In an ideal world, everyone, everywhere, would access the health services they need without having to pay more than they could afford. But is ‘health for all’, also known as universal health coverage, really possible, not just in rich countries, but in the poorest countries, too?
In short, yes. That’s why we joined hundreds of fellow economists in almost 50 countries to urge leaders to prioritize investments in universal health coverage. And the broader impetus behind this Economists’ Declaration, convened by The Rockefeller Foundation and now with more than 300 signatures, has placed global health and development at a historic crossroads.
In September, the United Nations General Assembly adopted a new set of 15-year global goals to guide the world’s efforts to end poverty, foster inclusive prosperity, and secure a healthy planet by 2030. As world leaders prepare to enact the most ambitious global to-do list yet – the Sustainable Development Goals will be launched on January 1 – deciding where to begin may seem a daunting task.
For economists, however, the answer is clear: The next chapter of development strategy should assign a high priority to better health – and must leave no one behind.
Reaching everyone with high-quality essential health services, without the threat of financial ruin, is first and foremost the right thing to do. Health and survival are basic values to virtually every individual. Furthermore, unlike other valuable goods, such as food, they cannot be supplied without deliberate social policy.
The fact that “preventable deaths” remain common in low- and middle-income countries is a symptom of broken or under-resourced health-care delivery systems, not a lack of medical know-how. If we increase investments in health now, by 2030 we can be that much closer to a world in which no parent loses a child – and no child loses a parent – to preventable causes.
Universal health coverage is also smart. When people are healthy and financially stable, their economies are stronger and more prosperous. And, with benefits ten times greater than initial costs, investing in health first may ultimately pay for the rest of the new global development agenda.
So the question is not whether universal health coverage is valuable, but how to make it a reality. More than a hundred countries have taken steps down this path; in the process, they have revealed important opportunities and strategies to accelerate progress toward the goal of health for all. In particular, we believe that three areas – technology, incentives, and seemingly “non-health” investments – have the potential to advance universal health coverage dramatically.
First, technology is fast becoming a game changer, especially in developing countries, where the gap in access to health care is the widest. In Kenya, which already leads the world in mobile money through “m-PESA,” an upsurge in telemedicine is enabling rural patients and health practitioners to interact, through video conferencing, with staff in Kenya’s main hospitals – thereby increasing quality of care at very little cost.
The m-PESA Foundation, in partnership with the African Medical Research Foundation, has also begun implementing online training of community health volunteers and complementing these trainings with bulk SMS/WhatsApp group messages to keep the group connected and share important updates. Investments in high-value, low-cost technologies will help us achieve more with every dollar.
Harnessing the power of incentives is another way to accelerate health reforms. This can and should be done without forcing the poor to pay for health-care services at the point of delivery. For example, when the state pays the private sector based on outcomes (for example, the number or share of vaccinated children), both accountability and results have been known to improve. Voucher programs for reproductive health care in Uganda and Kenya are now providing access to quality services from the private sector.
Finally, building resilient health-care systems – flexible enough to bend, but not break, in the face of shocks – means improving other public goods that are closely linked to human health. These include clean water and sanitation, and roads and infrastructure that enable emergency care and delivery of services. Health systems do not exist in a vacuum, and if we are serious about sustainable development, it is time to understand that investments in complementary systems are ‘trade-ons’ not trade-offs. We should be wary of viewing medicine as the only path to better health.
The success of the world’s development goals hinges on our ability to reach the poorest and most marginalized populations, who continue to bear the brunt of death and disability worldwide. A natural progression of the status quo will not be enough to reach them. Instead, we must push public health systems beyond their usual boundaries by investing in and promoting new technologies, sharpening incentives, and recognizing that health systems do not exist in a vacuum.
Universal health coverage is right, smart, and overdue. To achieve a world where everyone’s health needs are met and nobody is trapped in poverty, our leaders must heed this message and act on it.
Kenneth Arrow, a Nobel laureate in economics, is Emeritus Professor of Economics and Professor of Operations Research at Stanford University.
Apurva Sanghi is the World Bank’s lead economist for Kenya.