Overstretched, Underfunded Health Systems Undermining Sustainable Development Gains, Speakers Stress, as Population and Development Commission Continues Session
Overstretched, underfunded health systems that cannot meet the needs of the most vulnerable are undermining gains made towards sustainable development, the Commission on Population and Development heard today as it entered the third day of its current session.
“All of us in this room, all of us in this world” will require health products and technology, Deus Mubangizi, Director, Health Products Policy and Standards Department and acting Director of the Innovation and Emerging Technologies Department of the World Health Organization (WHO), said. This could be medicine, prescription eyeglasses, a vaccine, a pacemaker, an X-ray machine or blood supply for transfusion, he observed. Mr. Mubangizi was one of two WHO experts, who made a thematic presentation highlighting the need to advance the universal healthcare agenda.
“Too many of us,” he added, “could take the floor and tell stories of when we or our loved ones could not access these health products because they were too expensive or not available in our country, sometimes with life-changing or fatal consequences.” He then went on to share the story of his beloved aunt who was diagnosed with breast cancer and died because of the lack of her prescription medicine in Uganda — even as the country’s Chief Inspector of Drugs, he could not find it domestically or source it from abroad in time to save her life.
Role of World Health Organization in Improving Healthcare Access
Highlighting the WHO’s historical role in improving healthcare access, he said it has a presence in more than 150 countries. It provides global goods for health by delivering high-quality research, norms, technical and data products, as well as tailored support. WHO also facilitates scientific collaboration, and provides guidance for health-product selection and use, promotes standardized nomenclature and engages in market shaping strategies. Investing in universal health coverage — including access to health products — promotes equity and social cohesion, he stressed. It also boosts the economy and population development by improving health and well-being, increasing workforce participation and productivity.
Werner Obermayer, Director of WHO’s New York Office, stressed the need to strengthen and adequately finance health systems. “Yet. trends show that domestic health financing has not increased in recent years,” he lamented. Development assistance remains a crucial source of financing, with countries recovering from COVID-19 and increased levels of debt. Debt-servicing means less money for health, he warned, noting that some 3.3 billion people live in countries where interest payments are greater than health and education expenditures. He underscored how health taxation, such as tobacco and alcohol taxes, can generate not only Government revenues, but also promote healthier behaviours.
People Living Longer, But Health Systems Not Keeping up With Their Needs
“Longer lives are one of humanity’s greatest achievements, but we are not ensuring that people live and age in dignity with health and well-being,” he said, noting that, by 2050, the number of people over 60 will double from this year. So, focusing on the social determinants of health will become even more important, including social connection and reducing loneliness and isolation, as these have direct impacts on mental health conditions and chronic diseases, he said. Almost half of the world’s population still lacks any form of social protection. Universal health coverage shares the same objectives as universal social protection, and one cannot be achieved without the other, he stressed. The upcoming Financing for Development Conference and the World Summit on Social Development are both key for finding the fiscal space to meet these objectives.
Panel Discussion: Ensuring Healthy Lives and Promoting Well-being for All at All Ages
Next, the Commission held a multi-stakeholder panel discussion on the theme for this year’s session: “Ensuring healthy lives and promoting well-being for all at all ages”. It began with everyone standing up and stretching, at the instruction of its moderator, Pascale Allotey, Director of WHO’s Department of Sexual and Reproductive Health and Research.
Focus on Africa
It is often said that Africa’s greatest resource is its youth, observed Hanna Mulugeta, youth coordinator from the Development Expertise Centre — a non-profit organization based in Ethiopia. She then asked: “If that is the case, then why are we still budgeting like the future is optional?” Stating that youth should “not be seen as problems to solve, but as partners in progress”, she stressed that policies must be shaped by the lived experiences of the young people they are meant to serve. Further, she said that health must not be treated in a siloed manner. For example, a young girl’s ability to manage her menstrual health is tied to whether she is in school, feels safe from violence and has an income and a voice. “So, let us not fragment her dignity,” she urged.
On engaging youth, she asked what this phrase means if youth are “still knocking on locked doors” and their voices are “only welcomed when they can echo what adults already believe”. True engagement, she said, demands more — youth must be entrusted with decision-making power, resources and responsibilities. As an example of how this can be done, she pointed to Ethiopian youth’s success in advocating for the integration of gender-responsive budgeting and authoring a strategy to address the needs of diverse youth, including those with disabilities. Emphasizing that this was not achieved overnight, she said that it took persistence — “not just being present at all tables, but building the tables ourselves”.
On the other hand, Gloria Langat, Head of Ageing and Development of the African Population Health and Research Centre, highlighted the question of what it means to grow old in Africa, a continent considered to be youthful. Drawing attention to the huge number of older people that exist in the continent, she said that people 50 years or older are one of the fastest-growing age groups, increasing by more than 3 per cent annually in many countries. The African population has a high burden of disease and high functional impairment or disability. And this functional impairment or disease is happening at very early ages. Among those 50 or older in Eastern and Southern Africa, there is a high prevalence of functional impairment or disability.
Therefore, she said, it is critical to start focusing on addressing adult health in the continent, which, for a long time, has focused on children and early childhood mortality. Many countries assume that, as people age, the older population would move to rural areas. “But, that’s not been the case”, she said, stressing the need to start making urban environments — so focused on young people — conducive for older people. Only a handful of African countries have policies on older people. So, in many cases, health systems are not prepared to ensure the well-being of older adults. “And this is something that we need to change if we are really set to be all inclusive and meet SDG [Sustainable Development Goal] 3 on health for people of all ages,” she said.
Benefit of Public-Private Partnerships in Health amid Resource Constraints
Addressing financing, Ashley Ambrose, Deputy Director of Health Equity at the Clinton Global Initiative, said: “Across our portfolio of health equity commitments, we find that public-private partnerships can be particularly compelling when resources are constrained.” For this reason, the Initiative’s health equity strategy focuses on developing fit-for-purpose infrastructure, strengthening equity across the healthcare value chain, harnessing the benefits of new technology and adapting to the shifting needs of communities, whether it’s the epidemiological transition swaying towards noncommunicable diseases or climate change. “Conveners, public, private and philanthropic partners, and communities and persons with lived experience all have a unique and important role in in building partnerships for developing and amplifying inclusive programmes for health,” she said.
As funding significantly contracts, it will take creative solutions and innovative partnerships to fill funding gaps and continue to drive progress on universal healthcare, she continued. More and more of the health sector’s conversations will be around “blended financial models, innovative capital stacks, and cross-sector funding partnerships”, she added. The Global Public Investment framework has emerged as an ambitious way to increase the amount of public money available for global goals, while improving the effectiveness of spending. The framework builds on well-established movements on tax and the global debt and loans architecture to have countries contribute to mission-oriented finance for common global needs, she said.
Mexico’s Move to Restore Centralized Healthcare System for Improved Outcomes
“We don’t have good experience in Mexico with the participation of the private sector,” said Hugo López-Gatell Ramírez, Professor of Medical Sciences at the National Autonomous University of Mexico. Recalling the 2018 change in Government in his country, he said “this was not simply a change in Government but a change in regime”. Since then, Mexico has focused on “deconstructing neoliberalism policies” to recentralize the healthcare system which was decentralized in the 1990s. All policies and legislative efforts have been focused on empowering the poor, eliminating corruption and separating political power from economic power.
In healthcare, Mexico has implemented various policies focused on dealing with inequality. COVID-19 gave the country “a lot of lessons”, he added, also noting recent policies undertaken to curb smoking, altogether ban the import and export of e-cigarettes and prohibit trans fats. Access to universal healthcare can really transform the social and public life of citizens, he went on to say. As the country moves away from a system that used “purely financial principles”, the goal now is to reduce the role of the private sector, which did not meet the needs of poor people — a large percentage of Mexico’s population. “The State has restored its guiding role,” he added.
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* Owing to the liquidity crisis facing our Organization, the 4th through 6th Meetings were not covered.