Time for action
Urgent action is needed now to make universal health coverage a reality for everyone, everywhere. Universal health coverage means that all people have access to the quality health services they need, when and where they need them, including during emergencies, without risk of financial hardship. At least half of the world’s population, however, still lacks access to essential health services. Each year, about 70 million people are pushed into extreme poverty after paying the cost of services out of their own pockets, rendering the right to physical and mental health unattainable for far too many people.
In 2019, world leaders endorsed the most ambitious, comprehensive political declaration on health in history at the United Nations High-Level Meeting on Universal Health Coverage, committing themselves to ensure that all people have access to “quality essential health services and quality, safe, effective, affordable, and essential medicines, vaccines, diagnostics, and health technologies”, without experiencing financial hardship and without discrimination, by 2030. Although the majority of countries recognize universal health coverage as a goal, reflected in laws and national plans, there has been little implementation and inadequate public financing for universal health coverage.
The COVID-19 pandemic highlighted the need to build universal health coverage for times of crisis and calm, making clear that universal health coverage and global health security are two intertwined goals. As the climate crisis deepens, armed conflicts worsen, inequality widens, pandemics occur more frequently and economies become more volatile, countries with equitable and resilient health systems will be better able to prevent, prepare for and respond to health emergencies that threaten global health security.
Even before the COVID-19 pandemic, progress on achieving universal health coverage was not on track, and we are now even further away from reaching our goals. The pandemic has severely disrupted health systems and essential health services. With the combined health and economic impacts of COVID-19, many people face greater financial constraints in accessing care. Financial hardship is likely to worsen further for those who pay out-of-pocket for health services, particularly for vulnerable and disadvantaged populations. While public expenditure on health has increased during the pandemic, the levels of health spending have been volatile in low- and middle income countries over the past two decades and may drop again in the near future.
The means to achieve universal health coverage and health security is strengthening health systems. The most inclusive, equitable, cost-effective approach is primary health care. Ninety per cent of essential interventions for universal health coverage can be delivered through primary health care. Primary health care is also widely regarded as key to strengthening the resilience of health systems to prepare for, respond to and recover from shocks and crises. To achieve universal health coverage, leaders must make sustainable investments in health systems, properly resourcing and protecting health and care workers, and working with communities, civil society and the private sector. Leaders should also address the factors that are hampering progress towards universal health coverage and health security, and also promote equity for vulnerable and marginalized groups, gender equality, accountability, human rights and economic prosperity.
In 2023, world leaders have a unique opportunity to reinvigorate progress towards delivering health for all if they take urgent action to implement universal health coverage reforms, with accountability. Seizing the opportunity of the three United Nations (UN) high-level meetings on health in 2023 (universal health coverage; pandemic prevention, preparedness and response; and tuberculosis) and beyond, countries and stakeholders can build universal health coverage as a goal and a framework for health and well-being as well as broader global health challenges, to strengthen national and international resilience and improve global health security.