All roads lead to universal health coverage—and this is the top priority at WHO, Dr Ghebreyesus the WHO director general has asserted. The key question of universal health coverage is an ethical one. Should fellow citizens die because they are poor? Or should millions of families be impoverished by catastrophic health expenditures because they lack financial risk protection? Universal health coverage is a human right. The world has agreed on universal health coverage in Sustainable Development Goal 3.8. He asserts that universal health coverage is ultimately a political choice and responsibility of every country and national government. Countries have unique needs, and tailored political negotiations will determine domestic resource mobilisation. He indicates that WHO will catalyse proactive engagement and advocacy with global, regional, and national political structures and leaders including heads of state and national parliaments. Beyond benchmarking, countries learn from their peers, especially those they see as having similar political or economic contexts. WHO will thus document best practices in universal health coverage at the country level. Once this learning has occurred, countries may request technical assistance and WHO should be prepared to provide technical assistance to countries based on their specific needs, across the full range of health-related Sustainable Development Goals. He further posits that universal health coverage and health emergencies are cousins—two sides of the same coin. Strengthening health systems is the best way to safeguard against health crises. Outbreaks are inevitable, but epidemics are not and strong health systems are the best defence to prevent disease outbreaks from becoming epidemics. Achieving universal health coverage will require innovation. Given that what is measured is managed, data matters and WHO will track progress on how the world is meeting the health-related Sustainable Development Goal indicators. Finally he observes that universal health coverage is not an end in itself: its goal is to improve all health-related Sustainable Development Goals.
Values, Policies and Rights
Environmental health risks especially affect women and children, because they are more vulnerable socially and because exposures to environmental contaminants create greater risks for children’s developing bodies and cognitive functions. According to the 2016 World Health Organisation (WHO) estimates, modifiable environmental risk factors cause about 1.7 million deaths in children younger than five years and 12.6 million total deaths every year. The sustainable development goals (SDGs) offer opportunities for countries to create healthier environments for women, children and adolescents. This paper explores how the SDGs can be used to reduce environmental health risks and enhance the health of women, children and adolescents. In particular, the authors focus on drivers for urbanisation and sustainable development (e.g. transport, housing, urban design and energy provision) that can advance the global strategy, but have not traditionally been a focus of health policy-making. They frame the discussion around the three pillars of the global strategy: survive, thrive and transform, while recognising the inevitable overlap between these objectives.
At the 70th World Health Assembly, the “BRICS countries” – Brazil, the Russian Federation, India, China and South Africa – convened a side event sponsored by China. The aim was to share experiences and innovations on people-centred reforms as a means to making progress towards universal health coverage, The Executive Deputy Director, Office of State Council Healthcare Reform Leading Group in China, Dr Liang Wannian highlighted the importance the Chinese government has placed on providing improved primary health services, by transforming the primary service model and enhancing division and cooperation to build an integrated health service system. For Brazil, Mr Ricardo Barros, Minister of Health shared the aspiration that “what we want is to have 80% of problems resolved in primary-level care so that people don’t need to go to the hospital”. He noted that “(delivering) primary-level care is the great challenge that we have” and that although “we have resources available for health, we don’t use them very wisely, so we are trying to improve that.” Dr Veronika Skvortsova, Minister of Health of the Russian Federation also highlighted the important role of designing a patient-focused system for health care based on accessibility and quality. For India, Mr Sanjeev Kumar, Additional Secretary, Ministry of Health and Family Welfare highlighted that the country had adopted a new national policy linked to universal health coverage in March 2017. Dr Aaron Motsoaledi, Minister of Health of South Africa, concluded the series of country presentations by returning the conversation to the importance of reorienting the model of care to focus on primary care. He shared South Africa’s “ideal clinic” innovation, which encourages the development of more attractive primary care clinics to draw patients away from tertiary care centres.
Instead of being locked in crowded camps surrounded by barbed wire, the 1.2 million refugees in Uganda are given large plots of land in sprawling settlements to build homes or, if they like, small farms. If agrarian life isn’t for them, they can move freely around the country, traveling to towns or to the bustling capital of Kampala, which 95,000 refugees call their home. The distinguished scholar and humanitarian activist Noam Chomsky characterizes European attitudes towards refugees “[as] among the signs of the severe moral-cultural crisis of the West that is mislabeled a ‘refugee crisis.’” The five wealthiest countries [the U.S., China, Japan, the U.K. and Germany]— which make up half the global economy — are hosting less than 5 percent of the world’s refugees, while 86 percent of refugees are in poorer developing countries that are often struggling to meet the needs of their own people. The authors argues that Uganda points the way forward and that the country is a good model for compassionate hospitality towards refugees. It is however noted that the country is reaching a breaking point due to increasing demands for accommodation of the large numbers of refugees. What was promised for Uganda from external funders at the 2016 high level summit in New York has not been forthcoming. Supporting viable resettlement programs and working towards durable solutions is argued to be the only way to resolve the crisis. This involves using leverage to promote human rights and good governance in refugee producing countries.
Activists from organisations in North Africa met in Tunis in July 2017 to set up the North African Network for Food Sovereignty. The network’s charter states that food sovereignty is the human right of peoples as individuals and communities to define their own food systems. Food sovereignty is tied to the right of people to self-determination at the political, economic, social, cultural and environmental levels. It means, working with nature and protecting resources to produce sufficient, healthy and culturally appropriate food by giving priority to local production and staple food, putting in place popular agrarian reforms, guaranteeing free access to seeds, protecting national produce and by involving people in elaborating agricultural policies. The charter identifies that this is undermined by extractivist policies implemented in the name of development and by neoliberal adjustment policies. In order to address this the North African Food Sovereignty Network was formed to achieve food sovereignty, climate and environmental justice, through critical studies; campaigns, workshops, direct actions as well as networking, coordination and solidarity with movements that share objectives.
The WHO Director General Dr Ghebreyesus has set universal health coverage (UHC) as one of the main priorities for his term. His goal is a challenging one, especially for low and middle income countries which make up around 84% of the world’s population. They only have access to half the physicians and a quarter of the nurses that high income countries have access to. Similarly low and middle income countries only spend around US $266 per capita on health care. In contrast, high income countries spend US $5 251 per capita. This means that attaining universal health coverage in poorer settings is challenging. Large cuts to foreign aid investment from a number of high income economies only compound this challenge. Low and middle income countries also invest around a third of what high income countries invest in research to generate the knowledge needed for UHC. They also have access to around a fifth of the researchers high income countries have access to. Much of the knowledge required to establish the universal health coverage already exists but poor access presents a major barrier to achieving the goal. To unlock this knowledge for everyone’s benefit, the author proposes that policymakers and publishers consider more innovative ways to provide access to available knowledge.
This empirical research examines gender and leadership in the health sector, pooling learning from three complementary data sources: literature review, quantitative analysis of gender and leadership positions in global health organisations and qualitative life histories with health workers in Cambodia, Kenya and Zimbabwe. The findings highlight gender biases in leadership in global health, with women underrepresented. Gender roles, relations, norms and expectations shape progression and leadership at multiple levels. Increasing women's leadership within global health is an opportunity to further health system resilience and system responsiveness. The authors conclude with an agenda and tangible next steps of action for promoting women's leadership in health as a means to promote the global goals of achieving gender equity. This includes leadership that is gender responsive and institutionalised; development of enabling environments for women's leadership; increasing thought leadership events related to women's role in global health; supporting leadership development, including management training and soft skills and building capacity, including formal training in technical skills, research and mentorship. The authors also call for improved policy and practice in terms of the health and safety risks women face in carrying out their health-related roles.
A global coalition of civil society organisations and trade unions presented a report on 'Spotlight on Sustainable Development 2017'. The report provides a comprehensive independent assessment of the implementation of the 2030 Agenda and its Sustainable Development Goals (SDGs). In the 2030 Agenda governments committed to a revitalised Global Partnership between States and declared that public finance has to play a vital role in achieving the SDGs. But in recent decades, the combination of neoliberal ideology, corporate lobbying, business-friendly fiscal policies, tax avoidance and tax evasion has led to a massive weakening of the public sector and its ability to provide essential goods and services. The same corporate strategies and fiscal and regulatory policies that led to this weakening have enabled an unprecedented accumulation of individual wealth and increasing market concentration. The proponents of privatisation and public-private partnerships (PPPs) use these trends to present the private sector as the most efficient way to provide the necessary means for implementing the SDGs. But many studies and experiences by affected communities have shown that privatisation and PPPs involve disproportionate risks and costs for the public sector. PPPs can even exacerbate inequalities, decrease equitable access to essential services and jeopardise the fulfilment of human rights. Therefore, it is high time to counter these trends, reclaim public policy space and take bold measures to strengthen public finance, regulate or reject PPPs and weaken the grip of corporate power on people’s lives. These are indispensable prerequisites to achieve the SDGs and to turn the vision of the transformation of the world, as proclaimed in the title of the 2030 Agenda, into reality. The 160-page report is supported by a broad range of civil society organisations and trade unions, and based on experiences and reports by national and regional groups and coalitions from all parts of the world. Its 35 articles cover all sectors of the 2030 Agenda and the SDGs, and reflect the rich geographic and cultural diversity of their authors.
South Africa, as an emerging middle-income country, is becoming increasingly influential in global health diplomacy. However, little empirical research has been conducted to inform arguments for the integration of domestic health into foreign policy by state and non-state actors. This study aimed to address this knowledge gap, as an empirical case study analysing how South Africa integrates domestic health into its foreign policy, using the lens of access to antiretroviral (ARV) medicines. It explored state and non-state actors’ perceptions regarding how domestic health policy is integrated into foreign policy to achieve better insights into health and foreign policy processes at the national level. Employing qualitative approaches, the authors examined changes in the South African and global AIDS policy environment. Purposive sampling was used to select key informants, a sample of state and non-state actors who participated in in-depth interviews. Secondary data were collected through a systematic literature review of documents retrieved from five electronic databases, including review of key policy documents. Qualitative data were analysed for content. The findings showed the interplay among social, political, economic and institutional conditions in determining the success of this integration process. A series of national and external developments, stakeholders, and advocacy efforts and collaboration created these integrative processes. South Africa’s domestic HIV/AIDS constituencies, in partnership with the global advocacy movement, catalysed the mobilisation of support for universal access to ARV treatment nationally and globally, and the promotion of access to healthcare as a human right. The report concludes that transnational networks may influence government’s decision making by providing information and moving issues up the agenda.
Dr. Tedros Adhanom Ghebreyesus, newly elected Director-General of the World Health Organisation (WHO) for the next five years, believes WHO must evolve and adapt to urgent global health challenges, and “put the right to health at the core of its functions, and be the global vanguard to champion them.” Universal health coverage will be his topmost priority. “The growing momentum around universal health coverage—combined with the global commitment to sustainable development and its motto of “leaving no one behind”—offers unique opportunities to advance equity in health.” In a Q&A with Health and Human Rights Dr Tedros discussed the “hundreds of millions of people missing out on essential health care or falling into poverty trying to pay for it. That is a violation of the human right to health that demands our full attention and urgent action.” He acknowledged that implementation of policies to achieve universal health cover is difficult and requires collaboration and partnership across stakeholders. He explained this collaborative approach guided Ethiopia’s pursuit of equitable health access when he was minister of health. Dr Tedros told Health and Human Rights that he is committed to transforming the way that WHO operates with the core principles of health as a human right and universal health coverage for the most vulnerable are at the forefront of all our work. Too often, Dr Tedros noted, human rights and gender equity are secondary considerations when UN organisations develop programming. He stressed that this is outdated and must change.