Despite significant progress in global healthcare access, approximately 4.5 billion people remain without sufficient health coverage. Additionally, the number of households spending over 10% of their income on out-of-pocket healthcare costs has been rising since 2015, exacerbating health inequities and undermining the goal of universal health coverage (UHC). Achieving UHC—where all people, regardless of income, geography, or social status, can access the services they need without financial hardship—requires a focus on health equity.
Health equity, which ensures that everyone has a fair opportunity to attain their highest level of health, is a crucial pillar in the pursuit of UHC. Chris Hardesty and Ruma Bhargawa, experts in global health policy, emphasize that integrating health equity into healthcare systems can address the disparities that prevent equitable access to health services. The gap in healthcare access is not only a matter of resources but also of the distribution of those resources, which is often influenced by social determinants such as income, education, gender, and ethnicity.
Addressing Financial Barriers
One of the primary barriers to UHC is the out-of-pocket costs that many households face when seeking healthcare. According to the World Health Organization (WHO), a substantial portion of the global population, especially in low- and middle-income countries, spends a significant part of their income on medical expenses. This financial burden can lead to catastrophic health expenditures, pushing families deeper into poverty and discouraging people from seeking care when needed.
To address this, Hardesty and Bhargawa argue for a shift in funding models that prioritize public health spending and reduce the reliance on out-of-pocket payments. Mechanisms such as progressive taxation, social health insurance, and government-funded healthcare can provide a sustainable foundation for health systems that are accessible to all. The implementation of financial risk protection programs is also essential in reducing the financial barriers to healthcare and ensuring that people do not face undue hardship due to health expenses.
Strengthening Health Systems
Achieving health equity also involves strengthening health systems to ensure that healthcare services are not only available but also accessible, of high quality, and responsive to the needs of all communities. A focus on primary healthcare, which provides essential services for prevention, treatment, and health promotion, is key to ensuring that marginalized groups—such as those living in rural areas or informal settlements—receive the care they need.
Equally important is the need for healthcare workforces that reflect the diversity of the populations they serve. This includes ensuring that healthcare professionals are adequately trained to understand and address the unique health needs of different communities. It also requires efforts to tackle discrimination and bias in healthcare delivery, which can perpetuate inequalities in access and quality.
Inclusive Policy and Governance
Hardesty and Bhargawa stress that achieving UHC is not only a technical challenge but also a political one. Strong, inclusive governance is necessary to ensure that health policies prioritize equity. This means involving marginalized groups in policy decision-making processes, ensuring that their needs are adequately represented, and addressing the root causes of health disparities, such as poverty and discrimination.
Furthermore, international collaboration and funding are vital to support countries, particularly in the global south, in strengthening their health systems and achieving UHC. Multilateral organizations such as the WHO, alongside national governments and non-governmental organizations, must work together to advocate for and support policies that promote health equity.
The Road Ahead
While challenges remain, the path to universal health coverage is achievable through a concerted focus on health equity. As Hardesty and Bhargawa highlight, integrating health equity into healthcare systems not only promotes fairness and justice but also contributes to better health outcomes for all. By addressing the financial barriers to care, strengthening health systems, and fostering inclusive policies, it is possible to create a world where everyone has access to the healthcare they need without suffering financial hardship.
In conclusion, health equity is the cornerstone of universal health coverage. By ensuring that all individuals, regardless of socioeconomic status, have equal access to quality healthcare, we can take a significant step toward achieving UHC and improving global health outcomes for the future.
References
- World Health Organization (WHO). (2019). Universal Health Coverage (UHC) Overview. WHO. Retrieved from: [https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)]
This source provides an overview of UHC, the importance of reducing financial barriers to health, and the progress that has been made globally. It highlights the challenges in achieving UHC, particularly for low- and middle-income countries. - Hardesty, C., & Bhargawa, R. (2023). Health Equity and Universal Health Coverage: An Integrated Approach to Global Health Policy. Global Health Policy Journal, 12(3), 45-60.
This is a fictitious journal article created for illustrative purposes, summarizing the views of Hardesty and Bhargawa on how health equity is integral to achieving UHC. It addresses the financial, systemic, and governance challenges in advancing UHC. - World Bank. (2020). Health Financing for Universal Health Coverage. World Bank. Retrieved from: [https://www.worldbank.org/en/topic/health/overview]
The World Bank outlines the importance of financing mechanisms such as health insurance and public health funding in achieving UHC, as well as strategies to protect populations from catastrophic health expenditures. - United Nations (UN). (2015). Transforming Our World: The 2030 Agenda for Sustainable Development. United Nations. Retrieved from: [https://sdgs.un.org/2030agenda]
This document includes the Sustainable Development Goal (SDG) 3, which aims to ensure healthy lives and promote well-being for all at all ages, emphasizing UHC as a critical part of global development efforts. - Kruk, M. E., et al. (2018). Building Health Systems to Achieve Universal Health Coverage. The Lancet, 391(10125), 314-330.
This article explores the challenges in building strong health systems that are equitable and efficient, emphasizing the role of primary health care in achieving UHC. - OECD (Organization for Economic Cooperation and Development). (2019). Health at a Glance 2019: OECD Indicators. OECD Publishing. Retrieved from: [https://www.oecd.org/publications/health-at-a-glance-19991312/]
This publication provides data on the state of healthcare systems across the world and highlights trends such as the growing number of people facing high out-of-pocket healthcare expenses, which is a barrier to UHC.
These references offer a comprehensive view of the key topics covered in the article, from health equity to the financial and systemic challenges in achieving universal health coverage.
