Here is another way of approaching Universal Health Coverage(UHC).
UHC that leaves no one behind is about humanity and social cohesion and not economics.
Let us start this discussion by asking some basic questions. What is the purpose and nature of human life? As species Homo sapiens we are by nature empathetic, social and capable of collaborating in mutually supportive ways for individual and common good. We are naturally saddened when we see human suffering and cheered when we witness human success. This is what has enabled us to communally learn together, develop new knowledge and use it collectively and cohesively to transform the natural environment to our advantage.
Yes, we also have in us negative non cohesive tendencies such as selfishness and greed, jealousy and aggression. There is therefore permanent interplay between the socially cohesive and the non-cohesive tendencies however; ultimately the mutually supportive common good tendencies predominate. This is the reason why we have collectively overcome the consequences of our negative tendencies such as ending wars that we start; ending slavery, colonialism, apartheid and controlling pandemics. Indeed negotiating and adopting the SDGs is an example of the success of our cohesive tendencies. How is this interplay between our cohesive and negative tendencies currently impacting the achievement of UHC?
Yes, very much indeed. The negative human tendencies currently have the upper hand and are impeding the acceleration of the effort on SDGs. Last March, 2019, I attended the 3rd Global Solutions Summit (GSS) convened by the Global Solutions Initiative in Berlin, Germany where this matter was discussed. The speakers at the GSS argued that we now have a prevailing disconnect or decoupling between the economic, political and social dimensions of the collective human effort. Economic growth and wealth is disconnected from social and economic wellbeing and from political aspirations and participation of the majority of the populations. The greed tendency is ascendant and as a result global wealth is held by very few who use the wealth to monopolize political space for themselves. As a result we now have a disgruntled majority and a restless world with behaviors such as Brexit, populism, religious extremism, nationalism and homophobia against refugees.
One of the speakers at the GSS was Sir Paul Collier, Professor of Economics and Public Policy at Oxford University and formerly Chief Economist at the World Bank. Paul Collier told the meeting with regret that for the last forty years they have been teaching wrong economics. They taught economists to pursue greed and profit and to be arrogant and insensitive. He told us that there was now need to unlearn that wrong teaching and replace it with teaching that links economics to humanity, empathy and the social cohesiveness that is biologically innate to human nature. Paul Collier presented the hormone Oxytocin as the biological mediator that bonds humans when mutually released by individuals thereby enhancing collective action for the common good.
I had known Paul Collier when he was at the World Bank and I was Director General of Health Services in Uganda. I walked up to congratulate him and have now read his book “The Future of Capitalism” that discusses this matter in detail. So what are the practical implications of all this for UHC? How do we design health systems for UHC that capture this message?
The first message is that health and wellbeing should now be reclassified not as just a consumptive cost but take its rightful place as the central purpose of economic growth and political action and as the primary goal of all the SDGs. The unlearning of the discredited economics teaching needs to be deliberately embarked upon so that there is change of behavior in the Ministries of finance, other related agencies and sectors. This will need deliberate and purposeful work with clearly defined measurable outcomes. The leading economists such as Paul Collier and Joseph Stieglitz have made a start and the recommendations in the report of the UN High Level Commission on Health Employment and Economic Growth are being implemented. A lot more needs to be done in Africa to get this message home.
Secondly, we must work to advocate for societies and communities that value social cohesion and embed health in the routine governance of society so that people are encouraged and supported to appreciate their individual and collective participation as both a duty and right as part of the empathic human social beings. This will be achieved through people centered Primary Heath Care with strong community health systems as the foundation for UHC starting now with the available resources.
At regional and global level there is an urgent need to crank up the push for social justice, inclusive economies and participatory politics. A social movement is needed; led by civil society and strong synergistic institutions. A well-funded WHO in Geneva and in the Regions is critical as the technical lead for health and well being working cohesively with other members of the UN family and the private sector.
UHC will not happen without adopting this approach? What do you all think?