in several clauses. It is listed as fundamental for addressing poverty, inequality and environmental changes, and for promoting the rights of women and girls, education, social and economic development and sport.  

This is logical and understandable, as healthy people and communities contribute to more stable and thriving societies, healthy children benefit better from education, healthy women and girls are more empowered towards equity, and healthy workers add about 4% to GDP in terms of productivity. Investments in health are also needed to address climate change, this century's biggest health threat, and other risks including disease outbreaks, pandemics, and health emergencies. As for the costs of poor health, it is important to learn the lessons from the recent COVID-19 pandemic. According to the World Bank, it resulted in immense economic and social costs, including the largest global economic crisis in more than a century, an increase in inequality within and across countries, and a rise in global poverty for the first time in a generation, erasing progress made in the last decades to lift people out of poverty. 

As governments start preparing to implement the commitments made at the Summit of the Future, they will need to prioritize investments and actions from their health budgets, which are not at the level required to deliver on all the promises made in the Pact. 

The sustainable way to deliver on the cross-cutting actions promised will be for governments to invest in universal health coverage – meaning that all people, including those in the most vulnerable situations, have access to the full range of quality health services they need when and where they need them, without financial hardship. The latest Global Monitoring Report on UHC showed that, in 2021, about half of the world's population—4.5 billion people—lacked access to essential health services. In 2019, the same report shows that about 2 billion people experienced financial hardship due to out-of-pocket spending on health, including 344 million people living in extreme poverty. 

Working towards universal health coverage means establishing and funding a range of measures that guarantee equitable access to quality health services. The most inclusive, equitable, cost-effective and efficient way is through a primary health care approach that can deliver 90% of essential services. It also means passing laws and regulations, adopting budgets and policies, and implementing programmes that ensure no one faces financial hardship due to out-of-pocket payments for health. Agreement to accelerate reform of the international financial architecture must address sustainable borrowing and strengthen safeguards to reduce or prevent debt crises that stand in the way of adequate funding for health and all sustainable development. Reforms of the global governance system will benefit achievement of universal health coverage. 

Governments will need to build equitable and resilient health systems that can withstand external shocks and are equipped with a well-trained health workforce that works in decent and safe conditions. Policies and programmes should be designed to eliminate gender inequalities and ensure women and girls can access all the health services they need, including those related to sexual and reproductive health and rights.  

Moreover, policymakers should include people and communities in decision-making processes to ensure that interventions respond to their needs, as outlined in the World Health Assembly resolution on social participation. 

As governments finalize the Pact for the Future and move to prepare its implementation, we call on them to invest in health for all to guarantee a better future for all people, particularly women, youth and those who are yet to be born.