According to the World Health Organization Universal Health Coverage (UHC) is the cornerstone for achieving the health related Sustainable Development Goal (SDG3). UHC deals with two fundamental elements of health care: firstly, the access of people to the health services they need; secondly, the economic consequences that this access entails.
As long as all health policies are evidence-based to ensure that the necessary programs are implemented without medicalizing life, the first objective is for all people to have access to a full range of health services, including promotion, prevention, treatment, rehabilitation and palliative care. And that these services are of good quality. The second objective is to provide protection against the financial risks associated with health care.
Universal health coverage is literally a matter of life and death for many people, specifically for those who, lacking health coverage, are confronted with the prospect of untreated disease and the premature death of themselves and their children. Differences in maternal and infant mortality worldwide, or in access to treatment for infectious and non-communicable diseases, can be greatly improved if there is a political will to develop an equitable health system.
Universal health coverage can also make the difference between financial survival and misery. The need to pay for health care at the time it is received deters many people from seeking health services and also ruins millions of families each year. It is estimated that, each year, this mode of payment causes 150 million people to face health-related costs that leave them in financial ruin, while 100 million people fall below the poverty line simply because they need to use health services.
On the other hand, we cannot forget the overwhelming evidence that health does not only depend on genetic and biological factors and health interventions; that it is strongly influenced by people’s environment, how and where they are born, live, work, eat, sleep, interact, move or enjoy their leisure time and even the level of political and social participation they have.
Together with UHC, it is necessary to promote policies that go beyond the strictly sanitary ones and to place the emphasis on initiatives under the framework of Health in all the policies, advancing in the action on the determinants of health present in non- sanitary areas. This means involving all policies, from urban planning to labour, mobility, fiscal, environmental, immigration, etc., and at all levels from municipal to state and supra-state.
Still today, poverty continues to be the leading cause of illness and death in the world and inequalities of all kinds, economic, educational and social, are the leading cause of bleeding differences in the level of health, in life expectancy at birth (up to 10 years from one neighborhood to another in the same city), in perceived health, in access to health care.
Having a family doctor is a protective factor for health. This phrase summarizes several evidences that make health systems based on universal primary care, well organized and with well-trained human resources have better health results than systems oriented towards hospital and super-specialized care (see Davis et al., 2014). But 18 million health professionals are missing worldwide.
If, as I have stated in the beginning of this article, there exists the right of all people to have the best possible health recognized by all countries, it should be the States in charge of guaranteeing their citizens access to an adequate level of health and, to this end, the evidence tells us that the best alternative is through public health systems based on primary health care, in which this is the axis of the system and not only the gateway to it.
The last leg of this system is financing, which must rest on progressive fiscal policies, in which those who have more pay more and those who need more receive more, solidary fiscal policies, health financing policies that promote equity, efficiency and effectiveness, guaranteeing that the rights of the most vulnerable are taken into account.
Finally, all this is valid globally, all people in this globalized world have the same rights. The nations, in the SDG Agenda 2030, committed themselves not to leave anyone behind and, in the area of health, this must mean firstly cooperating to promote, in all countries and for all people, the highest possible level of health; and secondly, facilitating the financing of health in each country and at a global level with fair and supportive international fiscal policies.
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Eduardo García Langarica, President of medicusmundi Spain, on the occasion of the World Health Day, 7 April 2019