23 September 2019: UN Member States adopted a high-level political declaration to protect people from suffering financial ruin due to health costs; implement high-impact health interventions to combat diseases and protect women’s and children’s health; strengthen the health workforce and infrastructure; and to reinforce governance capacity to achieve these goals. The declaration was adopted at a one-day high-level meeting in New York on the theme of ‘Universal Health Coverage: Moving Together to Build a Healthier World.’

The declaration builds on SDG target 3.8 on universal health coverage (UHC) and the World Health Organization’s (WHO’s) ‘triple billion goals’, which include extending UHC to one billion more people by 2023. While welcoming the declaration, Member States expressed concerns regarding the health impacts of climate change, health coverage for migrants and refugees, and language around sexual and reproductive health and rights.

WHO hailed the agreement as the world’s most comprehensive set of health commitments to be adopted at this level, and Tedros Adhanom Ghebreyesus, WHO Director-General, highlighted how UHC is key to ensuring progress towards the SDGs and their 2030 deadline. On the previous day, 22 September, WHO called on world leaders to double health coverage between now and 2030, warning that failure to do so would leave up to five billion people unable to access health care.

WHO hailed the agreement as the world’s most comprehensive set of health commitments to be adopted at this level.

In his opening remarks, UN Secretary-General António Guterres emphasized the right to accessible, high-quality, affordable care, including during conflict and humanitarian crises. He noted that the high cost of healthcare impoverishes approximately 100 million people globally. He also drew attention to the challenge of mental health, which, he pointed out, has been a neglected issue. He concluded that UHC is at the center of the 2030 Agenda because good health is both an outcome and a driver of economic and social progress, and involves issues as diverse as food security (SDG 2), gender equality (SDG 5), climate change (SDG 13), and strengthening of governance (SDG 16) to efficiently deliver health services to all.

World Bank President David Malpass highlighted UHC as critical to alleviating extreme poverty and boosting shared prosperity. He cited Bank figures showing that the gap in financing to achieve UHC in the world’s 54 poorest countries is approximately US$176 billion annually. He called for: substantially increasing investments in affordable, quality primary health care; engaging the private sector and unlocking new models for health financing and delivery; supporting communities by improving education, broadening social services and creating jobs; and changing the way that health is financed by national governments as well as development partners. He highlighted examples of work done by the Bank and the International Finance Corporation (IFC), including the roll-out of mobile health insurance platforms such as M-Tiba in Kenya to support gig economy workers and those in precarious employment.

In addition to adopting the joint declaration, the one-day high-level meeting provided an occasion for countries to announce their commitments to global health.

Emmerson Mnangagwa, President of Zimbabwe, highlighted his country’s national health insurance strategy and its 10% tax on mobile data usage, of which 5% is allocated for health purposes.

Prayut Chan-o-cha, Prime Minister of Thailand, announced that from 1 October 2019, Thailand will expand its UHC benefit package to include the provision of pre-exposure prophylaxis (PrEP) to those at high risk of HIV infection. Other measures described included the earmarking of 15% of the UHC scheme budget for health promotion, increased use of revenue from taxes on alcohol and tobacco, online medical consultations for people in remote locations to reduce the cost burden of travel, and support for establishing local health funds.

Frank Bainimarama, Prime Minister of Fiji, explained the transport challenges faced by small island developing States (SIDS) that have populations dispersed over many islands, and envisaged a future with access to quality health care not limited by geography and economic status. He stated that climate change has increased health insecurity worldwide and argued for “climate proofing” health systems in every way possible. He urged world leaders to cooperate to develop resilient health infrastructure and attack the root causes of “the climate realities that we now face.”

Najla bint Mohammad al‑Awar, Minister of Community Development, United Arab Emirates (UAE), further emphasized the health impacts of climate change such as on air quality and water scarcity. She called on the international community to increase investment in tackling these issues and to ensure that the benefits of climate finance reach the health sector. She urged those responsible for UN programmes to ensure that gender and age markers are mainstreamed so that programmes consider the unique health needs of men and women at different life stages.

Sigrid Kaag, Minister for Foreign Trade and Development Cooperation, the Netherlands, presented a joint statement on sexual and reproductive health and rights (SRHR) on behalf of more than 50 countries. The statement argued that SRHR is an integral part of UHC and the SDGs, noting that around 62% of sexual and reproductive health services are financed out-of-pocket by patients, and calling for an investment of nine USD per capita per year to make these essential services available to all. The statement further called for directly involving women, adolescents and marginalized groups in the policy and program design of services to realize universal access to SRHR, and to invest in the needs of women, girls, adolescents and people in the most marginalized situations, who most need such services.

Alex Azar, US Secretary of Health and Human Services, highlighted US efforts to provide more Americans with health coverage, including by lowering the cost of prescription drugs and promoting partnerships that include civil society, NGOs, faith- and community-based organizations. He deplored “politicization of the negotiation” of the declaration text, which includes language that has been used, he argued, to promote abortion as healthcare and to give access to sex education that diminishes the protective role of the family in improving health. While joining consensus on the political declaration, he dissociated the US from paragraph 68 of the declaration and its mention, in relation to the Program of Action of the International Conference on Population and Development (ICPD) and the Beijing Platform for Action, of “sexual and reproductive health” and “sexual and reproductive health and reproductive rights.” He stressed that there is no universal right to abortion.

Péter Szijjártó, Minister of Foreign Affairs and Trade, Hungary, expressed concern that the political declaration was not based on SDG 3 on good health and well-being, but appeared to be pushing through goal 15 of the Global Compact on Migrants and Refugees “in a stealthy way.” He rejected the provisions of paragraph 70 and 71 of the political declaration on UHC, which addresses healthcare for migrants and refugees, among other vulnerable groups, in line with national contexts and priorities. He stressed that the declaration cannot be legally binding, that migration “is not a human right,” and that, in this context, the mention of migrants implies illegal migrants. He opposed approaches that would ensure the equality of healthcare, arguing that Hungary cannot discriminate against its own citizens.

Wang Hesheng, Vice-Minister of the National Health Commission of China, presented a statement on behalf of the Asia Pacific Economic Cooperation (APEC) Health Working Group, which encouraged governments to promote people-centered, quality and efficient primary health care delivery, increase health investment, optimize the allocation and utilization of health funds, and improve equitable access to health care services and health insurance. He described China’s work towards building a “Healthy Silk Road”, in cooperation with other countries, focusing on health security and other shared challenges. He highlighted China’s leadership in establishing the China-UN Peace and Development Fund, the South-South Cooperation Assistance Fund, and the China-Africa Health Care Initiative.

Zulema Tomas, Minister of Health, Peru, drew attention to the links between health and living standards, including access to safe water, nutrition, and dignified housing. She noted that approximately four million Peruvians still lack health coverage, and highlighted her government’s current legislative initiative to provide financial protection against health risks to all citizens by 2021, stressing that “health cannot wait.”

The high-level meeting on UHC preceded the launch of a Global Action Plan for health and well-being for all on 24 September, in which WHO and 11 other multilateral organizations, which account for one-third of development assistance for health, presented how they would support countries to deliver UHC and achieve the health-related SDG targets.

The UHC 2030 campaign notes that 2023 is the midpoint of the time horizon for achieving the SDGs, and that the high-level meeting therefore represented “the last chance” to mobilize high-level political support for UHC. In the political declaration that was adopted, Member States agree to convene a high-level meeting on UHC in 2023 in New York, the US to report back to the UN General Assembly on implementation of their commitments. Thailand and Georgia co-facilitated the negotiation process leading up to the historic adoption. [SDG Knowledge Hub Story on the UHC Negotiation] [SDG Knowledge Hub Story on the WHO Five-Year Plan] [UN Webcast of High-Level Meeting on UHC]