2019 Political declaration of the HLM on UHC

74th UNGA
10 Oct 2019

Res­o­lu­tion A/RES/74/2

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Analysis of precedential value

This dec­la­ra­tion is the prod­uct of the UN High-Level Meet­ing (HLM) on Uni­ver­sal Health Cov­er­age in Sep­tem­ber 2019. It was adopted by the UN Gen­eral Assem­bly with­out a gen­eral vote that same month. The Gen­eral Assem­bly is the pre­em­i­nent gov­ern­ing body of the UN sys­tem and con­sists of all 193 UN Mem­ber States.

Accord­ing to the press team of the High-Level Meet­ing, this dec­la­ra­tion is informed by “three-month con­sul­ta­tions with all actors of the UHC move­ment–par­lia­men­tar­i­ans, civil soci­ety, the pri­vate sec­tor, agen­cies, net­works and acad­e­mia.”

Used as precedent

universal health coverage

• “Rec­og­nize that uni­ver­sal health cov­er­age is fun­da­men­tal for achiev­ing the Sus­tain­able Devel­op­ment Goals related not only to health and well-being, but also to erad­i­cat­ing poverty in all its forms and dimen­sions, ensur­ing qual­ity edu­ca­tion, achiev­ing gen­der equal­ity and women’s empow­er­ment, pro­vid­ing decent work and eco­nomic growth, reduc­ing inequal­i­ties, ensur­ing just, peace­ful and inclu­sive soci­eties and to build­ing and fos­ter­ing part­ner­ships, while reach­ing the goals and tar­gets included through­out the 2030 Agenda for Sus­tain­able Devel­op­ment is crit­i­cal for the attain­ment of healthy lives and well-being for all, with a focus on health out­comes through­out the life course.” (para­graph 5)

• “Reaf­firm the impor­tance of national own­er­ship and the pri­mary role and respon­si­bil­ity of gov­ern­ments at all lev­els to deter­mine their own path towards achiev­ing uni­ver­sal health cov­er­age, in accor­dance with national con­texts and pri­or­i­ties, and under­score the impor­tance of polit­i­cal lead­er­ship for uni­ver­sal health cov­er­age beyond the health sec­tor in order to pur­sue whole-of-gov­ern­ment and whole-of-soci­ety approaches, as well as health-in-all-poli­cies approaches, equity-based approaches and life-course approaches.” (para­graph 6)

• “Pro­vide strate­gic lead­er­ship on uni­ver­sal health cov­er­age at the high­est polit­i­cal level and pro­mote greater pol­icy coher­ence and coor­di­nated actions through whole-of-gov­ern­ment and health-in-all-poli­cies approaches, and forge a coor­di­nated and inte­grated whole-of-soci­ety and mul­ti­sec­toral response, while rec­og­niz­ing the need to align sup­port from all stake­hold­ers to achieve national health goals” (para­graph 59)

key and vulnerable populations, universal health coverage

• “Rec­og­nize that uni­ver­sal health cov­er­age implies that all peo­ple have access, with­out dis­crim­i­na­tion, to nation­ally deter­mined sets of the needed pro­mo­tive, pre­ven­tive, cura­tive, reha­bil­i­ta­tive and pal­lia­tive essen­tial health ser­vices, and essen­tial, safe, afford­able, effec­tive and qual­ity med­i­cines and vac­cines, while ensur­ing that the use of these ser­vices does not expose the users to finan­cial hard­ship, with a spe­cial empha­sis on the poor, vul­ner­a­ble and mar­gin­al­ized seg­ments of the pop­u­la­tion.” (para­graph 9)

key population and community leadership

• “Rec­og­nize the need for health sys­tems that are strong, resilient, func­tional, well gov­erned, respon­sive, account­able, inte­grated, com­mu­nity-based, peo­ple-cen­tred and capa­ble of qual­ity ser­vice deliv­ery, sup­ported by a com­pe­tent health work­force, ade­quate health infra­struc­ture, enabling leg­isla­tive and reg­u­la­tory frame­works as well as suf­fi­cient and sus­tain­able fund­ing.” (para­graph 10)

• “Rec­og­nize that peo­ple’s engage­ment, par­tic­u­larly of women and girls, fam­i­lies and com­mu­ni­ties, and the inclu­sion of all rel­e­vant stake­hold­ers is one of the core com­po­nents of health sys­tem gov­er­nance, to fully empower all peo­ple in improv­ing and pro­tect­ing their own health, giv­ing due regard to address­ing and man­ag­ing con­flicts of inter­est and undue influ­ence, con­tribut­ing to the achieve­ment of uni­ver­sal health cov­er­age for all, with a focus on health out­comes.” (para­graph 20)

• “Expand the deliv­ery of and pri­or­i­tize pri­mary health care as a cor­ner­stone of a sus­tain­able peo­ple-cen­tred, com­mu­nity-based and inte­grated health sys­tem and the foun­da­tion for achiev­ing uni­ver­sal health cov­er­age, while strength­en­ing effec­tive refer­ral sys­tems between pri­mary and other lev­els of care, rec­og­niz­ing that com­mu­nity-based ser­vices con­sti­tute a strong plat­form for pri­mary health care.” (para­graph 46)

access to health products

• “The high prices of some health prod­ucts, and inequitable access to such prod­ucts within and among coun­tries, as well as finan­cial hard­ships asso­ci­ated with high prices of health prod­ucts, con­tinue to impede progress towards achiev­ing uni­ver­sal health cov­er­age.” (para­graph 12)

stigma and discrimination

• “Rec­og­nize the fun­da­men­tal impor­tance of equity, social jus­tice and social pro­tec­tion mech­a­nisms as well as the elim­i­na­tion of the root causes of dis­crim­i­na­tion and stigma in health-care set­tings to ensure uni­ver­sal and equi­table access to qual­ity health ser­vices with­out finan­cial hard­ship for all peo­ple, par­tic­u­larly for those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions.” (para­graph 14)

key and vulnerable populations

• “Rec­og­nize the con­se­quence of the adverse impact of cli­mate change, nat­ural dis­as­ters, extreme weather events as well as other envi­ron­men­tal deter­mi­nants of health, such as clean air, safe drink­ing water, san­i­ta­tion, safe, suf­fi­cient and nutri­tious food and secure shel­ter, for health and in this regard under­score the need to fos­ter health in cli­mate change adap­ta­tion efforts, under­lin­ing that resilient and peo­ple-cen­tred health sys­tems are nec­es­sary to pro­tect the health of all peo­ple, in par­tic­u­lar those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions, par­tic­u­larly those liv­ing in small island devel­op­ing States.” (para­graph 15)

• “Imple­ment the most effec­tive, high-impact, qual­ity-assured, peo­ple-cen­tred, gen­der- and dis­abil­ity-respon­sive and evi­dence-based inter­ven­tions to meet the health needs of all through­out the life course, and in par­tic­u­lar those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions, ensur­ing uni­ver­sal access to nation­ally deter­mined sets of inte­grated qual­ity health ser­vices at all lev­els of care for pre­ven­tion, diag­no­sis, treat­ment and care in a timely man­ner.” (para­graph 25)

• “Take mea­sures to reduce mater­nal, neona­tal, infant and child mor­tal­ity and mor­bid­ity and increase access to qual­ity health-care ser­vices for new­borns, infants and chil­dren, as well as all women before, dur­ing and after preg­nancy and child­birth.” (para­graph 29)

• “Scale up efforts to pro­mote healthy and active age­ing, main­tain and improve qual­ity of life of older per­sons and to respond to the needs of the rapidly age­ing pop­u­la­tion, espe­cially the need for pro­mo­tive, pre­ven­tive, cura­tive, reha­bil­i­ta­tive and pal­lia­tive care as well as spe­cial­ized care and the sus­tain­able pro­vi­sion of long-term care, tak­ing into account national con­texts and pri­or­i­ties.” (para­graph 30)

• “Ensure that no one is left behind, with an endeav­our to reach the fur­thest behind first, founded on the dig­nity of the human per­son and reflect­ing the prin­ci­ples of equal­ity and non-dis­crim­i­na­tion, as well as to empower those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions and address their phys­i­cal and men­tal health needs which are reflected in the 2030 Agenda for Sus­tain­able Devel­op­ment, includ­ing all chil­dren, youth, per­sons with dis­abil­i­ties, peo­ple liv­ing with HIV/AIDS, older per­sons, indige­nous peo­ples, refugees and inter­nally dis­placed per­sons and migrants.” (para­graph 70)

• “Address the par­tic­u­lar needs and vul­ner­a­bil­i­ties of migrants, refugees, inter­nally dis­placed per­sons and indige­nous peo­ples, which may include assis­tance, health care and psy­cho­log­i­cal and other coun­sell­ing ser­vices, in accor­dance with rel­e­vant inter­na­tional com­mit­ments, as applic­a­ble, and in line with national con­texts and pri­or­i­ties;” (para­graph 71)

• “Pro­mote strong and resilient health sys­tems, reach­ing those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions, and capa­ble of effec­tively imple­ment­ing the Inter­na­tional Health Reg­u­la­tions (2005), ensur­ing pan­demic pre­pared­ness and the pre­ven­tion and detec­tion of and response to any out­break.” (para­graph 72)

societal enablers

• “Imple­ment high-impact poli­cies to pro­tect peo­ple’s health and com­pre­hen­sively address social, eco­nomic and envi­ron­men­tal and other deter­mi­nants of health by work­ing across all sec­tors through a whole-of-gov­ern­ment and health-in-all-poli­cies approach.” (para­graph 26)

• “Build effec­tive, account­able, trans­par­ent and inclu­sive insti­tu­tions at all lev­els to end cor­rup­tion and ensure social jus­tice, the rule of law, good gov­er­nance and health for all.” (para­graph 56)

combination prevention

• “Strengthen pub­lic health sur­veil­lance and data sys­tems, improve rou­tine immu­niza­tion and vac­ci­na­tion capac­i­ties, includ­ing by pro­vid­ing evi­dence-based infor­ma­tion on coun­ter­ing vac­cine hes­i­tancy, and expand vac­cine cov­er­age to pre­vent out­breaks as well as the spread and re-emer­gence of com­mu­ni­ca­ble and non‐com­mu­ni­ca­ble dis­eases, includ­ing for vac­cine-pre­ventable dis­eases already elim­i­nated as well as for ongo­ing erad­i­ca­tion efforts, such as for poliomyelitis.” (para­graph 31)

• “Strengthen efforts to address com­mu­ni­ca­ble dis­eases, includ­ing HIV/AIDS, tuber­cu­lo­sis, malaria and hepati­tis, as part of uni­ver­sal health cov­er­age and to ensure that the frag­ile gains are sus­tained and expanded by advanc­ing com­pre­hen­sive approaches and inte­grated ser­vice deliv­ery and ensur­ing that no one is left behind.” (para­graph 32)

harm reduction, human rights

• “Imple­ment mea­sures to pro­mote and improve men­tal health and well-being as an essen­tial com­po­nent of uni­ver­sal health cov­er­age, includ­ing by scal­ing up com­pre­hen­sive and inte­grated ser­vices for pre­ven­tion, includ­ing sui­cide pre­ven­tion, as well as treat­ment for peo­ple with men­tal dis­or­ders and other men­tal health con­di­tions as well as neu­ro­log­i­cal dis­or­ders, pro­vid­ing psy­choso­cial sup­port, pro­mot­ing well-being, strength­en­ing the pre­ven­tion and treat­ment of sub­stance abuse, address­ing social deter­mi­nants and other health needs, and fully respect­ing their human rights, not­ing that men­tal dis­or­ders and other men­tal health con­di­tions as well as neu­ro­log­i­cal dis­or­ders are an impor­tant cause of mor­bid­ity and con­trib­ute to the non-com­mu­ni­ca­ble dis­eases bur­den world­wide.” (para­graph 36)

gender equality

• “Pro­vide bet­ter oppor­tu­ni­ties and work­ing envi­ron­ments for women to ensure their role and lead­er­ship in the health sec­tor, with a view to increas­ing the mean­ing­ful rep­re­sen­ta­tion, engage­ment, par­tic­i­pa­tion and empow­er­ment of all women in the work­force, address­ing inequal­i­ties and elim­i­nat­ing biases against women, includ­ing unequal remu­ner­a­tion, while not­ing that women, who cur­rently form 70 per cent of the health and social work­force, still often face sig­nif­i­cant bar­ri­ers in tak­ing lead­er­ship and deci­sion-mak­ing roles.” (para­graph 63)

• “Main­stream a gen­der per­spec­tive on a sys­tems-wide basis when design­ing, imple­ment­ing and mon­i­tor­ing health poli­cies, tak­ing into account the spe­cific needs of all women and girls, with a view to achiev­ing gen­der equal­ity and the empow­er­ment of women in health poli­cies and health sys­tems deliv­ery.” (para­graph 69)

bodily autonomy and integrity

• “Strengthen capac­ity on health inter­ven­tion and tech­nol­ogy assess­ment, data col­lec­tion and analy­sis, while respect­ing patient pri­vacy and pro­mot­ing data pro­tec­tion, to achieve evi­dence-based deci­sions at all lev­els, acknowl­edg­ing the role of dig­i­tal health tools in empow­er­ing patients, giv­ing them access to their own health- care infor­ma­tion, pro­mot­ing health lit­er­acy and strength­en­ing patient involve­ment in clin­i­cal deci­sion-mak­ing with a focus on health pro­fes­sional-patient com­mu­ni­ca­tion” (para­graph 65)

combination prevention, reproductive rights

• “Ensure, by 2030, uni­ver­sal access to sex­ual and repro­duc­tive health-care ser­vices, includ­ing for fam­ily plan­ning, infor­ma­tion and edu­ca­tion, and the inte­gra­tion of repro­duc­tive health into national strate­gies and pro­grammes, and ensure uni­ver­sal access to sex­ual and repro­duc­tive health and repro­duc­tive rights as agreed in accor­dance with the Pro­gramme of Action of the Inter­na­tional Con­fer­ence on Pop­u­la­tion and Devel­op­ment and the Bei­jing Plat­form for Action and the out­come doc­u­ments of their review con­fer­ences.” (para­graph 68)