General Assembly High-Level Meeting Research Articles

Health outcomes of the G7 Hiroshima Summit: breaking the cycle of panic and neglect and achieving UHC

Health outcomes of the G7 Hiroshima Summit: breaking the cycle of panic and neglect and achieving UHC

Shaping Global Health Law through United Nations Governance: The UN High-Level Meeting on Pandemic Prevention, Preparedness and Response.

The United Nations (UN) General Assembly High-Level Meeting (HLM) on pandemic prevention, preparedness and response (PPPR) was a missed opportunity to bring high-level commitment and momentum to the global governance of health emergencies. Intended to bring much-needed attention to a policy issue that is rapidly slipping down the international agenda, the fraught diplomacy among member states, lack of consensus on key issues, and weak UN Political Declaration in New York foreshadow a difficult road ahead for upcoming negotiations under the World Health Organization (WHO) in Geneva. This column chronicles the evolving engagement of the UN in global health governance, examines the diplomatic process leading to the UN HLM on PPPR, and assesses the contributions and missed opportunities of its resulting Political Declaration.

Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): a cluster-randomised trial

Reaching the UN General Assembly High-Level Meeting on Tuberculosis target of providing tuberculosis preventive treatment to at least 30 million people by 2022, including 4 million children under the age of 5 years and 20 million other household contacts, will require major efforts to strengthen health systems. The aim of this study was to evaluate the effectiveness and cost-effectiveness of a health systems intervention to strengthen management for latent tuberculosis infection (LTBI) in household contacts of confirmed tuberculosis cases. ACT4 was a cluster-randomised, open-label trial involving 24 health facilities in Benin, Canada, Ghana, Indonesia, and Vietnam randomly assigned to either a three-phase intervention (LTBI programme evaluation, local decision making, and strengthening activities) or control (standard LTBI care). Tuberculin and isoniazid were provided to control and intervention sites if not routinely available. Randomisation was stratified by country and restricted to ensure balance of index patients with tuberculosis by arm and country. The primary outcome was the number of household contacts who initiated tuberculosis preventive treatment at each health facility within 4 months of the diagnosis of the index case, recorded in the first or last 6 months of our 20-month study. To ease interpretation, this number was standardised per 100 newly diagnosed index patients with tuberculosis. Analysis was by intention to treat. Masking of staff at the coordinating centre and sites was not possible; however, those analysing data were masked to assignment of intervention or control. An economic analysis of the intervention was done in parallel with the trial. ACT4 is registered at ClinicalTrials.gov, NCT02810678. The study was done between Aug 1, 2016, and March 31, 2019. During the first 6 months of the study the crude overall proportion of household contacts initiating tuberculosis preventive treatment out of those eligible at intervention sites was 0·21. After the implementation of programme strengthening activities, the proportion initiating tuberculosis preventive treatment increased to 0·35. Overall, the number of household contacts initiating tuberculosis preventive treatment per 100 index patients with tuberculosis increased between study phases in intervention sites (adjusted rate difference 60, 95% CI 4 to 116), while control sites showed no statistically significant change (-12, -33 to 10). There was a difference in rate differences of 72 (95% CI 10 to 134) contacts per 100 index patients with tuberculosis initiating preventive treatment associated with the intervention. The total cost for the intervention, plus LTBI clinical care per additional contact initiating treatment was estimated to be CA$1348 (range 724 to 9708). A strategy of standardised evaluation, local decision making, and implementation of health systems strengthening activities can provide a mechanism for scale-up of tuberculosis prevention, particularly in low-income and middle-income countries. Canadian Institutes of Health Research.

Building a tuberculosis-free world while responding to the COVID-19 pandemic

Building a tuberculosis-free world while responding to the COVID-19 pandemic

Annual Primary Care 2030 Convening: Creating an Enabling Ecosystem for Person-Centered Primary Healthcare Models to Achieve Universal Health Coverage in Low- and Middle-Income Countries.

Background:The 2019 United Nations General Assembly High-Level Meeting on Universal Health Coverage and the 2018 Declaration of Astana reaffirm the highest level of political commitment by United Nations Member States to achieve access to health services and primary healthcare for all. Both documents emphasize the importance of person-centered care in both healthcare services and systems design. However, there is limited consensus on how to build a strong primary healthcare system to achieve these goals.Methods:We convened a diverse group of global stakeholders for a high-level dialogue on how to create a person-centered primary healthcare system, using the country examples of the Republic of Kenya and the Socialist Republic of Vietnam. We focused our discussion on four themes to enable the creation of person-centered primary healthcare systems in Kenya and Vietnam: (1) strengthened community, person and patient engagement in subnational and national decision making; (2) improved service delivery; (3) impactful use of innovation and technology; and (4) meaningful and timely use of measurement and data.Findings:Here, we present a summary of our convening’s proceedings, with specific insights on how to enable a person-centered primary healthcare system within each of these four domains.Conclusions:Following the 2019 United Nations General Assembly High-Level Meeting on Universal Health Coverage and the 2018 Declaration of Astana, there is high-level commitment and global consensus that a person-centered approach is necessary to achieve high-quality primary healthcare and universal health coverage. We offer our recommendations to the global community to catalyze further discourse and inform policy-making and program development on the path to Universal Health Coverage by 2030.

Building a law and NCDs workforce: A necessity for global cancer and NCD prevention and control

The rise of cancer and other noncommunicable diseases (NCDs)as priorities for global health and development was emphatically confirmed by their inclusion last year in the 2030 Sustainable Development Goals (SDGs) [1], and accompanying Financing for Development Accord, four years after the landmark 2011 UN General Assembly High-Level Meeting on the Prevention and Control of NCDs.

Making Effective Use of Law in the Global Governance of NCD Prevention

After long being neglected as a global health, economic and political priority, the case for attention and action on noncommunicable diseases (NCDs) has become irresistible. The last few years have seen the steady rise of NCDs on the global agenda, highlighted by the landmark September 2011 United Nations General Assembly High-Level Meeting on the Prevention and Control of NCDs and the substantial series of follow-up activities that the High-Level Meeting has generated. The effective use of law is indispensable to global NCD governance, particularly in addressing the key risk factors of tobacco, alcohol and unhealthy foods, where efforts to promote and protect health conflict with the interests of powerful commercial operators. As Part I of this Chapter notes, measures adopted are liable to face legal challenge by these powerful interests, whether in domestic courts or in international fora. Their lawfulness is being adjudicated upon in non-health fora, in which health norms, instruments and values are not the predominant considerations. In addition to the uncertainty that such challenges — or their threat (or mere possibility) — create, they can dramatically increase the implementation costs of measures that would otherwise be inexpensive. Part II sets out the current political and institutional context of global NCD governance, briefly sketching its evolving architecture. Part III locates the challenges of global NCD governance within three of the broader themes of global health governance, namely its ever-increasing complexity and the inter-relationships between global health and foreign policy, and global health and development. Part IV focuses on the role of law, outlining both its use as a proactive intervention and its role in setting the context in which power is exercised. It offers a number of observations relating to the important role of legal capacity within the NCD workforce, and through policy research, development and implementation; the power of treaties and of non-binding instruments; challenges involved in dealing with existing international trade and investment treaties; the need for deference to public health imperatives and governments’ regulatory choices in trade and investment adjudication; and managing the similarities and differences between tobacco, alcohol and unhealthy foods within the NCD agenda. Part V offers some concluding thoughts. It suggests that the ‘law and NCD prevention’ endeavour requires speaking, listening and learning across different disciplines, which make sense of and explain the world in different ways. Interdisciplinary respect and patience are key to its success.

Communication strategies to help reduce the prevalence of non-communicable diseases: proceedings from the inaugural IFIC Foundation Global Diet and Physical Activity Communications Summit.

Non-communicable diseases (NCDs), which include cardiovascular disease, cancer, and diabetes, all of which are associated with the common risk factors of poor diet and insufficient physical activity, caused 63% of all deaths globally in 2008. The increasing discussion of global NCDs, including at the 2011 United Nations General Assembly High-level Meeting on the Prevention and Control of Non-communicable Diseases, and a request for multi-stakeholder engagement, prompted the International Food Information Council Foundation to sponsor the Global Diet and Physical Activity Communications Summit: “Insights to Motivate Healthful, Active Lifestyles” on September 19, 2011, in New York City. The Summit brought together a diverse group of stakeholders, representing 34 nations from governments; communication, health, nutrition, and fitness professions; civil society; nonprofits; academia; and the private sector. The Summit provided expert insights and best practices for the use of science-based, behavior-focused communications to motivate individuals to achieve healthful, active lifestyles, with the goal of reducing the prevalence of NCDs. Presented here are some of the highlights and key findings from the Summit.

Action on social determinants of health is essential to tackle noncommunicable diseases

Noncommunicable diseases cannot be effectively addressed without action on social determinants of health. Without addressing social inequalities and the conditions in which people are born, grow, live, work and age, along with the reasons that health systems work better for some population groups than for others – that is, adopting a social determinants approach – prospects for reversing the noncommunicable diseases epidemics are poor.1 This year’s United Nations General Assembly High-Level Meeting on Prevention and Control of Noncommunicable Diseases (in New York) and the World Conference on Social Determinants of Health (in Rio de Janeiro) provide a unique opportunity for progress. There may never be a better global platform for countries, civil society and international organizations to commit to a coherent social determinants approach to tackling noncommunicable diseases and other global priorities at local, national and global levels. In this context, we explain why a social determinants approach is essential for combating noncommunicable diseases, discuss what such an approach entails, and identify priority actions for the global community.

Combination prevention: a deeper understanding of effective HIV prevention

Evidence-informed and human rights-based combination prevention combines behavioural, biomedical, and structural interventions to address both the immediate risks and underlying causes of vulnerability to HIV infection, and the pathways that link them. Because these are context-specific, no single prescription or standard package will apply universally. Anchored in 'know your epidemic' estimates of where the next 1000 infections will occur and 'know your response' analyses of resource allocation and programming gaps, combination prevention strategies seek to realign programme priorities for maximum effect to reduce epidemic reproductive rates at local, regional, and national levels. Effective prevention means tailoring programmes to local epidemics and ensuring that components are delivered with the intensity, quality, and scale necessary to achieve intended effects. Structural interventions, addressing the social, economic, cultural, and legal constraints that create HIV risk environments and undermine the agency of individuals to protect themselves and others, are also public goods in their own right. Applying the principles of combination prevention systematically and consistently in HIV programme planning, with due attention to context, can increase HIV programme effectiveness. Better outcome and impact measurement using multiple methods and data triangulation can build the evidence base on synergies between the components of combination prevention at individual, group, and societal levels, facilitating iterative knowledge translation within and among programmes.

Universal Access to Antiretroviral Therapy: Are We Moving the Targets?

T hree years ago at a United Nations (UN) General Assembly High-Level Meeting on HIV/AIDS, the World Health Organization (WHO) declared the lack of access to HIV treatment a global health emergency. The WHO subsequently launched its ‘‘3 by 5’’ initiative on World AIDS Day 2003, aiming to place 3 million people in the developing world on antiretroviral therapy (ART) by the end of 2005. The Millennium Development Goals Report 2008 stated that, ‘‘by the end of 2007, 3 million of an estimated 9.7 million people in need of AIDS treatment in developing countries were receiving the drugs.’’ This is remarkable progress when compared to the 2003 figures, indicating that 300 000 had access to ART of the 6 million who were clinically eligible. Because the number 1 is infinitesimally greater than 0, this was surely good news for these 3 million people and their families. Progress was achieved through the combined efforts of country programs, the WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and global health initiatives such as the Global Fund to Fight AIDS, Tuberculosis & Malaria; the US President’s Emergency Plan for AIDS Relief (PEPFAR); and the Clinton HIV/AIDS Initiative (CHAI). Global camaraderie against this insidious disease is to be applauded. However, one must also be attentive to the needs of the 6.7 million people who did not gain access to ART and who may be asking, ‘‘Why not us?’’ Is this fair? The world is now focused on achieving universal access to HIV prevention and treatment, including ART, by 2010, as called for at the 2006 UN General Assembly High-Level Meeting on HIV/AIDS. Yet, as we advance this goal, it is important to remember that the world has unfortunately not delivered on many of its other similar promises, the WHOs ‘‘3 by 5’’ initiative being a case in point. One may also remember ‘‘Health for All’’ by 2000, and perhaps other time-delimited goals. As we contemplate the slow pace of progress with respect to achieving Universal Access by 2010, as well as the Millennium Development Goals and the likelihood of not achieving them by 2015, it is important that we spare a thought to the mechanisms by which we set these global goals. First, the elaboration of global goals should effectively involve those who would be responsible for their implementation. These include, but are not limited to, the district health teams, the communities, and the ministries of finance. Second, resources, including capacity, should be provided at the implementation level to ensure that the job is not only done but that similar and related jobs are done in the process and that they are flexible enough to be capable to respond to these needs over time. Finally, the monitoring and evaluation should be done in a transparent and neutral manner to ensure that lessons learned are truly fed back into the process. If done well, we would heed the Confucian dictum: ‘‘When it is obvious that the goals cannot be met, do not change the goals but rather modify the strategies.’’ Our experience in tracking health care reforms at the district level has confirmed that holistic districtbased strategies are most efficient at delivering people-directed initiatives. This would require that the short-term, project-based approach be traded for the more rational long-term development initiatives embraced by the Declaration of Alma-Ata. Five years after making the commitment, I believe that we have the wherewithal to provide ART for all who are in need of its lifesaving and life-enhancing From the University of Buea in Cameroon.