Ambitious vision: how does the UK rebuild its reputation as a global health champion?

UK health spending has dwindled in recent years, hampering Britain’s status as a champion of health for all.

Action for Global Health’s Stocktake Review is a blueprint through which the UK government can regain its position as champion of global health.

To quote Stocktake Review lead author Elaine Green: “achieving health for all requires leadership and commitment from all governments, including the UK. The Stocktake Review provides a clear roadmap and recommendations for the UK to lead the way in ensuring that everyone, everywhere, has access to quality, affordable healthcare.”

An era-defining general election is drawing closer, presenting the perfect opportunity for this leadership to come to the fore. In its first 100 days, the new government can seize the initiative by implementing the report’s recommendations and building a more equitable future. With the world in the grip of colliding crises, the stakes could not be higher.

These recommendations include:

• Promote an ambitious vision for achieving universal health coverage (UHC).
• Appoint a Special Envoy for Universal Health Coverage to ensure that groups that have been marginalised have access to health services.
• Increase support to national strategies advancing UHC, ensuring they are reaching the furthest behind first.

The report sets out an ambitious vision. While it is recognised that recent global health position papers contain encouraging signs – namely a strong focus on global health equity – they lack the financial and programmatic backing to achieve their objectives. The UK government must take the bold steps necessary to achieve a world where all people have access to the healthcare they need, when and where they need it.

One pertinent example concerns the stark lack of funding and programming for non-communicable diseases (NCDs). This is despite NCDs affecting 41 million people a year, 71% of whom live in low- and middle-income countries. If the UK is truly serious about addressing health inequities, tangible action on NCDs, themselves rooted in inequalities in social conditions, would be evident.

But health spending cuts have impacted all manner of areas – from water, sanitation and hygiene (WASH) to sexual and reproductive health – with one shared outcome: a heavy toll on equity. The Foreign, Commonwealth and Development Office’s own Equalities Impact Assessment makes this abundantly clear when it states that “there will be a significant reduction in the number and size of targeted programme activities aimed at reaching those furthest behind – including women, girls and people with disabilities”.

Rather than interrogating the reasons for this disjunct, the Stocktake Review offers solutions. Taken together, these solutions form an ambitious vision through which the UK can address its shortcomings and advance the universal right to health.

The importance of universal health coverage

The story of Matrika Prasad Devkota brings the importance of UHC into sharp focus. Now the chairperson of KOSHISH Nepal, an organisation that promotes mental health, Matrika began struggling with severe and prolonged mental distress at the age of 15. In a society where awareness was scarce it was a lonely battle, compounded by discrimination and poverty.

“I firmly believe that if I had access to such support when I was struggling, my experience would have been vastly different,” says Matrika. “At my lowest point, I felt utterly alone and believed that nobody could understand what I was going through due to the stigma surrounding mental health.”

The hardship Matrika faced inspired him to work to break the silence and fight against the social stigma associated with mental health problems. His story underscores the importance of everyone, everywhere having access to quality, affordable healthcare.

This, in essence, is the goal of the Stocktake Review. Kamala Poudel, Program Officer at KOSHISH Nepal and Stocktake Review Advisory Group Member, describes the review as aiming to “ensure an oasis in the mirage of life of those living in poverty across the globe. If the UK commits to universal health coverage, other high-income countries could also be pleaded [with] to [make] similar commitments.”

How we achieve it

After analysing the current picture, the Stocktake Review charts a route forward. It recommends that a Special Envoy for UHC is appointed. This is a smart move for numerous reasons. By appointing a specified figure, UHC will remain a focus rather than being lost amid competing priorities. It is also conducive to accountability and progress tracking, helping to match words with actions.

The report envisages the Special Envoy role as one that “draws on pride in our own NHS”. This centres the concept of UHC within a UK context, dovetailing it with one of the UK’s finest national achievements, something that is critical for securing cross-party buy-in. That the NHS constitutes a shining example of UHC is too easily overlooked. The Stocktake Review provides a timely reminder, cementing the importance of health for all within the public consciousness.

A further recommendation is for the UK government to increase support to national strategies advancing UHC, ensuring they reach the furthest behind first. This adds crucial weight to the report’s ambitious vision by translating it into actionable steps. There is little worth in grand plans if they lack the substance to make them a reality – a recurring theme in the report. By committing equitable funding to progressive initiatives, the UK will take a major leap forward.

Above all, the Stocktake Review is a reset moment. A moment for taking stock of the UK’s role in global health and forging a path towards truly universal health coverage. As the UK heads towards its own reset moment on 4 July, the timing could not be better. Even more so given the many threats to global health, from conflict to climate change. Through the report’s ambitious vision, the incoming government is presented with achievable goals and practical steps. It is now time for progress.