HLPF: Health in the 2030 Agenda (2)

Thematic session on Goal 3 Ensure healthy lives and promote wellbeing for all at all ages – Statements following panel presentations

Of the 27 interventions that followed the panel presentations, nine were made by Major Groups and other Stakeholders (MGoS). The main focus of the majority was on universal health coverage (UHC) and its financing. Other issues related to the health workforce and the need for health system strengthening. At the same time, a number of the Member State interventions referred specifically to the progress that had been made in implementing the relevant health MDGs.

Target groups mentioned included in particular women and girls and young people, while the MGoS drew attention to other groups that required specific services, such as older persons, persons with disabilities and indigenous peoples.

Among the specific health issues raised, there was a strong focus on non-communicable diseases (NCDs) and also mental health. Following a statement by the Netherlands on behalf of a total of 18 countries (see below), Malaysia, Indonesia, Switzerland and Sudan also made references to reproductive health, as well as the Women’s Major Group.

In summing up the discussions, Ambassador Flores noted the universal characteristic of agenda allowing a top down and also bottom up approach. Alliances with civil society and the private sector are critical, as well as the participation of eachindividual in a wide variety of ways. Michael Meyers highlighted that some silos of expertise are needed to deal with specific concerns, such as reproductive health. At the same time there should be multi-sectoral collaboration and, as suggested by Julio Frenk, a former Minister of Health for Mexico, we should think not just vertically or horizontally but also diagonally. The moderator, Dr Nata Menabde, Executive Director of WHO Office at the United Nations, New York, stressed the importance of making medicines and technologies as well as information available for all. Human rights must be respected and there should be stronger political will.  The special needs of groups such as girls, migrants and others should be addressed and there should be a focus on health system strengthening, antimicrobial resistance (AMR) and UHC. The lessons from the MDGs show that monitoring and evaluation is critical. The question is how well all stakeholders will be engaged in addressing health across all sectors. To Leave no one behind, we must make all Ministers Health Ministers. 

Following are summaries of the interventions made during the session:

Cross-regional joint statement on SDG 3 and 5 delivered by the Netherlands

The Ambassador at large of the Netherlands, Mr. Jeroen Verheul, delivered a statement on behalf of Argentina, Australia, Belgium, Canada, Colombia, Denmark, Estonia, France, Finland, Germany, Iceland, Mexico, New Zealand, Norway, Sweden, Switzerland, Uruguay and the Netherlands.

They reaffirmed their commitment to the 2030 Agenda and all the SDGs and targets. In 2015, they had pledged that nobody will be left behind; that people are placed at the centre of development; and that human rights should be respected, protected and fulfilled without distinction of any kind. SDGs 3 and 5 on health and gender equality SDGs are inherently and strongly connected. Women, girls and adolescents continue to be denied their right to the highest attainable standard of physical and mental health, with their autonomy to decide freely on their sexual and reproductive health and rights often undermined by harmful socio-cultural norms, age barriers and third-party consent requirements and restrictions.

As reflected in the progress report of the Secretary General, this means that they cannot access the information they need to make healthy decisions, or get the health services to effectuate their choices. Although it notes progress has been made, it is still much too slow in areas such as violence against women and girls, including child, early and forced marriage and female genital mutilation. The report also clearly indicates that just over half of women worldwide are making their own decisions about consensual sexual relations and the use of contraception and health services. Improvements in the collection, use and dissemination of quality age and sex disaggregated data is needed to improve monitoring progress in these areas.

Realizing SDGs 3 and 5, particularly universal access to sexual and reproductive health and rights, are key for sustainable development and a pre-requisite for progress on all other SDGs. They help to empower women and girls; address inequalities; eradicate poverty; improve educational attainment and public health outcomes; foster productivity and labour force participation; reap the benefits of demographic dividends; improve environmental management, energy, food security, water and sanitation; and enhance resilience and impact of climate adaptation efforts. Investments in women, girls, adolescents and youths are an investment in our collective future.

They requested that linkages between SRHR and achieving SDGs 3, 5 and the other SDGs are reflected in the thematic review of these two goals.

Azerbaijan said that provision of quality and affordable services contributes to economic progress. To be effective there is a need to pay more attention to public health infrastructure, as well as ensuring a financial allocation, eg amount from Azerbaijan State budget has increased 18 times 2000-2015. Compulsory medical services to increase public access to services and to stimulate high quality SDG 3 should be one of the main accelerators, especially for low income countries. Implementation of SDG 3 will also have an impact on women’s development and women’s wellbeing.

Sierra Leone – Global human development challenges manifest themselves in Goal 3 showing the integrated nature, insofar as other goals are important for its achievement. Need to emphasize understanding of social determinants of health. There is a ‘chicken and egg’ situation in achieving SDG 3 in Sierra Leone, as many things need to be done, including addressing infrastructural issues; behavioural change; and literacy.

Cuba’s vision for attaining the SDGs includes addressing the structural causes, which generate poverty. There is a need for political will in developed countries to contribute new financial resources, which do exist. Cuba is in the vanguard in the region in child mortality. It has a high life expectancy at 78.5 years, which is better than many developed countries. Statement in 2015 important as being first country to eliminate mother-to-child transmission of HIV/AIDS.

Children and Youth Major Group urged a comprehensive integrated approach which will help with other SDGs. These include securing access to information and services and policies that are free of any discrimination or stigma; protecting a human-rights approach in providing health care services, including for mental health; addressing emerging diseases and promoting investment in health care systems; and ensuring access to affordable and equitable pharmaceutical products.

Vanuatu stressed that good health is a key pillar for achieving all the SDGs. Bottlenecks in health systems in small island developing states (SIDS) can hinder progress in implementing SDG 3. Key emerging issues for SIDS may include lack of a holistic approach to improving the health systems, while continuing to work in silos as well as inadequate access to overseas development assistance. Linking SDGs 3, 2, 13, 14, 15 is important together with strengthening partnerships.

Maldives on behalf of Alliance of Small Island States (AOSIS) referred to the Samoa Pathway and pointed out that SIDS did relatively well on HIV and MCH in the MDGs. NCDs and mosquito borne diseases, however, have hit SIDS hard and mental health issues, traffic injuries and fatalities are on the rise. Natural disasters and the effects of climate change overcome the most resilient of people. Interlinkages between SDGs and the other SDGs are important as 2030 Agenda must be implemented in a holistic manner.

Local Authorities spoke about the special challenge in ensuring healthy lives and issues related to the impact of pesticides on health in Brazil. He also raised the issue of low payments and the health of the workers.

Kenya has established UHC and has prioritized social health insurance. Forty-seven mobile clinics have been provided for those in more remote areas.  There are “waiting homes” for women, who are due to deliver, close to health centres. Through a partnership with private sector and UNICEF, mother and baby-friendly spaces are provided for working lactating mothers. Mobile phones and mobile money, as well as “Mtiba mobile health wallets” are being used for very low cost saving, borrowing and share money for healthcare.

Malaysia, commented UHC, saying that it has a nation-wide system, complemented by an active private healthcare system. Basic health care even reaches remote areas and strong collaboration exists with NGO partners on NCDs and communicable diseases. In addition to providing adequate public and private investment, major concerns are comprehensive health care services including sexual and reproductive health and improving the quality of health care. He referred to the role of NGOs in relation to HIV, the elderly and disabilities. However, there is a focus on reaching pockets of communities that have health needs, promoting a healthy life style and addressing adequate financing.

China said that public health is a common challenge faced by all countries. For safeguarding people’s health, public health is a public good. The Health China 2030 programme aims at public health reform for equity in service delivery and for the provision of medicinal drugs at community level. It is also establishing a safety net for those who cannot afford health care, with UHC being provided to 1.3 billion people in various health care schemes. Its maternal and infant mortality have been achieved. China also assists other developing countries in controlling communicable diseases, health policy development, capacity- building etc and has set up a Disease Control Centre in Africa.

Indonesia has a strong commitment to implement 2030 Agenda and LNOB. One obstacle to be resolved is data collection and disaggregation. The national security system is supported by national health insurance for all Indonesians, using a family health and life cycle approach, recognizing the wide disparities among regions. Multi-sectoral collaboration is being promoted in line with Goal 17. He also referred to areas for international cooperation such as improving reproductive, maternal and child health.

Rwanda has made acceptable and commendable progress on MDGs and UHC will provided to the entire population, recognizing that equity is essential. In the past 25 years, life expectancy has improved by more than 30 years. Importance is attached to involving local communities, with some 43,000 local health workers. There is a need to try to provide innovative way to improve access to services.

Switzerland noted the guidance provided by international organizations, including the International Health Regulations (IHR). Other actors must be involved to achieve SDG 3 and Switzerland supports several multi-stakeholder initiatives. More funding should be available for research and development. While AMR is not a target, they welcomed the reference to it, the Interagency Coordination Group on AMR. Cross sectoral action will help in implementation of SDG 3, including on sexual and reproductive health and rights.

Algeria said that programmes and action plans had been set up to improve standards of living and the provision of care. Achievements in Algeria include in the under-5 mortality rate and the maternal mortality rate, with improvements in pregnancies and deliveries. The HIV-prevalence rate has been low, being concentrated in at-risk populations. Health care available free-of-charge to all sectors of the population.

Sudan referred to the reduction in the maternal mortality and child mortality rates in the country, although malnutrition rates have remained the same. Health insurance for all has been extended as part of its multi-approach Health for All policy, with special consideration being given to reproductive health for women and youth. An important element in achieving health promotion is strengthening partnerships with the private sector. Sudan is focusing on health throughout the life cycle including maternal health, ageing and people with disabilities.

Nigeria recognizes that poor health threatens the rights of children to education with an increase in poverty. There should be equality of health through greater access to primary health care services. The health insurance programme provides wider coverage and a mobile community health insurance programme has been set up. The global community should pay particular attention to the health and well-being of women and girls and illicit financial flow particularly from Africa should be tackled

Russian Federation attaches great importance to combatting NCDs which requires coordination in the State, with universal access to health care. Positive results including a two-thirds improvement in health protection for the population and less pressure on women. In last four years, there have been substantial reduction in use of alcohol and maternal and child mortality have decreased. There has also been an improvement in youth health.

Indigenous Peoples’ Group highlighted obstacles to accessing public health systems, including literacy and lack of language skills. The Group recommends ensuring data gathering by ethnicity and allocation of sufficient budget and personnel with the inclusion of traditional health practices in UHC. Issues related to youth and mental health should also be addressed.

European Union reaffirmed their commitment to the right of all to enjoy the protection and promotion of the highest attainable standard of physical and mental health. It supports UHC and WHO’s leadership, stewardship and convening power, and tackling AMR. The EU is providing support to implement IHR. It also contributes to a variety of programmes, including crisis preparedness. They support a healthy, clean and productive environment in supporting and sustaining the health of people.

Business and industry Major Group, represented by the Food and Beverage Alliance commended the discussions. The Food and Beverage manufacturers support the efforts to align NCDs with WHO’s Global Action Plan, which provides the mandate for the private sector to prevent NCDs and has a common approach on nutrition and labelling. He noted that the third High-level meeting on NCDs will be held next year.

Workers and Trade Unions Major Group said it will be necessary to counter shortages in the health care work force and achieving SDG 3 is a matter of political will to adequately fund health systems. Cuts in health spending, on the other hand can have devastating outcomes. Meanwhile, it is important to implement the recommendations of the Commission on Health Employment and Economic Growth, adopted by General Assembly last year.

Women’s Major Group highlighted the need to address the health and rights of all people especially women in achieving SDG 3, including their physical, mental and social health and wellbeing. They stressed the importance of freedom from violence, stigma, discrimination and human rights in pursuit of health, irrespective of gender identity and sexual orientation. There should be respect for bodily integrity including sexual dimensions of pleasure. There should also be respect for sexual and reproductive health and rights, including rights to comprehensive sexuality education.

Stakeholder Group for Persons with Disabilities noted that persons with disabilities are much less likely to receive health services. They face physical barriers and cannot afford or are unable to access vital health care services. The call to establish UHC is the most powerful tool for achieving SDG 3. Persons with disabilities should be able to access national health systems with appropriate training for health workers. Health insurance should also include persons with disabilities and involuntary treatment and forced institutionalization should be abolished.

NGO Major Group, represented by the Palliative Care Alliance noted that there is a long way to go to achieve SDG 3. There is a lack of access to health information and there should be open access to scientific research. Access to health information is the essential for effective prevention as well as and removal of intellectual property rights. People must be able to access the quality essential health care services across the health coverage spectrum without being forced into financial hardship

Stakeholder Group of Ageing pointed out that SDG 3 refers to all ‘at all ages’. However, attention to the health for older people has been disappointing insofar as they were omitted from the background paper and there have been only a few references to older people in the discussions. Older persons face barriers in accessing services such as lack of physical access and prohibitive costs. Less attention is being given to health issues common in old age eg hypertension, diabetes and dementia and weaknesses are underpinned by the widespread ageism within the health systems.

UN Environmental Programme referred to the deaths due to environmental factors. Human health and the environment are mismanaged and there is a need to reduce soil degradation and waste. Reduction of indoor air pollution is a factor that could improve the health of women and children. And, improvement of water quality and marine pollution can also improve health. Addressing pollution also helps to reduce poverty.

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