Normative convergence between global health security and universal health coverage: a qualitative analysis of international health negotiations in the wake of COVID-19
Background The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health cov...
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| Published in | Globalization and health Vol. 21; no. 1; pp. 5 - 20 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | English |
| Published |
London
BioMed Central
24.02.2025
BioMed Central Ltd BMC |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1744-8603 1744-8603 |
| DOI | 10.1186/s12992-025-01099-3 |
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| Abstract | Background
The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations – specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage.
Results
UHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach).
Conclusions
The findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments – finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how ‘hybrid norms’ develop through the dynamic process of normative convergence via diplomacy. |
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| AbstractList | The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations - specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage.
UHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach).
The findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments - finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how 'hybrid norms' develop through the dynamic process of normative convergence via diplomacy. The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations - specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage.BACKGROUNDThe UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations - specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage.UHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach).RESULTSUHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach).The findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments - finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how 'hybrid norms' develop through the dynamic process of normative convergence via diplomacy.CONCLUSIONSThe findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments - finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how 'hybrid norms' develop through the dynamic process of normative convergence via diplomacy. Background The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations – specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage. Results UHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach). Conclusions The findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments – finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how ‘hybrid norms’ develop through the dynamic process of normative convergence via diplomacy. The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations - specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage. UHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach). The findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments - finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how 'hybrid norms' develop through the dynamic process of normative convergence via diplomacy. Abstract Background The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations – specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage. Results UHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach). Conclusions The findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments – finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how ‘hybrid norms’ develop through the dynamic process of normative convergence via diplomacy. BackgroundThe UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations – specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage.ResultsUHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach).ConclusionsThe findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments – finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how ‘hybrid norms’ develop through the dynamic process of normative convergence via diplomacy. Background The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations - specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage. Results UHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach). Conclusions The findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments - finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how 'hybrid norms' develop through the dynamic process of normative convergence via diplomacy. Keywords: Global health diplomacy, Global health security, Universal health coverage, Politics, Governance, Health systems, Negotiations, International affairs, Norms |
| ArticleNumber | 5 |
| Audience | Academic |
| Author | Wenham, Clare Lal, Arush Parkhurst, Justin |
| Author_xml | – sequence: 1 givenname: Arush orcidid: 0000-0002-5085-582X surname: Lal fullname: Lal, Arush email: arush.lal@gmail.com organization: Department of Health Policy, London School of Economics & Political Science – sequence: 2 givenname: Clare orcidid: 0000-0001-5378-3203 surname: Wenham fullname: Wenham, Clare organization: Department of Health Policy, London School of Economics & Political Science – sequence: 3 givenname: Justin orcidid: 0000-0003-0831-6213 surname: Parkhurst fullname: Parkhurst, Justin organization: Department of Health Policy, London School of Economics & Political Science |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39994683$$D View this record in MEDLINE/PubMed |
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| Keywords | Global health security Negotiations Norms Health systems Politics Global health diplomacy Governance Universal health coverage International affairs |
| Language | English |
| License | 2025. The Author(s). Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. |
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The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies... The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while... Background The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies... BackgroundThe UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies... Abstract Background The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health... |
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| SubjectTerms | Accessibility Agreements Analysis At risk populations Complementarity Control Convergence Convergence (Social sciences) COVID-19 COVID-19 - epidemiology Cross cutting Development Economics Diplomacy Emergency preparedness Emergency response Epidemics Epidemiology Finance Geopolitics Global Health Global health diplomacy Global health security Governance Health Policy Health services Health Services Research Health systems Humans Infectious diseases International agreements International Cooperation International relations Medicine Medicine & Public Health Methods National health insurance Negotiating Negotiations Norms Pandemics Politics Public Health Qualitative analysis Qualitative Research Quality of Life Research SARS-CoV-2 Security Social determinants of health Social norms Social Policy Sustainable development United Kingdom Universal health coverage Universal Health Insurance - organization & administration |
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| Title | Normative convergence between global health security and universal health coverage: a qualitative analysis of international health negotiations in the wake of COVID-19 |
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