Political rationale, aims, and outcomes of health-related high-level meetings and special sessions at the UN General Assembly: A policy research observational study

BackgroundRecognising the substantial political weight of the United Nations General Assembly (UNGA), a UN General Assembly special session (UNGASS) and high-level meetings (HLMs) have been pursued and held for 5 health-related topics thus far. They have focused on human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS, 2001), non-communicable diseases (NCDs, 2011), antimicrobial resistance (AMR, 2016), tuberculosis (TB, 2018), and universal health coverage (UHC, 2019). This observational study presents a comprehensive analysis of the political and policy background that prompted the events, as well as an assessment of aims, approaches, and ultimate outcomes. Methods and findingsWe investigated relevant agencies' official documents, performed a literature search, and accessed international institutions' websites for the period 1990-2020. Knowledgeable diplomatic staff and experts provided additional information. Outcomes were evaluated from a United Nations perspective based on national and international commitments, and funding trends. Eliciting an effective governmental response through UNGASSs/HLMs is a challenge. However, increased international commitment was evident after the HIV/AIDS (2001), NCDs (2011), and AMR (2016) meetings. The more recent TB (2018) and UHC (2019) HLMs have received general endorsements internationally, although concrete commitments are not yet documented. Although attribution can only be hypothesized, financial investments for HIV/AIDS following the UNGASS were remarkable, whereas following HLMs for NCDs, AMR, and TB, the financial investments remained insufficient to face the burden of these threats. Thus far, the HIV/AIDS UNGASS was the only one followed by a level of commitment that has likely contributed to the reversal of the previous burden trend. Limitations of this study include its global perspective and aerial view that cannot discern the effects at the country level. Additionally, possible peculiarities that modified the response to the meetings were not looked at in detail. Finally, we assessed a small sample of events; thus, the list of strategic characteristics for success is not exhaustive. ConclusionsOverall, UNGASSs and HLMs have the potential to lay better foundations and boldly address key health challenges. However, to succeed, they need to (i) be backed by large consensus; (ii) engage UN authorities and high-level bodies; (iii) emphasise implications for international security and the world economy; (iv) be supported by the civil society, activists, and champions; and (v) produce a political declaration containing specific, measurable, achievable, relevant, and time-bound (SMART) targets. Therefore, to ensure impact on health challenges, in addition to working with the World Health Assembly and health ministries, engaging the higher political level represented by the UNGA and heads of state and government is critical.Author summary Why was this study done? Between 2001 and 2019, 5 health-related topics reached the United Nations (UN) General Assembly in the form of special sessions or high-level meetings: human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (2001), non-communicable diseases (NCDs) (2011), antimicrobial resistance (AMR) (2016), tuberculosis (TB) (2018), and universal health coverage (UHC) (2019).Tackling these issues requires not only a response to biomedical threats, but also interventions in society, health systems, and markets, and engagement of heads of state and government in what is one of the most important political fora today: the UN General Assembly.To our knowledge, a comprehensive observational analysis of processes, political aims and motivations, policies, and financial outcomes of these meetings is missing. What did the researchers do and find? We assessed the political process conducive to organisation of the above-mentioned meetings by looking at relevant documents of the UN and other global health agencies, and published literature. We identified how strong support from countries and civil society contributed to raising the visibility of and commitment to health challenges at the UN General Assembly level.We established 2 political criteria (national and international commitment) and 2 financial criteria (domestic and international investments) for evaluation of the UN event outcomes.Increased international commitment was evident after the HIV/AIDS, NCDs, and AMR meetings. The TB and UHC high-level meetings (HLMs) received general endorsements internationally, although concrete commitments are yet to be documented. Financial investments for HIV/AIDS were remarkable following the UN event, whereas for NCDs, AMR, and TB, they remained insufficient.Finally, we looked at pre- and post-event changes in the global burden of the conditions at stake. Thus far, the HIV/AIDS UN General Assembly special session (UNGASS) was the only one followed by a reversal of the previous burden trend, although this outcome is multifactorial in origin. What do these findings mean? We conclude that UNGASSs and HLMs have the potential to promote the political visibility of key health challenges, and mobilise funding to face them, although this ultimately also depends upon the leaders' political will, the consensus generated, and the engagement of civil society.To achieve impact on major health challenges, besides working within the context of the World Health Assembly and ministries of health, there is a need to advocate internationally at the higher political level of heads of state and government.