Universal health coverage is quite simple really, it’s that everybody gets the health services they need with financial protection. So there are three aspects to it: firstly the universality, that everyone should be covered, then it’s people getting the health services they need, the complete range of services from prevention, promotion, curative, rehabilitative and palliative services but also this very important aspect about the financial protection, that in accessing services they’re not suffering financial hardship and certainly not being plunged into poverty as a result.
How can it be achieved?
It’s an aspiration. If we were being really honest I don’t think there’s a single country in the world that has a pure form of universal health coverage where every service is covered perfectly for everyone without any financial hardship. But you can see that countries are moving much faster towards it than others and there are great examples around the world. When you look at the definition, though, you can see very quickly that universal health coverage can only really be achieved in a system that is predominantly publically financed because to get that universal aspect, to get everyone getting the services with the financial protection, clearly it’s the case that healthy, wealthy people need to cross-subsidise services for the sick and the poor. If you leave it to a free market that will never, ever happen. So really moving towards universal health coverage is all about switching to a publically financed system and this is a trend that we’re seeing right across the world.
How is this progressing?
It’s growing very quickly and it’s very exciting that you can see that every country is trying to do it. There have been United Nations General Assembly resolutions on it, it’s one of the STG targets, so every country is signed up to doing it, every one says it’s doing it but obviously some are doing better than others. It’s fair to say that it has been in Western Europe, which is the continent that has made the greatest advances quickest, but then very quickly you can see parts of the Far East and Australasia, Latin America having moved very rapidly towards universal health coverage, Canada as well. But there are some noticeable outliers, thinking particularly of the United States with its highly private system is yet to achieve universal health coverage, despite it spending pretty much twice as much on healthcare as the rest of the world. So obviously you can mess it up even if you’re a wealthy country. But the exciting thing is there are lots of middle income countries now with the resources that they can do this so you’re seeing huge developments in Indonesia, India, South Africa, Kenya and these countries are likely to make the transition in the coming years.
How does cancer fit in to this?
Clearly it should and going again back to the definition about people with high health care needs being protected from the financial costs, you can see that people with cancer or threatened by cancer are a high need group who you need to be protecting. So objectively they are a population that desperately need effective services right across the spectrum again from prevention through to palliative care. Also because a number of the services are high cost and we need to be realistic about this, they need protecting from the financial consequences of the services. So objectively in terms of people requiring cancer services being a priority they definitely should be and there’s a very, very good case that a universal health coverage benefit package should explicitly include cancer services. So it’s very, very important that the cancer community recognises this and makes the technical arguments but also engages in the politics of this, because as we keep coming back to this that universal health coverage is as much about politics as it is about technical issues.
What would your take home message be?
That it’s very important for people in the cancer community to get involved. Universal health coverage is driving the global health agenda at the moment and you can see that at the World Health Assembly in the United Nations all countries are trying to do it. Now, that’s great but we need to be realistic – there is going to be a competition for resources and there are going to be very strong technical cases put forward by different groups and that if the cancer community really want people to get effective and good quality cancer services they’re going to need to argue the case both from a technical perspective but also to get involved in the politics. This is an area that people often feel a bit uncomfortable about but, at the end of the day, if you want these services to reach everyone you just have to get involved.
