Reaching the underserved: eliminating discrimination on the path to universal health coverage
World Health Assembly
20 May 2014
The governments of Canada and Norway – supported by WHO’s Gender, Equity and Rights team – brought together an interdisciplinary panel to discuss barriers and opportunities to eliminate discrimination on the path to Universal Health Coverage (UHC). This topic is of particular relevance as UHC is poised to feature prominently in the post-2015 health goal, and as WHO accelerates its efforts to anchor gender, equity and human rights more firmly within the health response.
Over 100 participants joined the conversation, noting the opportunity presented by UHC to address unfinished business related to the Millennium Development Goals and to strengthen health equity, gender equality and rights-based approaches in the post-2015 era. Craig Mokhiber, from the Office of the High Commissioner on Human Rights, emphasized that “a human rights-based approach is at the centre of UHC, and human rights instruments both give legal grounding to UHC, and unpack some practical steps that states can take to ensure the right to health of populations.”
Human rights instruments call upon states to ‘progressively realize’ the right to health, but Mr Mokhiber stressed that “there is no ‘progressive realisation’ of the removal of discrimination”. Discrimination – whether based on income, gender, geographical location, race or ethnicity, sexual orientation, or any other factor – must be confronted immediately and eliminated if the right to health is to be realized and if universal health coverage is to be achieved. Discrimination and healthy lives simply do not go hand in hand.
Panellists and participants from the floor provided examples on how a rights-based approach can be applied in practice to confront discrimination on the path towards UHC. Patricia O’Brien, Permanent Representative of Ireland to the UN in Geneva, highlighted how the Human Rights Council is working with WHO to look at under-5 child mortality as a human rights issue. This joint effort will result in practical guidance to assist Member States in their action to decrease child mortality – including addressing discrimination to ensure that all children can be reached with life-saving interventions.
Elissa Golberg, Permanent Representative of Canada to the UN and chair of the session, also underscored that to reach the underserved, “we need to know who they are, and where they are”. There is an urgent need to strengthen civil registration and vital statistics (CRVS) systems, an issue highly relevant to health equity that was recently addressed at the Summit on Maternal and Child Health in Toronto, Canada from May 28-30th.
Disaggregating data by sex, income, rural-urban and other equity stratifiers is also necessary to better understand populations who currently have greater health needs and are not effectively covered with services and financial protection. Research is needed to understand the access barriers that populations face, the driving forces behind those barriers, and – as highlighted by WHO India Country Office Head Dr Nata Menabde – what the health system can do to address them. The work of the Indian Government to tackle health inequities in rural disadvantaged areas, through strengthened primary health care and innovative participatory approaches, was highlighted in this context.
In closing, Ambassador Golberg underscored the need to "make the case" at a variety of levels for the strong inclusion of human rights principles – including accountability and anti-discrimination – at the heart of the discussion on UHC. UHC, she noted, must look at individuals in their diversity and “ensure equity is at the forefront”.