Part 1: Introduction to UHCWhy Do We Need UHC?
There are at least three important reasons why Universal Health Coverage is needed.
1. Lack of access to health for millions of poor, vulnerable, and marginalized people
According to WHO, at least half of the world’s population do not have full coverage of essential health services. 99% of the women who die in childbirth are in developing countries, and children are 14 times more likely to die before the age of five in sub-Saharan Africa. Communicable diseases such as HIV, TB and malaria have the worst impact on the poorest and most marginalized communities. In all countries – whether low, middle or high-income – wide health gaps remain between rich and poor. Weak health systems account for many of these gaps, highlighted and made worse by the COVID-19 pandemic.
UHC reforms have been a powerful driver for improving women’s health in a number of low- and middle-income countries including Afghanistan, Mexico, Rwanda and Thailand. For more details see ‘Improving Women’s Health through Universal Health Coverage’.
2. Health costs push millions into poverty
In most countries around the world, people have to pay for healthcare services. The fees that people pay when accessing these services are one of the main reasons why people fall into poverty. Many people with limited income, who must already make difficult choices among essential items and services, are forced to forgo the care they need.
Each year, more than 800 million people spend over 10% of their household income on health – this is known as catastrophic health spending. Of these, almost a 100 million people a year are driven into extreme poverty (living on less than $1.25 per day) because of health care expenses. At the current pace, up to one third of the world’s population will remain underserved by 203
In Thailand, UHC reforms led to a sharp reduction in the number of poor families facing catastrophic expenditure within six years. For more information, see ‘Attaining UHC: A research initiative to support evidence-based advocacy and policy-making’.
3. Good health lifts people out of poverty
Good health allows children to learn and adults to earn, helps people escape from poverty, and provides the basis for long-term economic development.
Many global health challenges stem from a shared obstacle: under-resourced, fragile health systems that fail to provide the poorest and most marginalized communities access to quality, affordable health services. These gaps threaten lives and livelihoods, exacerbate rising inequality, and undermine economic growth and social stability in rich and poor countries alike. As crises like COVID-19 and Ebola have made painfully clear, our health systems are only as strong as their weakest links.
Countries implementing health systems strengthening and UHC policies are seeing the benefits: healthier communities and stronger economies.
It has been estimated that every $1 that a country invests in health today can produce up to $20 in full-income growth within a generation (Lancet Commission).
How UHC Supports the Wider SDGs
Besides contributing to SDG 3 (Ensure healthy lives and promote wellbeing for all at all ages) and the goal of poverty alleviation (SDG1), UHC can make a major contribution to many of the other SDGs.
UHC promotes improved nutrition (SDG2), as nutrition-related interventions are a core part of comprehensive health benefits packages, and people receive more access to information and resources to address malnutrition. Strong health systems support educational goals because more children are healthy enough to attend school and families can afford schooling (SDG4) and gender equality, by ensuring women and girls receive the necessary services they need. UHC also can play an important role in economic growth (SDG8), and peaceful and inclusive societies (SDG16) as healthy populations help build effective, accountable and inclusive institutions at all levels.
Brazil provides free, universal access to medical care to anyone legally living in the country. Known as SUS (Sistema Único de Saúde), the Unified Health System was created in 1989 and is the largest non-discriminatory government-run public health care system in the world.
The SUS is a decentralized system managed by Brazilian states and municipalities. To access healthcare, a National Health Identification card is required so that medical records can be coordinated between public and private services. More than 80% of the Brazilian population depend on SUS to receive medical treatment.
Health is a right of all and an obligation of the State, guaranteed by socio-economic policies which seek to the reduction of the risk of disease and of other grievances and to the universal and equal access to the actions and services in its promotion, protection and recuperation
– Constitution of Brazil, 1988
Japan text here