Last updated August 30, 2023
Written by: Molly Moss, Global Health Policy Officer, United Nations Foundation
Research support by: Camden Malone, Global Health Policy Associate, United Nations Foundation
The 78th session of the United Nations General Assembly (UNGA) in New York in September will feature three greatly anticipated high-level meetings on global health topics. The meetings will focus on pandemic prevention, preparedness, and response (PPPR), universal health coverage (UHC), and the fight against tuberculosis (TB) and will take place on September 20, 21, and 22, respectively. At these convenings, Heads of State and Government and other senior leaders will be asked to signal their commitments to policy, financing, and partnership advancements to address these complex and pressing global challenges.
The meetings also provide a moment for three political declarations (on PPPR, UHC, and TB) to be approved by UN Member States. Though not legally binding agreements, political declarations generated at the UN can significantly impact the trajectory of health policy for years to come, both because they align all Member States on common purpose and priority, and because they are tools for advancing national and international accountability to progress.
The scope of ambition this year’s political declarations on health will express – and the extent to which they will reflect some of the hard-earned lessons of the COVID-19 pandemic and the broader imperative of the Sustainable Development Goals (SDGs) – is yet to be seen. The challenging geopolitical context makes it difficult to predict the final content of the political declarations. However, a look at the rich history of such processes in New York provides some useful points of reference.
A Brief History of UN High-Level Meetings on Health
The UN’s work on health diplomacy has historically been seated at the World Health Organization in Geneva, Switzerland, where ministers of health gather each year at the World Health Assembly. However, some health issues are so complex and urgent they require the involvement of many parts of government, not just ministries of health. Crisis situations like HIV/AIDS in the mid-1990s and multisectoral challenges like Antimicrobial Resistance demand the attention of heads of state and government. Since world leaders traditionally convene each year in New York for UNGA, it is a useful forum to utilize when specific health challenges must be elevated to the highest level of government.
There are no specific criteria for whether a health issue is taken up at the UN in New York. Usually, a group of Member State champions will propose the idea and work to generate support for it. Ultimately, only the Member States can make the decision to hold a high-level meeting, but civil society advocates and other stakeholders often play a significant role in pressuring the membership to take on a new health-related workstream.
The 2001 UNGA special session on HIV/AIDS was the genesis of health-related meetings in New York and was a watershed moment for the fight against HIV/AIDS. At the time, the HIV/AIDS epidemic was considered a state of emergency in sub-Saharan Africa, and the millions of infections around the globe – primarily in low-income countries – demanded exceptional national and international action. The Declaration of Commitment on HIV/AIDS adopted during the special session identified, among other things, the need to reduce the cost of and increase access to treatment. On the margins of the meeting, several major pharmaceutical companies announced steep price cuts for drugs for severely-affected countries. The Assembly also supported the establishment of a Global HIV/AIDS Health Fund (later renamed the Global Fund) to finance an urgent and expanded response to the epidemic based on an integrated approach to prevention, care, support, and treatment. Six subsequent meetings on HIV/AIDS were held from 2005 to 2021 to review progress made toward the 2001 declaration and facilitate the adoption of updated targets for reducing AIDS-related morbidity and mortality.
HIV/AIDS has been the subject of the greatest number of high-level meetings on health. Non-communicable diseases (NCDs), the number one cause of death and disability worldwide, was the next health-related issue to enter the New York diplomatic space with high-level meetings taking place in 2011, 2014, and 2018 and another scheduled for 2025. Within the past decade, an array of other health issues have made their way to New York, including Ebola (2014), antimicrobial resistance (2016 and 2024), tuberculosis (2018 and 2023), universal health coverage (2019 and 2023), global road safety (2022), and pandemic prevention, preparedness, and response (2023). The figure below depicts the proliferation of attention on an increasingly diverse range of health issues.
Impact of Successful High-Level Meetings
Though it is difficult to attribute specific global public health outcomes to the New York-based policy processes, there are instructive trends. In the HIV space, access to effective treatment has cut global AIDS-related deaths by 52% since 2010 and new HIV infections have declined by 59% since the peak of the epidemic in 1995, in line with commitments made through political declarations. Progress on HIV/AIDS is often highlighted as one of the significant achievements of the Millennium Development Goals (MDGs) and SDGs thus far.
High-level meetings can also spark new models of collective action and multilateral coordination to address complex health-related challenges. For example, with the High-Level Meeting on Antimicrobial Resistance (AMR) in 2016, Member States set in motion a process to establish new models of cooperation across the UN system through the Quadripartite Joint Secretariat on AMR and through novel stakeholder engagement mechanisms, like the Global Leaders Group and the Multistakeholder Partnership Platform. Even more recently in 2019, world leaders adopted the most comprehensive agreement on global health to date at the first High-Level Meeting on UHC. Following this, annual country commitments to UHC almost doubled between 2019 and 2021, though it’s important to acknowledge that setbacks associated with the COVID-19 pandemic have, in part, led to stagnation in that progress.
Another parameter by which a high-level meeting may be considered successful is how well it engages the actors that are instrumental in delivering the vision of the political declarations. Many, but not all of the high-level meetings held in New York have had a strong civil society presence surrounding the proceedings (e.g. the NCD Alliance, Stop TB Partnership, and UHC2030). These networks, and the myriad of other civil society and non-state actors who engage alongside and through them, push for evidence-based approaches, provide strong mechanisms for monitoring and accountability for unfulfilled commitments, and help measure the success of each high-level meeting. Their engagement throughout the process of developing the political declarations is an important step toward assuring their buy-in and support when it comes time to deploy their efforts against the agreed goals.
2023 – A Banner Year for Health
The frequency of health-related discussions at UNGA has been increasing, and 2023 is a banner year for health, with meetings on PPPR, UHC, and TB converging during High-level Week.
Each of these processes is mandated to conclude with the approval of a political declaration that is agreed by consensus (not decided by a vote). Member State delegations have been working throughout the summer to draft and agree on texts that include guiding principles, goals, and targets for each issue. This is no easy feat, especially amid continuing sensitivities related to the management of the COVID-19 pandemic and protracted divisions in the state of global political affairs. The TB and UHC processes have been able to model their work on the 2018 and 2019 declarations, respectively. The PPPR process does not have a baseline to work from and is further complicated by ongoing negotiations of a new pandemic accord and amendments to the International Health Regulations in Geneva.
As of this writing (less than a month from the start of UNGA 78), none of the three political declarations has been finalized. Member States will have to negotiate efficiently and skillfully in the coming weeks to close the gap on their positions and land an agreement by the third week of September. Going into the year, stakeholders were optimistic that this historic moment for health policy in New York would yield powerful new commitments on cross-cutting issues such as health equity, health workforce strengthening, and government accountability on financing for health. It will soon become clear whether these documents will capture and convey the high level of political support that many expect of them.
Galvanizing Ambition for a Safer, Healthier Future
Developing health policy at the global level is a complicated affair. It is subject to the influence of the powerful interests of national governments, which often disagree on the best approaches to solving difficult challenges. The call to action in each political declaration is meant, in part, to reflect a transformative vision for international cooperation on issues that cannot be solved by individual nation states alone. Though difficult, diplomacy is possible, and the long track record of ambitious work on HIV/AIDS is testament to this.
High-level meetings and their corresponding political declarations are important because they help countries justify key policy decisions and priorities, guide resource allocation and set specific targets for achievement. But governments can – and should – make domestic commitments and forge solution-oriented alliances outside the parameters of such high-profile convenings and agreements. Some political declarations have been scorned as the lowest common denominator to attain agreement from all countries, but it’s worth remembering that these agreements are not a ceiling on what governments can individually strive for and accomplish under their own sovereign authority.
Molly Moss covers policy issues related to global health governance, antimicrobial resistance, and Universal Health Coverage. Molly manages the Foundation’s official relations status with the World Health Organization and also supports engagement on health issues among UN Member States in New York. Prior to the UN Foundation, Molly worked for the Center for Global Health at the University of Colorado, focusing on immunization, pediatric infectious disease research, and research ethics. During her time at the University of Colorado, Molly earned her Master of Public Health in community and behavioral health. She holds a bachelor’s degree in medical anthropology from Hampshire College.
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