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‘The challenge is great, but so is the reward’: UN High-level Meeting on UHC

A week is a long, long time in world affairs at the moment – climate strikes, the UK Parliament has been un-prorogued, impeachment proceedings have begun against Trump … but, if anyone can remember this far back, it’s been that long since the High-level Meeting on universal health coverage, held at the start of the UN General Assembly.

And yes, dear reader, I watched it all.

It’s tricky enough to get a pass into the United Nations, and as an independent consultant the chances of somehow wangling one were vanishingly small. Instead, I watched it all live on UNTV from the comfort of my own sofa, taking a few notes and tweeting some of the more interesting points.* And then I spent a few hours the next day catching up on the two panel sessions that had been running in parallel with the plenary (this is the closest I get to Hermione Granger-style time-turning). This blog is partly by way of an output for the effort – and I’d be interested to hear others’ comments: what were the big plus points or frustrations for you? All views expressed are mine and mine alone, of course.

One of the main reasons I listened in was simply to hear who spoke: which countries understand and prioritise the concept and practice of UHC enough to send a senior representative (particularly as it clashed with the Climate Action Summit on the same day)? And of these, who sent either a president or a PM, who sent a health minister, and who sent a minister of international development (as did the UK) or foreign affairs?

My own interest was around who mentioned non-communicable diseases (NCDs – apologies for the alphabetti spaghetti). This was quite telling – I wasn’t necessarily expecting much mention of specific diseases because UHC is about building resilient health systems and primary care, about looking across all disease areas, rather than at specifics. And prevention and health promotion, although included within the definition of UHC, is often given less importance** – not helped by the ‘C’ in ‘UHC’ often being wrongly denoted as being ‘care’ rather than ‘coverage’. (In fact, very few of the high-level speakers made that mistake – unlike The Economist’s special report last year – but, irksomely, one of the few to get it wrong was the President of the General Assembly in his opening comments...)

In the event, many more of the speakers mentioned NCDs than I’d anticipated. If I’ve got my numbers right, 43 out of the total of 84 who spoke in the plenary session (though a smaller proportion in the panel sessions) specifically mentioned NCDs, with a further six mentioning either taxes on unhealthy commodities or the major risk factors for NCDs. I’ve drawn up a map of these 49 – notable for the clusters of speakers from small island states in the Caribbean (known for global leadership on NCDs for many years) and Pacific islands (which have a particular challenge with unhealthy, imported foods and sky-high obesity rates).

Only six countries mentioned obesity – Palau, Nauru, Honduras, Egypt, South Africa, and St Vincent and the Grenadines – even though it is responsible for more deaths than undernutrition and is at the heart of the Sustainable Development Goals.*** I was disappointed that Argentina didn’t give a shout out to the need to tackle childhood obesity – the minister of health, Adolfo Rubinstein, is a longstanding proponent of this agenda, and it was one of the priorities for Argentina’s recent presidency of the G20.

Another thing that struck me was how few of the plenary statements mentioned refugees/migrants/humanitarian settings. This was one of two real sticking points in the negotiations around the Political Declaration (approved at the opening of the High-level Meeting) – the other being sexual and reproductive rights, which were mentioned frequently, including by the UK: our Secretary of State for International Development announced £600 million for a reproductive health supplies programme, which gladdened my heart in these miserable, dark, Brexit-ridden times.

Of only nine countries that did mention humanitarian issues (five in the plenary; four in the panels), the most vocal was Hungary. That was no surprise: Hungary almost scuppered the Political Declaration entirely because they have such strong objections to being seen to be required to include refugees and ‘illegal’ migrants in UHC. But I’d been hoping to hear more support. Others who mentioned it were El Salvador (in the context of providing healthcare for migrants, whether ‘legal or illegal’ migrants), Spain (which provides health care both to regular migrants and what the translator described as ‘not-regular migrants’), Columbia (the need for social insurance for migrants from Venezuela) and Dominica (a plea for more international thinking on climate migration). In a panel session, the International Organization for Migration spoke strongly on ‘leave no migrant behind’. But I was frustrated that this didn’t come up more, if only to make the point that ‘universal’ does actually mean universal…

It was annoying – but in absolutely no way surprising for the UN – that there was almost no voice for civil society, other than a couple of interventions in the allegedly multi-stakeholder panels. But it is a real disappointment that, despite all the lipservice paid to the need to listen to the experiences of people living with diseases, the patient voice was completely silent, and rarely mentioned. This wasn’t helped by the International Association of Patient Organisations being called on in a panel to give an intervention, but they seem to have left the room… These are ‘high-level’ meetings, ministerial level and above – but even so it would be wonderful to hear from the people who are personally affected.

One voice that I had hoped to hear was, very regrettably, absent: the president of Uruguay, Tabaré Vázquez, an oncologist and a long-time supporter of the NCD agenda, was not able to be in New York. He has very recently been diagnosed with lung cancer – and his presence was very much missed. This also delayed the new ‘Coalition of Heads of State and Government for the prevention and control of NCDs and the promotion of mental health and well-being’, which President Vázquez was due (with Dr Tedros) to be launching.

And other points of interest?

There was an interesting split between speakers who focused on their own country experience and those who used the opportunity to really push the need for international cooperation on UHC (Italy, notably, took this approach).

Primary health care was a very strong theme, as a key step in ensuring UHC and equity. In contrast, palliative care was barely mentioned –something that should absolutely be available to all and is devastatingly lacking in so many parts of the world.

There were supposed to be summaries of the two panels at the end of the plenary session – as happened in the 2011 High-level Meeting on NCDs (at which the UK’s then minister of health took a lead role). This feedback disappeared without trace, I suppose to avoid hurting the feelings of as few of the eminent country speakers as possible (there was never going to be enough time to hear all 169 dignitaries who were lined up to speak).

I liked very much the comment from Winnie Byanyima (current director of Oxfam and about to take over at as director of the Joint UN Programme for HIV/AIDS) that it’s not that a billion people are being ‘left behind’, it’s that they are being ‘pushed behind’.

There weren’t many moments of real energy, although all speakers who made statements of support for sexual and reproductive rights were met with applause (the only unsolicited applause of the sessions). And Jeffrey Sachs during one of the panels spoke particularly strongly about the need to get rid of tax havens and corporate cheating, as well as get more from the ‘mega-billionaires’: ‘This is about money of rich people in rich countries that is needed to help poor people stay alive. Period.’

As for levity, it’s a meeting of heads of state, so what do you expect?! But the translator from Spanish to English had the most fabulously cut-glass voice – she sounded like an extra from Downton Abbey – and for a time, during one of the panels, everyone listening to what should have been the English translation was treated to a bit of a chat among the translators…

What really matters, of course, was not what was said but what will actually be done. It’s that that we should all be watching, and on which we should all hold our governments to account.


The quote in the title is a comment from Dr Tedros during his closing statement.

* I was tweeting both from my own account at @healthkaty and from the account of the UK Working Group on NCDs (@GlobalNCDsUK), of which I am the coordinator, if you want to check out what piqued my interest at the time.

** In early September, the UK Working Group on NCDs held a meeting on 'Acting early, saving lives: prevention and promotion as key aspects of UHC' with Chatham House. The report on this is in process (in my head) and in the meantime you can read a blog about it from the event moderator, Richard Smith.

*** If obesity and sustainable development floats your boat, I wrote a blog about the connections between the two for the World Obesity Federation, which was published to coincide with the SDG Summit during the same week as the UHC High-level Meeting: ‘Obesity and the SDGs: an opportunity hidden in plain sight’.

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