The United Nations at 70: Working as One to Deliver a Healthy Future for All

©Pierre O. Tulkens

In December 1948, following years of war and violence of previously unimaginable proportions, the world came together in Paris, where the General Assembly of the United Nations adopted the Universal Declaration of Human Rights. Under the driving force of the formidable Eleanor Roosevelt—widow of former President of the United States of America, Franklin D. Roosevelt—this Declaration complemented the relatively new Charter of the United Nations and guaranteed the rights of all individuals everywhere.

As the United Nations celebrates its 70th anniversary and we reflect on its associated impact, we would be remiss to not consider the power of this singular moment in 1948. Just years after the creation of the United Nations itself, the Universal Declaration of Human Rights capitalized on one of the darkest periods of our global history and unified the world around a commitment to certain universal human rights and placed people at the very centre of the narrative. With its adoption, leaders made a resounding vow to protect all people from atrocities such as those seen during the Second World War.

The Universal Declaration of Human Rights has provided an influential reference point for development discussions across the board—from security and conflict prevention and resolution, to health, trade and the ongoing dialogue on climate change.

Although it has protected hundreds of thousands from danger and violence, too often its core tenets are overlooked and people continue to be left behind.

In 2000, the world’s leaders once again came together, with a focused determination to eradicate disease and poverty through the Millennium Development Goals (MDGs) agreed upon by all the Member States of the United Nations. In 2015, as their deadline looms, global poverty continues to decline, more children than ever are attending primary school, child deaths have dropped dramatically and targeted investments in health have saved millions. Since 2001, more than 4 million lives have been saved from malaria alone, and under-five mortality is decreasing faster than at any time in the past two decades.

Our collective efforts are working, but as we transition to an ambitious set of sustainable development goals (SDGs) that will guide our actions through 2030, we must revisit the spirit of Ms. Roosevelt’s conviction to ensure that we enlist a truly people-centred approach to continue achieving progress against some of our most pressing challenges and deliver on the promises we have made to the people of the world, once and for all, for everyone.

Take health as an example. Health is fundamental to global development, with even small investments spurring progress against other areas of development, such as education and poverty reduction. We cannot dream of achieving a more prosperous world without improving health outcomes. Healthy communities create more stable societies and vibrant economies; but for that equation to fully work, we have to ensure affordable and equitable access to quality services for everyone.

In 2012, the General Assembly of the United Nations unanimously endorsed a resolution urging Governments to ensure that all people have access to quality health care without financial hardship. This idea remains a central pillar to future development efforts, and in the fall of 2015 Member States of the United Nations will adopt a set of SDGs that will likely include a “health for all” goal. As a global community, we must commit ourselves to guarantee universal health coverage so that health improves for all people.

This will require us to shift our thinking about health to a broader, more systems-wide approach, rather than the vertical, siloed perspective we have traditionally taken. Smart and comprehensive investments in health-care systems, including primary health-care facilities, community clinics and community health workers, will be critical to ensure quality care across the board. Entire systems must be enabled to respond to traditional communicable diseases common in developing communities and non-communicable diseases, such as stroke, cancer and heart disease that are becoming increasingly prevalent in lower- and middle-income countries. As the health landscape shifts, we must adapt our frameworks for service delivery.

Targeted investments in certain health areas will continue to play a role and will certainly lessen the disproportionate burden that diseases such as HIV/AIDS, tuberculosis and malaria place on often already struggling national health-care systems. Malaria, for example, accounts for as much as 40 per cent of public health expenditure in high-burden countries and can be responsible for up to 50 per cent of inpatient admissions and 60 per cent of outpatient visits. When we invest in programmes that combat malaria and reduce that burden, we unlock financial and human resources that can be redirected towards other issues, including preventive treatment and crises.

The recent Ebola outbreak that devastated parts of West Africa taught us an important lesson: health-care systems must be capable of responding to emergencies at any given moment to reduce the shock waves felt system-wide. The global community rushed to the aid of Ebola-affected countries, showing the need and importance of a unified response by the United Nations, including its many sister agencies and Member States. In the face of an historic number of crises—from natural disasters to violence and conflict—in Africa, the Middle East and Eastern Europe, we must carry the lessons we have learned from the Ebola outbreak forward, acting as one United Nations to achieve health, safety and prosperity for all.

The good news is that health is an incredibly cost-effective investment, with relatively small expenditures often yielding significant results across the board. In Ethiopia, where I served as the World Health Organization (WHO) Country Representative for a number of years, promising results were achieved against many leading health challenges with just under 15 per cent of total government expenditure. Malaria mortality decreased to 936 reported deaths in 2011, and maternal mortality decreased by 200 per 100,000 live births between 2005 and 2010. With an increased national health expenditure of less than US $20 per capita between 2002 and 2011, World Bank figures show that the Government of Ethiopia not only prevented disease and saved lives, but also offered hope to communities and helped create a more vibrant society.

In my view, health is a universal human right, and universal health coverage is by nature an obvious extension of the Universal Declaration of Human Rights. By affording quality health care to all people, at all ages and socioeconomic levels, we offer a basic standard of protection and ensure increased equity in health outcomes that will help us achieve greater progress with the development agenda. It’s my belief that universal health coverage is just as economically sound as it is morally compelling.

Good health cannot be achieved in a vacuum, however. If we are to truly create a healthier world, we must employ a “health for all” mentality and work across sectors to fully understand and respond to all social and environmental determinants of health. Organizations, foundations and other partners that combat malaria have long enjoyed a positive relationship with the private sector, leveraging its skill sets to expand markets and increase access to life-saving interventions. Time and time again, we have seen private sector engagement in health yield considerable gains with investments resulting in healthier communities, a more productive workforce and more vibrant economies that lead to sustainable progress in achieving the global health and development targets for entire societies. At this critical juncture, the United Nations community must capitalize on these important lessons learned and expand relationships with the private sector so we can increase the value of our investments, optimize efficiencies, expand our reach and maximize the impact of our efforts.

In December 2014, the Secretary-General of the United Nations, Ban Ki-moon, published his Synthesis Report on the Post-2015 Sustainable Development Agenda, highlighting, among other things, six essential elements to frame and reinforce the universal, integrated and transformative nature of the SDGs and ensure that the ambition behind them translates to effective implementation at country-level. Among these critical elements is the need to frame the goals around people to ensure healthy lives, education and the inclusion of women and children. With the global population at 7 billion and rising, we must anchor our efforts on behalf of the people they are meant to serve. Through health systems, we not only offer financial freedom and opportunity; we also allow greater participation in the development process itself.

In this context, the Roll Back Malaria Partnership will soon launch the second generation of its Global Malaria Action Plan: Action and Investment to Defeat Malaria 2016-2030. Anticipating the SDGs and in alignment with the Global Technical Strategy for Malaria (2016-2030) of the WHO, this strategic plan provides a framework for transformative, people-centred and multisectoral approaches needed to achieve ambitious malaria elimination targets and unlock economic potential in countless communities.

In a matter of months, the United Nations will formally transition from the MDGs to the SDGs, marking another milestone in its remarkable history. As we make this leap and continue along the path to success, one thing is clear: we must carry everyone into this next phase of development with us, leaving no one behind, so that we can all walk proudly, equally and in good health across the finish line. Until then, we must do everything we can to ensure universal access to quality care through capable health systems. It’s a simple thought, really, and I think Ms. Roosevelt would agree.