Universal Health Coverage

Preet Kaur Gill Excerpts

Wednesday 10th July 2019 Westminster Hall

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

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, and for his work in his previous role at the Department for International Development and the Foreign and Commonwealth Office; I know he is well respected by the whole House for his contributions and openness. He spoke compellingly about the importance of universal health coverage, and passionately about the strides made. He coined the term “Global Britain in action” in respect of our commitment to the Global Fund. He referenced, as many Members did, the high-level meeting in September on universal health coverage, and the UK’s role in that and our ongoing commitments. Finally, he made the point that DFID should remain a stand-alone Department.

As chair of the International Development Committee, my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) has made a vast contribution, and it will be a huge loss when he leaves that role. I thank him for raising the serious concerns about Ebola in the Democratic Republic of the Congo, and the Secretary of State’s declaration of an emergency. He spoke passionately about the One Last Push campaign to end polio globally.

The hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont) spoke of the small charities fund in the UK, and the impact it can have in supporting DFID’s work. The hon. Member for Central Ayrshire (Dr Whitford), chair of the all-party parliamentary group on vaccinations for all, spoke of how vaccinations have saved 20 million lives, but that must be in the context of access to universal health coverage. My hon. Friend the Member for Lincoln (Karen Lee) and the hon. Member for Glasgow East (David Linden) talked about the importance of incorporating nutrition in UHC.

Last week, the national health service celebrated its 71st birthday. The NHS has rightly become nothing short of a national treasure in the UK. It has allowed us all to access quality healthcare free at the point of use, regardless of our income. But for too many people across the world, their right to quality healthcare is far from realised. Despite the global commitment to sustainable development goal 3—to

“Ensure healthy lives and promote well-being for all”—

some 3.6 billion people do not receive the most essential health services they need, and 100 million are pushed into poverty from paying out-of-pocket for health services. It is right that securing health for all is a top priority for our international development work. It is essential that we take seriously this year’s UN high-level meeting in September, at which a universal health coverage agreement will be declared. I am delighted that this debate has been called, so that we can discuss how to achieve healthcare for all and what needs to be included in that declaration.

I will use my short time to cover four priority areas, starting with the need for public health systems. I mentioned the NHS; we know from our own experience that having a publicly provided universal health system, funded through progressive taxation and free at the point of delivery, is crucial to ensuring everyone can access the healthcare they need. It is only through putting people, rather than profit, at the heart of the agenda that we will ensure truly universal access to healthcare and meet the SDGs. After all, universal health coverage is about the social contract between the state and the population.

Country Governments are accountable to their population for delivering the right to healthcare. The NHS has provided us with a wealth of experience and expertise in universal health systems. That means the UK is well positioned to work with Governments, civil society groups and other stakeholders across the world to support the development of public health systems. Labour has committed to establishing, when it comes into government, a new dedicated unit for public services in DFID for that very purpose. We know that is crucial to gender equality. Women bear a greater burden of unpaid care work, so when a fully functioning health system is in place, women are freed up to engage in paid work opportunities, political decision making, education and other aspects of life.

Rather than strengthening public health systems, this Government have too often undermined them through their support for privatised forms of healthcare. Promoting public-private partnerships and private health facilities is not the way to achieve health for all. Health should never be commodified and turned into a profitable commercial venture, because that is a recipe for leaving the poorest without healthcare. Will the Minister inform us of the steps he is taking to ensure that we strengthen, not weaken, public health systems across the global south? Will the Government ensure that a strong focus on public health systems is included in the UN declaration?

Secondly, let me talk about health financing. Researchers at the World Health Organisation have estimated that the annual cost to poor countries of meeting the SDG target on healthcare for all by 2030 would be $112 per person. That is a significant increase on previous estimates, and would leave low-income countries facing an annual funding gap of up to $35 billion. The WHO estimates that poor countries will need to spend up to 20% of GDP on health to bridge that gap—clearly an impossible ask. If low-income countries are to have any chance of making up even part of the shortfall, Governments of rich countries and international institutions urgently need to address their role in creating global poverty and inequality, including through enabling unjust global tax and trade rules, demanding unsustainable debt repayments, failing to regulate their corporations properly, and imposing costs on poor countries through their contributions to climate change. I hope the Government will use their leadership position at the UN meeting in September to ensure that there is honest recognition of their responsibilities and the reasons why many poor countries do not have the domestic resources necessary to fund public health systems.

My third point is on access to medicines. We will never achieve healthcare for all without access to affordable medicines, vaccines and diagnostics. According to the STOPAIDS coalition, the price of new medicines worldwide is rising year on year. Due to a lack of transparency in drug pricing, too often we are left in the dark by pharmaceutical companies, which are free to set their own prices. As a result, treating a number of diseases remains unaffordable for both individuals and national health systems. Will the Minister ensure that improved affordability and access to medicines is championed in the declaration agreed at the UN meeting in September?

Fourthly and finally, I raise an important point about the “leave no one behind” agenda. At the launch of the SDGs, the Government pledged to ensure that

“every person counts and will be counted”,

and that the

“people who are furthest behind, who have the least opportunity and who are the most excluded, will be prioritised.”

Five years on from the SDGs being agreed, too often the most marginalised are still being left behind. An important piece of research by the UN’s population fund, and the UK non-governmental organisations Health Poverty Action and the Minority Rights Group, found that women from indigenous and ethnic minority communities experience far worse maternal health outcomes than the majority population in all 16 countries that they studied.

In the light of this evidence, do the Government agree that including data on ethnicity is a vital part of ensuring that we can keep track of inclusion in health systems? Will the Minister explain why ethnicity continues to be neglected in DFID’s inclusive data charter action plan? When do the Government intend to meet their commitment under the SDGs by disaggregating data by ethnicity? Can the Minister assure us that the most marginalised ethnic groups will be counted and included in the high-level discussions in September?

I conclude by saying a few words about the Government’s record on universal health coverage to date. It has been five years since the International Development Committee urged the Government to formulate a strategy for its approach to health systems strengthening. The Government accepted this recommendation, yet nearly five years on, there is still no sign of the strategy. It is true that there have been promises of imminent publication, most recently last December, but there is still nothing. I hope the Government will tell us why there has been such a delay to this most important document. After all, strengthening public health and health systems is the most important step we can take towards achieving health for all.