by Ferdinando Regalia
There is an old joke that if you ask five economists the same question, you will get six answers in return. Like most jokes (even bad ones), this quip’s value lies in its discovery of a basic truth—getting economists to agree on anything can be quite difficult.
That’s what makes the Economists’ Declaration on Universal Health Coverage so remarkable. Over 300 economists from around the world have come together to call on global leaders to prioritize health as a cornerstone of sustainable economic development. In particular, we are urging policymakers to invest their development resources in universal health coverage policies, which allow everyone to get the health services they need without suffering financial ruin to pay for them.
The launch of the Declaration coincided with the launch of the United Nations’ new Sustainable Development Goals, an ambitious global agenda for 2030 that includes everything from tackling climate change to ending world hunger. Achieving universal health coverage is on this agenda, but it has the potential to be so much more than one goal among many. My fellow signatories and I argue that, economically speaking, achieving “Health for All” is essential to making all of the new goals a reality.
This is because universal health coverage is not just right; it has also been proven to be a key driver of sustained and inclusive development. A Lancet commission chaired by Larry Summers—a former U.S. Secretary of the Treasury who also convened the Economists’ Declaration with The Rockefeller Foundation—found that over the past decade, health improvements drove 24% of full-income growth in low- and middle-income countries.
I am proud that Latin America and the Caribbean countries are in many ways ahead of the curve when it comes to realizing the benefits of investing in health. Over the past few decades, the region has demonstrated tremendous commitment to advancing health equity. As a result, key health indicators—from infection rates to maternal mortality—have improved dramatically.
Chile, Costa Rica and Cuba are home to some of the strongest health systems among the world’s middle-income countries. These gains are rooted in unwavering political resolve to eradicate poverty together with robust domestic investments in health and related areas such as water and sanitation. It is no coincidence that my fellow economists and I directed our call to action toward governments and policymakers. Our experience in Latin America and the Caribbean tells us that progress on universal health coverage begins as soon as leaders are convinced that it is a worthy and necessary investment.
But our work is far from done. While the national numbers tell a story of progress, the reality is much more complicated. Vast disparities in access to health persist across the region. For an example, let’s look at some countries in Central America. At the beginning of this decade, only about half of women in the poorest 20% of the population gave birth assisted by skilled personnel. Well above 90% in the richest quintile had access to skilled birth attendants. Inequities like this represent the single greatest hurdle to truly achieving UHC in Latin America.
Overcoming these inequities in effective coverage is being further complicated by the rise of non-communicable diseases in the Latin America and Caribbean region and around the world. Despite the attention that infectious diseases and the unfinished reproductive, maternal, newborn and child health agenda receive, we must not forget that the three leading causes of death in Latin America and the Caribbean are heart disease, cerebrovascular disease (e.g., strokes) and diabetes.
Non-communicable diseases threaten equity by unleashing a two-fold attack on the poor. The health burden of these illnesses falls hardest on the poorest populations, and they are also among the most expensive diseases to treat. Without universal health coverage, which eliminates crushing health costs, those most in need of treatment will be the least able to access it. The resulting upsurge in sickness and poverty prevents individuals, communities and countries from reaching their full potential.
For Latin American and Caribbean countries to achieve health for all and tackle infectious and non-communicable diseases alike, policymakers must proactively infuse equity and sustainability into every facet of the health system.
First, countries cannot address health system gaps if they are not aware of them. Policymakers and governments must work closely with technical experts to effectively monitor and track access to health services and their effective coverage in every community.
Second, truly universal and sustainable health systems must be underpinned by robust financial resources and their efficient and effective use. This is particularly important for addressing non-communicable diseases, which cost more to treat over a longer period of time. Preventive public health measures that double as sources of funding for health—such as taxes on tobacco products—are a good place to start and should be considered an essential element of health financing.
Achieving universal health coverage in the Americas by 2030 will not be easy. But with strong stewardship by finance and health authorities, reliable data and processes to guide evidence-based scale-up decisions of population-based and clinical interventions, determination to tackle implementation challenges and genuine engagement from community health workers to government policy-makers to non-state actors, it is possible. What’s more, economists agree that it is imperative.
Ferdinando Regalia is the Chief of the Social Protection and Health Division at the Inter-American Development Bank.