Universal Health Coverage (UHC) stands as a fundamental principle in global health, advocating for everyone, everywhere to access quality health services without facing financial hardship. But When Was The Universal Health Care Program truly recognized and pursued on a global scale? While the concept has roots stretching back decades, the formalization and global push for UHC as we know it today is a more recent and evolving journey.
UHC is not merely about treating illnesses; it’s a holistic approach encompassing the entire spectrum of essential health services. This includes everything from health promotion and disease prevention to treatment, rehabilitation, and palliative care, addressing health needs throughout every stage of life. Delivering such comprehensive care necessitates a robust health system supported by a skilled and equitably distributed health workforce, access to essential medicines and technologies, and sustainable financing mechanisms. Crucially, UHC aims to shield individuals and families from the devastating financial consequences of healthcare costs, preventing them from being pushed into poverty due to seeking necessary medical attention.
Alt text: A world map highlighting countries that have implemented various forms of universal health coverage programs, showing global progress towards healthcare access.
The pursuit of UHC gained significant momentum with the adoption of the 2030 Sustainable Development Goals (SDGs) by United Nations member states in 2015. Within the SDGs, UHC is explicitly enshrined as target 3.8, urging nations to “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” This commitment at the highest global level marked a pivotal moment, solidifying UHC as a central pillar of sustainable development and global well-being. Prior to this, in 2012, the United Nations General Assembly resolution on UHC already urged countries to move towards universal health coverage, highlighting its role in national development. The 2019 United Nations General Assembly High-Level Meeting on UHC further reinforced this commitment, with countries reaffirming that health is not only a fundamental human right but also a crucial prerequisite and indicator for social, economic, and environmental progress.
However, the journey towards UHC has faced significant headwinds. Even before the COVID-19 pandemic, progress in expanding health service coverage had begun to slow down. The UHC service coverage index, a key metric for tracking progress (SDG indicator 3.8.1), showed a concerning stagnation after 2015. While it increased significantly from 45 in 2000 to 68 by 2021, the pace of improvement decelerated notably after 2015, rising by a mere 3 index points between 2015 and 2021 and showing no improvement since 2019. This stagnation means that in 2021, an estimated 4.5 billion people globally were still not fully covered by essential health services.
Alt text: A bar chart depicting the global population that lacks full coverage of essential health services, emphasizing the large number of people still without adequate healthcare access.
Adding to the challenge, financial hardship due to healthcare costs continues to escalate. The proportion of the population experiencing catastrophic out-of-pocket health spending (SDG indicator 3.8.2) has been on a continuous rise since 2000, reaching 13.5% in 2019, affecting over a billion people. In 2019 alone, healthcare expenses pushed 344 million people deeper into extreme poverty and 1.3 billion into relative poverty. Overall, in 2019, approximately 2 billion people worldwide faced some form of financial hardship linked to healthcare costs. This concerning trend of stagnating service coverage coupled with increasing financial hardship is observed across all regions and income levels globally, highlighting the pervasive nature of the challenge.
Inequalities remain a significant obstacle in achieving UHC. Aggregate national data often masks disparities within countries. For instance, access to reproductive, maternal, child, and adolescent health services tends to be uneven, with wealthier, more educated, and urban populations generally having better coverage, especially in low-income countries. Financial hardship is also disproportionately borne by vulnerable groups, with catastrophic health spending being more prevalent in households with elderly members. People in poorer households, rural areas, and those with older family members are at a higher risk of being driven further into poverty by healthcare expenses. Addressing these inequalities is paramount for the equitable realization of UHC, requiring targeted policies and interventions to reach disadvantaged populations.
The COVID-19 pandemic further exacerbated the challenges, causing widespread disruptions to essential health services. At the peak of the pandemic in 2021, 92% of countries reported disruptions to essential health services, and even in 2022, 84% still reported ongoing disruptions. Routine immunization services were significantly impacted, with an estimated 25 million children under 5 years missing out on vaccinations in 2021. Furthermore, stark disparities in access to COVID-19 vaccines emerged, with low-income countries lagging far behind high-income countries in vaccination rates. These disruptions and inequities underscore the fragility of health systems and the urgent need for strengthening them to withstand future shocks and ensure continued progress towards UHC.
Alt text: A graph illustrating the percentage of countries reporting disruptions to essential health services during different phases of the COVID-19 pandemic, highlighting the pandemic’s impact on healthcare access.
To accelerate progress towards UHC and build more resilient health systems, the World Health Organization (WHO) advocates for reorienting health systems towards a primary health care (PHC) approach. PHC is recognized as the most inclusive, equitable, cost-effective, and efficient pathway to enhance both physical and mental health and overall social well-being. It emphasizes providing integrated health services that are universally accessible and located as close as possible to where people live and work. A PHC approach enables the delivery of a comprehensive range of quality health services and products, thereby improving both service coverage and financial protection. Importantly, it is estimated that approximately 90% of essential UHC interventions can be delivered through a PHC approach, potentially saving 60 million lives and increasing global average life expectancy by 3.7 years by 2030.
In conclusion, while the seeds of universal health care were sown in the WHO constitution of 1948 which declared health as a fundamental human right, the global commitment to UHC as a measurable goal truly solidified with the adoption of the Sustainable Development Goals in 2015. Despite this commitment and some progress, significant challenges remain, including stagnating service coverage, rising financial hardship, and persistent inequalities, further exacerbated by events like the COVID-19 pandemic. Embracing a primary health care approach is crucial for overcoming these challenges and accelerating progress towards the vision of health for all, ensuring that everyone can access the care they need, when and where they need it, without facing financial ruin.
