UHC and the 2030 Agenda

The cost of health services and products is the leading reason people miss out on the care and medicines they need. Too often, these costs force families to choose between paying for a visit to the doctor and other necessities, such as food, housing and education. These trade-offs can hinder early diagnosis and treatment of disease and lead to severe or life-threatening illness. 

When governments reduce or eliminate out-of-pocket payments for health services and products and remove financial barriers to essential health services, the gains are numerous. Education outcomes improve, as families are able to send children to school. Gender equality increases, as women and girls are able to get the services they need, including reproductive and sexual health and rights. And communities and economies thrive, as worker absenteeism and healthcare-related poverty decrease.  

Achieving universal health coverage entails removing financial barriers to health services and ensuring that people do not risk falling into or being pushed further into poverty when paying for health services out of their own pockets. 

Key facts: 

• About 2 billion people face financial hardship when accessing health services. Among them, 1.3 billion people are pushed below the poverty line and 344 million people are pushed further into poverty due to health expenses.
• Progress towards UHC has worsened or stagnated over the past 20 years, with progress on health service coverage stagnating since 2015 and financial hardship increasing continuously since 2000. This global pattern is consistent across all regions and the majority of countries. 

Read the 2023 Global Monitoring Report 

Equitable and resilient health systems improve nutrition through maternal and child health programs. Healthy people are better able to absorb nutrients, work and thrive. 

UHC is the backbone of this goal. Equitable access to quality care prevents disease, improves outcomes, and ensures no one is left behind. 

Universal health coverage and health security are two intertwined goals to protect everyone, everywhere - in crisis and calm. These goals are achieved through the same health system. 

Strengthening health systems, with a focus on primary health care, provides the foundations for both universal health coverage and health security. Countries with equitable and resilient health systems are more responsive to people’s needs during and after pandemics. They also have the necessary public health functions to address health emergencies and continue to deliver essential services. 

To accelerate progress on universal health coverage and health security, governments must increase and align resources for health systems. They must also take a primary health care approach that brings together efforts to strengthen health service delivery, essential public health functions and emergency risk management while empowering civil society and communities. 

Key facts:  

• In 2020, in the height of the COVID-19 pandemic, about half of essential health services were disrupted; in 2021 about 90% of countries reported ongoing disruptions. Disruptions hit countries of all income levels, with large backlogs and long-term implications for health systems and health outcomes. 
• The crisis worsened inequities, especially poverty and gender inequality, emphasizing the urgent need to strengthen health systems and ensure adequate public financing for health. 

Read our policy brief on UHC and the pandemic treaty 

People with access to quality education live healthier and longer lives. And healthy children learn better. To leave no one behind, governments must invest in both health for all and quality education.

Gender equality and equity, including equal rights and equal access to health systems and services, are essential principles for achieving universal health coverage and leaving no one behind. Universal health coverage processes are still gender-blind, and women and girls are being left behind. They are still struggling to access health services and are disproportionately affected by barriers to accessing and using health services. They are also under-represented in leadership roles. This affects their life expectancy, education, maternal health, livelihoods, nutrition, and well-being. 

When addressing gender inequality in health systems, it’s important to remember that the experiences of women seeking and receiving health services are not uniform and are heavily influenced by factors including race, ethnicity and age. Moreover, gender is not binary, and many members of LGBTQ+ communities face significant discrimination in the health system. Universal health coverage should be available for people of all genders, but to implement it, governments must start by prioritizing the health needs and access of people in vulnerable and marginalized situations, among whom women, girls, and gender and sexuality minorities are disproportionately represented. 

Key facts:  

• Women make up the majority of health workers, holding 67% of health worker positions and over 90% of positions in nursing and midwifery globally.
• Despite this, women occupy just 25% of leadership roles in the health sector and perform 76% of unpaid care work.
• They also face a 24% pay gap compared to men across the health and care sector, a number that is wider than in other sectors. 

Read our narrative on how to build gender-responsive health systems

Health systems prevent and treat waterborne diseases. Surveillance and response systems also ensure early detection of outbreaks linked to poor sanitation. 

Cleaner household energy reduces respiratory illness. Health data can also inform policies to transition away from harmful fuels like charcoal and kerosene. 

When populations are healthy, economies prosper. By ensuring that everyone has access to quality essential health services, governments avoid short-, medium- and long-term costs in health spending, reduce welfare losses, and increase household savings. This investment also ensures that workers are physically and mentally healthier, thus increasing their productivity. These factors contribute in turn to individual, family, community and national economic gains and complement government investments in other sectors. 

Achieving UHC also entails investing in health and care workers, the majority of which are women, and ensuring decent working conditions.

The digital revolution provides an unprecedented opportunity to transform the health landscape. Digital health is an enabler of universal health coverage progress given its capacity to contribute to equitable and resilient health systems, including inclusive, equitable and efficient health financing, service delivery and health governance. Digital health can also strengthen the resilience of health systems by expanding access to care, enabling real-time, data-driven decision-making, and enhancing coordination, making healthcare systems more adaptive and better equipped to meet challenges head-on.  

Moreover, digital health has the power to act as a bridge, connecting underserved communities to services, information and resources that may otherwise be out of reach. For underserved regions and populations in vulnerable situations, digital health has the potential to make health services more accessible, affordable and efficient.  

Key facts: 

• Approximately 2.9 billion people in the world remain offline, with access shaped by intersecting inequalities like gender, race, class and geography. 
• Weak governance of digital ecosystems and artificial intelligence (AI) puts people who are connected at risk of unregulated digital health tools, health misinformation and exposure to health-harming content and digital practices. 
• Putting communities at the center of digital and data governance is key to ensuring that digital health solutions are not only innovative but also inclusive, responsive to populations' needs, and aligned with equitable, patient-centered care for all, so that no one is left or pushed behind. 

Read the joint op-ed from UHC2030, DTH-Lab and OECD 

A person’s health should not be determined by their income, identity, beliefs, country, legal status, or any other identifier. UHC and financial protection for health reduce inequalities by decreasing health-related poverty and guaranteeing access to an affordable core package of essential health services, including quality medicines, particularly for people in vulnerable and marginalized situations. Delivering the right to health also strengthens gender equality, as women and girls can better access the health services they need, including for their reproductive health and rights.  

Ensuring access to quality health services and protecting people from the impoverishing effects of health costs and illness contributes to more inclusive and resilient communities. For instance, when large numbers of people and population groups are covered with health promotion and prevention services and are protected from impoverishing health costs, an emergency response is more effective and responsive to individual and community needs. 

Learn more about our Caring Cities contribution to UCLG's Gold VII report

Health policies influence behavior change, such as reducing tobacco and sugar use, which also curbs harmful production patterns. Health-environment links drive sustainability. 

To quote Dr Tedros, Director-General of the WHO, “A climate crisis is a health crisis.” Climate change is the biggest global health threat of the 21st century. It increases non-communicable diseases, facilitates the emergence and spread of infectious diseases, brings deadly weather events and drives health emergencies. Climate shocks and growing stresses such as droughts and rising sea levels undermine the environmental and social determinants of physical and mental health, such as clean air and water, sustainable food systems and livelihoods. Climate change also impacts the health and care workforce and infrastructure, reducing the capacity to provide health services that are needed to protect people. 

In a turbulent world facing climate change and other crises, governments must prioritize the health and well-being of populations more than ever. With more complex threats and challenges confronting people everywhere, healthier communities can cope better and thrive, even amidst the impacts of climate change. Countries with equitable and resilient health systems are better prepared to prevent and respond to health threats such as climate change and health-related crises. Climate change provides a strong impetus for countries to make progress towards UHC. 

Key facts: 

• Health care facilities are directly impacted by the effects of climate change. They are also at the forefront of managing the health effects of climate change on populations.
• However, many health care facilities remain ill-equipped to effectively manage these impacts: As of 2021, 22% of health care facilities had no basic water supply and 49% had no basic hygiene service.
• Health care facilities also play a role in exacerbating climate change, with the health sector being responsible for more than 5% of global greenhouse gas emissions. 

Read WHO’s overview on safe, climate-resilient and environmentally sustainable health care facilities 

Healthy oceans need healthy people. Investing in equitable and resilient health systems helps reduce medical waste, support coastal communities and build climate resilience. 

Integrated health and environmental strategies combat zoonotic diseases and manage the health risks of biodiversity loss and deforestation. 

SDG target 16.7 aims to “Ensure responsive, inclusive, participatory and representative decision-making at all levels”. 

Social participation means empowering people, communities and civil society through inclusive participation in decision-making processes across the policy cycle and at all levels of the system. It is critical to ensure people-centered health services and build equitable and resilient health systems that respond to the needs of people and communities, particularly those in vulnerable and marginalized situations. It is the key to closing the gaps in access to services and addressing the daily struggle of billions of people around the world who are denied the fundamental right to health, well-being and dignity.  

More inclusive governance for health also provides the basis for creating trust in public health policies and programs, which is indispensable for better outcomes during times of crisis and calm. Although governments have the primary responsibility to ensure people’s health, they alone cannot deliver health for all. In 2024, WHO Member States adopted the resolution on social participation for universal health coverage, health and well-being. In doing so, they recognized the importance of regular and meaningful social participation to ensure the accountability and legitimacy of health systems strengthening and universal health coverage efforts. Governments must now exercise political will and leadership to translate the resolution into country action, with clear strategies, milestones and timelines. 

Key facts:  

• Health inequities are widening, due to climate change, the COVID-19 pandemic and conflict, along with inadequate progress to address structural, social and commercial determinants of health equity and well-being. 
• Understanding people’s perceptions, lived experiences and preferences is crucial to develop policies, strategies and plans that are more responsive to their needs. 

Read WHO’s technical paper on social participation for universal health coverage 

To build equitable and resilient health systems that put people at the center and contribute to sustainable development, governments, donors, and civil society must align efforts.