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Gro Harlem Brundtland addresses the UN High-Level Meeting on Universal Health Coverage, in New York in September 2019. (Credit: UN Photo/Kim Haughton)

Speaking at the United Nations in New York, Gro Harlem Brundtland challenges world leaders to deliver Universal Health Coverage through publicly-financed primary healthcare-led reforms.

This speech was delivered at the UN High-Level Meeting on Universal Health Coverage in New York, on 23 September 2019.

Mister President, Secretary General, Excellencies, Ladies and Gentlemen,

I am delighted and honoured to address this historic meeting.

The Elders strongly believe that UHC is the best way to achieve the health Sustainable Development Goal and fulfil the right to health. As our founder Nelson Mandela said:

“Health cannot be a question of income; it’s a fundamental human right.”

Madiba recognised that if everybody is to receive quality health care, you cannot leave health to the free market. Only the rich will access services whilst the poor are excluded or are plunged further into poverty paying for healthcare.

Not only is this inequitable and a violation of human rights – it is dangerous for global health.

Yesterday we launched the report of the Global Preparedness Monitoring Board which I co-chair. It demonstrates there are alarming gaps in global preparedness against health emergencies.

We have seen this all too clearly with recent Ebola epidemics in West and Central Africa.

If there is one lesson the world has learnt, it is that you can only reach UHC through PUBLIC financing.

For me this has been one of the huge achievements of the UHC movement, to build an international consensus around progressive health financing.

This has, however, not always been the case.

Around 30 years ago, some development agencies and Western governments put enormous pressure on developing countries to cut their public health budgets and push the health financing burden onto households.

This was a huge mistake and resulted in hundreds of millions of people being denied health care and in extreme cases, poor people being imprisoned in health facilities because they couldn’t pay their medical bills. This outrageous violation of human rights continues to this day in some countries where health financing is still dominated by out-of-pocket payments.

I call on all heads of state to ban this practice immediately

Raising public financing and providing services free at the point of delivery to guarantee universal access has been the key to success in many countries we hold up as pioneers in UHC, including Thailand, Costa Rica, Cuba and Sri Lanka.

More recently, President Kenyatta has launched successful UHC pilots in four Kenyan counties, by increasing public financing and removing user fees throughout the public system.

Last month, I visited South Africa with my fellow Elder Ricardo Lagos, the former President of Chile, to meet President Ramaphosa.

What South Africa has learnt, like here in the United States, is also that you also cannot reach UHC through private voluntary insurance, which is extremely inefficient and inequitable. We commend President Ramaphosa’s commitment to create a tax-financed health system that will benefit all South Africans.

But raising health financing efficiently and fairly is not sufficient. Governments must also ensure that resources are allocated efficiently and equitably.  It is really important to implement UHC strategies based on primary health care.

This will be the best approach for ensuring that vulnerable groups and those with higher needs for healthcare, such as women and children, can access the services they need. 

There have been many examples of the success of Primary Healthcare-led UHC reforms from China’s barefoot doctors to Ethiopia’s community health workers programme – pioneered by Dr Tedros.

I am thrilled that after decades of often bitter debate, the global health community has come together to champion UHC and that we agree on how to achieve it -  through publicly-financed Primary Healthcare-led reforms that ensure nobody is left behind.

I call on political leaders to legislate, invest and collaborate with all of society to make UHC a reality. 

Thank you. 


Watch Gro Harlem Brundtland's address to the UN High-Level Meeting on Universal Health Coverage, at 0:26:20:

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