“Universal Health Coverage is an idea for the kind of society we want to live in: kind, prevalent, generous, caring, and compassionate. [...] UHC is not a technical matter of building blocks to be assembled [...] or a destination to be reached. It is a permanent and tough political struggle”, said Richard Horton, Editor-in-Chief of the The Lancet, in his guest address to the 72nd session of the World Health Assembly (WHA). The Assembly’s overall theme this year is Universal Health Coverage (UHC). Therefore, many of the health ministers and heads of delegation speaking at the beginning of the week highlighted UHC and more than half of the Assembly’s official side events refer to it, thus underlining its critical importance. 

Indeed, a political struggle it is. 

This struggle was not at the G7 Health Ministers’ meeting in Paris last week , nor in the halls and corridors of the Palais des Nations for this year’s WHA , but the political struggle is deciding how UHC can be achieved across the world, how quality and affordable health services can reach the poorest and most marginalised in society, and how we can ensure that the right political decisions are made in a society where populism and nationalism are on the rise. 

The first ever UN General Assembly High-Level Meeting on UHC (UCH HLM) will be held in New York on 23 September 2019, scheduled the same day as the UN Climate Action Summit hosted by UN Secretary-General, António Guterres. This in itself will bring along a struggle to ensure the highest political representation in order to obtain the required political commitment and leadership beyond health. 

As chairs of the intergovernmental process, Thailand and Georgia just released the zero draft of the Political Declaration on 21 May 2019. This particular timing also means that UHC discussions have been brought to the corridors of Geneva. This nine-page document lists 41 actions under 13 headings and reflects some of the Key Asks elaborated by the UHC2030 Movement, among them: reaffirming the responsibility of governments and the need for whole-of-government and whole-of-society approaches; participatory governance platforms and multi-stakeholder partnerships; the need to build effective, accountable and inclusive institutions; strengthening regulatory and legislative frameworks; and ensuring universal access to sexual and reproductive health and rights. It also mentions follow-up actions. 

Yet, the current draft Declaration falls short, among others, of mentioning that UHC is a social contract, that it requires social accountability, fighting tax evasion and corruption, managing conflicts of interests, as well as maintaining strong language on gender equality, data governance and the need to invest in public goods.  

So, more work is to be done and it remains to be seen how far governments at the informal consultation in New York on 9 June 2019 will amend the text, establish links to this year WHA’s most controversial issue on drug pricing and keep people at the centre because, as Mr Horton stated, “health is created among families, communities and within neighbours [...] and the strength of a health system cannot be separated from the strength of a society, the quality of political institutions, the rule of law, a free press, the absence of corruption and the protection of fundamental rights. The struggle for health is also a struggle for a just society” .