Assessing the universal health coverage target in the Sustainable Development Goals from a human rights perspective.

Audrey R Chapman

doi:10.1186/s12914-016-0106-y

Abstract

BackgroundThe UN’s Sustainable Development Goals (SDGs), adopted in September 2015, include a comprehensive health goal, “to ensure healthy lives and promote well-being at all ages.” The health goal (SDG 3) has nine substantive targets and four additional targets which are identified as a means of implementation. One of these commitments, to achieve universal health coverage (UHC), has been acknowledged as central to the achievement of all of the other health targets. As defined in the SDGs, UHC includes financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all.DiscussionThis article evaluates the extent to which the UHC target in the SDGs conforms with the requirements of the right to health enumerated in the International Covenant on Economic, Social and Cultural Rights, the Convention on the Rights of the Child, and other international human rights instruments and interpreted by international human rights bodies. It does so as a means to identify strengths and weaknesses in the framing of the UHC target that are likely to affect its implementation.SummaryWhile UHC as defined in the SDGs overlaps with human rights standards, there are important human rights omissions that will likely weaken the implementation and reduce the potential benefits of the UHC target. The most important of these is the failure to confer priority to providing access to health services to poor and disadvantaged communities in the process of expanding health coverage and in determining which health services to provide. Unless the furthest behind are given priority and strategies adopted to secure their participation in the development of national health plans, the SDGs, like the MDGs, are likely to leave the most disadvantaged and vulnerable communities behind.

Highlights

The UN’s Sustainable Development Goals (SDGs), adopted in September 2015, include a comprehensive health goal, “to ensure healthy lives and promote well-being at all ages.” The health goal (SDG 3) has nine substantive targets and four additional targets which are identified as a means of implementation
UHC receives special attention in the Declaration for Transforming Our World endorsed by heads of government that precedes the identification of the SDGs: UHC is linked with the central commitment in the SDGs to leave no one behind: “To promote physical and mental health and well-being, and to extend life expectancy for all, we must achieve universal health coverage and access to quality health care
This article evaluates the extent to which the UHC target in the SDGs conforms with the requirements of the right to health as enumerated in the International Covenant on Economic, Social and Cultural Rights [8] (ICESCR) and the Convention on the Rights of the Child [9] and interpreted in key documents, the United Nations Committee on Economic, Social and Cultural Rights in its 2000 general comment interpreting the right to health [10]

Summary

Discussion

Overlap of UHC with the right to health As noted, under some circumstances the goal of universal health coverage can be considered to be an expression of the right to health. Even though the SDGs have a goal to reduce inequalities within and between countries (Goal 10), this principle does not have a health component Nor is it applied to the implementation of the SDGs. Without an explicit commitment to confer priority on poor and disadvantaged individuals and communities and in the absence of a requirement to monitor targets on a disaggregated basis, low and middle-income countries seeking to improve their health coverage rates are likely to do so in the easiest and least expensive manner by focusing efforts in their more developed areas where there is already health infrastructure in place. In contrast with the MDGs, the SDGs follow from the premise that each country has primary responsibility for its own economic and social development [66]

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