It is safe to argue that the issue of income and wealth inequality is nowadays at the center of political debate across the world. Leading intellectuals such as Thomas Piketty in his seminal work, “Capital in the Twenty-First Century,” and Joseph Stiglitz in “The Price of Inequality” have rigorously analyzed the evolution of this social phenomenon and argued that increased inequality and lack of opportunity are creating divided societies that are endangering the future of nations.
Those working in public health have for years documented and discussed how low and decreasing incomes, decline in standards of living, and lack of or limited access health care and other essential services contribute to inequalities in health, manifested in a widening gap in life expectancy between the rich and the poor.
universal health coverage
It’s that time of year again, when we observe a day dedicated to the most ambitious health goal of all: universal health coverage, or UHC. On UHC Day (Dec. 12) we commemorate the date in 2012 when the United Nations unanimously endorsed a resolution urging governments to ensure that all people can access health care without financial hardship.
The launch of the Sustainable Development Goals (SDGs) at the recent U.N. General Assembly meetings brought especially welcome news: The future we want now officially includes universal health coverage (UHC), as defined under SDG 3, target 8. We also heard, the same week, from a group of economists from 44 countries, who publicly stated that “UHC makes economic sense.” It seems the tide has turned toward making essential health care available to all who need it, without creating financial hardship.
As the father of four children, I know how important access to good, quality health care is. All parents aspire to be able to provide the same for their children. That’s why we at the World Bank Group are working with our partners around the globe to make universal health coverage a reality for all.
Uniting finance and development has been a lifelong passion of mine. Earlier in my career, I supported then French President Jacques Chirac with the development of an international airline ticket solidarity tax to provide global public goods for the poor. This kind of innovative thinking eventually led to the creation of UNITAID which works to prevent, treat, and diagnose HIV/AIDS, tuberculosis, and malaria more quickly, cheaply and effectively. Other innovative financing mechanisms include the International Finance Facility for Immunization and the Global Vaccine Initiative.
Somehow, everyone in the universal health coverage (UHC) universe seems to assume that the future of health financing will be built on centralized financing institutions fed by a mix of general tax revenue, payroll taxes and other contributions. This large pot of money, so the assumption goes, is administered by bureaucrats sitting in big buildings in national or provincial capitals. They contract with providers and pay them through capitation, diagnosis-related groups, fee for service, and reimburse retailers (pharmacists) for medicines that the patient takes home.
Maya is waiting for the physician to call her name. Her three children play in the waiting room, making happy noises, but she is worried about her health. The physician confirms her worst fears: it turns out that she has cervical cancer. Now what? A social worker tries to comfort her, saying that the medical staff will do their best to get her treated soon so that she can keep on working to sustain her family.
Last Friday, I had the privilege of attending the launch of a new global report that provides the clearest picture to date of countries’ progress moving toward universal health coverage (UHC). UHC is critical for building resilient health systems, which protect communities and strengthen societies in times of crisis and calm alike.
As we know from many health financing studies, drug expenditure typically ranks first or second among out-of-pocket expenses. In fact, it is often the cause of catastrophic expenditure, driving people from lower middle class into poverty once a severe or chronic disease affects a family member.