We're a world away from universal healthcare — for now

We're a world away from universal healthcare — for now
© Stefani Reynolds

World leaders gathered at the United Nations two years ago unanimously committed to the lofty goal of every person worldwide being able to access essential health services by 2030.

As of today, the second anniversary of the Political Declaration on Universal Health Coverage, we could not be farther from that aspiration.

If the coronavirus pandemic has taught us anything, it is that we must meet health challenges directly — both those newly emerged and entrenched. We cannot risk small measures or deferred fixes, but instead, summon the courage to demand systemic transformation.

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Since the 2019 United Nations General Assembly meeting, COVID-19 has widened the chasm of health inequity, first in who gets sick and dies and now also by who can get vaccinated. The need for universal care has never been more urgent nor evident, yet our global health system is operating as it always has.

To course correct, we must recognize two inseparable truths. First, universal healthcare is the most potent tool the world has at its disposal to not only care for those impacted by disease but to prevent sickness in the first place. Second, to unlock the potential of universal health coverage, we must invest comprehensively in the trained health workforce.

Health, but especially the health workforce has been historically underinvested for the last 50 years and we are witnessing the tragic results of this failure. Prior to COVID, health worker shortages stood at nearly 17.4 million, a gap that has only worsened during the past 18 months. These shortages have meant that not only do victims of the pandemic go uncared for and vaccines delayed — but also those cancer patients, pregnant people and injured workers go untreated, and 23 million children miss life-saving inoculations.

The global COVID vaccine rollout offers a poignant example of the crisis we face.

For every dollar spent on vaccines, countries pay $5 to deliver the shots, half of which are required for training, equipping, and paying healthcare providers. Yet, amidst a historic resource mobilization for vaccine production and distribution, a complementary program that invests in health workers is absent. As a result, as vaccines have been prioritized, scarce health workers have been reassigned from patient care to vaccine delivery.

The status quo choice between short-term response and essential foundations is no longer tenable. 

Achieving universal health coverage and its requisite workforce will take planning, time, and holistic and sizable investment, but the results will speak for themselves. Evidence shows that the growth of the health sector and health system improvements have sizable returns. Macro-economic analysis has indicated that adding just one extra year to life expectancy can raise GDP per capita by nearly 4 percent, with studies that one-quarter of economic growth in low and middle-income countries from 2000-2011 was attributed to improvements in population health.

Investing in health systems can also have a multiplier effect, improving lives and livelihoods in the long term.

In Uganda, training nurses and physicians in the country resulted in a social return on investment of 17 to 1 in 10 years and more than 51 to 1 across 30 years. Additionally, almost  70 percent of health and social sector jobs will be held by women, advancing progress toward gender equality and poverty alleviation.  

Where the benefits of health investment are multifold, the cost of inaction is devastating.

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The World Health Organization has estimated more than 115,000 health workers have died in just the first year of the pandemic — the individual loss of each physician, nurse, or midwife bears actual costs in education and potential productivity.

In Kenya, for instance, the financial loss per physician is estimated to be over $500,000, while loss per nurse is estimated at over $330,000. These estimates do not consider the wider social and economic multiplier effects of healthcare worker employment.

At the broadest level, research from the Economist Intelligence Unit has forecasted economic disruptions costing more than $2.3 trillion by 2025.

In contrast, researchers have estimated the cost to achieve universal health care and filling the global shortages of health workers as a fraction of the loss; the $400 billion annual investment is a fraction of the cost of COVID and promises dividends in development, economic growth and wellbeing.

Two years ago, the world affirmed that health matters universally, as do the agents who ensure it. Today, we have a unique moment to spur global action, leveraging COVID’s incontrovertible proof of how poor health worsens inequities in every corner of the world.

There is a historic opportunity to realize our deepest values — we just have to choose it.

Dr. Vanessa Kerry is a critical care physician at Mass General Hospital, an associate professor at Harvard Medical School and CEO of Seed Global Health which partners with governments to invest in health care capacity for national, economic and human security.