The UN General Assembly (UNGA) is the main decision-making body of the UN, representing 193 Member States.
In 2015, the UN adopted The 2030 Agenda for Sustainable Development (Sustainable Development Goals – SDGs), with 17 goals of which number 3 is to Ensure healthy lives and promote wellbeing for all at all ages, with an overarching goal of achieving Universal Health Coverage by 2030.
The UNGA frequently decides to organise High-Level Meetings to increase awareness and consensus among heads of state on important global issues for the good of people worldwide. Since 2011, the UNGA has held 3 High-Level Meetings on Noncommunicable Diseases (which include cancer), and one on Universal Health Coverage in 2019.
ESMO participates in UN high-level meetings on topics related to cancer, such as noncommunicable diseases which include cancer, and universal health coverage.
The UN agency for health is the World Health Organization (WHO). ESMO has ‘official relations’ status with WHO since 2013. ESMO supports the 2015 United Nation's Sustainable Development Goals, and the 2017 WHO Cancer Resolution which set targets for reductions of cancer deaths, access to quality essential health care, improved access to safe, effective, quality and affordable essential medicines and vaccines, and the achievement of universal health coverage by 2030.
Recent important UN decisions supported by ESMO are the 2018 UN Political Declaration on Non-communicable Diseases and the 2019 UN Political Declaration on Universal Coverage, which uphold the human right to health through the provision of quality health services that leave no one behind.
ESMO advocates for the needs of medical oncologists and cancer patients to be addressed in the 2023 UN Political Declaration on Universal Health Coverage
The Draft UN Political Declaration on Universal Health Coverage (UHC), published on 22 May 2023, reflects many of the ESMO asks for cancer care, including, continued and timely access to affordable essential health services, the establishment of interoperable disease-based registries, and for governments to prioritise the strengthening of referral systems from primary care.
Because the current text (OP5) of the draft UHC Declaration calls to ‘Strengthen referral systems between primary and other levels of care to ensure their effectiveness’, ESMO will continue to advocate for the wording of ‘other levels of care’ to specifically refer to ‘secondary and tertiary health care levels’, which is where the majority of cancer patients are treated.
Other sections of the Draft Declaration reflect ESMO’s consistent call for governments to include in their national UHC health benefit packages safe, affordable, effective and high-quality services for prevention, screening, diagnosis, treatment, rehabilitation, and palliative care for all NCDs, including cancer, to be delivered by an adequate, well-trained, and well-equipped workforce, in a way that does not cause financial harm to patients.
The final 2023 Political Declaration on UHC, is intended to build on the 2019 Political Declaration on UHC and aims to accelerate and intensify priority actions towards achieving Universal Health Coverage by 2030. As NCDs are responsible for 74 per cent of all deaths worldwide, and an estimated 1 in 5 people develop cancer over their life course, the acknowledgement of NCDs in the 2023 UHC Declaration as a priority area for action is welcome and timely. The Covid-19 pandemic further exacerbated challenges to health systems, and societies at large, resulting in a set back to the progress towards achieving UHC. At the current pace, up to one-third of the world’s population will remain underserved by 2030, and trends in financial protection of out-of-pocket costs for patients are worsening.
The draft 2023 Political Declaration will be subject to deliberation by Member States in June, and the final Declaration is due to be adopted on 21 September at the second UN High-Level Meeting on UHC in New York.
ESMO has raised awareness with the World Health Organization and the UN of ESMO’s cancer resources that can help support countries in their efforts to deliver the three strands of Universal Health Coverage:
- The ‘ESMO Global Curriculum in Medical Oncology’ can support training the necessary workforce to ‘increase population coverage’.
- The evidence-based ‘ESMO Clinical Practice Guidelines’ and ‘Pan-Asian Adapted Guidelines’ can support decisions to cost-effectively ‘expand essential health services’.
- The ‘ESMO-Magnitude of Clinical Benefit Scale’ can support countries to prioritize the use of cancer medicines to both improve health outcomes and ‘reduce the financial burden of health services’.
Together with WHO, ESMO has already assisted 7 WHO Member States deliver cost-effective cancer services in their Universal Health Coverage packages, and remains available to help others to do the same.
About Universal Health Coverage
- Universal Health Coverage means that everyone, everywhere, should have access to the health services, when and wherever they need them, without risk of financial hardship. It includes the full range of essential health services, spanning health promotion to prevention, treatment, rehabilitation and palliative care.
- Universal Health Coverage upholds the human right to health through the provision of affordable quality health services that leave no one behind.
- Universal Health Coverage is key to achieving sustainable and resilient healthcare systems, including access to cancer services, and avoiding delays and disruptions in healthcare services during health emergencies and pandemics.
- In 2019 the United Nations held its first High-Level Meeting on Universal Health Coverage. The outcome of that meeting was a Political Declaration indicating political commitment by Heads of State to achieving Universal Health Coverage by 2030.
- Achieving Universal Health Coverage was previously agreed by the UN in 2015 within the 2030 Sustainable Development Goals:
Target 3.8 “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
The High-Level Political Forum on Sustainable Development (HLPF) is the main United Nations platform for the follow-up and review of the 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs).
The theme of the 2021 Forum, held 6-15 July, was "Sustainable and resilient recovery from the COVID-19 pandemic that promotes the economic, social and environmental dimensions of sustainable development: building an inclusive and effective path for the achievement of the 2030 Agenda in the context of the decade of action and delivery for sustainable development". It focused on several SDGs including SDG Goal 3 on good health and well-being, and considered the interdependence of all of the SDG goals within the larger framework.
The Forum is held annually under the under the auspices of the United Nations Economic and Social Council (ECOSOC), the central coordinator of UN activities and overseer of the implementation of the UN SDGs for 2030. The overarching aim of SDG 3 on good health and well-being is the achievement of ‘universal health coverage’ by 2030. Of particular importance to ESMO are SDG 3 targets 3.4 and 3.8.
3.4: By 2030 reduce by one-third premature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing.
3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
As granted by ESMO’s ‘special consultative status’ with ECOSOC, ESMO submitted an official statement during the Forum. The ESMO statement expressed concern that the 2020 WHO Report on Cancer stated that only 12 countries are on track to achieve target 3.4 for cancer by 2030. To assist governments, ESMO noted its various resources that can support the reduction of premature cancer deaths such as:
- Over 80 evidence-based ESMO Clinical Practice Guidelines that set the standard of cancer care.
- An ESMO COVID-19 and Cancer Portal that includes recommendations for cancer treatment during the pandemic, patient and palliative care guides, and a call to action to prioritise COVID-19 vaccination for cancer patients.
- ESMO Recommendations on preventing and managing shortages of inexpensive essential cancer medicines used in the treatment of many cancers.
- The ESMO-Magnitude of Clinical Benefit Scale for the prioritisation of expensive innovative cancer medicines to frame appropriate use of limited public and personal resources.
The Forum discussions formed the basis for the outcome Ministerial Declaration, which was adopted and reaffirms countries’ commitments to implementing the 2030 UN Agenda on Sustainable Development. Regarding NCDs the Declaration calls for increased action to achieve universal health coverage and reduce premature mortality from non-communicable diseases through prevention and treatment, and assist low- and middle-income countries with NCDs, because only a few countries are on track to meet the target on reducing premature deaths from non-communicable diseases by one third by 2030.
On 23 September 2019, the UN held a High-Level Meeting to discuss and adopt a UN Political Declaration on Universal Health Coverage (UHC).
ESMO provided input to the UN Political Declaration on UHC by submitting an official statement during the UN multi-stakeholder hearing on universal health coverage on 29 April 2019. The ESMO statement supports universal health coverage for cancer patients based on ESMO’s commitment to health as a human right, not a privilege.
The ESMO statement requested that the United Nations Political Declaration on UHC state that "countries must guarantee their entire population ‘universal health coverage benefit packages’ that ensure financial protection for patients, and include a core set of comprehensive, safe, affordable, effective and quality cancer prevention, treatment, and palliative care services". This would contribute to reducing cancer deaths worldwide. It would also require that governments strengthen primary care, guarantee referral services to secondary and tertiary facilities, and maintain comprehensive cancer registries to measure progress.
For the 2019 UN High-Level Meeting on UHC entitled ‘Universal Health Coverage: Moving Together to Build a Healthier World’, held on 23 September 2019 in New York, ESMO issued an official statement that welcomed the meeting’s Political Declaration on UHC and called on governments prioritize high-impact investments in cancer care by accelerating implementation of the 2017 WHO ‘Cancer Resolution’ (WHA 70.12). ESMO also requested that countries pay for comprehensive essential cancer services within national UHC packages, which is currently lacking in many countries. WHO and UN documents note that:
- At least half of the world’s population lack access to essential health services.
- More than 800 million people spend at least 10% of their household income on health care.
- Out-of-pocket expenses drive almost 100 million people into poverty each year.
- At the current pace of health coverage, up to one-third of the population will remain underserved in 2030.
In its official statement, ESMO also raised awareness to countries around the world of its tools and resources that can support countries in achieving the 3 dimensions of UHC:
- The ESMO-ASCO Global Curriculum in Medical Oncology supports training the necessary workforce to ‘increase population coverage’.
- The evidence-based ESMO Clinical Practice Guidelines and Pan-Asian Adapted ESMO Guidelines can guide decisions to cost-effectively ‘expand essential health services’.
- The ESMO-Magnitude of Clinical Benefit Scale can help prioritize cancer medicines to frame appropriate use of limited public and personal resources to ‘reduce the financial burden of health services’.
The UN will hold another High-Level Meeting on UHC in 2023, supported by WHO progress reports in 2020 and 2022.
Universal health coverage (UHC) is founded on the 1948 United Nation’s Universal Declaration of Human Rights that states that health is a basic human right and everyone everywhere should be able to enjoy the highest possible attainable standard of health. It means that all people and communities can receive essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care, without suffering financial hardship.
The WHO focuses on three dimensions of UHC
- Percentage of the population covered by health services
- Reduction of the patient’s portion of direct costs for health services
- Number and quality of health services offered by the national health system
The United Nations (UN) adopted a UN Political Declaration on Non-communicable Diseases (NCDs) on 27 September 2018. Supported by advocacy efforts by ESMO and other societies, the Declaration includes a specific paragraph about cancer, which says that UN Member States will promote access to affordable diagnostic, screening, treatment and care as well as vaccines that lower the risk for cancer, as part of the comprehensive approach to its prevention and control, including cervical and breast cancers.
The UN Political Declaration on NCDs represents a major win for the oncology community. Its main goal is to lower health risks and to improve patient outcomes through Universal Health Coverage in order to reduce deaths from NCDs by 25% by 2025 and 33% by 2030. These are ambitious goals whose implementation will require the engagement of all stakeholders.
The UN Political Declaration complements the 2017 WHO ‘Cancer Resolution’ which is the reference document for actions by the WHO and its Member States across the entire continuum of cancer care.
As part of its global policy efforts, ESMO attended the 3rd United Nations High-level Meeting on NCDs in September 2018. ESMO submitted a statement to the UN Secretariat to raise awareness that 30 to 50% of cancer deaths can be avoided with investments in prevention, early detection, and cancer treatment, and that essential cancer medicines, vaccines, and opioids are affordable. The statement highlights the ESMO Magnitude of Clinical Benefit Scale as a tool to assist governments to prioritize expensive cancer medicines that have the highest clinical benefit for patients.
Before the 2018 UN High-Level Meeting on NCDs, ESMO and ASCO issued a joint public statement on cancer urging all UN Member States to make sure that cancer was included in the 2018 UN Political Declaration on NCDs.
In the joint statement, ESMO and ASCO advocated for the UN Member States to increase prevention, screening and early detection as well as to ensure the principle of ‘access for all’, which means making quality cancer services available to everyone who requires them.
The ESMO-ASCO statement was instrumental in achieving the inclusion of a specific text on cancer in the 2018 UN Political Declaration on NCDs.
During the 2018 UN High-Level Meeting on NCDs, Heads of State and Government reviewed progress their Member States made to reduce deaths from NCDs since the first UN meeting on the topic in 2011. Recent UN and WHO reports show that progress made to date is inadequate to avoid a preventable global health crisis.
The 2018 UN Political Declaration on NCDs addresses the need to strengthen health systems, improve access to safe, affordable, effective quality essential medicines and vaccines, and to properly plan for a well-trained and equipped oncology workforce to deliver optimal cancer care and achieve Universal Health Coverage. The Declaration reaffirms health as a basic human right and as the precondition for sustainable global development and achievement of the 2030 UN Sustainable Development Goals.
The UN General Assembly has held 3 High-level Meetings on the Prevention and Control of NCDs in 2011, 2014, and 2018. The UN Political Declarations from these meetings summarize the actions that governments commit to implement in order to reduce the burden of NCDs worldwide.
In 2011, the WHO transformed the UN commitments on NCDs into a WHO Global Action Plan on the Prevention and Control of NCDs 2013-2020, with voluntary targets countries commit to achieve by 2025 when the UN will hold another High-level Meeting on NCDs.
In 2014 the UN HLM on NCDs produced an UN Outcome Document on NCDs that set national time-bound commitments for 2015 and 2016 to develop multi-sectoral strategies to reduce NCD risk factors, improve care, and monitor progress.
The 2018 UN HLM on NCDs adopted a UN Political Declaration on NCDs that focused on measuring the progress countries achieved to meet their 2011 and 2014 goals and to accelerate the process to achieve those in 2030.
2018 publications by the WHO and The Lancet support countries to implement WHO and UN Resolutions and to understand the costs associated with achieving the goals:
- ‘Saving lives, spending less: a strategic response to noncommunicable diseases’, outlines the health and economic benefits of implementing the most cost-effective and feasible interventions (WHO Best Buys) to prevent and control NCDs in low- and middle-income countries. An additional investment of US$1.27 per person per year would reduce deaths from NCDs by 15%, save 8 million lives, produce a positive return on investment of US$7 for every $1 invested, and generate 350 billion in economic growth, all by 2030.
A healthier humanity: the WHO investment case for 2019-2023
- To provide a billion more people with universal health coverage
- To protect one more billion people from health emergencies
- To provide a further billion people with better health and well-being
- The Lancet article NCD Countdown 2030: worldwide trends in NCD mortality and progress towards SDG target 3.4 says that more than half of the world’s countries are not on target to reduce premature NCD mortality by 33% by 2030. The report is the first from NCD Countdown 2030, an independent annual monitor of progress on reducing the worldwide burden of NCDs. The NCD Countdown 2030 is a collaboration between the WHO, The Lancet, the NCD Alliance, the WHO Collaborating Centre on NCD Surveillance and Epidemiology at Imperial College London, and researchers and practitioners from all regions.