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 (http://www.ifmsa.org/Activities/Initiatives/The-IFMSA-Global-Health-Equity-Initiative). For more information about the workshop, visit http://www.scribd.com/doc/193822108/Universal-Health-Care-PreGA-Program

1. Universal Health Care
Perceptions, Values, and Issues
Ramon Lorenzo Luis R. Guinto, MD

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. Universal
+ Health
+ Care
???

4. What is Health?

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. Universal Declaration
of 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. Human Rights
Basic protections and entitlements needed to
safeguard every person’s dignity and
promote the realization of each person’s full
potential

8. Principles of Human Rights
Universality
Nondiscrimination
Inalienable
Indivisible
Interconnected
Participation
Accountability

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. Ottawa Charter for Health
Promotion, 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. 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. A New Definition?
“the ability to adapt and to self-manage.”
Huber, et al. British Medical Journal, 2011

14. What shapes HEALTH?

21. Health or Health Equity?

27. 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)

28. How about Health Care?

29. The Spectrum of Health Care

30. 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)

31. WHO Health System Framework

32. How universal is
UNIVERSAL?

35. So what is
Universal Health Care?

36. Is Universal Health Care =
Universal Health Coverage?

37. World Health Assembly, 2005
“access to key promotive, preventive,
curative and rehabilitative health
interventions for all at an affordable
cost”

38. WHAT IS UNIVERSAL HEALTH
COVERAGE?
A simple definition on UHC:
All people receive the health services
they need without suffering financial
hardship

39. 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

40. 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

41. World Momentum for
Universal Health Care

43. 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

51. "Universal coverage is the ultimate
expression of fairness."
"Universal coverage is the single most
powerful concept that public health has to
offer."
Dr. Margaret Chan
WHO Director-General
65th World Health Assembly 2012

53. WHY UHC ADVOCACY IS GAINING
MOMENTUM
• 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

54. Emerging Overarching
Questions about UHC

55. 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?