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Universal Health Care: Perceptions, Values, and Issues


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From the workshop "Universal Health Care: The First Step to Global Health Equity" held last August 5-9, 2012 in Mumbai, India during the 61st General Assembly March Meeting of the International Federation of Medical Students' Associations (IFMSA). Brought to you by the IFMSA Global Health Equity Initiative (

For more information about the workshop, visit

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Universal Health Care: Perceptions, Values, and Issues

  1. 1. Universal Health CarePerceptions, Values, and Issues Ramon Lorenzo Luis R. Guinto, MD
  2. 2. Universal Health Care• Deconstructing UHC o Health o Health Care o Universal o Health Equity• World Momentum for Universal Health Care• Emerging Overarching Questions about UHC
  3. 3. Universal+ Health+ Care ???
  4. 4. What is Health?
  5. 5. The Constitution of WHO, 1948“a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity... a fundamental human right”
  6. 6. Universal Declarationof Human Rights, 1948 Article 25 “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
  7. 7. Human RightsBasic protections and entitlements needed to safeguard every person’s dignity and promote the realization of each person’s full potential
  8. 8. Principles of Human Rights Universality Nondiscrimination Inalienable Indivisible Interconnected Participation Accountability
  9. 9. Alma Ata Declaration, 1978“The Conference strongly reaffirms that health is a fundamental human right”“The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable”
  10. 10. Ottawa Charter for HealthPromotion, 1986 “a resource for everyday life, not the objective of living... a positive concept emphasizing social and personal resources, as well as physical capacities”
  11. 11. Health as a Public Good“Public goods are non-excludable and are available in the public domain for all to enjoy. The public good concept implies that health cannot be reduced to a commodity and needs political will and a ‘public push’.”Ilona Kickbusch, 2004
  12. 12. A New Definition?“the ability to adapt and to self-manage.” Huber, et al. British Medical Journal, 2011
  13. 13. What shapes HEALTH?
  14. 14. Health or Health Equity?
  15. 15. Health Equity• Inequalities in health – ‘differences’ in health across individuals / population groups• Inequities in health – avoidable differences ‘Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. It is this that we label health inequity.’WHO Commission on Social Determinants of Health (2008)
  16. 16. How about Health Care?
  17. 17. The Spectrum of Health Care
  18. 18. Health System“A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. And it needs to provide services that are responsive and financially fair, while treating people decently.” (WHO website)
  19. 19. WHO Health System Framework
  20. 20. How universal isUNIVERSAL?
  21. 21. So what isUniversal Health Care?
  22. 22. Is Universal Health Care =Universal Health Coverage?
  23. 23. World Health Assembly, 2005“access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost”
  24. 24. WHAT IS UNIVERSAL HEALTHCOVERAGE?A simple definition on UHC: All people receive the health services they need without suffering financial hardship
  25. 25. Indian Definition"Ensuring equitable access for all Indian citizens, resident in any part of the country, regardless of income level, social status, gender, caste or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative and rehabilitative) as well as public health services addressing the wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services."High Level Expert Group for Universal Health Coverage
  26. 26. Philippine Definition“provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public”Universal Health Care Study Group, University of the Philippines
  27. 27. World Momentum forUniversal Health Care
  28. 28. GLOBAL HISTORY OF UHC• Most High Income Countries achieved UHC 30-100 years ago – exception of US• Post independence many developing countries had UHC aspirations but lacked sufficient public funding• With notable exceptions (China, Sri Lanka, Kerala, Cuba) UHC restricted to richer countries in 20th Century• Donor policies of 1980s inhibited UHC Yates 2012
  29. 29. "Universal coverage is the ultimate expression of fairness." "Universal coverage is the single mostpowerful concept that public health has to offer."Dr. Margaret ChanWHO Director-General65th World Health Assembly 2012
  30. 30. WHY UHC ADVOCACY IS GAININGMOMENTUM• UHC is relatively easy to understand• Compatible with human rights agenda• UHC is an attainable goal – especially as countries make transition to MIC status• UHC is popular and inherently political• UHC brings politics into health systems agenda – people receiving services• Opportunity to celebrate national successes (perhaps at the expense of others failures) Yates 2012
  31. 31. Emerging OverarchingQuestions about UHC
  32. 32. Questions• Which UHC model promotes equity? Health for all?• Is UHC a mere financing issue?• What is the role of action on SDH in achieving UHC?• Is UHC really the answer?