By Renzo Guinto
On December 12 the global health community celebrated Universal Health Coverage Day, commemorating the passing of the UN resolution in 2012 which called for the provision of quality, affordable health care to any person, anywhere. Coincidentally, also on the same day, at the 21st Conference of Parties (COP 21) of the UN Framework Convention on Climate Change held in Paris, the world’s governments arrived at a consensus to reduce greenhouse gas emissions, keep the global temperature rise to below 2 degrees Celsius, and ultimately protect human lives and the global climate.
During the past decade, we have witnessed the global health agendas of universal health coverage and climate change and human health evolve separately yet parallel to each other, with occasional overlaps. It seems that now, the two rivers are reaching the confluence. The UN UHC resolution may not have mentioned the phrase “climate change,” and the Paris Agreement did not make any reference to UHC, but the recently adopted Sustainable Development Goals allow these two agendas to unite under a comprehensive global framework for sustainable human development. UHC is identified as a target under Goal number 3 on health, while addressing climate change has its own Goal, number 13. Recently, WHO released a report discussing the place of health in the transition from MDGs to SDGs, laying out both UHC and climate action as priorities in its post-2015 global health agenda.
Achieving UHC and addressing climate change at the same time will lead to greater health equity. Effective UHC systems will greatly help in reducing inequities in access to essential health care. On the other hand, addressing climate change will prevent further exacerbation of existing health inequities, and also provide an opportunity for acting on the social and environmental determinants of health such as energy access, transport, agriculture, and urbanization that, by themselves, determine the distribution of health outcomes in society.
Aside from the convergence in goals between the two streams, actions in one side can also be beneficial in the other. For instance, mitigating climate change and reaching the 2-degree target will require massive divestments from coal and other fossil fuels, which are the leading emitters of climate-destabilizing greenhouse gases. These fossil fuel subsidies can instead be reinvested not only in clean, renewable energy technologies, but also in strengthening health systems to achieve UHC. It is unfortunate that countries that allocate large sums of public funds to fossil fuel subsidies are also the same countries that spend less for health and therefore result in low health coverage. The UHC and climate change agendas may provide these countries the additional push required to transfer financial resources being spent on burning dirty energy to enhancing health systems.
In addition, transitioning to healthy renewable energy will improve health outcomes, reduce burden on health systems, and secure the future of UHC overall. The WHO reports that annually, 7 million deaths result from both outdoor and indoor air pollution due to our energy choices, from fossil fuels for electricity and transport, to solid fuels for household cooking. Decarbonizing our global energy mix will not only mitigate long-term climate change but also reduce short-lived climate pollutants such as black carbon, which produce enormous number of cases of cardiovascular and respiratory diseases, among others. Through reduced health spending and hospitalizations due to hugely avoidable causes such as air pollution, the public health “co-benefits” of climate mitigation will also be beneficial for the preservation and sustainability of UHC systems. The Healthy Energy Initiative, which shortly before COP21 launched the Paris Platform for Healthy Energy, emphasized this much-need energy transformation for the benefit of both human health and the global climate.
Finally, UHC is a powerful approach towards building resilient health systems. It is not only a step towards health equity but an important measure for climate adaptation. It was estimated that climate change is expected to cause approximately 250,000 additional deaths per year between 2030 and 2050, and it is clear that UHC systems will bear this brunt. In the face of external shocks and stresses such as extreme weather events, health systems must have the capacity to bend without breaking – this means health systems that possess well-equipped, adequate, and responsive health workforce, steady financing to fund health emergencies, robust information systems that can monitor climate-sensitive diseases, and hospitals and other health facilities that will be the “last building standing.”
For example, my home country, the Philippines, has a wealth of experience in preserving UHC as it addresses the health consequences of climate-related disasters. When Typhoon Haiyan – considered one of the strongest typhoons to ever hit land in history – struck central Philippines in 2013, PhilHealth, the country’s national health insurance agency, immediately activated flexibilities for disaster victims, including granting of hospital benefits to members and non-members alike. Hospitals and health facilities were also restored using the “Build Back Better” approach to ensure that they are able to withstand future disasters. Strengthening these “building blocks,” which were identified as priorities in an operational framework recently published by the WHO, is critical to the success of both UHC and climate adaptation.
Certainly, there are other opportunities for convergence between the sister agendas of #UHC and #ClimateHealth that are yet to unfold and be discovered. Next year’s Fourth Global Symposium on Health Systems Research, which will revolve around the theme “Resilient and responsive health systems for a changing world,” may provide the platform for such a conversation to happen. Now that we are entering the post-2015, post-COP21 era, the two global movements must interact more with each other, jointly explore synergies, and work in closer collaboration. After all, these two sister agendas share a common goal – to make #HealthForAll a reality in our generation and those to come.