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Unfortunately, this year too there is little hope that key issues in international health can be advanced policy through a joint declaration by the heads of state and government… A sober outlook on the “High-Level Meeting on Universal Health Coverage” at the UN General Assembly, on 21 September 2023.

In September 2019, heads of state and government and other high-level government officials met in New York for a “High-Level Meeting on Universal Health Coverage” (UHC). The final political declaration was entitled “Moving together to build a healthier world”. The Medicus Mundi International Network was heavily involved in the preparation process at the time and took part in the High-Level Meeting with a representative. Following the New York event, we criticized the Political Declaration, the outcome document of the meeting, with its eleven pages and a total of 59 “commitments,” as a weak and unspecific wish list that would not lead to a significant change in people’s access to health care.

Four years later, the World Health Organization and governments are preparing for another High-Level Meeting on UHC, to be held on September 21 at the UN in New York. But the signs are bleak: in a deeply divided world characterized by conflicts, national egoisms and geopolitical tensions, the states have not “moved together” and the world has certainly not become healthier. The COVID-19 pandemic has further weakened health systems and highlighted the consequences of great inequalities, economic and financial injustice, the commercialization of health care, and the lack of solidarity and international action.

More specifically, according to the 2021 global monitoring report “Tracking Universal Health Coverage,” some advances in coverage over the past 20 years have been partially wiped out by the COVID-19 pandemic, while goals to reduce financial hardship are far from being reached. According to a report presented by the WHO Director-General to this year’s World Health Assembly, “although the majority of countries recognize Universal Health Coverage as a goal that is reflected in laws and national plans, a lack of concrete operational steps coupled with inadequate public financing for health are pushing progress towards relevant targets for 2030 further off track.”

Nevertheless, in the year of its 75th anniversary, the WHO wanted to use the opportunity to once again receive support and concrete commitments at the highest political level of the UN General Assembly to advance the social and political project “Health for All” in concrete terms, in every country, and as a joint enterprise of the international community.

This time the final declaration should be short, concise and action-oriented, with clear and measurable action points. This was the declared aim of the WHO Secretariat, but also of the government of Thailand, which, together with Guyana, was commissioned by the UN Secretary General with the process of drafting the “political declaration”. This optimism was still there in November 2022, when we were invited by the government of Thailand to a strategy meeting regarding the High-Level Meeting, and in January 2023, when we invited ourselves WHO and Thailand to a panel discussion hosted by G2H2 and organized by MMI as part of a team.

But New York is not Geneva and certainly not Bangkok. UN diplomacy is even more complicated and “political” than that of the World Health Organization. This was already evident when a first draft of the final declaration of the High-Level Meeting was published in May 2023 and even more so in the (preliminary) “final draft” – the negotiations were broken off at the end of August because the negotiators disagreed on some key points, such as sexual and reproductive issues rights.

The draft final declaration published by the UN Secretary-General begins with Member States “recognizing” and “affirming” some references to previous declarations and statements as well as other principles (paragraphs 1-17), followed by Member States expressing “deep concern” about the lack of progress and increasing inequality (paragraphs 18-46), and then leads to an endless list of ambitions or “commitments” or action points (paragraphs 46 to 109).

Despite the introductory paragraph to this final section, the commitments set out are weak and vague. All language on burning and controversial issues was either deleted or watered down to the lowest common denominator, often taken from the 2019 final declaration or other UN documents. Also, the “action points” are not really action-oriented, with specific goals to achieve. They therefore do not enable monitoring and cannot be used to hold governments accountable. The few, very limited, advances in language, such as the addition of the term “social participation” or clearer language regarding the rights of health workers, are made in undisputed areas, while in other areas, such as gender and women’s rights, the “commitments” are formulated even weaker than four years ago (and might even not be agreed).

Based on our experience with the 2019 High-Level Meeting, we must therefore assume that the same UN Member States will no longer bother about their own nice and vague declarations and commitments once they have left the UN meeting room to celebrate another ” groundbreaking declaration. This is all the more regrettable since this year the WHO Director General and the international partnership “UHC 2030” presented quite solid plans for the implementation and implementation of universal health coverage that are action-oriented and measurable.

At least there is a clear action point at the very end of the 109 paragraphs: “Convene a high-level meeting on Universal Health Coverage in New York in 2027…”

So, unfortunately, when you ask us about our expectations as to whether the WHO will be able to bring health back to the “highest political level” of the UN General Assembly, the simple answer is: “No, sorry, no expectations, it’s hopeless.” But maybe during the week of the “High-Level Meetings” there will be some interesting and relevant side events and good networking for those in New York, and maybe somewhere else in the UN building you will hear a young woman shouting: “ How dare you!” We will not hear this call. We will not be there this time.

Thomas Schwarz has been Executive Secretary of the Medicus Mundi International Network since 2008 and was previously Managing Director of Medicus Mundi Switzerland. He works and publishes on topics of international health cooperation and governance. He wrote this analysis for publication in the blog series “Med in Switzerland” published by Medicus Mundi Switzerland (English version translated from German).

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