General Assembly Adopts Inclusive Global Health Resolution, as Several Delegates Reject Language on Protecting Reproductive Rights, Promoting Access to Medicine
While the General Assembly today adopted, without a vote, a draft resolution on global health and foreign policy that aims at strengthening health‑care systems, some delegations rejected language referring to reproductive rights, contending that abortion should not be recognized as a right, and called for a vote on two paragraphs.
In adopting the draft resolution “Global health and foreign policy: an inclusive approach to strengthening health systems” (document A/74/L.26), as a whole, without a vote, the Assembly called on Member States to accelerate efforts towards the achievement of universal health coverage by 2030 and re‑emphasized the resolve to progressively cover 1 billion additional people by 2023 with quality essential health services and essential medicines, vaccines, and health technologies, with a view to covering all people by 2030.
By other terms of the draft, the Assembly re‑emphasized the resolve to stop the rise and reverse the trend of catastrophic out‑of‑pocket health expenditure by providing measures to ensure financial risk protection and eliminate impoverishment due to health‑related expenses by 2030. It also called on Member States to strengthen health systems, in order to provide universal access to health‑care services that will help to empower those who are vulnerable in addressing their health needs, and to develop evidence‑based training that is sensitive to different cultures and the specific needs of women, children and persons with disabilities.
Prior to adopting “L.26”, the Assembly decided, by separate recorded votes, to include two paragraphs. By a recorded vote of 121 in favour to 8 against (Belarus, Iran, Iraq, Libya, Nauru, Qatar, Saudi Arabia, United States), with 19 abstentions, the Assembly decided to include preambular paragraph 13, by which it reaffirmed its commitment to ensure universal access to sexual and reproductive health 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.
The Assembly also decided to retain operative paragraph 29, by a recorded vote of 148 in favour to 1 against (United States), with 1 abstention (Burundi). By the terms of this paragraph, the Assembly reaffirmed the right to use the provisions contained in the World Trade Organization Agreement on Trade‑Related Aspects of Intellectual Property Rights, which provides flexibilities for the protection of public health and promotes access to medicines for all. The Assembly also reaffirmed the right to use the provisions contained in the Doha Declaration on the Agreement and Public Health, which recognizes that intellectual property protection is important for the development of new medicines and also recognizes the concerns about its effects on prices.
Speaking after the action, Libya’s delegate, who also spoke on behalf of Iraq, stressed the need to avoid raising contentious issues, such as those relating to sexual education and reproductive health. States have unique social and religious realities, and international organizations should never impose their beliefs on sovereign States, he said.
The United States representative said her delegation does not recognize abortion as a method of family planning, and it is unacceptable to interject controversial terms like sexual and reproductive health into the draft. On operative paragraph 29, she said its language has no operative precedent, noting that it was moved from the preambular to operative section after negotiations concluded.
Guatemala’s representative said his country’s Constitution establishes that the enjoyment of health is a human right and guarantees and protects human life from conception. As such, reproductive and sexual rights should not include abortion rights.
An observer for the Holy See said his delegation rejects the interpretation of reproductive health that considers abortion or access to abortion, maternal surrogacy or sterilization as dimensions of the term.
Israel’s representative said women should have equal access to health‑care systems, including sexual and reproductive health services.
The Russian Federation’s representative said his delegation joined consensus on the draft, but cautioned that year after year, attempts are made to shift the focus from key health aspects to borderline issues, risking a duplication of work with specialized United Nations platforms, decreasing attention to pressing international problems within the medical agenda and politicizing policy discussions.
In the general discussion prior to adopting the draft, several Member States highlighted the need to ensure health‑care access to all people, with India’s delegate saying that affordability is key to equitable access to health care. While both public and private sectors have a role to play in building stronger health systems, it is important to be cautious about the commercialization of health‑care services, he said.
Several delegates cited national achievements, with Japan’s representative saying that managing universal health coverage has been a key to his country’s socioeconomic development and a healthy ageing society. Indonesia’s delegate said one initiative has expanded health insurance coverage to reach more than 223 million people in his country, representing 83.5 per cent of the population.
The Assembly also considered a note of the Secretary‑General on “Improving international coordination and cooperation to address health needs and the challenges for the achievement of a healthier world through better nutrition” (document A/74/470).
Also speaking were representatives of France, Cuba, Finland (on behalf of the European Union), Hungary, Iran, Switzerland, as well as the European Union delegation.
The Assembly will meet again on Thursday, 12 December at 10 a.m. to take action on draft resolutions on the culture of peace and the death of Dag Hammarskjöld and of the members of the party accompanying him.
Global Health and Foreign Policy
NICOLAS DE RIVIERE (France), introducing the draft resolution “Global health and foreign policy: an inclusive approach to strengthening health systems” (document A/74/L.26), said the driving ideas behind the text are inclusiveness in the context of governance and health care. Inclusiveness in governance allows citizens to make better choices for their health and enables them to better participate in shaping public health policies. Inclusiveness in terms of access to health care means providing services to all people, he said, citing the importance of civil society participation in ensuring universal access. France remains wholly committed to fighting HIV/AIDS, tuberculosis and malaria, he added, also emphasizing the importance of guaranteeing universal access to sexual and reproductive health services. Guaranteeing health care in a non‑discriminatory way is essential. Moreover, access to health care for all is a factor behind social cohesion and helps to promote and ensure gender equality. He also highlighted the important role of World Health Organization (WHO) in global health and called on all Member States to vote in favour of “L.26”.
CARLOS CASAL RODRÍGUEZ, European Union delegation, said sexual and gender‑based violence is a global health epidemic with far‑reaching implications on the physical, mental, sexual and reproductive health of individuals. He welcomed the importance “L.26” attaches to ensuring that persons affected by sexual violence in natural disasters, humanitarian emergencies and armed conflict have access to non‑discriminatory health‑care services. Health is an essential investment in security, achieving stable and prosperous societies and economic and social well‑being. The European Union promotes a “health in all policies” approach with specific emphasis on inclusivity, equity and gender equality. To this end, he said the international community must invest more in the health sector through financing and by ensuring a more robust and comprehensive approach that guarantees equitable access to vaccinations and affordable medicines, while also tackling the rise of non‑communicable diseases and antimicrobial resistance.
ANA SILVIA RODRÍGUEZ ABASCAL (Cuba) said that 5.4 million children under age five died in 2017, 2.5 million of which were painful deaths in the first 28 days of life, many that could have been prevented with proper health care and medicine. Noting that health is a right for all people in Cuba, she said the United States blockade imposed on her country is the main obstacle to achieve even more effective results in health. “We denounce the Government of the United States that now attacks the bilateral and intergovernmental programmes of health cooperation,” she said. Since last year, the United States has waged an intensive and defamatory campaign against medical cooperation provided by Cuba, which has been accused of allegedly engaging in modern slavery and trafficking in persons working in the Cuban health system. “It is immoral and unacceptable to question the dignity, professionalism and altruism of the more than 400,000 Cuban health cooperators who, in 56 years, have accomplished missions in 164 nations,” she said, adding: “The United States Government’s approach to this matter is despicable.”
SATOSHI EZOE (Japan) said managing universal health coverage has been a key to his country’s socioeconomic development and a healthy ageing society. As such, Japan has promoted such coverage bilaterally and through global fora, including the Group of Seven (G7) and through the Group of 20 (G20) presidency. Recalling the work of recently deceased Nakamura Tetsu in Afghanistan, he said dedication to serving patients there embodies the core concept of human security, which is to leave no one behind. Japan is ready to accelerate efforts towards achieving universal health coverage by 2030. The theme of “L.26”, its drafting and facilitation should be carefully conducted in a more inclusive, transparent and timely manner to reinforce and supplement ongoing discussions and commitments, particularly with regard to relevant high‑level General Assembly meetings.
NAGARAJ NAIDU KAKANUR (India) said affordability is key to equitable access to health care, and stronger systems must be geared to increasing both access and choice. While both public and private sectors have a role to play in building stronger health systems, it is important to be cautious about the commercialization of health care services. Advancing competencies of the health workforce and improving distribution and diversity are important as well, he said, highlighting the importance of clinical and drug‑related research and innovation. India launched the National Health Protection Scheme focused on expanding access to primary health care and providing insurance coverage for secondary and tertiary care, including hospitalization for poor and vulnerable families in need. Noting that a robust information technology system has been created for connecting service providers, beneficiaries and administrators at federal and state levels, he said 75 medical colleges are being set up to add more than 15,000 new seats for medical education.
MOHAMMAD KURNIADI KOBA (Indonesia), citing national achievements over the past five years, said health insurance now reaches more than 223 million people, representing 83.5 per cent of the population. The State now finances 44 per cent of that insurance, subsidizing those who cannot pay, and boasts over 25,000 registered health‑care providers in its network. The Government is also improving the quality, access and facilities of services, with inclusive and participatory contributions from all stakeholders with a view to ensuring affordable health care will be available to all. Indonesia wishes to revitalize the Global Health and Foreign Policy Initiative, as promoting health worldwide requires concerted efforts by multiple stakeholders.
Prior to taking action on “L.26”, the Assembly heard explanations of delegations’ positions.
The representative of France expressed regret that a recorded vote had been requested on preambular paragraph 13 and operative paragraph 29, which were both negotiated at great length, noting that language in both was taken from previously agreed upon texts.
The representative of Finland, speaking on behalf of the European Union, expressed disappointment that a vote was requested on preambular paragraph 13, as its language was agreed upon in the 2030 Agenda for Sustainable Development. Noting that his delegation will vote in favour of the paragraphs, he encouraged others to follow suit.
The Assembly then decided to retain preambular paragraph 13, by a recorded vote of 121 in favour to 8 against (Belarus, Iran, Iraq, Libya, Nauru, Qatar, Saudi Arabia, United States) with 19 abstentions. By its terms, the Assembly reaffirmed its commitment to ensure universal access to sexual and reproductive health 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.
By a recorded vote of 148 in favour to 1 against (United States), with 1 abstention (Burundi), it decided to retain operative paragraph 29, by which the Assembly reaffirmed the right to use, to the fullest extent, the provisions contained in the World Trade Organization Agreement on Trade‑Related Aspects of Intellectual Property Rights (TRIPS Agreement), which provides flexibilities for the protection of public health and promotes access to medicines for all, in particular for developing countries, and the Doha Declaration on the TRIPS Agreement and Public Health, which recognizes that intellectual property protection is important for the development of new medicines and also recognizes the concerns about its effects on prices.
The Assembly then adopted “L.26” by consensus.
The representative of Hungary, explaining her delegation’s position, said her country joined consensus on “L.26”, as it is fully committed to ensuring achievement of the highest standards of health by focusing on an inclusive approach. However, Hungary does not align itself with operative paragraph 5 and believes that operative paragraph 25 should be aligned with national regulations and policies.
The representative of Iran said that while his country joined consensus, the provision of medicines and equipment requires sustainable financing and the draft resolution lacks balance. Iran had proposed a paragraph including several human rights provisions that was rejected by the European Union and the United States. It is unfortunate that sanctions imposed on his country are denying it needed medicines and equipment, which is affecting the health of its citizens, especially children.
The representative of Switzerland said her country supported complementary mechanisms to the intellectual property system, which mainly apply in cases of when the system does not generate sufficient incentives for investment. She also highlighted the importance of avoiding a duplication of discussions in this forum.
The representative of Libya, speaking also on behalf of Iraq, encouraged all Member States to avoid raising contentious issues such as those relating to sexual education and reproductive health. States have the sovereign right to implement resolutions in accordance with their unique social and religious contexts. In this vein, Libya opposed the two paragraphs put to a vote, he said, adding that international organizations should not impose beliefs on sovereign States.
The representative of Israel said women should have equal access to health‑care systems, including sexual and reproductive health services. Israel has a national plan that helps to support progress towards realizing Sustainable Development Goal 3 on health. Expressing support for additional language on persons with disabilities, she welcomed the use of technology as a tool to promote their rights. The issue of migration, however, should be subject to the national policies and laws of every State.
The representative of the Russian Federation, expressing support for “L.26”, noted that it contained several controversial provisions and non‑agreed terms unrelated to the suggested theme of the draft resolution. Year after year, there are attempts to shift the focus of this important document from key health aspects to borderline issues, risking a duplication of work with specialized United Nations platforms, decreasing attention to pressing international problems within the medical agenda and politicizing sectoral policy discussions. Due to non‑optimal negotiations that undermined consensus, his delegation disassociates itself from preambular paragraph 42, which misinterprets the WHO mandate, and operative paragraph 12, which uses non‑agreed language on emergencies and combating sexual violence.
The representative of the United States expressed disappointment in weak language referring to human rights abuses and health care, noting that important references were removed. She also pointed to the less than ideal timing of the resolution, as informal consultations on it began during the busiest time for the Assembly’s Second Committee (Economic and Financial) and Third Committee (Social, Humanitarian and Cultural), resulting in a text that did not feel “final” to several delegations. On women having equal access to health care, she said it is unacceptable to interject controversial terms like sexual and reproductive health into the document, adding that the United States does not recognize abortion as a method of family planning. Referring to operative paragraph 29, she said its language has no operative precedent, noting that it was moved from the preambular to operative section after negotiations were concluded. There was no justification for this from the main sponsors and undermined consensus on the entire resolution.
The representative of Guatemala said his country’s Constitution establishes that the enjoyment of health is a human right. Regarding the reference to sexual and reproductive health, he said Guatemala guarantees and protects human life from conception. As such, reproductive and sexual rights should not include abortion rights.
FREDRIK HANSEN, an observer for the Holy See, said an inclusive approach to strengthening health systems must include the most vulnerable, adding that approximately 100,000 Catholic health‑care institutions around the world serve these populations. Reaffirming health as a basic human right, he said “the right to health is thus inextricably linked with the right to life”. While supporting language that reflects the need to provide access to high‑quality antenatal care to prevent maternal and newborn deaths, he expressed regret that several paragraphs did not find consensus because of issues of profound and well‑known disagreement. It is unfortunate that “L.26” includes references to sexual and reproductive health‑care services and rights as components of inclusive health systems, he said, adding that his delegation rejects the interpretation of reproductive health that considers abortion or access to abortion, maternal surrogacy or sterilization as dimensions of the term.