Global politicians have the chance to adopt universal health coverage

27 Sep 19

World leaders are discussing healthcare for all - whatever a person’s financial circumstances - at a time when the issue is increasingly politicised, says the Open Society Foundation’s Julia Greenberg.

 

This week, heads of state from around the globe will gather at the United Nations for a high-level meeting on (UHC).

These leaders have committed to halting the catastrophic rise of out-of-pocket costs and covering an additional billion people with quality health services - a powerful aspiration for global economic justice. Indeed, every year another 100 million people fall into poverty because of out-of-pocket spending on healthcare.

But there is reason for caution: governments will be debating how to achieve UHC at the very moment when health is increasingly politicised and exposed to market forces that have pushed healthcare out of reach for so many.

As political leaders and corporate interests begin to see UHC as something they could leverage to their benefit, it becomes increasingly important to safeguard the basic principles of health as a public good and a human right. UHC must be a tool for justice and equitable public health, not an opportunity for those who already have power to accumulate more of it.

The question then becomes: will the UN meeting be a step toward restoring accountability for health to governments, or a platform for further politicisation and marketisation of healthcare?

Around the world, health has become a prominent political issue for heads of state and those who want to be them, particularly during elections and political crises. This can be for the good, as when politicians promise progressive health reforms, and for the bad, as when they seek to sabotage those same reforms to win populist support.

Nowhere is this more clearly illustrated than in the US in the endless battle over the Affordable Care Act, and in the prominence of drug pricing in the debates among democratic candidates for president.

Such dynamics are playing out in countries across the world. Newly elected Ukrainian president Volodymyr Zelensky campaigned against the progressive health reforms enacted by a ‘pro-Western’ health minister, Ulana Suprun.

Her reforms to the country’s notoriously corrupt health system cut the “pharma mafia” out of national procurement systems, and created a National Health Service—guaranteeing access to free primary care services for all citizens and raising doctor salaries. According to the deputy director of the charity organisation Patients for Ukraine, “She’s the only minister who came not to steal or to collect profits, but to actually change something.”


'Private actors have long played a role in healthcare systems around the world. But in recent years, skepticism has grown about the profit model’s role in public health. The pharmaceutical industry’s relentless pursuit of patent protections has led to soaring drug prices, and private sector actors have been implicated in corrupt medical equipment procurement processes.'


Yet despite the success of Suprun’s reforms, which laid a solid foundation for UHC, president Zelensky did not reappoint her when he formed his administration last month.

Worse, officials who have been associated with corruption scandals have assumed positions in the ministry of health. Now Ukraine’s UHC hangs in the balance. Health and anti-corruption advocates worry that Suprun’s health reforms will be dismantled in a crass effort to discredit the former administration and re-establish corrupt schemes.

The UN meeting itself is not immune to these political struggles. Hungary stepped down from its high-profile role as co-facilitator - just eight months after being appointed - when its nationalist, anti-immigrant government seemingly realised that the “universal” in UHC might extend to migrants and refugees, showing all too clearly how healthcare can fall victim to global and domestic politics.

Politicians aren’t the only ones riding the wave of UHC’s momentum. The private sector, sensing the potential for a windfall, is jockeying for position, too.

Private actors have long played a role in healthcare systems around the world. But in recent years, skepticism has grown about the profit model’s role in public health. The pharmaceutical industry’s relentless pursuit of patent protections has led to soaring drug prices, and private sector actors have been implicated in corrupt medical equipment procurement processes. Meanwhile, taxpayer money has been ploughed into public-private partnership hospitals that guarantee profits for companies while placing the bulk of the financial risk on governments.

These private interests clearly see an opportunity to cash in on an increasingly globalised health care industry to which UHC will add billions of patients. This ambition was laid bare during a May 2019 UHC conference in Kenya, where Phillips and General Electric, alongside the Kenyan government, promoted what is considered by many health advocates to be a failing medical leasing scheme.

Corporate partners receive $50m a year from Kenyan taxpayers in leasing fees for high-end equipment that, in some cases, wasn‘t needed in district hopsitals that are in desperate need of basic infrastructure upgrades and more human resources. Despite this, the partnership between the corporate entities and the governments of the Netherlands, Kenya and others was presented as a model for procurement that will deliver on UHC.

UHC has the potential to provide a guiding vision for economically just healthcare systems that will, at minimum, provide basic care for billions and alleviate poverty. It is a moment of opportunity—and of peril.

We have the opportunity to seize the momentum building behind the push to make healthcare a human right. But this momentum will also be irresistible to corporations and politicians who seek to harness it. Whether they do so for the benefit of all, or merely to gain their own advantage, will determine whether universal healthcare fulfills its promise as a tool for equity and justice.

  • Julia Greenberg

    director of governance and financing at the Open Society Public Health Program, an international grantmaking network, where she leads work on leveraging global financing for health and human rights and challenging harmful influences on health-related policy making.

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