If governments have the obligation to help keep their citizens healthy, many of them are struggling to strengthen their health systems. A variety of hurdles is in the way, and lack of access to medicines is one of them, as underlined by the World Health Organization director general in her address to the United Nations Human Rights Council yesterday.

Following a resolution adopted by the Human Rights Council in July 2016, a panel discussion on enhancing capacity-building in public health was organised yesterday at the 35th session of the Human Rights Council taking place from 6-23 June.

WHO Director General Margaret Chan delivered a keynote speech underlying the need for countries to have fundamental health capacities, and for populations of the world to have access to mostly unaffordable new medicines.

The ability of governments to cater to the health of their populations depends on a number of factors, she said, including the provision of essential preventive and curative health services and medicines, health facilities located close to people’s homes, and sufficient numbers of trained staff.

The right to health depends on legislation and its enforcement, in different ways, Chan said, citing as an example the WHO Framework Convention on Tobacco Control. WHO has also issued guidance on legislation aiming to reduce the harmful use of alcohol, and protect children from the marketing of unhealthy foods and beverages, she said.

“Tobacco kills,” she said, and underlined the tobacco issue as one of the most important messages of her 10-year WHO tenure, which comes to a close this month.

Building capacities, although key to upholding the right to health, is not an easy task, she said, adding that the determinants of health and the right to health encompass a number of volatile factors, such as people’s behaviours, mobile populations, and pathogens.

Remarking on the issue of access to medicines, she said WHO has developed instruments and mechanisms contributing to fair access to care, by making the prices of pharmaceutical products more affordable.

However, “this is a world where the price of some generic medicines has dropped so low that manufacturers have left the market, creating holes in the availability of essential medicines,” she remarked.

“This is also a world in which the costs of some new medicines, especially for chronic conditions, are unaffordable, even for the richest countries in the world,” she added.

As an example, she said in some South American countries, the cost of treating a single woman with breast cancer, using a drug included on the WHO model list of essential medicines, is equivalent to nearly twice the annual per capita income.  “How many individuals can afford that kind of health care cost,” she asked.

She also cited the estimated 5.9 million children dying each year before their fifth birthday (2015 estimate). Those millions of young deaths that could be prevented or cured by existing medical products “would be unthinkable in a fair and just world,” she said.

“Unfortunately, the world we live in is neither fair nor just,” she said, adding that an estimated two billion people have no access to essential medicines.

She praised the global effort for universal health coverage, saying that such coverage protects people from the financial hardship of paying for essential health care, thus acts as a poverty reduction strategy.

“At a time when policies in so many sectors are increasing social inequalities and denying the right to health, it is especially gratifying to see health lead the world towards greater fairness in ways that matter to each and every person on this planet,” she concluded.

Lack of Access to Medicines ‘Insufferable’

Kate Gilmore, deputy high commissioner for human rights, speaking before Chan, said international law obliges states to enable all to realise the right to health, as it is a foundation for the fulfilment of all other human rights. She underlined and confirmed the close cooperation of the Human Rights Council and the WHO on health and human rights.

Panel moderator Nozipho Joyce Mxakato-Diseko, the permanent representative of South Africa, said the resolution came after a proposal sponsored by China, supported by a number of developing countries. “It is insufferable that in the year 2017, millions of people are still lacking access to affordable medicines,” she said.

She added that antimicrobial resistance is already killing “upwards of 700,000 people worldwide every year,” and transnational food production means that “industry oversight can compromise the health” of millions of people worldwide.

She also underlined the conclusions and recommendations of the United Nations Secretary General’s High Level Panel on Access to Medicines, which was discussed at the Human Rights Council in March (IPW, Public Health, 9 March 2017).

Ilona Kickbusch, director of the Global Health Centre at the Geneva Graduate Institute of International and Development Studies, remarked on the importance of empowering people as a key component of capacity building in public health. According to sources, she underlined the importance of health literacy in a consumer society, as people need to make a significant number of health decisions, but some countries are poorly equipped to do so.

Countries’ Efforts Toward Universal Health Coverage

A number of panellists described the challenges and efforts undertaken to strengthen their health systems, such as Tolbert Nyenswah, Liberia’s deputy minister of health, talking about the Ebola epidemics in Western Africa, and remarking that China rose to assist the country in what became a South-South collaboration initiative, according to sources.

Lorenzo Somarriba López, national director for public health at the Ministry of Public Health in Cuba, described the experience of Cuba, and the 100 percent health coverage of the population, based on primary health care. He underlined the life expectancy at birth of 78.5 years and the Cuban immunisation programme covering 13 diseases.

According to sources, Gong Xiangguang, deputy director general at the Department of Law and Legislation, National Health and Family Planning Commission in China, underlined the priority for China to provide an efficient health system for all citizens. He also remarked on the rising life expectancy in China, and the adoption in 2016 of a five-year plan on “Healthy China.”