Universal Health Coverage

Chris Law Excerpts

Wednesday 10th July 2019 Westminster Hall

[Chris Law (Dundee West) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the right hon. Member for North East Bedfordshire (Alistair Burt) for securing this debate, for his great work as a Minister, and for championing the need for a separate Department for International Development.

Sustainable development goal 3 aims to

“Ensure healthy lives and promote well-being for all at all ages”,

and target 3.8 looks to “Achieve universal health coverage”, which is something that all of us in this House and across these islands have taken for granted since the establishment of the NHS in the 1940s. Everyone here already knows that implementing universal health coverage ensures that everyone receives quality healthcare without financial cost. We know that that reduces the risk of people being pushed into poverty, drives inclusive growth, builds more trust in health systems, and is more sustainable than simply responding to global health security threats.

Globally, it is important to note that access to healthcare has been increasing fairly steadily over the past 35 years. The healthcare access and quality index shows that almost all countries have seen at least some improvement during that time. However, we still have a long way to go if we are to meet sustainable development goal 3 by 2030. While access to healthcare has been increasing, the countries with the worst healthcare are still a long way behind those with the best, and that gap shows little sign of closing.

At least half the world’s population still do not have full coverage of essential health services, with one in eight people in the world spending at least 10% of their household budgets to pay for healthcare. As a result, about 100 million people are still being pushed into extreme poverty because they have to pay for their healthcare. Furthermore, the World Bank has identified that low-income developing countries are starting to face the challenges of ageing populations, and of increases in chronic, non-communicable diseases. That will only exacerbate the funding gap between what those countries have and what they need to provide universal health care. Aid spending on health is just as important now as it has ever been.

To turn my attention to the UK’s impact on universal health coverage, it is important to remind ourselves that of the $58 billion spent on health aid between 1990 and 2017, the UK spent $5 billion, and is the second largest national donor after the US—something we should all be proud of. Is it not ironic that the birthplace of national healthcare is second to a country that does not provide that for its citizens? Indeed, regressive attempts have been made by the US Administration to roll back the progress made under Obamacare.

The Department for International Development states that it is committed to supporting progress towards sustainable development goal 3, and aid spending on health is generally higher now than in previous years, representing 10.5% of all bilateral aid. That has to be welcomed. Last month, the UK increased its pledge to the Global Fund by 16%, in advance of the time of replenishment. That is a total of £1.4 billion.

We cannot be complacent about our past or current successes. The pathway to universal health coverage will be long and winding with no quick fixes, and the UK Government need to maintain their commitments in that area. All hon. Members in the debate have shown they are fully committed to that. However, there are possible changes ahead. In two weeks’ time we will have a new Prime Minister. The leading candidate has stated:

“We could make sure that 0.7 % is spent more in line with Britain’s political commercial and diplomatic interests”.

Let me be crystal clear: the SNP is unequivocal about the fact that trade and development are two different areas and must not be forced together at the expense of the world’s most vulnerable. Will we respond to an Ebola outbreak only if that is in the UK’s commercial interest? Who will judge if it is in our political interest to distribute mosquito nets to prevent the spread of malaria? Will children be vaccinated only in countries with whom the UK is on good diplomatic terms? Those questions may need to be answered. We should consider seriously the comments that have been made—they should send a shiver down our spines.

The same lead candidate has said:

“We can’t keep spending huge sums of British taxpayers’ money as though we were some independent Scandinavian NGO. The present system is leading to inevitable waste as money is shoved out of the door in order to meet the 0.7 per cent target”.

Let us examine that ludicrous statement. Of course, the UK is not some independent Scandinavian NGO, but one of the largest economies in the world. It has both a legal and moral duty to commit to 0.7% aid spending, and to assist in the fight against the diseases we have heard about in the debate. That is not inevitable waste or shoving money out the door; it is exactly what the UK should spend its money on while meeting the 0.7% target.

Let us look at an alternative approach in these islands. Ben Macpherson, the Scottish Government’s Minister for Europe, Migration and International Development, has given the following pledge for the Scottish Government:

“international development should be in the national interests of our partner countries and not in Scotland’s national interest.”

We should all agree that that is what international development means. We firmly believe that spending that must be focused on helping the poorest and most vulnerable, and on alleviating global poverty.

The SNP Scottish Government are playing their part in tackling global challenges, including epidemics and health inequalities. For example, as part of Scotland’s global goals partnership agreement with Malawi, the Scottish Government have pledged to strengthen the prevention and management of infectious diseases such as malaria, tuberculosis and HIV/AIDS. The Scottish Government respond to humanitarian crises through the humanitarian emergency fund, which includes provision to ensure the containment of diseases at times of crisis. While the challenges are fewer at home than abroad, the SNP is committed to defending the NHS, and to ensuring access to universal healthcare domestically; health spending is £185 higher per person in Scotland than in England.

To deliver universal health coverage, all countries must strive to provide quality healthcare at home. Those who are able to do that have a responsibility to support the same abroad. With a Department committed to international development and a 0.7% aid target, the UK already plays a significant role in doing so, and should never lose sight of that. The likely next Prime Minister talks about the UK walking away from its aid commitments, but it is imperative that the UK instead uses the opportunity of the universal healthcare agreement, which is due to be signed at the UN General Assembly in September, to refocus and renew efforts, for many years to come, to ensure universal health coverage.