Universal health coverage gains momentum in 2016

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WHO definition: Universal Health Coverage (UHC) means everyone can access the quality health services they need without financial hardship.

This year it seems that organisations, governments and citizens everywhere are answering the call to UHC, whose annual awareness day is December 12th.

From this year forward, UHC is seen as central to improving health systems, improving economies, and ensuring global health security. The G7 group countries, the primary source of funding for Low and Middle-Income Countries (LMIC), met in Ise-Shima Japan 2016 and made UHC their umbrella concept. Through this, they seek to improve health systems and global health security.  Of the 17 SDGs agreed by the United Nations, just one is directly health-related but it is “achieving UHC”.

Judith Rodin, (President Rockefeller Foundation, has observed that “25 of the wealthiest nations all have some form of universal coverage, as do some middle-income countries including Brazil, Mexico and Thailand and lower-income nations, such as Ghana, the Philippines, Rwanda and Viet Nam, are working towards achieving UHC.”

Rather than talk about why we need UHC, I thought I’d talk  about what is actually proposed by middle-income and lower-income countries (LMIC) to fulfil UHC and what the NGOs, donors and global health community championing UHC would like it to encompass.

What is UHC?

UHC systems vary from country to country: there is no one size fits all.  It very much depends on the minimum health outcomes a government wants to achieve and how much of its GDP it is prepared to spend. The main variables being the level of care delivered, who delivers it, who receives it and how it is funded. 

UHC of itself does not mean universal access to health services nor care for all diseases. It’s about providing a basic level of health services (“Essential Packages of Health Services”) to as much of the population as possible.

The first UHC system was the UK’s National Health Service set up in 1948.

The USA has a non-universal system of health coverage.

What do LMIC see it as?

Over time,  as far as I can see, these basics for a cost-effective UHC have emerged:

  • government regulation, legislation and taxation
  • primary health care
  • vaccination programmes for children (for LMIC this is organised through GAVI, the Vaccine Alliance)
  • maternal healthcare (pregnancy)
  • health insurance to finance (public tax, private insurance or a mix of both)
  • financial protection: pooled funds to reduce out of pocket payments amongst the poorest and vulnerable  

Much of the information that now follows is derived from  the RSTMH 2016 Chadwick memorial lecture "Neglected Tropical Diseases in the Time of Blue Marble Health and the Anthropocene Epoch", given by  Professor Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine, Texas and President of the Sabin Vaccine Institute. 

 

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One Health: free online course from FutureLearn features CABI authors

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One Health is about connectedness: "the collaborative efforts of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, plants and our environment”.

On One Health Day, November 3rd 2016, CABI's editors held a One Health (#OneHealth) Blogathon to focus attention, contributing a total of 6 blogs to Handpicked… and Carefully Sorted, each written from the viewpoint of a different sector.   Our Plantwise Blog contributed One Health: Plantwise’s ambition to improve the health of people, plants and animals.

We hope you found them informative but your learning need not be confined to our blogs!

Sign up to a free online One Health course from FutureLearn: starts November 7th 2016, runs for 6 weeks. Lecturers are the CABI authors Esther Schelling,  Jakob Zinsstag and Bassirou Bonfoh of Swiss Tropical & Public Health Institute.

Esther, Jakob  and Bassirou are all authors of chapters in CABI’s  book One Health: The Theory and Practice of Integrated Health Approaches [2015].  Indeed Esther and Jakob are also co-editors.

FutureLearn  courses are easy to follow and well-paced: you get one unit per week.  I speak from experience as because of my interest in evidence-based medicine, in October 2015, I took "Informed Health Consumer: Making Sense of Evidence". 

I hope you can make use of this One Health course.

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One Health working will improve health and well-being of us all: plant, animal, human and ecosystem!

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    Pastoralists, Mongolia. Image courtesy of Esther Schelling, Swiss TPH.

 One of a series of blogs written by CABI editors for One Health Day on November 3rd 2016
 
It's always nice to meet up with a CABI author at a conference especially when they are giving a talk around a theme dear to CABI‘s heart,  namely “One Health”: the concept of working across the interface of animal, plant, human  and environment  to achieve health  & development  which is sustainable and fair. CABI has been gathering, managing and generating research information across all these sectors since 1912.  We know “its all connected”.

The conference was the RSTMH biennial meeting [Cambridge UK, Sept 12-16th, 2016], and the author in question, Esther Schelling, co-editor  of CABI’s  book One Health: The Theory and Practice of Integrated Health Approaches [2015].    To read a  free e-chapter, use this link.

In One Health beyond early detection and control of zoonoses Esther talked about her long-time project with nomadic pastoralists in Chad and a rift valley fever (RVF) control project in Kenya.  She drew attention to the need for:

  • more interdisciplinary studies to include an evaluation of One Health working
  • involvement of social scientists
  • engagement of key stakeholders

And tellingly she provided a cost-benefit analysis to society of controlling zoonoses when the disease is in its animal host before it infects human beings. 

Those cost-benefit analyses made a deep impression on the delegates, many of whom were involved in zoonotic neglected tropical diseases. Perhaps for the first time they were appreciating the added benefits and synergies that a transdisciplinary approach between science, society, humanities and medicine could bring.

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TTIP and its potential impacts on health in Europe

Pixabay_business-361488_640Concern is rising in the European public health community about the TTIP trade agreement, an agreement being negotiated between the US and the EU Commission to reduce barriers to trade. While there may be economic benefits, the agreement could have a health and environmental cost. The public health and environmental communities think it will weaken the power of governments to make laws to protect their citizens’ health and the environment.

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More from AHILA14: Information literacy, ICT and the problems in rural areas

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AHILA14 delegates. Courtesy of Jean Shaw, Phi.

Report from Jean Shaw of Partnerships in Health Information, attending the 14th biennial AHILA congress.  Dar Es Salaam, Tanzania. AHILA14 Days 2-4.

The papers at the past three days at the AHILA Congress have covered a wide spectrum of subjects reflecting the Congress themes: ICTs and access to information and knowledge. Information seeking behaviours, access to and resources for health information have been extensively reported in papers covering disparate groups ranging from academic researchers and students to mothers and students, teenage pregnant girls and older people (60 onwards).

Health information in rural areas..the role of community health workers

The problems of providing health information in rural areas, where some religious and cultural values can be a barrier to western medicine were the subject of a number of studies and lengthy discussion. They were enhanced by a session organised by Dr. Neil Pakenham-Walsh of HIFA, who had invited community health workers and their Project Manager, Dr. Edoardo Occa, to describe the work of CUAMMDoctors with Africa (an Italian organization involved in the training of Community Health Workers at the grassroots level in seven African countries). 

 

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Dr.Occa with Tanzania community health workers & trainers, CUAMM. The NGO works in Angola, Ethiopia, Mozambique, South Sudan, Sierra Leone, Tanzania and Uganda.

 

IT was an eye-opener to learn of the tremendous workload and the problems they met.

Neither of the two health workers who spoke had ever been to Dar es Salaam and their presentations were given in almost instant translation by Mr. G. Faresi a community health worker trainer with the project. To round it off we were shown all the books and equipment that has to be carried by visiting health workers as they cycle great distances. It is obviously very heavy.

This was followed up by an excellent and complementary description of training Community Health Extension Workers in Kenya – an initiative carefully planned and carried out by the Kenya Chapter of AHILA (Ken-AHILA).

This blog also appears on Global Health Knowledge Base

 Editors comment

  •  the 3rd day of AHILA 14 was devoted to the  2nd HIFA conference.
    The session on community health workers & CUAMM, formed part of the HIFA conference.
  • CABI's Global Health database has 1030 records on community health workers (FREETEXT search).  Even more records can be achieved using this searchstring:  "community health" and "medical auxillaries".

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Prostate cancer prevention – why do posters target women?

PEH1939 All of a sudden I’m seeing public health posters everywhere- about symptoms of bowel cancer and prostate cancer. The second one was a bit odd, as it’s a man’s disease but the poster was in the ladies toilets. And it was aimed at women. Why? Are there posters about breast cancer prevention in the men’s loo? I’m told not.

The impression this poster gave me is that men need their wives/girlfriends/mothers to look after their health. Wouldn’t it be better if men took responsibility themselves? Why don’t they?

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Health inequality, health disparity, health equity: what’s the difference?

Well if you are at the bottom of the social heap, striving to find enough money to put food on the table and keep a roof over your head…not much.

But if you want to understand how a government or a researcher or  development worker thinks and works to improve your lot (& public health in general), then you need to know the difference.

So here goes:

Health inequality and health disparity are used interchangeably, depending on the country. AS an English speaker, there is a nuanced difference between the term inequality and disparity. Inequality  to me comes with an ethical link behind it whereas disparity implies there’s just a difference.

But for researchers and policymakers, there is no difference between health inequality and health disparity. So here is their definition:  differences in health between populations (defined by country or regions) and between groups based on gender or socio-economic status or ethnicity. Having established these differences through evidence (and there’s lots), its up to you or your government to decide if the difference is worth addressing.[ In our database Global Health, records using either term are found but are all indexed with & will be retrieved consistently using “health inequalities”]

Whereas health equity is understood by all in the field that these differences in health are immoral, that they are linked to social or economic status, “the rich live 7 years longer than the poor” in the UK, the average life expectancy of a woman in Swaziland is just over 1/2 that of her equivalent in Sweden (48 vs 84 years): it comes with a value judgement that “everyone is entitled to a healthy life” unless demonstrated otherwise…and that otherwise would  have to be environmental  or genetic effects which could not be changed.  And at that point you’d move into the area of Quality of Life, which is outside the subject of this blog.

Indeed it has been suggested that it is a human right to expect a healthy life (for however long that might be);

Article 25 of the U.N. Universal Declaration of Human Rights (1948):

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

The implications of this for international law &, clearly, the practicalities are still being worked out…

Two conferences in November (EUPHA 10 ( Amsterdam) and APHA  2010 (Denver) are addressing health inequality and health equity (the latter under the theme of "social justice").