Universal health coverage gains momentum in 2016

Measure-what-matters

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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Health & Wellness: making a drama out of public health

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A
great
deal of time and effort these days goes into making TV medical dramas both authentic and technically accurate. But it would appear that an unlooked for bonus of such detail is that these dramas – whilst being mainly entertainment vehicles- unintentionally improve health awareness in the watching public. They do so by providing accurate health information and can cause individuals to take action in regard to their own health or that of their family. In other words, take action to achieve “wellness”. These dramas can thus aid the current shift of focus of governments and public health practitioners to deliver Health & Wellness, aka Health & Wellbeing, (a National Wellness service rather than a National Health service?)  

This shift to Wellness i.e. staying healthy, is in response to the rise of chronic diseases and inequity. The aim is to empower the individual to make healthy choices and to address the social, environmental and economic factors which limit that choice. Health awareness is therefore a prerequisite for wellness.

Call the Midwife, the hit medical TV drama,  works hard to depict accuracy and authenticity 

An essay in April's Journal of the Royal Society of Medicine describes the steps taken by the writers, production team and actors of the hit BBC TV series, Call the Midwife, to ensure the series has sufficient medical accuracy and authenticity [the series is set in the poor Poplar district of East London during the early years of the National Health Service (1950s)]. The series  is viewed by more than 10 million people each week, and sold to almost 200 territories worldwide.

The author  of the essay is the actor Stephen McGann who plays the local community docter [GP], Dr Patrick Turner.

As one would expect, a clinical advisor [a practising midwife and lecturer] oversees childbirth and nursing procedures but this series has gone further. Open-access journals and the Wellcome Trust archive are used as resources by the writer, and relevant health charities are called upon to provide an insight into the health impact of social conditions of the time. McGann himself deliberately chose to make his character a smoker “after reading a BMJ study* [by Richard Doll: Mortality in relation to smoking’: 50 years' observation on male British doctors  BMJ 328 (7455): 1519] which observed the effects of smoking on men over a 50-year period, starting in 1951.  A total of 34,439 smokers took part in the research – all of them doctors.” [*The first publication based on this cohort was in 1954 and is in the Global Health Archive database: ‘The mortality of doctors in relation to their smoking habits.  BMJ 328 (7455): 1529.]

But McGann then goes on to explain that the medical accuracy and authenticity pioneered by ‘Call the Midwife’ has communicated valuable insights to ordinary people into important public health issues …giving them the information to improve their own health.

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