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Submitted by Andrea Planter-Otter, MD, MPH on

You are correct that there are two sides to this issue. But I do not agree that laudable programs of prevention are optional. On the contrary, they are an absolute necessity if health of the poor is to improve. Mr Bloomberg and Mr Summers again and again said that prevention must be a priority. Educating girls is the best investment according to Mr Summers because it will prevent health problems for their children, too. That way they will not need expensive medical care.

So if a country wants universal health care, it absolutely has to prevent as much disease as possible first, so that it can actually afford the health care that those who do get ill will need. Hopefully as few people as possible will get ill but this can only happen if there are robust and well funded prevention programs . For example to improve sanitation, reduce pollution, stop cigarette smoking, eliminate indoor smoke, make roads safer, control infectious diseases, educate girls. This was the point that Minister Ngozi made very well in the discussion.

I do not think your view that prevention is optional, but health care is a necessity, is correct. This view gives a very high priority to those who are already ill, and through that weakens prevention. Because more money and attention go to health care, less money and attention go to prevention. This conclusion appears in virtually all analyses of health expenditures. Therefore, with less prevention now, more people will get ill because of preventable diseases and accidents in the future.

This is a bad legacy to leave for your children. It is truly unsettling how little concern the UHC campaign shows for the health and wellbeing of people alive in 2020, 2030, 2040 - todays children and the next generation. The campaign for UHC might as well be financed bythe Koch brothers who oppose climate change mitigation since they, too, have no sympathy for the wellbeing of future population cohorts.