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The Global Movement for Universal Health Coverage Ariel Pablos-Méndez, MD, MPH Columbia University Medical Center, NY IUATLD. Chicago,IL. February 28th, 2020
The Global Movement for Universal Health Coverage
Ariel Pablos-Méndez, MD, MPH
Columbia University Medical Center, NY
IUATLD. Chicago,IL.
February 28th, 2020
My presentation today:
The Changing World of Global Health
The Economic Transition of Health
UHC conquers the global agenda
1960's 1990's
End of Euro-colonialism
End of theCold War
2010's
The Changing World of Global Health
TropicalMedicine
InternationalHealth
GlobalHealth
Colonial arrangements
Pioneer age/missions
Western tech experts
Parasitic diseases and anti-viral vaccines
Eradication campaigns
New UN member states
East-West geopolitical divide
International solidarity
Health as social construct
Primary Health Care for all (Alma Ata to Selective PHC)
Globalization: trade, markets, information and communication technology (ICT)
AIDS and Millennium Development Goals (MDGs)
World Health Organization joined by World Bank, Non-governmental organizations (NGOs)
New Philanthropy & Funds
Public-private partnerships
Health Systems neglectSource: Pablos-Mendez A, Ravilgione MC. GHSP 2018
Development Assistance for Health:
The Golden Era of Global Health
GTB
Establishment of GTB
at WHO
HIV incidence & mortality cut by half
TB and Malaria deaths reduced by 40%
50% fewer women have died giving birth
125 million children’s lives have been spared
Family planning has empowered women, saved lives and brought a
demographic dividend to families and national economies.
Dramatic results since 1990
The End of Preventable Child Deaths
A Grand Convergence in sight
1960's 1990's
End of Euro-colonialism
End of theCold War
2010's
The Grand Recession
A New Political Economy
TropicalMedicine
InternationalHealth
GlobalHealth ?
Source: Pablos-Mendez A, Ravilgione MC. GHSP 2018
a New World
Health
Economic Transition
At global level, development assistance is diluted with new focus on fragile and the poorest states and global public goods like normativity and innovation.
At national level, growing political demands for social protection promote domestic resource mobilization and universal health coverage.
Opportunities arise for member-state organizations like WHO to confront emerging challenges like pandemic threats, HSS, and NCDIs
Development Assistance for Health:
Money is flat since 2010
My presentation today:
The Changing World of Global Health
The Economic Transition of Health
UHC conquers the global agenda
The changing global burden of disease
Source: IHME 2015
Source: J. Bradford DeLong, Estimates of World GDP, One Million B.C. – Present, 1998
Unprecedented Economic Growth in Human History
Maddison
DeLong
World per capita GDP
1990 dollars
Source: Jacques van der Gaag; WHO/IMF 2004
N = 178R2 = 90%
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Log Gross Domestic Product (GDP)
“The First Law of Health Economics”& The Economic Transition of Health
THE grows with GDPIn fact faster than GDP, %And it seems fungible
1965: Medicare and Medicaid Introduced
1973: HMO Act signed
1983: DRG/bundle payments to hospitals
1993: Clinton HealthPlan fails
2010: Obamacarepasses
National health expenditures as a share of GDP with recessionary periods, 1960-2013
Privateinterna onal
Publicdomes c
Privatedomes c
Publicinterna onal
Source: UN Research Institute or Social Development. Mobilizing domestic resources for sustainable development. In: Policy Innovations for Transformative Change: UNRISD Flagship Report 2016. Data sources: ODI et al. 2015: 32; World Bank 2016; OECD 2016a, 2016d; IMF 2016; ICTD and UNU-Wider 2016.
Domestic Resources dwarf International Funds(USD Bn, 2013 prices), 2000–2014
The Economic Transition of Health
India - Projected THE/K and Affordability
USAID Global Health Programs, 2015
Current Bilateral Programs
Former Bilateral Programs
Out-of-Pocket Expenditures: Inefficient and Regressive
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Source: WHO 2011 data based on World Bank Country Income Groupings
OOP SpendingIs inefficient& regressive: nearly 50% in SSA(more in S.Asia)
Most of THE is public but it may lag GDP’s growth & demand
AP 2018: Private Hospital Jails in 30 countries
Toussain Kanyimb Nawej shows goods left as collateral by patients unable to pay their bills at the Katuba Reference Hospital. (AP Photo/Jerome Delay)
My presentation today:
The Changing World of Global Health
The Economic Transition of Health
UHC conquers the global agenda
The Progressive Realization of UHC
Health System
Human Development Report 2014
Old role models & new examples existed already
2005 WHA Resolution 58.33 Sustainable health financing, universal coverage and social health insurance
URGES Member States:
to ensure that health-financing systems include a method for prepaymentof financial contributions for health care, with a view to sharing risk among the population and avoiding catastrophic health-care expenditure and impoverishment of patients;
(4) to plan the transition to universal coverage of their citizens so as to contribute to meeting the needs of the population for health care and improving its quality, to reducing poverty, … and to achieving health for all;
A New Movement for a New World Health
Source: The Lancet 2009 (based on ILO data).
Universal health coverage (UHC): A New Frontier for Global Heath
Strategic retreats and New Platforms
Bellagio PMAC
WHO
Foreign Affairs for Global Health
2015 Sustainable Development Goals 2030
UHC reaches the top of the global agenda
U.N.G.A. Special Session 2019
Coverage expanding . . .
but with growing catastrophic health expenditures
DRM for TB
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Conclusions:
The Golden Era of Global Health saw a 7-fold increase in (vertical) DAH which has produced significant gains in TB control and overall life expectancy >70 (a grand convergence for equity).
A New World Health Era is taking shape with flat or shrinking DAH but growing domestic resource mobilization for HSS that is now dwarfing international sources.
Except for public goods like R&D, GHS & pooled procurement (ej. GDF), Financing for TB control will be country gov-sourced and increasingly as part of reforms for Universal Health Coverage.
UHC Health for All
