An Expert View: After The UN High-Level Meetings On TB, NCDs, What Happens Next?

The United Nations late last month sought to hold landmark high-level meetings on ending tuberculosis and fighting noncommunicable diseases like cancer and cardiovascular disease, with mixed results. Now a Swiss-based expert is looking at the outcomes and what comes next, and in a webinar talked about the political trade-offs resulting from the meetings, the need to push for an integrated agenda on Universal Health Coverage, and how the private sector should be engaged.

The webinar, entitled “Two Weeks After: The UNGA and its HLMs – What next?,” was organised by the Global Health Centre of the Graduate Institute of Geneva on 11 October, and featured Ilona Kickbusch, director of the centre, as the respondent. Kickbusch, a former World Health Organization official at various levels, was recently elected co-chair of UHC2030, a multi-stakeholder platform to promote universal health coverage. She was at the UN General Assembly throughout the week. A recording of the webinar is available here.

The High-Level Meeting on TB and the High-Level Meeting on NCDs took place respectively on 26 and 27 September during the annual UN General Assembly in New York (Health Policy Watch, United Nations, 27 September 2018; HPW, United Nations, 28 September 2018).

Ilona Kickbusch

High-Level Meeting Outcomes

At the start of the webinar, Kickbusch was asked if the high-level meetings achieved their aims. She responded that “it depends on what you want to achieve.” She explained that the aims of the high-level meetings include increasing political attention and commitments from heads of state, expanding the debate among civil society and academics, increasing funding, and building public media attention. She further noted that holding these meetings on “health” at the UN, rather than at the World Health Assembly, is really to “reach out to broader society.”

She said that while the TB epidemic has raised political attention for some time, it has not been sufficiently prioritized the Global Fund to Fight AIDS, Tuberculosis and Malaria, by states, and by other donors. However, after holding the high-level meeting on TB at the UN, she explained, broader society was engaged and member states came together to make commitments to raise significant funds – $13 billion for prevention and care, and $2 billion for research and development each year through 2022. These commitments are detailed in the political declaration on TB [pdf].

The NCD meeting was a different story, she argued. The NCD declaration was not as ambitious and strong as the TB declaration, and it did not include direct mentions of funding, she said. However, one positive aspect of the NCD declaration is that for the first time it included mental health and air pollution in the NCD agenda, she noted.

While accountability was low in both declarations, she said, something new occurred at both high-level meetings. “We heard a new voice, the voice of people living with these diseases.” When it is about people, Kickbusch said, the health agenda is no longer abstract, and this is where leaders respond.

Political Trade-Offs

While the high-level meeting on TB was in “Millennium Development Goal mode,” Kickbusch said, the high-level meeting on NCDs was in “Sustainable Development Goal mode,” referring to the fact that the TB high-level meeting was focused on one disease, while the NCD high-level meeting “encompassed health issues that are complex.”

The complexity of NCDs is that they involve issues of commercial and political interest, as well as ideological clashes, Kickbusch said, adding, “The minute you bring such a contentious issue into the political context, you lose some of the technical agreement on key issues. It becomes: will I win, or will I lose?” That, she explained, is one of the reasons that the commitments in the NCD declaration were less prominent than in the TB declaration.

Additionally, since both high-level meetings happened so closely together, this opened the opportunity to make political trade-offs between the two, Kickbusch explained.

“The G77 [Group of 77 developing countries] was able to save the TRIPS language [on intellectual property flexibilities in international trade rules] in the TB declaration, by giving up the tax issues in the NCD declaration,” she said. Taxing sugary drinks, tobacco and alcohol is one of the most effective measures to address NCDs, and this was not strong enough in the NCD declaration, she argued.

Universal Health Coverage

In order to better address the systemic issues related to health, Kickbusch emphasised the need to be in SDG mode, and avoid single-issue approaches. Everyone “needs to move out of silos,” and “everyone should concentrate on the Universal Health Coverage agenda,” she said. The real challenge will be how to keep the energy and passion that advocates have for individual problems and diseases, and channel it into systemic solutions, she said, noting the need to make UHC “tangible, and not so abstract.”

“People, no matter where they are, have a right to public health care. It is an issue of human rights and equity and social determinants,” said Kickbusch.

“It’s about a solidarity system, and a solidarity system always has elements of redistribution,” she explained. “This doesn’t have to be a tax-based system; it can be a social security system.”  Domestic financing in the case of UHC will be central, she said, highlighting the need to transition from reliance on global funding to domestic funding.

Addressing health issues systemically will require “building health services where the people are,” and delivering “people-centred health services,” including vaccination and preventative services, and to achieve this, Kickbusch said, “one has to ensure that domestic resources go to where the people are.”

During the 2019 General Assembly, the UN will hold the first-ever high-level meeting on UHC. The scope, modalities and format of the meeting can be found here [pdf].

Private Sector Engagement: A Change in Health Diplomacy

Kickbusch noted that the private sector was “very present” at the high-level meetings on TB and NCDs, and that in some cases it “got more airtime than classic civil society.” This is “definitely a change in health diplomacy in the UN,” she said.

Kickbusch, however, expressed scepticism regarding blanket references to the “private sector,” noting that the private sector in fact “ranges from insurance companies to individual doctors.” She also noted that the private sector has a range of business models, including those that “drive sustainability,” and those built around “rapid profit.”

The private sector needs to be referenced more specifically, she said, and questions of whether a company exploits people, harms their health, or is unsafe for workers must be asked. “Let’s get very specific, and hold the private sector to account,” she said, regarding “its types of industries, the types of product it sells, and what its products are used for.”

Connecting the private sector to the issue of domestic financing, Kickbusch added the question, “do they pay their taxes?” She noted that “if we want fiscal space and social solidarity, we need the private sector to pay taxes, so that we can provide public health.”


Image Credits: The Graduate Institute, Geneva.

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