World Health Day 2019 – universal health coverage as a societal investment

On Sunday, 7 April 2019 it is World Health Day. This year, as last year, the focus is on universal health coverage.

Despite health being long recognised as a human right, far too many people can’t access even the basic services they need. According to the World Health Organisation (WHO), this is the reality for at least half the world’s population.

Among other things, this means: over 200 million women without adequate access to family planning services and 20 million infants going without essential immunisations.

Moreover, the WHO says that some 100 million people are pushed into extreme poverty each year from having to dip into their own pockets to cover health costs. Lack of access to essential healthcare is tragic on its own terms; worse still if it’s also driving people into poverty.

This is why universal health coverage (UHC) is so important, and the focus of both this year’s and last year’s World Health Day. The aim of UHC is to ensure that everyone can access essential health services without risking financial hardship. It is defined as one of the targets within the Sustainable Development Goals (SDGs), to:

Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

This is of course vital to good health but something as foundational as UHC can also support other sustainable development objectives like poverty eradication and greater inclusion. While stronger health systems do cost money, the WHO and others are right to articulate the provision of UHC as an investment in a secure and thriving society.

Health as wealth

If good health is one of the foundations of a successful society, a lack of good health and quality healthcare is a serious crack in that foundation. There could be substantial societal and economic costs of poor health, posing wider risks to sustainable development.

This wider case for better health is hardly new. Since the 1990s, there’s been a succession of reports on the economic benefits of better health, including:

• the World Bank in 1993: Investing in health
• the WHO in 2001: Macroeconomics and health
• a Lancet Commission in 2013: Global Health 2035
• an Economists’ declaration on universal health coverage, in 2015

In all cases, the arguments re-conceive good health and health spending as another tool for policymakers to promote sustainable development and growth. This contrasts with the (now rather tired) idea of health spending as a simple drain on resources. Health policy is a strategic tool.

Not only would UHC help support a healthy population but, as a societal investment, there are potentially substantial returns from improvements in:

• adult health, with lower mortality and morbidity extending lives, contributing to a larger and more productive workforce
• child health, leading to better educational outcomes and longer-term productivity gains

These impacts can support stronger economic growth. Importantly, the impacts come on top of the enormous benefits to individual people and families from being able to access quality healthcare, safe in the knowledge that it won’t impoverish them.

At a time when economic security, or a lack of it, has become increasingly prominent as an issue, this could be a substantial welfare gain, even if it doesn’t show up easily in conventional macro-level indicators.

Source: Jamison, D. T. et al (2013) ‘Global health 2035: A world converging within a generation’, The Lancet, 382:9908, 1898-1955 (link)

In the short term, these effects may also help to reduce costs elsewhere in the system, if better primary care helps prevent some conditions deteriorating to a point where they require more intensive intervention. In the round, there may be cost savings.

The benefits of UHC can be substantial. For example, the economists’ declaration in 2015 reported the estimated benefits of UHC investment as vastly outweighing the (financial) costs. The benefits of a ‘grand convergence’ in global health could be worth more than ten times those costs.

Our study ‘Economic impacts of national health insurance in the Bahamas’ also supports the idea of there being benefits to providing essential services. Good health is both intrinsically valuable to those that have it as well as socially/economically valuable.

As with a number of areas of public policy, there are things like gender equality which, at least in my view, we should just get on and do. I think UHC is one of those. Nevertheless, if you do need an economist’s reassurance, the case for UHC in those terms is a strong one. Rather than ask if we can afford to pay for good health, we should really be asking whether we can afford not to.