Universal Health Coverage: New Political Declaration

Earlier this year I wrote about Universal Health Coverage (UHC) being on the agenda for 2023 in anticipation of the United Nations High-Level Meeting on UHC. The meeting took place in New York this September during the 78th Session of the United Nations General Assembly (UNGA). The resulting political declaration adopted on September 21 is entitled “Universal Health Coverage: expanding our ambition for health and well-being in a post-COVID world.”

The Political Declaration has 109 points beginning with background on past agreements and UNGA resolutions and moving into our current global context including urgent action needed to achieve the Sustainable Development Goals (SDGs).

The World Health Organization issued a media release on September 21 celebrating the approved declaration with its strong focus on primary health care:

In the Political Declaration, Heads of State and world leaders committed to take key national actions, make essential investments, strengthen international cooperation and global solidarity at the highest political level to accelerate progress towards UHC by 2030, using a primary health care (PHC) approach.

For health care to be truly universal, it requires a shift from health systems designed around diseases to systems designed for people. PHC, an approach to strengthening health systems centred on people’s needs, is one of the most effective areas for investment to accelerate progress towards UHC.”

Further, as stated in the declaration , political leaders are called to recognize and act upon the health inequities that exist within and among countries. Throughout the document there is a call for greater political commitment along with global solidarity and cooperation to tackle “social, economic, environmental and other determinants of health” and to eliminate barriers to health care access. There are numerous points on Health Human Resources highlighting the need for national governments to invest in their health workforce and to attend to issues of migration.

UHC2030 Coalition

The UHC2030 Coalition continues its excellent advocacy as well as its educational work on UHC. The Action Agenda serves as a clear framework: Action Agenda from the UHC Movement – UHC2030

Credit: UHC2030 Coalition

See also the statement issued on September 26: Statement of the UHC2030 co-chairs on the adoption of the Political Declaration on Universal Health Coverage – UHC2030

International Council of Nurses

The International Council of Nurses (ICN) was represented at the UNGA by President Dr. Pam Cipriano who gave presentations during the High-Level Meetings on Health. It was great to know that ICN brought strong global nursing expertise and presence to the deliberations. ICN had contributed to the Action Agenda as a member of UN High-Level Meeting Task Force. As Dr. Cipriano stated:

The political declaration gives governments an opportunity to make a clearsighted and enduring change that will make a real difference by giving everyone equitable access to the health care that they need. Governments must not only make these commitments; They must follow through with the necessary investment to make these historic changes a reality that will benefit many millions of people who currently have little or no access to basic health care.”

ICN’s coverage included these media releases:

https://www.icn.ch/news/icn-president-says-universal-health-coverage-will-only-be-achieved-2030-if-there-dramatic

https://www.icn.ch/news/icn-president-calls-resilient-health-systems-un-high-level-meeting-pandemic-prevention

Much more will be written about the UHC movement, the SDGs and the UHC 2030 action agenda. We need to ensure that the momentum is sustained along with the renewed enthusiasm for primary health care.

Credit: World Health Organization

By Nora Whyte – September 27, 2023

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

New ICN Campaign: “Our Nurses. Our Future”

The International Council of Nurses (ICN) launched an exciting new campaign – “Our Nurses. Our Future.” – on International Nurses Day, May 12, 2023. A key resource is a ten-point Charter for Change that provides guidance for the future.

Courtesy of ICN – 2023

The first point sets the tone for global health action:

Protect and invest in the nursing profession to rebuild health systems that can deliver the Sustainable Development Goals and Universal Health Coverage to improve global health. Recognise and value health and health care as an investment not a cost. Secure commitments for investment to maintain equitable and people-centred care.

Each point is worth attention and action this year. I will reflect on point 8 as we prepare for the ICN Congress in Montreal this July:

Actively and meaningfully engage national nursing associations as critical professional partners in all aspects of health and social care policy, delivery and leadership as the experienced and trusted voice of nursing. Build local, national and global multilateral partnerships.”

On this day, I am reminded of warm connections with international colleagues I have met through partnerships, exchange visits and conferences over many decades. In particular I’m thinking about the nurses, faculty members and students at Guru Nanak College of Nursing in Punjab and my friends at the Canada India Education Society and UBC School of Nursing. The hospitality and conversations were wonderful! Also remembering nurse leaders I met and admired in the Japanese Nursing Association and the Democratic Nursing Organization of South Africa (DENOSA). Thank you and best wishes for International Nurses Day and beyond!

By Nora Whyte – May 12, 2023

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

Congress Banner courtesy of ICN.

Universal Health Coverage on the Agenda in 2023

The World Health Organization (WHO) Executive Board met recently from January 30 to February 7 in Geneva. A major theme this year is Universal Health Coverage (UHC) in preparation for the UN High-Level Meeting on UHC in September 2023. The previous High-Level Meeting on UHC in 2019 resulted in a commitment “to ensuring that, by 2030, everyone, everywhere will be able to receive quality health services without suffering financial hardship.” Further, UHC “covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.” (WHO 2022).

Courtesy of UHC Coalition

There is an important connection between primary health care and sustaining the workforce to achieve the goal of UHC. I like the way it was expressed by the United Nations Foundation following the Executive Board meetings:

“Member States emphasized that stronger primary health care delivery and a robust health workforce were force multipliers that could jointly serve UHC and pandemic preparedness, response, and resilience goals and the Sustainable Development Goals writ large.” (UN Foundation 2023).

WHO’s Executive Board meeting sets the tone for a big year in global health (unfoundation.org)

The International Council of Nurses (ICN) delivered statements at the Executive Board meetings as part of civil society coalitions urging Member States to commit to investing in the health workforce for UHC. Themes of equity, patient advocacy, emergency preparedness & response and quality of care came through in the statements. A summary of ICN interventions on health care issues during this Executive Board session is worth reading to see the topics covered.

In keeping with the strong global health presence of ICN and its national nursing association members, the next ICN Congress holds promise for discussion of global policy directions. The ICN Congress co-hosted by the Canadian Nurses Association is taking place in Montreal from July 1-5. I have enjoyed participating in past congresses and look forward to attending this one on Canadian soil. The theme – Nurses Together: A Force for Global Health – provides optimism amidst troubling times for the profession and the world. I expect to hear perspectives on current global health challenges and examples of solutions to common issues: nursing retention, Sustainable Development Goals and contributions to achieving UHC. There will be symposia profiling national nursing associations and their activities, plenary sessions, a student assembly, posters and concurrent presentations.

Another feature is the Policy Cafés – highly informative and interactive as I observed in Singapore in 2019. For this congress ICN describes them as: “Located in the exhibition hall, the two Cafés give the opportunity for small group discussion with a panel of experts on a key ICN policy or priority topic. Arranged in an informal setting, the Cafés allow delegates to ask in-depth questions and interact with keynote speakers.” For registration and further details, please visit the ICN Congress Site and follow updates on social media.

By Nora Whyte – February 22, 2023

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

Resources

UHC 2030 Coalition: Taking Action for Universal Health Coverage.

UHC 2023 Coalition: Universal Health Coverage Message Sheet for 2023.

World Health Organization (2022). Fact Sheet on Universal Health Coverage.

Nurses for Peace

ICN Campaign: Nurses for Peace

The International Council of Nurses (ICN) has launched a #NursesforPeace social media campaign to join nurses around the world in solidarity with the nurses of Ukraine.

ICN in partnership with the European Federation of Nurses Associations (EFN) and the European Forum of National Nursing and Midwifery Associations (EFNNMA) issued a powerful statement on March 3, 2022. Speaking on behalf of the global nursing community, they condemn the illegal invasion of Ukraine and call for an immediate ceasefire.

ICN is encouraging nurses around the globe to participate in the social media campaign and to add our support by signing the statement.

Thank you to ICN and European partners for your strong leadership at this critical moment and for demonstrating support for the Ukrainian people in this call for humanitarian action. For updates and suggested actions, please visit the ICN website.

#NursesforPeace

By Nora Whyte – March 3, 2022

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

Year in Review: 2021

ICN Congress

A highlight of 2021 was the opportunity to participate in the International Council of Nurses (ICN) Congress, held in a virtual format for the first time. The ICN Board and Staff team along with congress partner Emirates Nursing Association did an outstanding job of hosting the three-day event attended by 5,000 nurses and guests from around the globe. Speakers and participants added to the richness of the discussions on key topics relevant to nursing today and conveyed the sense of urgency on workforce issues and equity in global health. Among the important documents discussed was the Global Strategic Directions for Nursing and Midwifery 2021–2025 released in April 2021 by the World Health Organization. Four focal areas for health systems – education, jobs, leadership and service delivery – were important strategic directions covered in congress sessions.

I enjoyed the daily keynote presentations and the continuity provided by ICN leaders who conveyed the enthusiasm and spirit I had experienced at past congresses. However, I did miss the informal social gatherings and memorable encounters with nurses from other countries at congresses in Singapore (2019), Barcelona (2017) and Durban (2009).

Prior to the congress, I was pleased to continue my collaboration with Patrick Chui and Susan Duncan in planning a presentation delivered by Patrick as a pre-recorded oral concurrent session. The presentation drew on previous work and explored policy advocacy leadership by Canadian nursing organizations using a current example of COVID-19 vaccine equity. We discussed ways in which nursing organizations demonstrate policy advocacy leadership in highly complex and evolving contexts. In our conclusion we proposed areas of research that will be useful in generating knowledge to strengthen nursing organizations’ influence on health systems and policy.


Professional Development Highlights

Webinars were the way to go for professional development this year. I enjoyed sessions organized by the Canadian Nurses Association throughout 2021 and the Annual Marion Woodward Lecture hosted by UBC School of Nursing in November. A stimulating session in December was hosted by the International Collaboration for Community Health Nursing Research (ICCHNR): Dr. Barbara Stilwell delivered the annual Lisbeth Hockey Lecture on The Power of the Nursing Narrative. I liked Barbara Stilwell’s call to nurses: “Let’s power together” as she concluded her lecture. Thank you to the organizers and speakers for contributing to my learning and thinking during the past year.

A New Roadmap

Looking to this new year and beyond, the WHO Regional Office for Europe has published Building Better Together: Roadmap to Guide Implementation of the Global Strategic Directions for Nursing and Midwifery in the European Region.  As noted in the foreword by Hans Kluge, WHO Regional Director for Europe, “…we will work over the next five years to ensure that nurses and midwives have the capacity to contribute to key areas of public health, primary care, long-term care and post-COVID-19 recovery. We will put this into practice through relevant education, improved working conditions, the promotion of leadership opportunities and clear career pathways.” (WHO, 2021, p. v).  Taking into account regional and global policy contexts, it lays out key directions and monitoring mechanisms.  It’s an excellent resource that may serve as a guide for other regions to follow.

I end my year in review comments with a special note of appreciation to all the colleagues who continue to involve me in fascinating projects and who stay in touch through regular email exchanges and on social media. Thank you to my Twitter followers!

By Nora Whyte – January 4, 2022

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

Public Health and Climate Change

The COP26 conference opens in Glasgow on October 31, 2021 and is generating considerable interest in the weeks leading up to the event. Officially known as the 2021 United Nations Climate Change Conference, it is the 26th UN Climate Change conference. As explained on the COP26 website, “COP stands for Conference of the Parties – the signatories of the United Nations Framework Convention on Climate Change (UNFCCC) – a treaty agreed in 1994 which has 197 Parties (196 countries and the EU).”

Telegraph Cove, Vancouver Island, BC – August 2021

It is heartening to see the growing public awareness of climate change impacts and the sense of urgency being expressed this year. Leading health organizations have formed coalitions to advocate for climate action. A recent open letter – Healthy Climate Prescription – issued by the Global Climate and Health Alliance (a coalition of organizations representing 45 million health professionals) is a good example of this important collaboration. Describing the climate crisis as “the single biggest health threat facing humanity” the authors of the letter call on world leaders to deliver on climate action. Among the key demands listed are: “a rapid and just transition away from fossil fuels; for high income countries to provide the promised transfer of climate funds; and for pandemic recovery investments to support climate action and reduce social and health inequities.” Likewise, leading international health journals have published a strong editorial that appeared in multiple journals in September with a vital message: “Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.”  

The annual Lancet Countdown: Tracking Progress on Health and Climate Change report was released on October 21, 2021. Key findings are presented in five domains: 1) climate change impacts, exposures, and vulnerabilities; 2) adaptation, planning, and resilience for health; 3) mitigation actions and health co-benefits; 4) economics and finance; and 5) public and political engagement. Indicators are provided under each of the domains to give a quick view of changes since the previous report. 

In Canada, the Canadian Association of Nurses for the Environment (CANE-AIIE) has been active since 2009. Their website features articles, presentations, and campaigns. CANE was among the Canadian signatories to the Healthy Climate Prescription letter, along with the Canadian Nurses Association, Canadian Medical Association, Canadian Public Health Association, and other organizations. I found CANE’s definition of planetary health quite helpful in thinking about the health of populations and the natural world:

Planetary health is a recognition of the fact that human health depends on healthy natural environments/ecosystems, and moreover, that we as a civilization find ourselves at a tipping point. We have depended on our natural systems to promote human health to the point where the human population is healthier than ever before, but to achieve this, we have exploited the planet at an unprecedented rate. If we want to continue to safeguard human health, we also need to maintain the health of the planet and its natural systems on which we depend (CANE website, n.d.).

Nurses are being called upon to use our individual and collective influence. Writing in the International Nursing Review, Dr. Pamela Mitchell (2021) offers a thoughtful piece on Nursing’s mandate in climate change. She notes that nurses have written about climate change in the context of the UN Sustainable Development Goals, and now urges collective advocacy to move our focus to climate justice and equity.

Dr. Sally Thorne’s recent editorial in Nursing Inquiry, Awakening to the climate emergency, is a fitting reminder to nurses to pay attention to planetary health. As Editor-in Chief, she anticipates an increase in manuscripts on “a nursing response to the climate crisis” as we take up a shared goal (Thorne, 2021).

I believe that events of recent years are awakening us to the urgency to act as part of our organizations, coalitions, and nations in the quest for climate justice.

Post COP26 Update: The Global Climate and Health Alliance provided an assessment of what was achieved and what work remains. There is positive news in COP26’s Glasgow Climate Pact “that re-commits governments to limiting temperature rise to 1.5C, in line with the most recent science” with concern about the lack of substance in the countries’ commitments. Read more in the media release from Glasgow dated November 13, 2021.

The International Council of Nurses issued a strong statement on the final day of COP26: “ICN is calling for nurses and other healthcare workers to be included at the centre of climate change policymaking, underscoring that climate change is a health issue. As COP26 closes and leaders look ahead to COP27 next year, ICN says it is more important than ever that the voice of health professionals is heard on the climate change debate because if nothing changes nurses and health systems will suffer the consequences.” See full media release (November 12, 2021).

By Nora Whyte – October 24, 2021 (Updated November 22, 2021)

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

References:

Mitchell, P.H. (2021). Nursing’s mandate in climate change. International NursingReview, 68, 279– 280. https://doi.org/10.1111/inr.12704

Thorne, S. (2021). Awakening to the climate emergency. Nursing Inquiry, 28: e12459. https://doi.org/10.1111/nin.12459