IAHPC at the United Nations General Assembly
By Afsan Bhadelia, PhD
IAHPC member, International Association for Hospice and Palliative Care; & assistant professor, Purdue University
Septembers on the island of Manhattan generally mean the arrival of heads of state, dignitaries, and citizens from around the world gathering to discuss the greatest challenges facing humanity and our planet. After disruptions caused by—and the dismantling of progress due to—the COVID-19 pandemic, the 78th United Nations General Assembly was especially packed with diplomats and champions wanting to get back on track and to “leave no one behind” as time is quickly running out to achieve its sustainable development goals (SDGs) by 2030. As threats of global security loom, health was expected to be a common ground toward peace and prosperity, though for many citizens worldwide this may be largely aspirational.
I had the privilege of representing the International Association for Hospice and Palliative Care at the Special Session and to attend the SDG Summit, the UN High-Level Meetings on “Pandemic Prevention, Preparedness and Response” and “Universal Health Coverage: Expanding Our Ambition for Health and Wellbeing in a Post-COVID World,” as well as a side event cosponsored by IAPHC (with UICC, Global Hope, Vital Strategies, and WHPCA) on “Ensuring Access to Quality Affordable Medicines under Universal Health Coverage.”
Although the side event focused on cancer, speakers drew comparisons with the early days of the HIV epidemic, citing cost and regulatory barriers and supply chain issues that generate stock outs and leave rural communities unsupplied. While the focus of such meetings is usually on treatment, the discussion spotlighted palliative care as a critical component of the service continuum. The alleviation of suffering, it was noted, is a matter of respecting human dignity and a fundamental starting point to improve the health of populations worldwide.
Applauding member states’ adoption of Political Declarations on pandemic readiness and on universal health coverage (UHC) was momentarily energizing, given the massive efforts undertaken to achieve these milestones. Advocacy efforts were visibly rewarded when the Political Declaration on Universal Health Coverage mentioned palliative care five times (up from three in 2019). The making and renewing of commitments remains a worthwhile endeavor and a precursor to changes in policy and practice.
Some words stood out as critical reminders:
“Healthy people are the foundation of healthy societies and economies. Indeed, health and sustainable development are two sides of the same coin. As an issue that cuts across every single sustainable development goal, health tells us how well we are delivering on our entire 2030 agenda, from ending poverty and tackling climate change to building safe and peaceful societies.”
—Dennis Francis, president of the UN General Assembly
Words on the fundamental role of health in development and on solidarity around the common human experience will need to be coupled with translatable and implementable actions. In the hallways of UN headquarters, there were whispers of unrealized past commitments and resignation that there will likely be much of the same ahead.
To avoid this, the overwhelming sentiment was that there must be urgent and dramatic change to the global financial architecture as the status quo is untenable and will not generate effective, equitable, and sustainable development, including on health.
Specific calls by member states included the need to fast track the Addis Ababa Action Agenda on improving financial policies and flows that meet the needs of countries and to embrace multilateralism, a vision championed by the UN Secretary-General to strengthen global cooperation and governance. If seriously answered, these calls could serve to improve access to affordable and quality medicines, including for palliative care. The SDG Stimulus plan also provides some glimmers of hope, with proposals for rapid scaling up of SDG financing and investment.
Woes of compounding and crippling crises, including the implications of climate change, were echoed in many statements related to health. These statements also highlighted the needed strengthening of health systems and encompassed reminders of major health workforce shortages during—and burnout following—the height of the pandemic.
The need for more adequate training, conducive work environments, and fair compensation were cited as lessons from the pandemic. The central role of primary health care was reiterated in the face of the continued rise of chronic conditions and aging populations, as was the need to provide care across the continuum that addresses the suffering of individuals and communities worldwide.
Pleas for support to strengthen regional capacity, especially on the African continent, in the development and production of medicines and vaccines were made, particularly given concerns around out-of-pocket expenditure pertaining to the high cost of many essential medicines and lifesaving vaccines. With a financial partnership that supports local manufacturing of affordable vaccines announced earlier this year, Senegal is a practical example and a welcome step forward. The TRIPS agreement was cited to address intellectual property and patent restrictions alongside expressions and reminders of inequitable access to vaccines during the pandemic.
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