Health For All is a shared responsibility, and parliaments are situated crucially at the meeting point of health, governance and accountability
The right to health was established by the Universal Declaration of Human Rights and has been enshrined in many international and national frameworks. However, its implementation has been unequal, with vulnerable and marginalised populations disproportionately affected by ill health and facing significant obstacles to accessing health care.
The Covid-19 pandemic has affected people’s livelihoods and education prospects, increasing poverty, malnutrition and inequalities. The consequences for the societies and economies of countries have been so far-reaching that response and recovery measures have often had an economic character. Beyond science and evidence of the disease itself, the political response has shaped the trade-offs between the health sector and the economy, and the allocation of resources determining sectors and groups to be prioritised. Within this context, it is important not to lose sight of the right to health. In 2019, the Inter-Parliamentary Union, bringing together 178 national parliaments, adopted a landmark resolution on universal health coverage that called on parliaments to ensure the right to health in law and in practice. This means not only enshrining this fundamental right into national constitutions and legislation, but also removing remaining barriers to access to health – be they legislative, financial, cultural or others.
The role of parliaments
Parliaments can ensure universal health coverage is high on political agendas in their countries, support legislation that expands access to priority health interventions and ensure that relevant parliamentary committees address health financing issues to prioritise health in their annual budgets. Reports from parliaments in 2020 and 2021 show a mixed picture. They highlight disruptions of essential health services such as immunisation and maternal health services, as well as parliamentary work on universal health coverage, due to the diversion of attention and resources. Health equity was a major challenge, including for countries with established health systems. The pandemic further increased inequalities, including through misinformation and inequitable distribution of vaccines. However, parliaments have also been stepping up to the challenge, remaining committed to universal health coverage and the right to health. Legislation is being debated or passed in different countries to improve financial protection for accessing healthcare services. Parliaments are further conducting inquiries into their countries’ Covid-19 response from the human rights and gender perspectives.
The IPU pays particular attention to women’s, children’s and adolescents’ health as these groups globally face considerable social, economic and cultural challenges that have profound implications for their health and well-being, with significant variances in health status between and within countries. Although the translation of political commitment into legislative and policy frameworks is an essential first step, equity is not automatically achieved with the implementation of policies and strategies for universal health coverage. Parliamentarians must play a robust role in identifying and targeting those who are being left behind by complementing official data through engagement with communities and local stakeholders to assess the impact of existing laws and policies. Parliamentarians can and must further ensure that the needs and concerns of women, children and adolescents, who often do not have a political voice, feed into decision-making processes. Making parliaments more gender sensitive includes strengthening instruments and mechanisms for mainstreaming gender into law-making and budgeting, and also increasing women’s political participation. When only about 26% of parliamentarians worldwide are women, with slight increases over the years mainly due to well-designed quotas, half the world’s population remains under-represented.
Instruments in place
All the instruments to ensure the right to health are in place at the global level through human rights frameworks, the 2030 Agenda for Sustainable Development, universal health coverage and other health commitments. In spite of this, Health For All remains a promise. The IPU continues to support parliaments to strengthen their capacity to carry out their many important roles in serving and representing diverse constituents, holding governments accountable, and passing and resourcing legislation to ensure the well-being of their people. This means promoting equal representation of men and women and political participation of youth for more inclusive decision-making; reiterating the centrality of the 2030 Agenda as the global framework to implement recovery plans that deliver social and environmental sustainability; and promoting dialogue at the national and global levels to build solidarity and share effective strategies for better health outcomes. National parliaments are leading the way: in 2021, the Parliament of Uganda passed the National Health Insurance Scheme Bill to address high rates of out-of-pocket expenditures; Australia prioritised investment into women’s health to improve gender equity and health outcomes for women and girls; and Thailand’s parliamentary Committee on Public Health started an investigation into people’s rights under universal health coverage to make policy recommendations on pressing public health challenges, to name just a few examples. Much more needs to be done.
Health For All cannot be achieved by one actor alone – it is a shared responsibility, and parliaments are crucially placed at the interface of health, governance and accountability.