Since a year or two, perhaps three, almost all international conferences about global health discuss Universal Health Coverage, the new battle cry of the WHO.
But here, at the AIDS 2012 conference in Washington DC, Universal Health Coverage is not a big issue. There are about 200 sessions at this conference, and not one of them includes Universal Health Coverage in its title. (OK, there was a satellite session organized by Management Sciences for Health about “Beyond MDG 6: HIV and Chronic NCDs: Integrating Health Systems Towards Universal Health Coverage”.) It looks as if the worlds of UNAIDS’ New Investment Framework and WHO’s Universal Health Coverage are two different worlds; it looks as if the ‘historic’ letter of agreement between WHO and UNAIDS is not about Universal Health Coverage.
What’s going on here? Are the AIDS activists wearing blinders? In his opening address of the conference, Michel Sidibé (the UNAIDS executive director), said this: “This is also our best opportunity to take AIDS completely out of isolation, tapping into its social movements, leveraging AIDS resources, and using the amazing delivery platforms we have built to deliver not just for AIDS, but for all of health and development.” How serious is this, if UNAIDS does not explicitly support Universal Health Coverage? Surprisingly, however, even Margaret Chan (Director-General of the WHO) did not mention Universal Health Coverage in her statement at the WHO satellite symposium to this conference.
The truth is that although Universal Health Coverage could have the potential to unite the AIDS movement and other health movements, it contains a major ambiguity that prevents it from being that uniting force. Universal Health Coverage sounds like Health for All by the year 2000 in a new dress. Richard Horton of the Lancet recently tweeted that “Universal Health Coverage is going to be Margaret Chan’s Health for All”. And many AIDS activists have not forgotten the fatal flaw in the Declaration of Alma Ata, the line that says: “Primary health care is essential health care … made universally accessible to individuals and families in the community … at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.” For people living with AIDS in low-income countries, that was a death sentence – and also a disingenuous way of ignoring how the poverty of some is related to the wealth of others, and of presenting a total lack of global solidarity as an encouragement of national emancipation.
If Universal Health Coverage is to become the uniting force, it will have to be totally unambiguous about its aim for global social justice and its willingness to demand and rely on global solidarity.
It will require some serious efforts to clarify the intentions behind the battle cries from the Universal Health Coverage movement and the AIDS movement. Yet, their possible union is also a tremendous opportunity. The legacy of the AIDS movement would be a truly universal Universal Health Coverage, based on human rights and corresponding human (national and international) responsibilities. And the Universal Health Coverage could take the fight against AIDS out of its exceptionality/isolation – were it is, in my opinion, doomed to slide backwards. The combination of both could be transformative.