Introduction by Croakey: World Health Organisation chief Dr Tedros Adhanom Ghebreyesus last week congratulated world leaders for embracing the “political choice” of #HealthForAll as they adopted a high-level political declaration on universal health coverage at the UN General Assembly.
Described by Tedros as the “most comprehensive health declaration in history”, the document commits member states to actions advancing a vision for universal health coverage by 2030.
These include investing in primary care, targeting out of pocket costs, and high-impact interventions to tackle diseases like malaria, tuberculosis and HIV, as well as measures to safeguard women’s and children’s health including universal access to sexual and reproductive healthcare services.
Today world leaders approved the most comprehensive health declaration in history. Our vision is not health for some. It’s not health for most. It’s #HealthForAll: rich and poor, able and disabled, old and young, urban and rural, citizen and refugee. Everyone, everywhere. #UNGA https://t.co/P8g0V6N5Et
— Tedros Adhanom Ghebreyesus (@DrTedros) September 23, 2019
Tedros described it as a “landmark for global health and development”:
The world has 11 years left to make good on its sustainable development goals. Universal health coverage is key to ensuring that happens.
Universal health coverage is a political choice: today world leaders have signaled their readiness to make that choice. I congratulate them.”
The declaration calls for action on the social, economic and environmental determinants of health — including climate change — through a health-in-all-policies approach.
In this piece for Croakey, Sharon McGowan and Emma Lonsdale from the Australian Chronic Disease Prevention Alliance examine what the UN’s #HealthForAll pledge means in Australia, and whether our health care system is really as universal as it claims.
Sharon McGowan and Emma Lonsdale write:
Last week, global leaders gathered in New York for the United Nations Leaders Week.
For the first time ever, universal health coverage was a key topic amongst leaders, with a high-level meeting to drive action towards affordable, quality healthcare for all.
The meeting resulted in a landmark political declaration on universal health coverage and a comprehensive set of commitments to boost access to affordable care.
The @UN declaration on universal health coverage #UHC represents a landmark for global health & development. The world has 11 years left to make good on its @GlobalGoalsUN. UHC is key to ensuring that happens. It’s time for #HealthForAll! https://t.co/MYvJ2V5Bzo
— Tedros Adhanom Ghebreyesus (@DrTedros) September 23, 2019
Back in Australia this meeting generated little more than a flicker of interest. Partly, the UN Climate Summit and global #ClimateStrike protests have rightly seized the world’s attention, but access to quality healthcare is also sometimes taken for granted here in Australia.
The World Health Organization defines universal health coverage as ensuring that “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”
Access and equity
In Australia, the pillars of our universal health system – Medicare and the Pharmaceutical Benefits Scheme – are deeply entrenched. Access to care and to medicine is expected.
Around nine in 10 Australians visited a GP in 2017-18 and the use of GP services has increased since 2013-14, with further increases in Medicare benefits paid for these services.
While many costs are billed back to the government, sometimes out-of-pocket expenses climb rapidly. This could be due to complex or chronic conditions and an ongoing schedule of appointments, tests, treatments and medications. Our long-term wellbeing may be peppered with GP visits, hospital admissions and medical bills.
Globally, around 200 million people spend at least one-quarter of their income on health. Out-of-pocket costs can have a staggering impact on our day-to-day lives, and it is crucial that affordable healthcare is considered a key component of universal health coverage.
Equity is another vital part of universal health coverage. Our health system in Australia has great merit but it is not working equally well for all of us.
The theme for the UN meeting on Universal Health Coverage reminds us of this: “Moving together to build a healthier world.” A core premise is health for all; leaving no one behind.
Australian negotiators highlighted equity and inclusion in the lead up to the meeting, which was attended by the Minister for Foreign Affairs Senator the Hon Marise Payne. In her address, the Minister focused on Australia’s efforts to boost global health outcomes and support the delivery of care.
Chronic disadvantage
While we recognise that globally there are staggering inequities in access to affordable and quality healthcare, we also acknowledge that inequities continue at home.
In Australia, risk factors are much more common in some population groups; early detection is less likely; chronic diseases are more prevalent; and outcomes are worse. Medical improvements are not reflected across the board. We may be living longer but we are not living well on measures of quality of life.
The Australian Institute of Health and Welfare reported earlier this year that rates of heart attack and stroke increased with socioeconomic disadvantage, as did the number of people living with type 2 diabetes or chronic kidney disease.
Chronic diseases contribute 80 percent of the mortality gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. Amongst Aboriginal and Torres Strait Islander people, chronic kidney disease is much more likely to result in hospitalisations or death compared to non-Indigenous people. And, despite national screening programs, Aboriginal and Torres Strait Islander people still face lower survival rates from certain cancers.
Further contributing to inequities are the vast distances required to access care in Australia.
People living in rural and regional areas are 19 percent more likely to have a stroke but are much less likely to receive the emergency lifesaving treatment they need to survive and recover. This disadvantage is further compounded by poor access to post-stroke rehabilitation services in regional and rural areas, which has long-term repercussions for survivors’ recovery.
Prioritising prevention
Through the UN meeting and the landmark political declaration, momentum is building towards universal health coverage by 2030, as pledged in the Sustainable Development Goals. World leaders acknowledged that health coverage exists across the spectrum of services – prevention, promotion, treatment, rehabilitation and palliation. And that sustainable financing is essential.
Spending on chronic diseases makes up around one-third of health spending in Australia. Yet investment in prevention is minuscule in comparison. This trend is reflected around the world, with Australia ranked an embarrassing 16th among OECD countries for per capita expenditure on prevention and public health.
Recently, in the face of rising healthcare costs, the Western Australian Government Sustainable Health Review committed to increasing prevention spending up to at least 5 percent of total health expenditure by 2029. This model would channel commitments into prevention to drive health and wellbeing, rather than ongoing bandaid solutions to treat the ever-growing burden of disease.
This is the courage of conviction we hope to see as the foundation of the Australian Government’s new National Prevention Strategy.
While the UN meeting may seem a world away, it has elevated global discussions about health financing and generated political interest and a landmark commitment towards health for all.
Universal health coverage is more than just treating people well in hospital. It is prioritising prevention and primary care; promoting wellbeing and access to affordable care; and putting equity at the forefront of health decision-making.
Sharon McGowan is the Chair, Australian Chronic Disease Prevention Alliance and CEO, Stroke Foundation
Emma Lonsdale is the Executive Officer, Australian Chronic Disease Prevention Alliance
The Australian Chronic Disease Prevention Alliance (ACDPA) brings together Cancer Council Australia; Diabetes Australia; National Heart Foundation of Australia; Kidney Health Australia; and Stroke Foundation to collectively advocate for prevention, integrated risk assessment and effective management of chronic disease risk
