news News

Around the world, the right to health of millions is increasingly coming under threat
by MSF, WHO, The Lancet, agencies
7:33am 26th Feb, 2024
Apr. 2024
Around the world, the right to health of millions is increasingly coming under threat
To mark World Health Day, the World Health Organization has launched the “My health, my right” campaign to champion the right to health of everyone, everywhere.
The campaign advocates for ensuring universal access to quality health services, education, and information, as well as safe drinking water, clean air, good nutrition, quality housing, decent working and environmental conditions, and freedom from discrimination.
All around the world, the core challenges consistently compromising the right to health are political inaction coupled with a lack of accountability and funding, compounded by intolerance, discrimination and stigma.
Populations facing marginalization or vulnerability suffer the most, such as people who live in poverty, are displaced, are older or live with disabilities.
While inaction and injustice are the major drivers of the global failure to deliver on the right to health, current crises are leading to especially egregious violations of this right. Conflicts are leaving trails of devastation, mental and physical distress, and death.
The burning of fossil fuels is simultaneously driving the climate crisis and violating our right to breathe clean air. The climate crisis is in turn causing extreme weather events that threaten health and well-being across the planet and strain access to services to meet basic needs.
Everyone deserves access to quality, timely and appropriate health services, without being subjected to discrimination or financial hardship.
Yet, in 2021, 4.5 billion people, more than half of the world’s population, were not covered by essential health services, leaving them vulnerable to diseases and disasters.
Even those who do access care often suffer economically for it, with about 2 billion people facing financial hardship due to health costs, a situation that has been worsening for two decades.
To expand coverage, an additional US$ 200–328 billion a year is needed globally to scale up primary health care in low- and middle-income countries. Progress has shown to be possible where there is political will.
“Realizing the right to health requires governments to pass and implement laws, invest, address discrimination and be held accountable by their populations,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Realizing the highest attainable standard of health, is a fundamental right for all people, everywhere.”
The right to health is enshrined within the WHO Constitution, and at least 140 countries recognize the right to health in their national constitutions. But recognition alone is not enough, which is why WHO supports countries to legislate the right to health across sectors and integrate human rights into health policies and programmes.
The aim of this support is to make health services available, accessible and responsive to the needs of the populations they serve and to increase community participation in health decision-making.
On this World Health Day and beyond, WHO is calling for governments to make meaningful investments to scale up primary health care; to ensure transparency and accountability; and to meaningfully involve individuals and communities in decision-making around health.
Recognizing the interdependence between the right to health and other fundamental rights, the campaign includes calls to action on finance, agriculture, environment, justice, transport, labour and social affairs.
Individuals, communities and civil society have long defended their right to health, improving access to health care services by breaking down barriers and advocating for equity.
Mar. 2024
Investing in women’s health is essential in the era of polycrises, by Johanna Riha, Zaida Orth, Rajat Khosla. (United Nations University: International Institute for Global Health)
In a time of overlapping crises that demand urgent attention, prioritising women’s health will benefit everyone
The world is in a state of “polycrises” where multiple economic, environmental, social, and geopolitical shocks have converged and are driving and deepening existing gender inequalities and health inequities.
These polycrises are additionally contributing to backsliding on human rights culminating in devastating effects on women’s and girls’ health worldwide. Steps to prioritise women’s health must be taken to prevent it being neglected among competing priorities.
Globally, the cost-of-living crisis and austerity measures will push over 340 million of the most vulnerable women into poverty by 2030, forcing many to choose between basic human rights like food or medical treatment.
This exacerbates existing gendered gaps in access to healthcare and adversely affects women’s and girl’s ability to stay healthy.
For example, it is currently estimated that 500 million women worldwide lack access to menstrual products and hygiene facilities, with this trend worsening because of ongoing polycrises. Denial of this basic health right forces many, in high and low income countries alike, to avoid work and school, adversely affecting their income and education.
Conflict, climate displacement, and covid-19 are driving worrying increases in gender based violence, child marriage, and female genital mutilation. Pooled survey data from 13 countries with over 16,000 respondents shows that almost half of women report that they or a woman they know has experienced a form of violence since the pandemic.
Additionally, the pandemic fuelled a rise in the unpaid care and domestic work that disproportionately falls on women and girls. Concurrent crises, such as climate change and declining health systems, directly and indirectly affect women’s physical and mental health as they make up 67% of health and care workers and 40% of the total agricultural workforce worldwide.
These polycrises will likely have detrimental effects on the health of future generations. In some cases, intergenerational health effects are well understood (such as the associations between maternal education and infant health), while for others evidence is only beginning to emerge.
Plastic pollution, for example, which accounts for 85% of all marine litter, has disastrous consequences on livelihoods, food security, and health. Microplastics are particularly harmful to the health of women and girls, impacting gestational weight and genital structures in fetuses.
What can be done to prioritise women’s health in the era of polycrises?
On International Women’s Day, as we grapple with how to manage and build resilience in the current climate, the call for continued and increased investment for gender equality and health is imperative. It makes economic, social, political, climate, and public health sense to invest now for a more sustainable and healthier future.
A recent report by the World Economic Forum shows how narrowing of the existing gap in women’s health would avoid 24 million life years lost because of disability, add over $1tn to the global economy, and boost economic productivity by up to $400bn. But actionable steps must be taken to prioritise women’s health, especially given the competing priorities.
We believe that investing in the following three areas is critical.
Firstly, investment in feminist leadership is needed. Although women contribute an estimated $3tn annually to global health, half in the form of unpaid work, and are the backbone of health service delivery, women hold only 25% of health leadership roles.
Having representative leadership is critical to ensure prioritisation of actions that support and empower women in times of polycrises. This leadership must move beyond tokenism and have decision making powers.
With rapidly shrinking civic spaces and growing, well coordinated anti-gender movements, the need for feminist leadership with representation from indigenous women, people with disabilities, and those living in rural, remote, and disaster prone areas is even more acute.
Secondly, support for feminist civil society organisations is needed. Feminist civil society groups have a long history of building knowledge and evidence, advocating for advancements in women’s health, and holding governments and other actors to account.
Feminist movements have been most effective when they form broad coalitions and alliances with other social movements, including trade unions and environmental groups. Increasing investment in feminist civil society organisations, especially to build alliances and bridges between different groups, will help promote women’s health in the face of growing backlash and concurrent crises.
Thirdly, technical capacity to advance sex and gender integration in policies and programmes must increase. Ensuring sex and gender based inequities in health are adequately tackled and not further reinforced—including prevention, preparedness, response, and recovery plans—requires specific technical expertise.
Investing in strengthening this technical capacity, which includes staff with specialised skillsets, contextualised knowledge, and understanding of how intersecting axes of discrimination harm women’s health, can help mitigate inequities and improve health.
For far too long, women’s health has been deprioritised. Now more than ever, investing in women’s health presents an opportunity for a big win for everyone.
* British Medical Journal:
Mar. 2024
The Pandemic Treaty: shameful and unjust. (The Lancet)
The Intergovernmental Negotiating Body (INB), which is tasked under WHO with drawing up an international instrument on pandemic prevention, preparedness, and response, will sit for the 9th and final time from March 18–29. In the 2 years since it first met, hundreds of hours and unknown costs have been spent, but the political impetus has died.
The convention is now at a critical juncture: the final text for countries to ratify is due to be presented at the World Health Assembly in May. With only limited days of negotiation left and a long way to go to secure a meaningful agreement, it is now or never for a treaty that can make the world a safer place.
It is hard to remember sometimes, among the highly diplomatic and technical negotiations, but that is what this treaty is trying to do: to protect all people, in all countries, no matter how rich or poor, from harm.
As The Lancet went to press, a new publicly available draft text was awaited, but judging from the most recently available version, from October, 2023, the treaty will fail in this aim. Much of the language is greatly weakened from the initial ambition, filled with platitudes, caveats, and the term “where appropriate”.
A key recommendation from the Independent Panel for Pandemic Preparedness and Response, met with widespread support, was the need for a treaty that would “address gaps in international response, clarify responsibilities between States and international organisations, and establish and reinforce legal obligations and norms”.
At the heart of this recommendation was the need to ensure that high-income countries and private companies behave fairly, that they do not stockpile millions of excess doses of vaccine or refuse to share life-saving knowledge and products, and that there are mechanisms to ensure that countries work together rather than against each other.
These issues still represent the broad sticking points in current negotiations: access and benefit sharing (who gets what, how much, and when) and governance and accountability (to what degree are countries made to do something).
The word equity appears nine times in the October negotiating text, including as a guiding principle of the whole treaty. But in reality, Article 12 stipulates that WHO would have access to only 20% of “pandemic-related products for distribution based on public health risks and needs”.
The other 80%—whether vaccines, treatments, or diagnostics—would be prey to the international scramble seen in COVID-19 that saw vital health technologies sold to the highest bidder. Most of the world's peoples live in countries that might not be able to afford these products, but 20% seems to be all that high-income countries were willing to agree to.
This is not only shameful, unjust, and inequitable, it is also ignorant. Creating and signing up to a strong and truly equitable set of terms on access and benefit sharing is not an act of kindness or charity. It is an act of science, an act of security, and an act of self-interest. There is still time to correct this misjudgment.
Even the anaemic commitments of the agreement are in jeopardy. Independent monitoring of whether countries are complying with their commitments is essential for the efficacy and longevity of the treaty. Yet, as colleagues have pointed out, all indications suggest that the governance and accountability mechanisms of the treaty are being further undermined.
There is little in the way of clear enforceable obligations to prevent zoonotic disease outbreaks, implement One Health principles, strengthen health systems, or counter disinformation. Heads of states and the INB might not see pandemic governance as a priority now, but it is fundamental to the success of any agreement.
Creating a global convention acceptable to all is undoubtedly a challenge. The aims for a pandemic treaty are easy to articulate but many are difficult to enact and agree to. The INB might be doing its best, but ultimately it is the politicians of G7 countries who must put aside vested industry interests and finally understand that in a pandemic it is not possible to protect only your own citizens: the health of one depends on the health of all.
Millions of lives that could have been saved during the COVID-19 pandemic were not. Far from making amends, a handful of powerful countries are sabotaging the best chance to translate the lessons from the COVID-19 pandemic into legally binding commitments that will protect us all. The treaty is an opportunity that must not be squandered.
* The Global Initiative for Economic, Social and Cultural Rights (GI-ESCR) publishes a new policy brief entitled: ‘Transformative Policies to Realise Universal Access to Medicines. Why we Need Knowledge Commons and Public Options for Pharmaceuticals to Realise the Rights to Health and Science.’
The research frames universal access to medicines as a fundamental component of several human rights, including the rights to life, health, and science. However, as exemplified by stark inequalities in accessing COVID-19 vaccines, progress towards universal access to life-saving medicines is staggering. In this context, the policy brief argues that commercial models for researching, developing, manufacturing, and delivering medicines are limited when it comes to meet human rights goals:
Sep. 2023
Billions left behind on the path to Universal Health Coverage
The World Health Organization (WHO) has published the 2023 Universal Health Coverage (UHC) Global Monitoring Report, revealing an alarming stagnation in the progress towards providing people everywhere with quality, affordable, and accessible health care.
The report exposes a stark reality based on the latest available evidence – more than half of the world’s population is still not covered by essential health services. Two billion people face severe financial hardship when paying out-of-pocket for the services and products they needed.
"The COVID-19 pandemic was a reminder that healthy societies and economies depend on healthy people," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
"The fact that so many people cannot benefit from affordable, quality, essential health services not only puts their own health at risk, it also puts the stability of communities, societies and economies at risk. We urgently need stronger political will, more aggressive investments in health, and a decisive shift to transform health systems based on primary health care."
The 2023 report found that, over the past two decades, less than a third of countries have improved health service coverage and reduced catastrophic out-of-pocket health spending. Moreover, most countries for which data are available on both UHC dimensions (96 out of 138) are off-track in either service coverage, financial protection, or both.
“We know that achieving Universal Health Coverage is a critical step in helping people escape and stay out of poverty, yet there continues to be increased financial hardship, especially for the poorest and most vulnerable people,” said Dr Tedros Adhanom Ghebreyesus.
In 2021, about 4.5 billion people, more than half of the global population, were not fully covered by essential health services. And this estimate does not yet reflect the potential long-term impacts of the COVID-19 pandemic.
Catastrophic out-of-pocket health spending, defined as exceeding 10% of a household budget, continues to rise. More than one billion people, about 14% of the global population, experienced such large out-of-pocket payments relative to their budgets. But even small expenditures in absolute terms can be devastating for low-income families; approximately 1.3 billion individuals were pushed or further pushed into poverty by such payments, including 300 million people who were already living in extreme poverty.
Out-of-pocket health payments can also cause individuals to forego essential care and force families to choose between paying for a visit to the doctor, buying food and water, or sending their children to school. Such trade-offs can spell the difference between the early treatment of a preventable disease and, at a later stage, suffering severe illness or even death. Addressing this problem requires progressive health financing policies that exempt those with limited ability to pay for health services.
Achieving Universal Health Coverage by 2030 is crucial for realizing the fundamental human right to health.
To reach the goal of UHC, substantial public sector investment and accelerated action by governments and development partners are essential. Key actions include a radical reorientation of health systems towards a primary health care approach, advancing equity in health-care access and financial protection, and investing in robust health information systems.
Sep. 2023
Universal Health Coverage targets leave behind the most vulnerable, reports Medecins Sans Frontieres, Doctors Without Borders
UN member states have committed to achieving Universal Health Coverage (UHC) by 2030. This is defined as, “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”.
We speak to Dr Mit Philips, Medecins Sans Frontieres (MSF) senior advisor on health policies, to learn if these commitments are on track to becoming a reality.
How do you judge progress towards the UHC goal?
“Access to essential care today varies widely depending on where a person lives, who this person is, and what is his or her health need. A citizen in a well-equipped city has a completely different experience to someone from a vulnerable background when they need lifesaving surgery, prenatal care, a reliable supply of medicine for HIV or malaria; or when they need to pay for drugs for diabetes.
In that sense, health coverage today is nowhere near universal. MSF teams witness every day human tragedies caused by a lack of access to healthcare.
People living in vulnerable circumstances today face the most acute barriers in accessing care: people who cannot afford to pay for essential care, people facing a crisis situation, people excluded or discriminated because they’re migrants, refugees or socially marginalised people.
There is little attention being given to the most vulnerable in the current UHC agenda and country plans. The focus is on long-term plans and system change, but the crucial link to the direct response to patients’ health needs is missing. UHC needs to focus on measures that aid the most vulnerable people, who cannot afford to wait for theoretical plans to bear fruit.”
A patient in Port-au-Prince, Haiti: "I didn’t come to the hospital because there was fighting in the neighbourhood. The gangs didn’t allow anyone to pass. I contacted a nurse to have my wounds treated, but it was expensive... and I didn’t have money."
Universal Health Coverage means people should not suffer financial hardship to access healthcare. Has there been improvement in that regard?
“There are more people today at risk of falling into poverty because they have to pay for health services than in the year 2000. Poor and vulnerable households are more exposed to so-called ‘catastrophic health expenditure’.
In order to access healthcare, they have to sell goods, borrow money or reduce other important expenses for their family, such as food or education. This does not even account for the people who are forced to renounce seeking care because they know they simply cannot afford it. Too many people have to choose between illness or even death versus their family’s economic survival.
We have already pointed to the increased burden of user fees. Today, patients are forced to pay fees before they can get care, exemptions from payments are strongly limited, and in the UHC agenda there is still no concrete action proposed to make sure that those who need it most can access healthcare free of charge.
Grandmother of a patient in Lankien, South Sudan:
“We walked for five hours by foot to reach the closest place that offers hospital care. The people here only take their children to the hospital when they are extremely sick. The hospital is far, so many of them cannot even reach the hospital.”
Most UHC plans rely heavily on domestic resource mobilisation. But countries with the weakest health systems also tend to have the smallest tax bases. In most contexts where MSF works, public budgets for health have been undermined and suffer from austerity measures since the COVID-19 pandemic and the global economic crisis.
Patients already face gaps in essential medical supplies and services. At the same time, there is a reduction of international funding for health, with strong cuts in countries like South Sudan, Sierra Leone, etc.
This undermines strategies to ensure essential care free of charge. How can countries with crippling staff shortages and stock outs of essential medicines hope to provide UHC to their people?
To compensate for the losses in healthcare coverage and the increased precariousness of people, UHC plans need to urgently address financial access barriers. User fees should be abolished for essential care.”
Mother of a patient in Herat, Afghanistan:
"When my child was sick... the public clinic did not give us all the medication we needed. It was difficult to pay for transport to the city, that’s why we went to private clinics. Now my child is worse, and we owe a lot of money."
UHC is a pillar of the Sustainable Development Goal. Is the underlying promise to “leave no one behind” on track?
“Most country UHC-plans don’t just neglect the needs and vulnerabilities of migrants, asylum seekers, non-residents, or marginalised people; they often deliberately exclude these people from social protection schemes.
In some provinces in South Africa, migrant women and children are required to pay out-of-pocket for essential services, when paperwork cannot be shown immediately. In Belgium, asylum seekers are excluded from timely lifesaving hepatitis C treatment. Most European countries fail to provide preventive care such as vaccinations, and now epidemic outbreaks of vaccine-preventable illnesses are spreading among asylum seekers.
Secondly, the aspiring narrative of UHC is not translated and adapted to respond effectively to the needs of people affected by emergency situations. For example, even when increased funding is provided by international donors, the requirement to suspend user fees or to take measures to reduce other out-of-pocket expenses is missing.
It’s difficult to mobilise additional frontline workers and support them adequately. Bureaucratic hurdles block the rapid supply of medical items. We recommend that each UHC-country plan includes a specific chapter on what adaptations and extra interventions will be applied during crisis or emergency situations to ensure effective access to care.”
* Marking The Lancet Medical Journal's 200th anniversary, this special issue features critical issues impacting health globally:
Sep. 2023
UN High-Level meeting on Pandemic Prevention, Preparedness and Response. (Reuters)
Health officials from around the world will gather to discuss a treaty addressing pandemic prevention in Geneva next week. The meeting is part of ongoing negotiations by the decision-making body of the World Health Organization to tackle pandemic threats in a legally binding accord. Representatives from as many as 194 member countries are planned to take part.
Ongoing discussions include access to funding to manage the costs of measures meant to address the risk of pathogens emerging from wildlife. Risk factors, many of which disproportionately affect the developing world, include deforestation, climate change, rapid urbanization and the wildlife trade.
Previous discussions on the proposed treaty, which began two years ago, have centered on preparedness of health systems. The discussions next week, by contrast, are meant to focus on prevention. Many health experts say that finding ways to stop potential pandemics before they can emerge is as crucial as any amount of readiness for when they do.
“We will see more pandemics and we will see more severe outbreaks if we don’t act on prevention,” said Chadia Wannous, a global coordinator at the World Organisation for Animal Health, a France-based intergovernmental body involved in the treaty discussions.
In May, Reuters published a global analysis of environmental risk factors associated with zoonotic spillover, the term used by scientists to describe a leap by a pathogen from animals into humans. Spillovers are the leading source of infectious diseases in humans. The pathogens that cause COVID-19, Ebola, Nipah and other deadly illnesses are caused by or closely related to viruses found in the wild, particularly among some tropical bats.
Reuters’ analysis found that the number of people living in areas at high risk for spillover, mostly tropical locales and undergoing rapid urbanization, grew by 57% in the two decades ending in 2020. Nearly 1.8 billion people, or one of every five on the planet, now live in these areas.
Since early in the COVID-19 pandemic, global health officials have sought to create a “pandemic treaty” to better prepare for future outbreaks. The governing body of the World Health Organization chose delegates from each of its six administrative regions worldwide to lead the negotiations. The delegates have met with representatives of member countries and are tasked with forging an agreement by May 2024.
But governments remain divided, failing to agree on some of the basics needed to strengthen health systems worldwide. Those basics, all issues that hindered a coordinated global response to the COVID-19 outbreak, include the sharing of information, costs and vaccines.
The divisions arose anew in June, when the European Union negotiated new agreements with pharmaceutical companies to reserve vaccines for future pandemics. The agreements led critics to accuse the bloc of “vaccine apartheid.”
“The trust between higher and low-income countries has plummeted,” said Lawrence Gostin, who is director of the WHO Collaborating Center on National and Global Health Law and involved in treaty discussions.
The disparity between rich and poor countries at present is noted in the very first paragraph of the proposed treaty to be discussed in Geneva. The draft cites “the catastrophic failure of the international community in showing solidarity and equity in response to the coronavirus disease.”
Despite broad consensus on the need for pandemic prevention, negotiators remain divided when it comes to specifics. Ahead of the meeting, according to officials interviewed by Reuters, the biggest sticking point remains financing for poor countries.
Already struggling for resources to strengthen their public health systems, governments of developing nations need more funds if they are to invest in prevention. That could include measures like improved surveillance for emerging diseases, efforts to combat deforestation and more oversight of development in areas that could be prone to new spillover.
At present, such measures are proposed in the treaty through a concept known as “One Health,” outlined by the WHO and other international agencies in a 2022 “ plan of action.” The concept links human wellbeing to that of animals and the environment. The United States and the European Union have both said they support the inclusion of “One Health” provisions in a pandemic treaty.
“Lower income countries don’t want to make obligations unless they get funding,” Gostin, of the WHO global health law center, told Reuters. “Higher income countries are resistant to guaranteeing funds.”
Nearly all of the highest-risk areas identified by the Reuters spillover analysis are in low- and middle-income countries across Asia, Africa and Latin America. But much of the deforestation and development in these areas is driven by demand for minerals, food and other raw materials among wealthier countries. The shared responsibility – not to mention the shared consequences – should mean shared expenditures, officials argue.
“It should be in everyone’s combined interest to find solutions, for it not just to be the problems or financial problems for low income countries,” said Maria Van Kerkhove, an infectious disease epidemiologist who is the head of the WHO’s emerging diseases unit. “We live in this interconnected world and any pathogen that emerges on one part of the planet could be in another within 24 to 48 hours.”
Sep. 20, 2023
Lawrence Gostin’s Statement at UN High-Level Meeting on Pandemic Prevention, Preparedness and Response:
The “call to action” States make today in the Political Declaration are laudable, but aspirational, even empty in terms of hard commitments, funding, and action. The Political Declaration will be of little value if States fail to follow through with concrete mechanisms to promote solidarity and secure compliance.
What is most urgent is achieving a fairer, more equitable world, where lifesaving medical resources are affordable, available, and accessible everywhere. Fourteen million lives were lost to COVID-19. What we decide today, and in the negotiations for the Pandemic Accord and revised IHR, will determine whether we allow the same in the next pandemic.
During COVID-19, the lack of investment in health care systems and pandemic preparedness left health systems overwhelmed, and wealthier nations buying out the limited global supplies of lifesaving countermeasures.
Lower income nations were left reliant on charitable donations and aid, a model that proved unworkable and entirely inequitable. This was especially true in sharing vaccines and the knowledge and resources needed to produce vaccines.
States failed to comply with the even minimal obligations set out through the IHR, as well as with the recommendations set by the World Health Organization. It did little good to have well-intended norms that were not enforceable.
Today, the O’Neill Institute, a WHO Collaborating Center, makes three recommendations for States to maintain political momentum and solidarity for Pandemic Prevention, Preparedness and Response.
First, financing. We urge Heads of State and Government to sustainably and adequately fund pandemic preparedness and response with concrete pledges and targets. This requires full financial, political and technical support for new mechanisms for equitable access to lifesaving countermeasures.
Second, equity must be operationalized. Commitments to pandemic prevention, preparedness, and response should be universal but also cognizant of States’ varying resources and capacities. Lower-income countries, which often face compliance challenges, should be guaranteed financial, technical and other assistance.
Third, compliance with international law. States must agree on robust, transparent mechanisms for compliance and accountability. Heads of State and Government should provide full support for peer review mechanisms, and for an independent mechanism for monitoring the implementation of States’ commitments.
These mechanisms need not be punitive. Accountability mechanisms could identify compliance gaps, and link unmet obligations with financial and technical assistance. To build trust and transparency, accountability mechanisms could offer a formal role for civil society, and be located in the public domain.
If we fail to meet this historic moment through watered-down promises, and without bold commitments, it could be many decades before we regain the opportunity to make the world more secure from pandemics, for ourselves and for future generations. We have a great responsibility, and I urge us all to rise together to meet it.

Next (more recent) news item
Next (older) news item