The comeback of Universal Health Coverage in the post-2015 debate?
Perhaps the most provocative outcome of the Prince Mahidol Awards Conference (PMAC) in Bangkok (26-31 January 2015) was its proposal to reword the proposed Sustainable Development Goal (SDG) on health. In their call to action, Universal Health Coverage was again given prominence by amending the Open Working Group's SDG3 from "Ensure healthy lives and promote well-being for all at all ages" to "Progressively achieve Universal Health Coverage and ensure healthy lives for all". With the conference hosted by Thailand, one of the strongest proponents of UHC, and sponsors including WHO, the World Bank, JICA, USAID, China Medical Board and the Rockefeller Foundation—all strong UHC advocates—the recommendation was not unsurprising.
The endorsement of Director-General Margaret Chan’s priority global goal--“the single most powerful concept that public health has to offer”—must have been gratifying to WHO, which has watched UHC progressively lose prominence in successive documentation leading to the SDGs. The PMAC theme “Global Health Post-2015 Accelerating Equity” lent itself readily to explorations of UHC as the vehicle for that acceleration; with the conference broadly, if sometimes critically, supportive of WHO’s role. Suwit Wibulpolprasert chaired a mischievous post conference dinner panel "Do we still need the WHO?" provoking his eminent guests into proposing a series of significant changes necessary for WHO to step up to its role in post-2015 global governance—all “not feasible” in Suwit’s judgement. The inescapable conclusion was that radical changes in global governance for health were unlikely to coincide with this amended SDG vision.
But the proposed amendment is not without other problems--"progressively achieve" is sympathetic to the concept of differential development, but removes any definitive end-point to measure achievement. If defining UHC has been one of its long-term criticisms, this will compound that. This is now a double goal, with elements set in parallel, rather than UHC seen as instrumental to the "ensuring healthy lives for all".
And it raises the question of whether the centrality of UHC is where the action really is, in terms of the broader sustainable development discourse, and the implications of that whole agenda for health. In a conference that rightly identified the changed health governance landscape, the increasing role of private and civil society actors, and the impact of trade and economic policy on health inequity, the call for action speaks to debates within the health community. But the challenge for accelerating equity will lie in our engagement with all elements of the sustainable development agenda.
Written by Peter Hill for the GHP newsletter
Associate Professor of Global Health Systems, School of Public Health, The University of Queensland
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