Universal Health Coverage (UHC) is intolerance for health inequities. This is a key message at the Prince Mahidol Award Conference 2012 that resonated well with me. Our attempts at UHC will benefit from a clear articulation of the need to address inequities and the underlying power imbalances. The whole social-determinants-of-health-movement has placed this agenda several strides forward but in our five-minutes-of-fame world, addressing inequities is oh-not-so-fashionable.
There are both global and local inequities in health. Deaths in pregnancy and childbirth are almost entirely avoided in developed countries and are largely concentrated in the poorest countries of the world. The risk of dying from pregnancy-related causes is around one in 6 in Afghanistan compared to around one in 30,000 in northern Europe. In the Philippines, eighty three percent of women from wealthier households delivered in health facilities while only thirteen percent from the poorest families accessed facility-based delivery care. The difference is a staggering 650%.
If UHC is to become a reality, we have to address inequities, globally and locally. We also need to strengthen the sense of solidarity globally and locally.
At the conference, there was talk for countries to increase domestic spending for health to achieve UHC. This might be true and feasible for transitioning economies in Asia and Latin America, but for the world’s poorest countries, what domestic resources are we really talking about? If health is a universally recognized human right, can the poorest countries in the world claim this right to the global community? A new global social contract? Our colleague Gorik Ooms has discussed this extensively in a background paper for the First Global Symposium on Health Systems Research. The idea seemed to resonate with others at PMAC. A former Thai senator and a strong UHC advocate saw this as some sort of natural progression and evolution of global health. This is an interesting thought given some perceived slowdown in aid brought about by economic woes in Europe and the US.
I come from a country marred with great inequities, where the rich enjoy life in their enclaves and beach hideaways. Most are unmindful of the poverty around them. Some of the elite feel a sense of responsibility for the poor but are unwilling to take substantive redistributive actions. The sense of responsibility is met with philanthropic activities in the context often of Christian charity and not out of sincere solidarity and empowerment of the poor.
Short of a social revolution, we may need to rethink the underlying philosophies and values of our society to achieve universal health coverage.