Universal healthcare must be a priority – even in the midst of COVID


The COVID pandemic has illustrated how the lack of reliable health care leaves communities vulnerable.Credit: John Moore / Getty

Vaccinating the world’s population against COVID-19 remains a global health priority. But it is vital that this effort does not overshadow the need to ensure that everyone, everywhere, has access to basic health care.

Despite the urgency of the current crisis, the provision of universal health care remains a priority for Tedros Adhanom Ghebreyesus, the director general of the World Health Organization (WHO). It is also enshrined in the United Nations Sustainable Development Goals on the basis that health is a prerequisite for economic growth. Governments, scientists and the public should support this goal, because it is in everyone’s interest. And they will have the opportunity next week, when the World Health Assembly meets online.

The pandemic has amply demonstrated how a lack of reliable health care can leave communities vulnerable. While access to health care is not the only factor determining the success of countries, its absence has clearly fueled the flames. Many lives have been lost in India because hospitals have been overwhelmed. In the United States, deaths from COVID-19 have been higher among low-income people, who are less likely to have health insurance and therefore less likely to seek medical attention quickly. A similar pattern has been observed elsewhere: A study found that in the poorest neighborhoods of Santiago, more than 90% of people whose deaths have been attributed to COVID-19 died outside health facilities (GE Mena et al. Science https://doi.org/f9b4; 2021). Additionally, people without reliable healthcare may be more vulnerable to complications from COVID-19 due to poorly controlled chronic illnesses.

The lack of easily accessible healthcare – and health systems for sharing information – has hampered detection and surveillance of COVID-19 infections. If another deadly virus emerges in a region with inadequate health care, the world could waste precious time containing the outbreak. The two largest Ebola outbreaks to date – in West Africa and the Democratic Republic of the Congo – spread for weeks, if not months, before being identified.

Despite nearly a century of calls to provide health care to all, attempts have been hampered by crises and disease-specific interventions. After the economic depression of the 1930s, international health officials working for the League of Nations touted the need to provide basic health services through networks of clinics nationwide. This vision was interrupted by World War II, but was rekindled in 1946, when the newly formed United Nations came together to draft a constitution for the WHO. The constitution declares that health is a human right and that governments are responsible for the health of their people.

But the United States almost rejected outright the WHO and its constitution. At the time, opponents of providing national health care in the country linked the measure to socialism and communism. The US eventually signed on, but inserted a clause stating that it could opt out of the WHO at any time – meaning the country giving the most money (dues are based on height savings) could withdraw if he opposed the organization’s ideology. .

The next 20 years of single disease programs led by WHO and global health funders, however, were not ideological. Ironically, they were also driven by a wave of scientific advancements that offered simple technological solutions to specific health problems, such as the use of the insecticide DDT to fight malaria and antibiotics to fight malaria. infections.

But in 1978 the momentum for building health systems was revived at an international conference on the provision of primary health care to all, held in Alma-Ata in what was then the Soviet Union. . The WHO-sponsored Alma-Ata Declaration pledged to provide essential care at the neighborhood level by the year 2000.

But according to Tedros and health policy experts, the Alma-Ata declaration was undermined by factors such as inadequate political leadership, economic crises, political instability and overinvestment in treating individual diseases (TA Ghebreyesus et al. Lancet 392, 1371-1372; 2018). Others have suggested the movement lacks defined, evidence-based milestones, as well as cost-benefit assessments. Compare that with UNICEF, the United Nations children’s charity, which in the 1980s pledged to save the lives of four to five million children a year through well-defined and budgeted programs for provide vaccines against diseases such as measles, tetanus and polio. The government and philanthropic donors immediately grasped the concept and UNICEF quickly became one of the largest United Nations agencies. In 2019, its budget was almost three times that of the WHO.

Childhood immunization programs save lives, but lack of investment in strengthening countries’ health systems has resulted in untold deaths. The answer is not to stop vaccinations, of course, but to learn from the success of the UNICEF campaign and the failures of Alma-Ata.

In 2019, the WHO re-emphasized health care for all, this time at the first United Nations high-level meeting on universal health care. A corresponding report said that in order to provide primary health care for all, countries must, on average, increase their spending in this area by 1% of their gross domestic product. And world leaders signed a declaration pledging to pursue universal health care – in its national context – and to provide basic and affordable health services to everyone in the country. To hold them accountable, global health researchers have created an online portal to track progress towards achieving this goal by 2030. For example, the tracker says that about 15% of populations in the United States and Cuba do not have access to essential health care. services. The rate rises to 20% in China and 45% in India and Kenya.

WHO has placed “health for all” high on the agenda for next week’s meeting, hoping to generate political and financial commitments from governments. Perhaps aware of the vagueness of past efforts, Tedros has created a new council of economists, health and development experts to advise on the economics of providing basic health care to everyone. , including ways to quantify their value.

Universal health care may seem like an ambitious goal in times of crisis, but if we don’t push for change now, we will regret it. The pandemic has increased the number of people living in extreme poverty, making them more vulnerable to disease. It infected, killed and traumatized healthcare workers everywhere, more devastatingly in places that already had too few. “Our failure to invest in health systems not only puts individuals, families and communities at risk, it also leaves the world vulnerable to epidemics and other health emergencies,” Tedros said in October 2019. “A pandemic could potentially bring economies and nations to their knees. A few months later, it’s done. We must not let this happen again.


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