Inequalities are Standing in the Way of Universal Health Coverage
By Mandeep Dhaliwal, Director of HIV, Health and Development, UNDP
2019 is the year of “health for all”. In September, world leaders will commit to stepping up action at the High-Level Meeting on universal health coverage (UHC) during the UN General Assembly. One of the central challenges to UHC is the growing inequalities between and within countries.
Today, in New York, a hearing with organisations from around the world — including civil society, academia and the private sector — will discuss accelerating progress towards UHC. One of the key focus areas should be how to ensure that the most marginalised in our societies get the quality health services they need without falling into financial hardship.
Individuals and families should not have to decide between health and wealth. Yet nearly 100 million people globally are pushed into extreme poverty by having to pay for the healthcare of a loved one or themselves. Between 2015 and 2030, effective and timely healthcare would save low- and middle-income countries US$ 11.2 trillion in lost economic output.
Moreover, at present far too many people are denied their right to health because of their gender, ethnicity, sexual orientation or socio-economic status. This reality goes directly against the fundamental inclusivity of UHC, as well as the pledge made by all countries to “leave no one behind”.
Addressing inequalities goes beyond economics, it involves investing in action to address the social, political and environmental determinants of health, including gender inequality.
Membership to certain groups within society often comes with health repercussions. No identity or behaviour — past or present — is cause for violating the right to health. Whether a person is a member of the LGBTI community, incarcerated or a person who uses drugs, they have a right to health. This means providing affordable, accessible and quality health services that meet their unique needs. For instance, men who have sex with men, sex workers and transgender people are at increased risk of HIV and so must have access to appropriate prevention interventions. People who use drugs should have equivalent access to health care, whether they are living in detention or communities, as outlined in the new International Guidelines on Human Rights and Drug Policy.
In addition, UHC calls on us to systematically and specifically address women’s health needs, which in turn contributes to empowerment and development.
Beyond technical concerns of appropriate and quality health services, laws that criminalise marginalized groups add to stigma and discrimination, driving people away from health services or even leading to additional human rights violations. The Global Commission on HIV and the Law calls on countries to outlaw discrimination, repeal punitive laws, and enact protective laws for effective HIV and health responses.
Part of what makes the concept of UHC so powerful is the fundamental opportunity it provides to address the inequalities driving poor health and reach those who are typically left behind. UHC can be an effective rallying cry for health and development but if we do not concretely address the central challenge of inequalities, ultimately we will fail to deliver on the promise to achieve health for all.
