Global Health

Healthcare costs are pushing millions into extreme poverty. This outrage must end 

A girl is treated by a medic at the Aweil State Hospital in Aweil, the only hospital in the South Sudanese state of Northern Bahr el Ghazal, June 2, 2012. As in many developing nations, international aid is both an invaluable help to South Sudan and a crutch that sometimes enables it to avoid reality. Development experts have grown more sophisticated in recent decades about how they deliver aid. But in fragile states such as South Sudan, getting the balance right between helping a country and helping that country help itself remains incredibly difficult. Picture taken June 2, 2012.   To match Special Report SOUTH-SUDAN/AID  REUTERS/Adriane Ohanesian (SOUTH SUDAN - Tags: ANNIVERSARY HEALTH SOCIETY) - GM1E87A0K9L01

At least half of the world’s 7.3 billion people still do not have access to essential health services Image: REUTERS/Adriane Ohanesian

Tedros Adhanom Ghebreyesus
Director-General, World Health Organization (WHO)
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Global Health

A friend of mine was diagnosed with cancer a few years ago.

He had two options. He could be treated, but it would cost him most or all of the money he had put aside for his family’s future.

Or he could forego treatment, allow the disease to run its course and die knowing his family would have a more comfortable life, even if he was not there to enjoy it with them.

He chose the latter.

He chose death because he could not afford the treatment that could have kept him alive.

This is an outrage. No one should have to choose between death and financial hardship.

But the shocking truth is that this is a reality for millions of people every year. New data from the World Health Organization and the World Bank reveal that at least half of the world’s 7.3 billion people still do not have access to essential health services, such as having a skilled birth attendant, vaccinations for children or treatment for HIV.

As a result, more than 1 billion people live with uncontrolled hypertension, which can kill without treatment. Every day, more than 800 women die from causes related to pregnancy and childbirth. And because nearly 20 million infants do not receive the immunizations they need, they run the risk of dying from diseases like diphtheria, tetanus, pertussis (whooping cough) and measles.

Even when health services are available, using them can mean financial ruin. Every year, 100 million people are pushed into poverty because of health spending, and 179 million people spend more than a quarter of their household budget on health care – a level we consider to be “catastrophic health spending”.

Almost 70 years ago, WHO was founded on the conviction that health is a human right, not a privilege. This is a conviction I share. No one should get sick and die just because they are poor, or because they cannot access the health services they need.

Why should a child die from drinking unsafe water?

Why should a woman die from complications of childbirth that are treated easily even in most middle-income countries?

Why should a family have to choose between buying food and buying medicine?

Universal health coverage (UHC) is the practical expression of the right to health. It means that all people, including the most disadvantaged, can access the quality health services they need, when and where they need them, without facing financial hardship.

But UHC is about more than health insurance, or treating the sick – it’s about protecting the healthy by promoting healthy lifestyles and preventing disease.

The power of UHC is that it doesn’t only result in improved health. It also reduces poverty by eliminating one of its causes; it creates jobs for health and care workers; it drives inclusive economic growth by ensuring people are healthy and able to work; it promotes gender equality, because it is often women who miss out on health services; and it protects people against epidemics by ensuring outbreaks are prevented, detected early and contained.

Image: World Health Organization/The World Bank

UHC is not a new idea. But its inclusion as one of the targets in the Sustainable Development Goals (SDGs) has given new political impetus to the global movement that has been gathering pace for some years. It is also the one target that, if achieved, will catalyze progress towards all the other health targets and many of the other goals.

Far from being a luxury that only rich countries can afford, UHC is achievable and affordable for all countries, at all income levels.

Senegal, for example, is making progress towards a publicly-funded health insurance system.

In Vietnam, more than 60% of the population, and 90% of the poor, are now covered by state-subsidized social health insurance. That’s six times more than 20 years ago.

In Peru, budget-funded health insurance for the poor and those who do not work in the formal sector has led to significant improvements in the health of women and children, and large reductions in the death of newborns and infants.

Similar stories can be told in countries as diverse as the Czech Republic, Indonesia and Rwanda.

A WHO study earlier this year predicted that among 67 low- and middle-income countries that account for 75% of the world’s population, 85% of the costs of achieving the SDG health targets by 2030 could be met with domestic resources.

Yes, some of the most fragile countries will continue to need external assistance. But for most countries, UHC is affordable and achievable.

Ultimately, it’s a matter of political will.

Governments with the determination, courage and foresight to invest in strengthening their health systems towards UHC will reap the benefits long into the future.

This is our vision. We back it up with hard evidence, technical know-how and lessons from around the world about what works and what doesn’t.

At the UHC Forum in Tokyo this week, more countries are committing to making the investments in a future that is healthier, safer and fairer for their citizens.

The World Health Organization/World Bank report, Tracking Universal Health Coverage: 2017 Global Monitoring Report, is available here.

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