On Monday 23 September 2019, Heads of State and governments will meet at the United Nations General Assembly for the first UN High Level Meeting (HLM) on universal health coverage (UHC). One of the key outcomes of the UN HLM is a joint Political Declaration, reflecting consensus among 193 Member States that it is imperative to achieve health for all. Tragically, the declaration will be silent about the needs of lesbian, gay, bisexual, transgender, and intersex (LGBTI) people.
In signing up to the 2030 Agenda for sustainable development, UN Member States agreed that “no one must be left behind”. Upholding this principle requires countries to go beyond general pledges of support for UHC and commit to investments and activities expressly intended for LGBTI people and other communities who are the furthest back and in greatest need of assistance.
We believe universal health coverage is unattainable unless LGBTI people everywhere can access quality, affordable, evidence-based, comprehensive health services, free from stigma and discrimination. If LGBTI people are ignored and sidelined in country commitments for universal health coverage, the world will fail in its promises to leave no one behind.
In too many parts of the world, LGBTI people are treated as criminals and are the victims of high rates of violence due to laws that criminalize consensual same-sex behavior, nonconforming gender identity and expression, HIV non-disclosure, exposure, and transmission, sex work and drug use. Eliminating disparities in LGBTI health due to criminalization and discrimination requires governments to promote equity and human rights, in tandem with increasing their investments in – and focus on – people who have the least access to health services. Critically, this includes ensuring access to comprehensive sexual and reproductive health and rights information, services and commodities, while addressing specific legal and social barriers for the LGBTI community.
Echoing and building on MPact's 'Put the Last Mile First in Universal Health Coverage', we call on all heads of state and leaders in government, health, civil society and private sector to express their commitment to ensuring LGBTI people’s access to health services, as an essential part of achieving universal health coverage. Accessible services should include those for sexual, reproductive and mental health, as well as substance use and gender-affirming care.
To lay the groundwork for investing in LGBTI health, governments should:
1. Disaggregate health data by sexual orientation, gender identity and expression, and sex characteristics, while ensuring the privacy and safety of all client data.
2. Ensure that gender affirmation and sex reassignment services are essential services.
3. Fund community-led health services.
4. Ensure laws and policies clearly prohibit discrimination based on sexual orientation and gender identity and expression, and that there are policy mechanisms at the country level for redress for those suffering from discrimination in health care settings.
Putting LGBTI people at the core of services means meaningfully engaging their community-based organizations and networks. LGBTI communities should be involved in the design, implementation, and evaluation of health services. LGBTI communities are also best-positioned to hold service providers and policy makers accountable to their needs
We urge civil society and other HLM participants to share this statement with their Permanent Missions to the UN in New York (see contact information here), Ministries of Foreign Affairs, Ministries of Health, and other stakeholders around the world to ensure that governments remain committed to a truly inclusive version of UHC.
We thank the organizers and co-facilitators of the HLM on UHC, including H.E. Mr. António Guterres Secretary-General of the United Nations, H.E. Mr. Tijjani Muhammad Bande, President of the 74th Session of the UN General Assembly, and Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, for their commitments to achieving health for all. Dr Tedros in particular, has made achieving universal health coverage a central part of his work.
We raise our voices for this issue in honor of all the community members, advocates, and healthcare providers tirelessly championing LGBTI health and rights around the world, too often under challenging conditions.
Health for All means ALL.