Universal Health Coverage Saves Lives—So Why Aren’t We Talking About It More?

What is it about?

After the cataclysmic 1918 influenza outbreak killed between 50 and 100 million people, many countries instituted healthcare systems which were free at the point of delivery. We would refer to those systems today as universal health coverage—where all residents of a country or region have access to a wide range of health services without financial hardship. Just as the 1918 pandemic started the universal health coverage movement, the ongoing COVID-19 pandemic should reignite countries’ adoption of universal health coverage. Our recently published research indicates that universal health coverage increased overall health system resilience against the effects of the pandemic. Using a methodology that allowed us to compare trends in health system resilience before and during the pandemic, we presented strong evidence in our PLoS Medicine article that countries which made greater progress towards achieving universal health coverage prevented a 3% reduction in childhood immunization coverage. In other words, countries which adopted universal health coverage were disproportionately able to continue provisioning other essential health services. This universal health coverage “resilience effect” likely leads to stronger health institutions and averted deaths.

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Photo by Kyle Glenn on Unsplash

Photo by Kyle Glenn on Unsplash

Why is it important?

These findings are important because it is almost certain that COVID-19 will not be the last public health crisis of the 21st century. Since 2020, the WHO has already declared monkeypox to be a global health emergency, and alarm bells are beginning to ring for other nascent diseases as well. Traditional disease surveillance efforts, while important, may only go so far. The triumvirate of climate change, globalization, and population movements ensure the rapid and wide spread of diseases when they appear. We therefore need to look at the underlying health system structures and institutions to safeguard against harshest effects of public health crises rather than relying solely on vaccines, masks, and quarantines. Universal health coverage is not something that can be instituted overnight. The political and economic costs of instituting universal health coverage can be high, and institutions are slow to change due to bureaucratic inertia. But it’s still important to begin a discourse about adopting universal health coverage—even and especially during the pandemic. In 1994, the World Health Organization described the 1918 pandemic as the “most deadly disease event in the history of humanity.” In 2020, that crown was overtaken after WHO claiming COVID-19 pandemic as the “worst-ever global health emergency.” Adopting universal health coverage is one way to help ensure that the COVID-19 pandemic stays that way.

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