Experts on health and development meeting at the Pan American Health Organization/World Health Organization (PAHO/WHO) this week said that universal health coverage should be the central health-related goal of the global health agenda post-2015, and that greater social inclusion in general will be essential to advance human well-being in the Americas and worldwide.
Social determinants of health should be part of the framework for monitoring progress toward universal coverage, experts say
Experts on health and development meeting at the Pan American Health Organization/World Health Organization (PAHO/WHO) this week said that universal health coverage should be the central health-related goal of the global health agenda post-2015, and that greater social inclusion in general will be essential to advance human well-being in the Americas and worldwide.
{slideshow}225,478,317,n{/slideshow}
"Good policies that promote equity and social inclusion have a better chance of improving people's well-being," said PAHO Assistant Director Francisco Becerra. "Universal health coverage represents the spirit of Alma Ata in 21st-century terms and opens up a new opportunity to place sound policies and people at the very core of development in an inclusive manner."
The remarks came during a special seminar on "Universal health coverage: Paving the way in the region of the Americas," held on 3 February 2014 at PAHO/WHO headquarters in Washington, D.C.
Maitreyi Bordia Das, the World Bank's lead specialist on social development, said that research carried out by the World Bank shows that the causes of social exclusion go far beyond income differences, in general as well as in terms of access to health care. For example, tribal women in India are much more likely to give birth at home than in health centers, where they could benefit from skilled attendance at birth. In-depth research revealed that the reason for this reluctance was poor treatment of tribal women by health center staff.
Social exclusion "is not always about money," said Das. "The real causes may be much deeper and not due to the health system at all."
Understanding the complex causes of social exclusion can help advance progress toward universal health coverage, Das noted. By shedding light on systematic differences in access to care, such research can help the health sector address areas of need.
Patricia Frenz, Assistant Professor in the School of Public Health at the University of Chile, noted that there is a broad global consensus on the importance of social determinants of health. "Seventy-five percent of health outcomes depend on living and working conditions," she said.
While this has led some to question universal health coverage as a specific development goal, Frenz said it is "the only health goal that integrates all aspects of the right to health."
She noted, however, that measures of progress toward universal health coverage should look at more than the percentage of the population covered. To ensure true universality, key social determinants—including education, early child development, employment, poverty, income distribution, and others—should be incorporated as core indicators into a monitoring framework for progress toward universal coverage.
Rosilene Mendes dos Santos, advisor to Brazil's National Agency for Health Surveillance (ANVISA), described Brazil's ambitious efforts to expand social protection and improve production by incorporating microentrepreneurs and small-scale agricultural producers into the formal economy and providing them with social and economic benefits, including health coverage.
"We know that small businesses are truly leveraging the economy, but most microentrepreneurs are not covered," said Dos Santos. She said these efforts have involved multiple ministries and have required a "paradigm change" in her own agency, which has shifted from a focus on regulatory enforcement to "a focus on artisanal production, respect for local communities and traditions, and preservation of traditional knowledge."
Luiz Galvão, head of PAHO/WHO's Special Program on Sustainable Development and Health Equity, noted that social exclusion remains a challenge for most countries in the Americas, despite impressive progress in increasing life expectancy and improving other key health indicators. Universal health coverage is central to efforts to reduce social exclusion. "It opens up a new opportunity to place people at the core of development, taking into account the social determinants of health, including comprehensive health care, and is predicated on the needs of people and communities, thus promoting both equity and dignity," he said.
The event was the second in a series of PAHO/WHO seminars on the subject of universal health coverage.
