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Submitted by Marianne Brown on

The emphasis of the Lancet commission is as follows:
"Conclusion 4: progressive universalism is an efficient way to achieve health and financial protection.

UHC — usually achieved through public prepayment of most of the cost of insuring health services for a country’s population — offers the promise of financing health gains and providing health security while minimizing the financial risks to households of excessive health expenditures. The Commission endorses two progressive pathways towards UHC that are pro-poor from the outset."

1. Note that "progressive universalism" in the report is far more realistic than "UHC by 2030" . If it took Germany 100 years to attain UHC , pushing Nigeria or Myanmar to aim for reaching the same goal in 16 years does seem somewhat hearless. What compelled the health care sector to latch onto a patently elusive goal? Which of the panelists and eminent speakers will be held accountable for shortfalls relative to this goal. The Nigeria minister repeatedly pleaded "show me how".

2. The report does not say that UHC is the most efficient way to achieve health. That is so because it is not true. Prevention of disease is by far the most efficient way. Larry Summers and Michael Bloomberg emphasized this repeatedly, too. Education of girls will prevent the bulk of disease and premature death. None of these critical investments and measures are stressedin the links you provided.

It is mindboggling that the two UHC goals adopted by WHO and World Bank as the only possible goals for population health in fact do not even mention prevention. Poor people will be less poor and more healthy in 2030 if instead of these 2 UHC goals policy makers squarely focus on better health status with sustainable improvements. For instance every country should be able to Prevent preventable cholera and other disease outbreaks. The economic rate of return on this capacity is extremely high, as stressed in the Lancet Commission report.

3. What is measured gets done. The 2 goals adopted by World Bank and WHO virtually guarantee higher costs, implementation snags, diversion of resources away from prevention (education of girls, sanitation, public health capacity, safe roads, clean water, etc) and lots of jobs for consultants. It will be better for each country to have goals related to better health outcomes instead of goals that in effect require people to be ill before the goal becomes relevant and that serve to expand the healthcare industry and skew ministries of health even more toward preoccupations with cures, rather than prevention. It is tragically self-serving IMHO. The ministries of health should prioritize prevention first, second, and third -- for the sake of health of the population and the taxpayers. (I regret that Oxfam signed onto this scheme and consequently do not plan to donate to it this year.)