Earlier this month, the UN General Assembly formally adopted three political declarations on health: one on universal health coverage (UHC), one on pandemic preparedness, prevention and response (PPPR), and one on tuberculosis (TB). This follows the UN member states reaching a consensus on the texts of the political declarations during their respective high-level meetings at the 78th UN General Assembly in September. This article explains the process around these political declarations and the role we, as a civil society organization, played in it. It also discusses the commitments that countries have made and assesses whether these help to reach universal health coverage and health equity.
A political declaration is a document that captures the commitments of UN member states in response to urgent reasons or exceptional circumstances that require joint action. After several rounds of negotiations, the heads of state convene during a high-level meeting to reach a consensus on the final text of the political declaration. While not legally binding, such a declaration is significant because it is a reflection of the political will of countries to tackle issues together and outlines standards for member states’ conduct.
In 2023, UN member states worked on crafting three political declarations on health: one on UHC, another on PPPR, and a third on TB. After some months of preparation, including informal consultations among countries and a formal resolution in the World Health Assembly, the UN published the first draft – the so-called ‘zero draft’ – of each political declaration in May.
Member states engaged in three rounds of negotiations before they reached the final text, which was submitted to the President of the General Assembly in August for the ‘silence procedure’.
The silence procedure is common in the UN; it marks a certain period of time after reaching the final text. Since it is the assumption that the rounds of negotiations have led to consensus on the content, this should be a silent time of agreement. However, any member state may raise an objection (or “break the silence”) on a specific topic during the silence procedure. This then triggers a renegotiation of that particular topic and a re-submission of the (new) final text to be endorsed in the high-level meeting.
Silence was broken for all three health-related political declarations. There was so much discussion that it was not clear whether consensus would be reached at all. Groups of countries disagreed with issues such as refraining from unilateral sanctions in accordance with international law and the Charter of the UN, the rights dimension of sexual and reproductive health, mentioning the Future of Global Health Initiatives, and the importance of countering illicit financial flows in generating domestic resources for health. As a result, these topics were unfortunately omitted from the final versions.
On 5 October, the General Assembly endorsed the three political declarations. As the UN General Assembly´s press release reads: “While hailing the declarations as a show of international solidarity to achieve the third Sustainable Development Goal on good health and well-being, many delegates said that while they joined the consensus, they also disagreed with several parts of the texts.”
Civil society organizations such as ours, alongside other non-state actors and member states, had the opportunity to provide input for the zero drafts through so-called Multi-Stakeholder Hearings with the President of the UN General Assembly, in spring. We provided written input to the political declarations on PPPR and UHC in April and pitched a 2-minute statement at the Hearing on UHC on May 9th, calling for the strengthening of public health systems and more.
In Geneva, we were able to convey our main messages in informal talks with members of various country delegations in the corridors of the WHO Executive Board meeting in January and the World Health Assembly in May
And last but not least, the Dutch government allowed the members of the Dutch Global Health Alliance – of which Wemos is one of the founders – to provide written feedback to the text of the political declaration in the course of three short time windows, right after the release of the zero draft in May, the first revision in June and the second revision in July. Each time right before they would negotiate the text in the European Union. We acted on each of these opportunities by providing specific text suggestions (additions or deletions) and a rationale.
Assessing the political declaration on UHC, we regrettably observe that member states did not agree on more actionable commitments than in 2019, as was intended. There are no specifics as to how countries will collaborate to tackle the most important determinants of health, based on in-depth analysis and with measurable targets.
Nevertheless, gains were made. The right to health was reasserted by all UN member states, who also stressed the primary role and responsibility of governments to make progress towards UHC. They explicitly linked UHC to core principles of equity, social justice, social protection and non-discrimination, and recognized that achieving UHC essentially means to “ensure universal and equitable access to quality health services without financial hardship for all people.”
Our network partners in the People’s Health Movement provide a detailed analysis of strengths and weaknesses of the political declaration on UHC – to which we contributed – and the other health political declarations.
Although the political declaration on UHC reiterates the importance of public finance for health, it fails to mention the structural drains on public money that many countries will not overcome unless unified global action is taken. In particular, inadequate taxation of wealth and corporate income, as well as unsustainable levels of debt servicing to external creditors, constitute formidable diminishment of public money.
As we voiced in our joint statement with Akina Mama wa Afrika during the high-level meeting on UHC, we find it regrettable that the final draft of the political declaration on UHC omitted the remark on countering illicit financial flows for effective resource mobilization. Without systemic solutions to address these drains, countries cannot hope to make concrete progress towards UHC. We had hoped that member states would express the need to undertake decisive action towards a UN tax framework and tax body, building on last year’s milestone resolution on inclusive and effective international tax cooperation. We also suggested a text around the need for a debt resolution framework under UN aegis; one that binds all creditors and offers timely, fair and comprehensive debt cancellation and restructuring to all countries in need. Instead, the language on debt in terms of “debt relief and debt restructuring” in the earlier draft changed to “debt financing as appropriate” in the final version, which unfortunately points in the opposite direction of decreasing the burden of debt.
We are happy that one particular paragraph got omitted. The paragraph stating “mobilization of additional financial resources through the use of innovative financing approaches and mechanisms, including private sector financing” was conclusively deleted. We had advocated this deletion, since there is no evidence that financing the private sector or leveraging private financing is effective in closing the gaps for progress towards UHC and health equity. On the contrary, studies show the harmful effects of these mechanisms, including cost escalations, fiscal liabilities for the public purse and the commercialization of essential healthcare. This is especially the case in public-private partnerships, which not only risk reducing access but can also lead to direct human rights violations such as hospital detentions.
The adoption of the political declarations on health was accompanied by member states’ goodwill and determination to accelerate progress towards UHC. However, in terms of actionable commitments, national priorities greatly vary. The international community, including civil society organizations, will monitor outcomes regularly to identify gaps and opportunities. This will inform specific policy actions and support decision-making.
At the global level, the World Health Organization (WHO) promised its support to “work with member states and partners to ramp up policy actions for UHC to expand service coverage, ensure financial protection and shape the financing architecture to invest more and better in health.” We think that this is much needed support in many countries, because not anything goes on the road to UHC. It is important that the WHO gets sufficient, unearmarked funding to help countries make suitable and evidence-based decisions.
The Summit of the Future at the UN next year constitutes a new opportunity for greater convergence of member states on matters of finance for the SDGs for instance.
For pandemic prevention preparedness and response, progress in international coordinated action depends a lot on the Pandemic Accord, which is being developed under the constitution of the WHO. Last week, negotiating text for the accord was released and will be publicly available by the end of this month. If all goes according to schedule, the negotiations will be concluded by the World Health Assembly in May next year.
At Wemos, we will be closely watching these next steps and play our role as health advocates promoting a fairer global financial architecture. The protection and promotion of people’s health should not be at the mercy of global markets and the power of wealthier countries. Governments and international actors should regard it as a global public good – ensuring everyone, everywhere has equitable access to high-quality health services and commodities.
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