On May 27th, 2015 the executive Board (EB) of the World Health Organization (WHO) met in Geneva and discussed the non-inclusion of an agenda item about health disparities faced by lesbian, gay, bisexual and transgender (LGBT) individuals worldwide.
It was a queer discussion on how to avoid discussing queer issues within the WHO. You can clearly sense the frustration of Egypt, among other countries, that appeared so uncomfortable by the fact that the health of this marginalized group of individuals is being brought to such a high level meeting. At one moment, Egyptian executive director pulled an Ahmadinejad moment suggesting that there is no discrimination in Egypt against LGBT individuals; he further called on other countries to deal with their own discrimination against their sexual minority groups.
Here is some background:
Two member states requested to add an LGBT health item to the agenda of the EB meeting in Geneva in May 2013. Before even specifying what this item will entail, countries from the AFRO and EMRO regions opposed, on principle, the inclusion of any item that would tend to the healthcare of LGBT individuals. As a compromise, a footnote was added, instead of the item, to allow for continuing the discussion without officially having such item on the agenda. The Director General, Dr. Margaret Chan, attempted to find consensus between Member States on the final title and content of the agenda item. 323 civil society organizations from 89 countries signed on an appeal to support the efforts of Dr. Chan. Two years later, here is where we are on this:
The ultimate decision of the WHO’s Director General at the end of the meeting was the following:
- Delete the footnote.
- Create an informal, open-ended, Member State-led working group to continue the discussion with the goal of reaching a consensus on how to address this item within the EB
- Request the chair of each working group to report on the outcome by the 139th Executive Board meeting scheduled for May 2016.
- Request the Director General to support the work of the working groups
For more details, feel free to read the notes from the meeting brought to you by Leigh Haynes of the People’s Health Movement. Here it is unedited:
WHO EB 137 Notes on LGBT Health
US: Speaking in regard to the footnote on the agenda. Appreciate DG consultation on LGBT health. US & Thailand were originators & now think it’s time for a new approach. Only positive way forward is to delete the footnote & Thai and US work together to form a working group to develop a new proposal Would work with DG & Sec to reach consensus by all six regions on a way forward.
Liberia: The EB is a technical body charged with taking care of people who need health care. Affiliations, religious or otherwise, should not be considered. African region supports suggestion by the US. We should not refer to sex orientation with talking about health. If you are sick, you are sick, no matter what you do in public or private.
Pakistan: Supports deletion of footnote on behalf of EMR countries. Group formed on this very important subject should be open-ended.
Saudi Arabia: Aligns with Pakistan.
Brazil: Prefers to keep the footnote of EB 133. It would be a possibility to withdraw footnote if body agrees on follow-up. Proposal by the US is important and good way to move forward. But wants everyone to join constructively and would like a decision to maintain the footnote. The current situation/trust in DG in the discussion is important to move forward. So the footnote should be kept, in spirit of good will, talk about keeping the footnote as consultations continue OR if a decision is taken on the working group.
Canada: Happy to hear that delegations are for the working group. This is an open dialogue so open working group is a good idea. If removing the footnote is a way to lift the hesitation to carry on the dialogue then so be it. But pressure need to remains for the decision/discussion to continue and conclude. Would like for the Sec to lay out a timeline for the working group to convene and conclude.
DRC: Supports proposal by the US to delete the footnote.
Eritrea: Aligns with Liberia. Supports deletion of footnote and an open-ended working group.
Argentina: Reassert, in principle, that RTH is an essential human right that can’t be neglected expected in populations who suffer from discrimination. Has always supported Res 52/R6 and is concerned that access to health of LGBT health is not assessed in this space. Alarmed that a footnote can cause such an uproar. Endorse working group. In the meantime, proposes to leave footnote in this and future sessions of the Board.
Malta, on behalf of EU: Committed to move forward in a constructive way. Prefers to keep the footnote. Supports the proposal by the US on the cross-regional working group to propose a future agenda item. Would appreciate the outline of such a group as proposed by Canada. Takes prejudice to the role of the WHO to deal with the issue from a health perspective.
Thailand: Supports proposal by the US, Canada, & others for the spirit of solidarity and peace among member states. Should move ahead with the proposal.
Dominican Republic: Endorses position of US and Canada re the working group. The WHO and its EB cannot feel any kind of taboo in taking up every kind of health problem, particularly regarding vulnerable groups. Obviously there are vulnerable groups that suffer abuses to their right to health. We do need to have a good idea as to when to take up the issue and get a good analysis of the situation, and this could be done in a working group.
Russian Federation: According to their medical law the provision of health care should be delivered regardless of sexual orientation. Open ended working group should be formed. Would like the Secretariat to discuss rules around developing and conducting working group.
New Zealand: In spirit of inclusiveness supports proposal by US and Canada. Has no objections to maintenance of footnote as a reminder while working group progresses.
Egypt: Supports Liberia Pakistan. Fully agree to the deletion of the footnote. This subject is one that has been a source of dissent and we have spent more that 1/2 hour to move forward on the agenda and have failed. This won’t be solved at the present sitting and future working groups will probably not be able to solve it. So, we should lee how we can work together to fulfill our mandates. Should steer clear of cultural/religious issues that lead to dissent/away from consensus and get in the way of the mandate.
Albania: aligns with Malta & EU.
Kazakhstan: Agrees with Malta. Open-ended group would be most effective and the decision reached within would be acceptable by everyone.
Jordan: Associates position of Jordan with EMR group—Pakistan, Saudi Arabia, Egypt. The working group should be open-ended.
DG response: MS interventions are very interesting. They agree with another country, but US actually made two proposals 1) deletion of footnotes & 2) have small informal group. Most support working group so this is mostly decided. But footnote question remains undecided. (Notes that it is good that they spent less than 1 hr on this vs 5 hrs last time. 80% improvement! :))
Chair: There is a general consensus about the working group. Russian Federation would like to hear rules about establishing the group.
Legal Counsel: Two positions on working group: 1) informal group as proposed by the US.
UK: Supports informal, cross-region discussion group (rather than formal working group) even though that means keeping the footnote so as to not lose sight of the issue.
DG: UK proposal goes back to EB133. And DG will continue with what she’s been doing until she gets the consensus and then come back.
Andorra: Fully supports proposal of the UK. The issue needs deep discussion & participation of all the regions.
US: Because US knows there are strong feelings around this so they proposed pulling the footnote. The difference between the US proposal is that US proposed a member state led consultation vs DG led consultation. They propose this because progress hasn’t been made, DG-led consultations haven’t led to any progress & US is eager for this topic to be talked about in a constructive way with a fresh start.
Russian Federation: Any decision that needs to be taken as an outcome needs to be discussed by the EB.
Liberia: I don’t know how we got to where we are. If there is a member country who wants to discriminate against gays and lesbians they should not impose it on others. We should not waste our time on this discussion. No working group should be formed to discuss it further.
Egypt: Liberia said it all. To continue an informal group can find a way, but it is not likely. Developing a formal group would require terms of reference, etc. but this would not happen today. There is no consensus about having a group at all, so the discussion should probably end.
Brazil: The footnote is important. This discussion is different. Wants to recognize the way to move forward and Brazil is committed. Wants to have clear direction from the sec how things are going to be. If it is an informal group, how are we going to move it forward and reach a decision. There are many procedural aspects that the sec must clarify for member states.
Chair: Several proposals & need to make a decision on 1) working group and 2) footnote.
Zimbabwe (not an EM member): Agrees with the US. The footnote isn’t serving the purpose it was supposed to serve—instruct the DG in consultations and reaching consensus. It’s only served to bring more division among countries. There is a level of mistrust now, even about the intentions of member states with this item. Some issues are of national concern and otherwise regions have reached agreements. We should respect countries and value the opinions of member states. We should have an informal working group so it will come up with its own terms of reference. For the African countries, they participated in consultations even though they didn’t want to and will also participate in informal working group.
Zambia (not an EB member): Supports proposal of the US. The current status is a compromise as Zambia didn’t want to have these discussions at all. Other countries should be open to compromise if discrimination of any groups is to be addressed by WHO.
Ecuador: Expresses concern about how this item is being handled as health of LGBT people is important issue and requires a human rights approach. If equity is to be guaranteed with a UHC viewpoint then improving the health of LGBT people should not be based on marginalization and making them invisible, which is what the footnote is. The best way is to keep lines of communication open. Support delegations of Brazil and Argentina. Also supports working group but to keep the footnote.
Libya: Supports proposal of the US and aligns with statement by Liberia on behalf of the African region. Hopes for a open-ended informal working group.
Malta: Seems to be consensus around furthering discussion in informal working group. Need direction from Sec on how it will function and how it will report back.
Congo: There is no consensus on informal or informal working group. Need clarity on method/working of the informal group. Whether there is a discrimination issue or not seems to be causing the underlying disagreement. Hope that position of African nations will be taken into account but consensus should be found.
Sec: EB endorse an approach toward consensus: adopt an open ended group so all delegations interested can participate; it will be informal and would define its own modalities and chair and etc. It could report back to EB: sec can support the group (providing meeting room, documentation) DG can report back to EB on the progress or outcome of this group.
Chair: In summary— Will have an informal open-ended working group with reporting mechanisms back to EB, group will determine its own terms of reference and MS can choose to participate or not.
Brazil: concerned that sec is not part of the process. Propose maintaining footnote along with having an informal working group to ensure that working group will actually report back.
Chair: Moving to discussing maintaining the footnote or not.
Egypt: What is missing is the topic of the working group. What is it supposed to discuss.
Chair: The previous decision was that DG would consult member states and not it is that member states will consult amongst themselves.
Canada: Pause on this and ask if any interested delegations could meet at lunch time to sketch out the procedural aspects, timelines in which a report to EB will be achieved.
Liberia: This item is wasting our time. Liberia proposes a vote to kill it. If we can’t reach a consensus, proposes a vote to throw out this from the agenda forever.
Chair: Humbly, pleads for tolerance.
South Africa: Moves to support chairs proposal in an effort to conclude this.
DG: The chair has proposed a way forward. Listen to this first and see if it satisfies everyone before having a lunchtime working group.
DPRK: Aligns with Liberia. This isn’t on the agenda and we need to move on.
UK: In agreement with South Africa, supports Chair’s proposal.
Chair: Summarizes earlier proposal—
Brazil: Chair’s proposal is reasonable. Wants to put on the table the possibility for all MS to know the possibilities and considerations for reporting.
Chair: Proposes that this be done informally with assistance of secretariat.
Egypt: Reporting must be factual as to which members have accepted (or not) a particular direction. Reporting should reflect actual positions of members. (As clearly there is a difference of opinion as to what consensus actually is.)
Brazil: We can reach consensus through talking. Would like to hear the final text.
Sec: EB decided 1) to delete the footnote to the item on adoption of the agenda; 2) to support working toward consensus through an informal open-ended working group of member states; 3) to request the DG to support the working group and to report to the EB either on the outcome of the working group or on the progress of the working group
??: What’s the point in setting up the working group since it’s clear that there will never be consensus.
Namibia: Supports working group simply to take this discussion out of the EB because it’s wasting a lot of time.
Dominican Republic: Most countries have laws that concretely identify that these people need protections (especially coming out of HIV/AIDS). We need to take up health problems. We need to take up this issue in the working group and whoever wants to participate in it can. Also, consensus does not mean unanimity.
DPRK: Understands that this is not on the agenda. So, if this is right discussion should be stopped.
Legal Counsel: explains that the footnote was accepted in lieu of item being prominently on the agenda subject to further deliberations & consultations. It’s a placeholder, the item is neither on nor of.
Gambia: Is cared and worried that while people are dying everywhere discussing this one group of people is important. Proposes to suspend this topic and bring it to the next EB until day 2 of the meeting to really address issues that are affecting the globe.
Egypt: Obviously there is no LGBT item on the agenda. Any decision shouldn’t be seen as an attempt to slip an item on the agenda. The consultations are intended to see if the Board can get their positions closer or not. Personal perception is it is not, but as Brazil mentioned, that countries are willing. No discussion in a working group would have any effect on each government to deal with challenges it faces at national level. If you feel there is discrimination against certain groups in your country, please take the necessary measures. These consultations are moving from DG consultations to working group consultations.
Thailand: Proposes to consider the proposal previously summarized. If there is an agreement then we have a consensus. If not, then go with Canadian proposal for a lunch time consultation.
Namibia: There is a consensus that there should be a formal decision.
Brazil: We are talking about procedure, but also about people, health, and rights. The proposal is fine. Maybe the chair of the group could be the one to report to the EB.
Argentina: Endorse the position of Brazil. Thinks that the human right to health is the right to health.
Malta: On behalf or EU and member states—endorses proposal put forth by the secretariat.
Sec: reads proposal once more— EB decided 1) to delete the footnote to the item on adoption of the agenda; 2) to support that further work be conducted through an informal open-ended working group of member states; 3) requests the chair of the group to report on the progress of the group to the 138th session of the EB; 4) request the DG to support the work of the working group
Egypt: Doubts this is acceptable to the Egypt delegation. Proposes that reporting be on outcome of the working group rather than progress. Notes that African countries have a decision about this issue already.
Liberia: Reiterates that they don’t want this discussed ever again in this body. Whatever agreement is reached, do not call it consensus.
Chair: matter is concluded an have a way forward.
Brazil: have a doubt regarding the reporting. Wants to report on progress not just on outcomes.
Chair: Brazil and Egypt need to discuss progress vs. outcome
Thailand: Propose that secretariat prints out text and circulate. Use the Canadian model (lunch working group) if the text is not ok.
will return to this item after lunch
Chair: Proposal—> Delete the footnote. New work be conducted through an informal open-ended working group; request the chair of the informal working group to report on the outcome by the 139th EB. Request the DG to support the work of the working group.