Universal Health Coverage International Development Summit 2019 Dr Kathrin Thomas, Wales for Africa Health Links Network Dr Gill Richardson, Public Health Wales

Outline What is health? What makes people healthy? What is Universal Health Coverage? What could we do in Wales?

Question 1: What’s your definition of health? Lets start by understanding what we mean by health and wellbeing and then what could be the contribution of Universal Health Coverage

Definitions of health “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” WHO 1948

Definitions of health Ottawa Charter 1986 Health is "a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities." Ottawa Charter 1986

Health – same as Well Being?? a new definition of wellbeing as the balance point between an individual’s resource pool and the challenges faced: https://www.internationaljournalofwellbeing.org/index.php/ijow/article/view/89 Dodge et al 2012

Health is unfairly distributed

Hans Rosling video You tube Source www.gapminder.org World Poster 2015 Hans Rosling video my laptop Inequalities in Health February 2019

And look! Child mortality http://ourworldindata.org/ From Max Roser In Germany in the 1860s, one in two children died before age 5

Question 2: what links poverty and health?

What makes people healthy?

Health systems are a determinant The contribution of health care services to health outcomes has been estimated to be between 15% and 45%, and is probably diminishing returns as countries get richer – has greater impact in poorer countries It is a combination of access to care and the quality of this care.

3.1 maternal mortality ratio<than 70 per100 000 live births. 3.2 reduce neonatal mortality and under-5 mortality 3.3 end the epidemics of AIDS,TB, malaria, communicable diseases. 3.4 reduce by one third premature mortality from NCDs 3.5 Strengthen the prevention and treatment of substance abuse 3.6 halve the number of global deaths/injuries from RTAs 3.7 ensure universal access to sexual and reproductive health-care 3.8 Achieve universal health coverage 3.9 substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, soil pollution and contamination. 3.a WHO Framework Convention on Tobacco Control in all countries, 3.b Support the research and development of vaccines and medicines 3.c Substantially increase health financing and the health workforce in developing countries, 3.d Strengthen the capacity for management of national and global health risks.

Universal Health Coverage UHC is ensuring a minimum package of health services, and a progressive expansion of coverage of health services and financial protection UHC also includes population-based services such as public health campaigns, adding fluoride to water, controlling mosquito breeding grounds, and so on. UHC is comprised of much more than just health; taking steps towards UHC means steps towards equity, development priorities, and social inclusion and cohesion.

WHO’s number 1 goal https://youtu.be/C1bIjISMlTo?list=PL9S6xGsoqIBWsxThBfcdFgGtCInYOl774 UHC is a “coin” with two sides: that health care reaches everyone, and that no one incurs in financial hardship as a result of being sick and seeking for care.

Key Facts At least half of the world’s population still do not have full coverage of essential health services. About 100 million people are still being pushed into extreme poverty (defined as living on 1.90 USD or less a day) because they have to pay for health care. Over 800 million people (almost 12% of the world’s population) spent at least 10% of their household budgets to pay for health care. All UN Member States have agreed to try to achieve universal health coverage (UHC) by 2030, as part of the Sustainable Development Goals.

What is Primary Health Care? Ensuring people’s health problems are addressed through comprehensive promotive, protective, preventive, curative, rehabilitative, and palliative care throughout the life course, Systematically addressing the broader determinants of health (including social, economic, environmental, as well as people’s characteristics and behaviours) Empowering individuals, families, and communities to optimize their health, as advocates for policies that promote and protect health and wellbeing, as co-developers of health and social services through their participation, and as self-carers and care- givers to others. Primary health care is the most efficient and cost effective way to achieve universal health coverage around the world.

Welsh contribution

Question 3: how can you include UHC in your development work?

How to make the case Health as a human right creates a legal obligation on states to ensure access to affordable good health care as well as to providing for the underlying determinants of health. Requires that health policy and programmes must prioritize the needs of those furthest behind first It works: improves life expectancy, reduces mortality, reduces infant mortality. Reliance on out-of-pocket payments (OOP) has been shown to contribute to worse health outcomes

Health Partnerships in Wales

Benefits to Wales Poster for BCUHB International health Week November 2017

Resources Gapminder World Health Organisation Universal Health Coverage WHO Euro Universal Health Coverage World Health Day 2019 United Nations UHC2030 Wales International Health Coordinating Centre Wales for Africa Health Links Network UK Tropical Health and Education Trust (THET)