Universal health coverage and the post-2015 agenda
Most of us have lost count of the number of times we have visited a doctor or health facility. It is something we take for granted: nothing exceptional, simply routine. Yet in our 21st-century world, 1 billion people have never seen a doctor or received quality health services. Furthermore, given that health has not been guaranteed as a global public good, hundreds of millions of people have had to sell assets and take out loans to pay for the health care they need to stay alive and healthy, resulting in 100 million people falling below their countries’ national poverty lines each year. No matter how many times governments have acknowledged the right to the highest standard of health, good quality health services remain a luxury available only to those who can afford them.
Today, it is possible to change this reality and ensure that nobody is denied access to the quality health services they need. The global community is working to establish a new international agreement that would commit the world to universal health coverage (UHC). UHC implies that all people have access to nationally determined sets of needed quality health services and essential medicines, without discrimination or risking impoverishment. UHC provides a crucial opportunity not only to end one of the biggest injustices of our time, but also to ensure healthier lives for future generations by strengthening our fight against child and maternal mortality, HIV/AIDS, malaria, and non-communicable diseases.
14 years ago, the leaders of 189 nations signed the Millennium Declaration, committing their countries to fight poverty and promote development by 2015. The Declaration included eight Millennium Development Goals (MDGs) that have since shaped development policies around the globe. Much has been achieved during these years: new HIV infections fell by more than a third between 2001 and 2012, mortality rates from malaria fell by more than 25% between 2000 and 2010, and a total of 51 million patients with tuberculosis were successfully treated between 1995 and 2011, saving 20 million lives. Worldwide, the mortality rate for children younger than 5 years decreased by 41% from 1990 to 2011, and the maternal mortality ratio similarly declined by 47% between 1990 and 2010.
We are now approaching the original deadline for fulfi lment of the MDGs, but there is still much to be done. While we are committed to the unfinished health development agenda until 2015, global leaders must now produce a new blueprint for the post-2015 development agenda. Health is a precondition, consequence, and indicator of all three dimensions of sustainable development: economic, environmental, and social. Health is also an essential part of people’s lives and a driver of poverty reduction.
As Ministers of Health of both developing and developed countries, we have seen that when the right to health is not fulfi lled, the poor and most vulnerable are aff ected the most. Children from the poorest 20% of households are nearly twice as likely to die before their fifth birthday as children in the richest 20%. For women in one African country, the rate of caesarean sections and the use of modern contraceptive methods are, respectively, 200% and 72% higher in the wealthiest income quintile than in the lower income quintile.5 The way a health system is organised and fi nanced can help to limit these injustices and inequities.
On Dec 12, 2012, the United Nations General Assembly (UNGA) unanimously adopted a landmark resolution endorsing UHC as a global priority for sustainable development. The General Assembly called upon governments to “urgently and signifi cantly scale up eff orts to accelerate the transition towards universal access to aff ordable and quality health-care services”. UHC means that life expectancy and health standards improve for everybody, and that rural poor families, people working in the informal sector (mainly women), or those aff ected by social and cultural barriers to health care are not left behind. Dozens of countries at all income levels have chosen to pursue UHC to ensure that their citizens are protected and able to contribute to the development of their nations.
A large number of factors outside immediate health services have an impact on population health, including conflict, income levels and distribution, consumption and production patterns, working conditions, sanitation, access to clean energy, environmental conditions, and education. To improve the health of their citizens, governments should work to strengthen performance in all these areas, and measure the impact of all policies on health. However, formal health sectors must also play their part by developing health systems able to meet all citizens’ needs without exception, so that health care is no longer a luxury that the poor cannot afford.
While countries are negotiating to agree on a new set of objectives for the development framework after 2015, the undersigned Ministers of Health from seven countries want to underline that UHC is crucial to increase healthy life expectancy, eradicate poverty, promote equity, and achieve sustainable development.
Moreover, UHC gives people the peace of mind that the health services they might need are available, aff ordable, and of good quality.
The path to UHC will not be easy. It will take time. So let’s start now by internationally committing our governments to move UHC forward in the post-2015 development agenda. Let us make sure that every person on the planet, rich or poor, receives the quality health services they need.
Marisol Touraine, Hermann Gröhe, Raymonde Goudou Coffie, Subramaniam Sathasivam, Mercedes Juan, El Houssaine Louardi, Awa Call Seck Ministry of Health, Paris, France (MT); Ministry of Health, Bonn, Germany (HG); Ministry of Health, Abidjan, Cote d’Ivoire (RGC); Ministry of Health, Putrajaya, Malaysia (SS); Ministry of Health, Mexico City, Mexico (MJ); Ministry of Health, Rabat, Morocco (EHL); and Ministry of Health, Dakar, Senegal (ACS)
MT is Minister of Health for France; HG is Minister of Health for Germany; RGC is Minister of Health for Côte d’Ivoire; SS is Minister of Health for Malaysia; MJ is Health Secretary of State for Mexico; EHL is Minister of Health for Morocco; and ACS is Minister of Health for Senegal.