Abstract
Background
The UN Sustainable Development Goals (SDGs) and the WHO Thirteenth General Programme of Work (2019–2023) underscored the importance of mitigating health emergencies alongside ensuring accessible and affordable health services. Key to these efforts are global health security (GHS) and universal health coverage (UHC), which serve as both standalone goals as well as cross-cutting approaches to health policy and practice. While GHS and UHC each function as distinct norms, global health stakeholders increasingly argue that advancing them synergistically may better address interconnected health challenges amidst greater resource constraints. However, little is understood about the extent of convergence between GHS and UHC norms, particularly in the wake of the COVID-19 pandemic. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two recent international health negotiations – specifically unpacking the expression of UHC norms in the WHO Pandemic Agreement, and GHS norms in the 2023 UNGA Political Declaration on Universal Health Coverage.
Results
The findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to foster normative convergence between GHS and UHC. Both international agreements advanced GHS and UHC convergence by demonstrating increased complementarity and interdependency between the two norms. However, sustaining this proved difficult, as negotiators made political and operational trade-offs which sometimes undermined normative convergence.
Conclusions
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 enhances scholarly understanding of the dynamic process of norm convergence through health diplomacy.