by Mathilde Bouyé and
Jean-Michel Severino
The Millennium Development Goals (MDGs) agreed by the United Nations in 2000 (1)
have made an unprecedented contribution to the fight against poverty.
But with the 2015 deadline approaching, and in spite of significant
progress, the MDGs are a long way from being achieved. Worldwide,
1.2 billion people still live on less than $1.25 a day. The MDGs that
remain furthest from being reached include the targets on child and
maternal health (MDGs 4 and 5) and transmissible diseases (MDG 6).
Every year, throughout the world, 6.9 million children die before their fifth birthday and 50 million women give birth without any professional medical assistance. There has been significant progress in the fight against major pandemics, but 2.5 million people still become infected with HIV each year and additional efforts are needed to consolidate the advances made against malaria and tuberculosis (2). So, as international discussion of the post-2015 period intensifies, attention is focusing on these three MDGs in particular.
Universal health coverage (UHC) is often mentioned as a future global objective, but it is not uncontentious: some governments take the view that it is ill defined and hard to measure. Yet a growing number of emerging and developing countries — including Indonesia, India, Turkey, Thailand, Vietnam, Rwanda, Ghana, Mali and Senegal (see “Senegal, women first”) — have set it as one of their national priorities. In December 2012 a resolution supporting UHC worldwide, put forward by France and the organisation Diplomatie et Santé (Foreign Policy and Global Health Initiative) (3), obtained the backing of over 90 countries and overwhelming support from the UN General Assembly (4). This document defines UHC as access to good quality basic healthcare and medicines at a price the patient can afford. The World Health Organisation (WHO), the World Bank and numerous other organisations such as Global Health Advocates France support UHC and believe it should be one of the UN’s future development goals. At a special event this September chaired by John W Ashe, president of the UN General Assembly, to assess the progress and future of the MDGs, national delegations defined the principles that should govern the post-2015 agenda (5).
Participant states decided to build on the UN Millennium Declaration of 8 September 2000 and the Rio+20 Declaration, produced at the 2012 Conference on Sustainable Development, in order to set out common objectives that take into account the three dimensions of development: economic, social and environmental. The document emphasises the need for solidarity with the least developed countries (LDCs), an indication that future objectives should apply to all states, including members of the Organisation for Economic Cooperation and Development. These international discussions demonstrate a will to ensure a better quality of healthcare for the most marginalised and to reduce inequality.
UHC — universal by definition — is very much a concrete manifestation of such ambitions. It is based on everyone’s right to enjoy the best possible state of health, a right embodied in the WHO constitution (1948) and the International Covenant on Economic, Social and Cultural Rights (1966). It also accords with the right to enjoy a quality of life that ensures health and well-being set out in article 25 of the International Declaration of Human Rights. It emphasises physical and financial equality of access to basic care in a context in which disparities are still growing. Every year 100 million people fall into poverty as a result of unexpected medical expenses (calculated at 40% of their income). UHC also has the advantage of enabling an all-encompassing approach; the “silo” approach to health as defined by the MDGs was piecemeal and didn’t encourage a global vision of health systems.
But there are other threats that will have to be taken into account for 2015 and beyond: non-infectious diseases; the increased risk of pandemics as a result of globalisation; the re-emergence of infectious diseases; increasing resistance to antibiotics; health risks associated with environmental degradation; and obesity, now a bigger killer than hunger. The objective of UHC will make it possible to develop a continuum of integrated, lifelong care (rehabilitation, prevention, improvement, treatment) adaptable to future challenges.
UHC is a transformational objective in that it encourages improvements in health provision, since it relates to the equitable distribution of national social protection mechanisms. It responds to the challenge of sustainability as it aims to achieve viable long-term health funding. Prepayment mechanisms and collective solidarity should enable the use of national resources to reduce payments at the point of delivery and therefore to reduce the number of individuals facing catastrophic bills. According to the African Development Bank, by 2060, most African nations will be able to guarantee basic health insurance, even if not complete coverage (6). The bank emphasises however that, in the start-up phase, public development aid remains essential in the LDCs.
Finally, the WHO and the World Bank are proposing a new assessment framework to make it possible to measure UHC in a way that will satisfy the most sceptical states. Two targets are of particular interest: access to quality healthcare and financial protection for those who use the services.
(1) www.un.org/millenniumgoals.
(2) See Global Fund to Fight AIDS, Tuberculosis and Malaria supplement, Le Monde diplomatique, English edition, June 2013.
(3) This group has seven members: South Africa, Brazil, Indonesia, France, Norway, Senegal and Thailand.
(4) Resolution A 67/81, 10 December 2012.
(5) “Special Event 25 September: Outcome Document”, un.org.
(6) African Development Bank economic brief, “Health in Africa over the next 50 Years”; see also Yves Ekoué Amaïzo, “Keep the African Development Bank African”, African Development Bank supplement, Le Monde diplomatique, English edition, May 2010.
Mathilde Bouyé is a member and the president of Convergences (www.convergences2015.org/en); Jean-Michel Severino is a member of the UN Secretary General’s High-Level Panel on the Post-2015 Development Agenda
http://mondediplo.com/2014/01/18healthcover
Every year, throughout the world, 6.9 million children die before their fifth birthday and 50 million women give birth without any professional medical assistance. There has been significant progress in the fight against major pandemics, but 2.5 million people still become infected with HIV each year and additional efforts are needed to consolidate the advances made against malaria and tuberculosis (2). So, as international discussion of the post-2015 period intensifies, attention is focusing on these three MDGs in particular.
Universal health coverage (UHC) is often mentioned as a future global objective, but it is not uncontentious: some governments take the view that it is ill defined and hard to measure. Yet a growing number of emerging and developing countries — including Indonesia, India, Turkey, Thailand, Vietnam, Rwanda, Ghana, Mali and Senegal (see “Senegal, women first”) — have set it as one of their national priorities. In December 2012 a resolution supporting UHC worldwide, put forward by France and the organisation Diplomatie et Santé (Foreign Policy and Global Health Initiative) (3), obtained the backing of over 90 countries and overwhelming support from the UN General Assembly (4). This document defines UHC as access to good quality basic healthcare and medicines at a price the patient can afford. The World Health Organisation (WHO), the World Bank and numerous other organisations such as Global Health Advocates France support UHC and believe it should be one of the UN’s future development goals. At a special event this September chaired by John W Ashe, president of the UN General Assembly, to assess the progress and future of the MDGs, national delegations defined the principles that should govern the post-2015 agenda (5).
Participant states decided to build on the UN Millennium Declaration of 8 September 2000 and the Rio+20 Declaration, produced at the 2012 Conference on Sustainable Development, in order to set out common objectives that take into account the three dimensions of development: economic, social and environmental. The document emphasises the need for solidarity with the least developed countries (LDCs), an indication that future objectives should apply to all states, including members of the Organisation for Economic Cooperation and Development. These international discussions demonstrate a will to ensure a better quality of healthcare for the most marginalised and to reduce inequality.
UHC — universal by definition — is very much a concrete manifestation of such ambitions. It is based on everyone’s right to enjoy the best possible state of health, a right embodied in the WHO constitution (1948) and the International Covenant on Economic, Social and Cultural Rights (1966). It also accords with the right to enjoy a quality of life that ensures health and well-being set out in article 25 of the International Declaration of Human Rights. It emphasises physical and financial equality of access to basic care in a context in which disparities are still growing. Every year 100 million people fall into poverty as a result of unexpected medical expenses (calculated at 40% of their income). UHC also has the advantage of enabling an all-encompassing approach; the “silo” approach to health as defined by the MDGs was piecemeal and didn’t encourage a global vision of health systems.
But there are other threats that will have to be taken into account for 2015 and beyond: non-infectious diseases; the increased risk of pandemics as a result of globalisation; the re-emergence of infectious diseases; increasing resistance to antibiotics; health risks associated with environmental degradation; and obesity, now a bigger killer than hunger. The objective of UHC will make it possible to develop a continuum of integrated, lifelong care (rehabilitation, prevention, improvement, treatment) adaptable to future challenges.
UHC is a transformational objective in that it encourages improvements in health provision, since it relates to the equitable distribution of national social protection mechanisms. It responds to the challenge of sustainability as it aims to achieve viable long-term health funding. Prepayment mechanisms and collective solidarity should enable the use of national resources to reduce payments at the point of delivery and therefore to reduce the number of individuals facing catastrophic bills. According to the African Development Bank, by 2060, most African nations will be able to guarantee basic health insurance, even if not complete coverage (6). The bank emphasises however that, in the start-up phase, public development aid remains essential in the LDCs.
Finally, the WHO and the World Bank are proposing a new assessment framework to make it possible to measure UHC in a way that will satisfy the most sceptical states. Two targets are of particular interest: access to quality healthcare and financial protection for those who use the services.
(1) www.un.org/millenniumgoals.
(2) See Global Fund to Fight AIDS, Tuberculosis and Malaria supplement, Le Monde diplomatique, English edition, June 2013.
(3) This group has seven members: South Africa, Brazil, Indonesia, France, Norway, Senegal and Thailand.
(4) Resolution A 67/81, 10 December 2012.
(5) “Special Event 25 September: Outcome Document”, un.org.
(6) African Development Bank economic brief, “Health in Africa over the next 50 Years”; see also Yves Ekoué Amaïzo, “Keep the African Development Bank African”, African Development Bank supplement, Le Monde diplomatique, English edition, May 2010.
Mathilde Bouyé is a member and the president of Convergences (www.convergences2015.org/en); Jean-Michel Severino is a member of the UN Secretary General’s High-Level Panel on the Post-2015 Development Agenda
http://mondediplo.com/2014/01/18healthcover
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