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  • Brendan Shaw

Universal health coverage needs a new political campaign

In a recent poll Britons were asked what historical event in British history makes them feel proud.

Believe it or not, the creation of the National Health Service in 1948 came out way ahead as the British people’s proudest moment in their history, scoring 69%.

Source: YouGovUK, “One in three Brits say the Suffragettes’ campaign makes them especially proud to be British”, 5-6 February 2018,, accessed 31/3/2018.

Think about it.

The creation of the NHS outpolled events such as standing alone against Hitler, the abolition of slavery, and the Suffragette movement to give women the vote as the historical event in British history that makes Britons the proudest.

Events such as the signing of the Magna Carta, having the largest empire in the 19th century, the Battle of Waterloo and defeating the Spanish Armada pale into insignificance compared to the creation of the NHS.

So, health and universal health coverage is a major success story in British politics, at least.

You might think this is a quirk of the British, but time and time again in democracies around the world health has ranked as one of the top political issues in polls.

In many recent polls around election time in countries like the UK, the United States, Australia, Ireland and Canada health comes out as one of the top political issues influencing the way they vote.

Universal health coverage is, and should be, a major vote winner for politicians.

You’d think with all this vote-drawing power of health that governments would be falling over themselves to make health a top priority.

But, it seems the political message is not getting through to at least some governments.

There are examples where politicians, apparently, are not always responding to public concerns on health in election campaigns. One possible explanation is that concerns about health revealed in polls do not always grab the headlines. The media has some influence here. You don’t see many eye-catching headlines saying “No one died from polio today”. Long term health progress and development doesn’t always translate into an easy headline, and if the media aren’t reporting it, it’s difficult for it to stay on the political agenda.

Another reason might be that while political parties may try to use ‘wedge politics’ issues to differentiate themselves from each other, such as on social policy or law-and-order, they can ignore the public’s broader united desire to prioritise health spending and policy.

We know that once aid from international donors is taken out, lower-middle-income countries’ spending on health as a share of total government spending has barely changed since the beginning of the century and low-income countries have seen health spending as a share of government budgets steadily fall over the same period.

Moreover, those same countries that are not maintaining their health spending are the countries where a large portion of the total cost of health care is paid by people out of their own pockets, or their family’s pockets, when they get sick with little or no insurance coverage.

This can lead to catastrophic financial loss or people foregoing health care because they can’t afford it.

This is what universal health coverage is designed to avoid.

And it’s not as if people in low income countries don’t want good health services. One recent Lancet Commission study on universal health coverage found that in lower income countries, when “Presented with the option of affordable services of acceptable quality, data suggest that demand for unqualified, low-quality providers that are used mainly by the poor will fall”.

People in lower income countries prefer affordable quality health services the same as people in higher income countries do.

A recent joint WHO-World Bank progress report on UHC found that half the world’s population still lacks access to essential health services.

It found that 800 million people spend more than 10% of their household budget on healthcare.

And it also found that 100 million people each year are pushed into extreme poverty because of out-of-pocket health expenses.

That’s a lot of people looking for politicians who can solve the problem, many of whom will be voters.

This decline the priority of health spending in some countries comes in an era when we first had the Millennium Development Goals on health commencing in 2000 and now the Sustainable Development Goals on health commencing in 2015. The 2015 SDGs include an explicit target for all countries to implement universal health coverage by 2030.

Increasingly, the discussion of implementing universal health coverage across the world has been to get the political momentum behind increased health spending.

The head of the WHO, Dr Tedros, for example has consistently urged governments to make UHC a political priority and WHO reports on implementing UHC have identified the importance of getting political priority to implementing UHC.

This year's World Health Day is also focussing on implementing universal health coverage.

And there's no doubting that health is becoming more of a political issue, as evidenced by recent G7 and G20 meetings where health has started to feature on the agendas.

But, based on the spending figures at least, that political message hasn’t got through in many countries over the last couple of decades.

Many of these have growing government budgets and are seeing economic growth, but they are not investing it in health, while acknowledging that varying levels of government funding will be required depending on how active private sector providers of health there are in a country.

Whichever mix is used - public, private or a mix of public-private sector driven UHC, there needs to be a political leadership from the government in a country to at least create the environment for UHC to occur.

It’s probably time for a more serious new international political campaign to highlight the importance of health care to peoples’ lives and economic development, but also to highlight to politicians that health makes good political sense.

The health sector collectively needs to get better at arguing it’s social, economic and political case for investment.

Historically, the health sector hasn’t always done a great job of marketing itself to its political, economic and business masters in the same way that other sectors like education, defence, IT and infrastructure have done. It needs to get better at this.

Perhaps we need to develop a strong, overt, cross-country, cross-sectoral political campaign to demonstrate public opinion on universal health coverage and how it is potentially a vote-winner in many countries.

It’s something all stakeholders across the health system could support and participate in – a political campaign for universal health coverage, especially in countries where people are at severe risk of impoverishment when they get sick.

It would be nice to think other countries could also take pride in their health systems in the future.

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