Universal Health Coverage

Andrew Murrison Excerpts

Wednesday 10th July 2019 Westminster Hall

[The Minister of State, Department for International Development (Dr Andrew Murrison)]

I congratulate all involved today on an excellent debate. It is timely because on 23 September we will be discussing universal health coverage at the high-level meeting in New York.

I am pleased to have heard almost universal praise from across the House for the advance declaration that the UK has made in relation to the Global Fund. I am proud of that, and I hope everybody here is proud of it too. Not only is it a significant sum of money and an uplift to what we were spending before, but when taken with the other Global Funds, it propels us to the top of the league table of international development, particularly relating to healthcare.

It is more important still because it is advance notification. The whole point is to encourage others to pledge and commit—the two are slightly different—generous funds aimed at dealing with the healthcare issues we all struggle with, because we are all in this together, particularly in relation to infectious disease. That point has been made by a number of right hon. and hon. Members, because infectious diseases respect no borders.

Having started on a positive note, may I introduce an element of gloom? Strategic development goal 3 and the 17 development goals related to it are not on track to be successfully rolled out. Universal health coverage is an aspiration, but it is not secure; the glass is indeed half empty.

I congratulate my right hon. Friend the Member for North East Bedfordshire (Alistair Burt). It is ironic that I am here potentially answering for decisions that he made in Government.

[Alistair Burt]

All good ones.

[Dr Murrison]

I was about to say that I am really comfortable to do so, because the decisions he made, and those he is associated with vicariously, are good ones. I am happy to have inherited his portfolio, but he is a difficult act to follow, that is for sure.

My right hon. Friend identified all the issues in his contribution, as I would expect him to do. He started by highlighting universal health coverage and its contribution to SDG 3, but he also made the point that universal health coverage touches on the other SDGs as well. In advance of the high-level meeting on 23 September, he was right to ask about the aims and ambitions the UK Government have for that meeting. They are encapsulated in getting more money—obviously—and getting better quality and integrated healthcare. That is something many of the contributions have touched on one way or another. I have been struck by the level of support for an holistic approach to delivering universal healthcare.

We have talked about immunisation and about the mistake we would be making if we simply imagined that going around the world offering people vaccinations and inoculations would be “job done”. It really would not be. Those interventions would be treated with a great deal of suspicion by communities, as they are at the moment, if that were all we were offering. It has to be much more than that; it truly has to be integrated. I look forward to making this point loud and clear in September in New York.

On a broader theme, as I have gone around the world, I have been struck by the roll-out of healthcare systems. Very often, there is a temptation for politicians to roll out shiny things that they can demonstrate to their constituents. That generally means hospitals, and hospitals are great things, but they may not be the right thing in low and middle-income countries.

[Dr Whitford]

In the four health systems across the UK, we are trying to address our obsession with hospitals and tertiary centres, realising we have not got enough resources in primary care, and certainly not in prevention. We need to share that knowledge with developing countries.

[Dr Murrison]

I agree with the hon. Lady. In the context of low and middle-income countries, my focus would be on primary healthcare and public healthcare, by which I understand something slightly different from public healthcare in the context introduced by the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), who speaks for the Opposition, and I will come to that in a minute. The focus needs to be on prevention and on things that deal with the problems that the poor are exposed to, first and foremost. The difficulty with shiny stuff—electorally obliging though that might be—is that it risks exacerbating health inequality; shiny things tend to be in urban centres and accessed more easily by the better-off, rather than the poor, and particularly the rural poor. We need to be very careful about that.

We need to introduce the notion that countries themselves must grow their healthcare systems, and a number of contributions touched on that. That means addressing unpleasant things such as taxation. In addressing universal health coverage, we need to ensure that we encourage Governments to establish proper mechanisms for raising taxation, so that countries can ultimately stand on their own feet. I am pleased that the UK has introduced some trailblazers in that respect—the four in Africa are Rwanda, Ethiopia, Ghana and Uganda, and the other is Pakistan—where we will be assisting Governments to build structures that will make their healthcare systems sustainable in the longer term.

A number of contributions touched on polio. I know that will be the subject of my grilling later by the hon. Member for Liverpool, West Derby (Stephen Twigg)—I will say lots of nice things about him in anticipation that he will give me an easy ride this afternoon. I am sorry that he is standing down; it will be a great loss to the House, and I urge him to think again. Polio is on the cusp of being defeated. There were 33 cases last years, from only three countries—only two countries, really. We must make sure the boot remains on the carotid, because there is a real risk that, if we are tempted to divert funds from this, we will be back to square one. That would be a tragedy because of the lives that would be lost, and because, at some point, we would have to pick up the pieces. It makes no sense, in raw economic terms, to relieve the pressure on that particular nasty at this point. I hope we will make sure in September that the pressure stays on that particular one of the “Captains of the Men of Death”.

I appreciated the comments made by right hon. and hon. Members about nutrition; they were absolutely right. The hon. Member for Central Ayrshire (Dr Whitford) rightly said in an intervention that there is no point vaccinating people if they are undernourished. It is nonsense epidemiologically and in public health terms to do so, and we must adopt an integrated, holistic approach to universal health coverage. If we can get that across to people in New York in September, we will have done the world a great service.

I am proud to be a member of a Government who are fully committed to not just the Global Fund but other funds that require replenishment. Our leadership has been salutary over many years—not just under the present Government, although I am pleased about the commitment they have made to the Global Fund—and I am confident, whoever wins in two weeks’ time, to answer the point made by the hon. Member for Dundee West (Chris Law), that that process will continue.