Shocks, stresses and Universal Health Coverage
This blog post is part of a wider HSG blog series in the lead up to the Universal Health Coverage Forum 2017, which takes place in Tokyo, Japan from 12 - 15 December. In this series, HSG members provide their perspectives on how Health Policy and Systems Research is fundamental to acheiving Universal Health Coverage by 2030.
By Lorcan Clarke and Virginie Le Masson
Extreme weather events alone result in an estimated 200 million people losing their home or needing emergency assistance each year, leading to direct and indirect impacts on peoples' physical and mental health. Initiatives to address the global shortfall of the 400 million people who lack access to essential health services will fail if they do not acknowledge these risks to individuals and the wider health systems. Governments also need incentives to meet calls to increase spending on health to at least 5% of GDP; a figure met by less than two-thirds of governments globally in 2014. Doing so requires policies for health, resilience and sustainable development that are informed by the potential impacts from disasters, from infectious disease outbreaks to extreme weather events to industrial calamities.
Whether they occur rapidly or are drawn-out over time, disasters disrupt health systems and infrastructure and lead to particularly negative consequences for economically marginalised populations living in the global south. Meanwhile, shifts in climatic, geographic and demographic drivers of risk and vulnerability will alter the potential impacts of disasters to individuals’ health and wellbeing. These will appear through new profiles of extreme weather events, migration and population age profiles globally. As a result, societies will face shifting disease burdens and related health costs, which further constrain the sustainability of health systems and poses a risk to achieving universal health coverage (UHC).
This November saw the launch of the annual Lancet Countdown on Health and Climate Change and the Sixth Annual Climate and Health Summit 2017 at COP23. Yet the focus remains on how current health systems will experience climate change and its negative impacts, rather than on engaging in transformational processes such as UHC to improve equity and adaptability to current and future climate risks. In parallel, emerging calls for climate justice focus on financial solutions to losses and damages. However, placing a unit value on past and future impacts on health and wellbeing is problematic, especially as the costs of care change due to increasingly complex chronic disease burdens globally.
Health policy and systems research needs to consider integrated development planning, by creating avenues to improve the accountability of governments to provide healthcare to all. This could involve controlling polluting and hazardous industrial activities that negatively affect health, or supporting policies that expand access to essential medicines by reallocating carbon subsidies. The SDGs, the Paris Climate Agreement and the Sendai Framework for Disaster Risk Reduction offer templates for moving from commitment to action, but this action requires research for all contexts.
Addressing inequitable access to healthcare requires innovative financing instruments, better monitoring systems to identify vulnerable groups during and after disasters, and mechanisms to ensure minimal disruption when delivering care and essential medicines. Planning and estimating required healthcare spending to move towards UHC will need to account for this, building on assessments informed by conflict and governance related vulnerabilities.
UHC offers the best policy platform to reduce the vulnerabilities of the most marginalised people in the face of disaster risks and climate change. Yet, its achievement requires research on context-specific policies and actions informed by different drivers of risk and vulnerability, their impacts on health systems and the potential consequences for the health and wellbeing of populations. Doing so will ensure policies are more sustainable, accountable and supportive in countries moving towards universal health coverage.
For more information, read the latest working paper from the Overseas Development Institute: Shocks, stresses and universal health coverage: Pathways to address resilience and health. It was produced by Lorcan Clarke and Virginie Le Masson as part of the Resilience Scan, a quarterly analysis of key emerging resilience-related topics.