Why the UN’s ‘Health for All’ initiative matters

Satya Sivaraman | Updated on September 25, 2019 Published on September 25, 2019

A global commitment to ‘Universal Health Coverage’ can improve socio-economic outcomes. Thailand is a good example for us

It took a while get there, but finally, the Universal Health Coverage (UHC) — the holy grail of all health policy objectives — is now at the centre of the world’s attention.

On September 23, heads of state of all UN member nations met at the UN General Assembly in New York to adopt a historic political declaration on UHC, calling for a world where everyone has access to free or low-cost healthcare. World leaders gathered at the special session of the UNGA and committed to progressively cover one billion additional people with quality essential health services, affordable and effective medicines, vaccines and technologies by 2023, and an additional two billion people by 2030.

Currently, according to the WHO, at least half of the world’s population does not have access to essential health services, and about 100 million people are pushed into extreme poverty due to health-related costs. In 2017, over 800 million people, almost 12 per cent of the world’s population, spent at least 10 per cent of their household budgets to pay for healthcare. The last time there was such global focus on providing healthcare to everyone was in 1978, when the WHO’s ‘Declaration of Alma Ata’ identified primary healthcare as the key to attaining the goal of “Health for All”. At that time, a strong case was made that health systems oriented toward primary healthcare produce better outcomes, lower costs, and with higher user satisfaction.

Like at Alma Ata, the Declaration in the UN General Assembly links health investments to larger social development, arguing for instance that implementing the UHC will benefit a wide range of sectors from economic development to gender equality. Indeed, the UN Declaration promotes the idea of health as both “a precondition for and an outcome and indicator of” achieving many key Sustainable Development Goals (SDGs).

Fight against diseases

Even within the field of health itself, it is difficult to see any intervention or policy succeeding if it is not built on the foundation of a UHC system.

One significant case in point is the phenomenon of antimicrobial resistance (AMR), that has become a major global concern in recent years around the world. If unchecked through various measures, AMR, which renders many antibiotics ineffective, threatens to collapse modern medical procedures and take the world back to when bacterial infections were incurable.

The problem with tackling AMR lies in the complex and myriad factors that drive it. These range from overall burden of infectious diseases, rampant misuse of antibiotics in both human and animal health sectors, and widespread contamination of the environment by toxic chemicals that spur bacterial resistance.

To curb AMR, governments need to control infections at all levels and moderate antibiotic consumption, but this becomes extremely difficult in contexts where there is no access to low-cost and good-quality healthcare for a bulk of the population. Countries such as those in South Asia or sub-Saharan Africa are even less prepared to tackle AMR, due to lack of basic infrastructure and trained personnel at the grassroots.

It is precisely in these contexts that making healthcare affordable for everyone can make a big impact. It is not a coincidence that countries around the globe, which have good UHC systems, also tend to have greater success in curbing indiscriminate use of antibiotics or spread of AMR.

Thailand model

In Asia itself, a shining example of a middle-income country with a robust UHC is Thailand. Thailand’s UHC system, formally launched in 2001 and totally funded through direct taxation, allows access to publicly-funded healthcare without co-payments and covers 98 per cent of the population.

To achieve this, Thailand, starting in the 1970s, first tackled the problem of malnutrition and ensured provision of clean drinking water and access to sanitation facilities, while creating a strong primary healthcare network in the rural areas. This, together with a vaccination programme covering a bulk of the country’s population, helped reduce infectious disease mortality rate by five-fold over the last half century.

As a result of these efforts, Thailand stands out when it comes to the quality and implementation of its national action plan on AMR. Thailand has already instituted a rational use of medicine policy within its UHC system in recent years, improved surveillance and instituted stewardship programmes at different levels for prevention of healthcare-associated infections. It has also run successful nationwide campaigns to raise public awareness on appropriate use of antibiotics.

According to one World Bank study, over 24.1 million people could fall into extreme poverty by 2030 if AMR is not contained. What the example of Thailand shows is investing in a robust UHC system now is an excellent way of saving on huge costs of dealing with untreatable infectious diseases in the future. In other words, investing in UHC makes very good business sense.

Hopefully, the UN Declaration on UHC will inspire governments, particularly in developing countries, to consider this wisdom seriously and mobilise both resources and political commitment to make the slogan of ‘Health for All’ a practical reality.

The author is a writer and independent filmmaker

Published on September 25, 2019
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