Universal health coverage is fundamental to preparing for a healthier and better tomorrow
Authors: Angeli Achrekar, Svetlana Akselrod, Gabriela Cuevas Barron, Michael Adekunle Charles, Helen Clark, Katie Dain, Justin Koonin
Journal: The Lancet Global Health (2023)

On Dec 12, Universal Health Coverage (UHC) Day, we stand at a crossroads in our collective journey towards achieving health for all. This moment is not just a checkpoint at which to gauge current progress; it also represents a crucial opportunity to place health at the forefront of global development, political agendas, and collective actions. Time is of the essence, and we can ill afford to squander it. This year has been pivotal for UHC and global health on the political stage. Just last week, the 28th session of the Conference of the Parties to the UN Framework Convention on Climate Change organised the first-ever climate-health ministerial day, indicating that global leaders must recognise climate change as a health crisis. In September, during the High-Level Week at the UN General Assembly, Member States adopted political declarations on pandemic prevention, preparedness, and response; tuberculosis; and UHC. Now it is time for collective and intensified action. We look forward to seeing governments implement their renewed commitments to improve the health and wellbeing of their populations. The need for faster progress on UHC is substantive and pressing. The latest Global Monitoring Report on UHC showed that, in 2021, about half of the world's population—4·5 billion people—lacked access to essential health services.1World Health OrganizationInternational Bank for Reconstruction and DevelopmentTracking universal health coverage: 2023 global monitoring report.https://www.who.int/publications/i/item/9789240080379Date accessed: December 7, 2023Google Scholar Health financing remains inadequate in many countries,2UHC2030State of UHC commitment review: key findings.https://www.uhc2030.org/fileadmin/uploads/uhc2030/2_What_we_do/2.1_Elevating_voices/2.1.4_State_of_UHC_Commitment/2022/SoUHCc_key_findings_final_EN.pdfDate accessed: December 7, 2023Google Scholar leaving health systems without appropriate resources to respond to people's needs across the life course. Health and care workers, including community health workers, the majority of whom are women, are often overworked and underpaid while lacking the healthy, safe, decent working conditions they deserve and need to provide quality services. National legal frameworks frequently fail to prioritise UHC,2UHC2030State of UHC commitment review: key findings.https://www.uhc2030.org/fileadmin/uploads/uhc2030/2_What_we_do/2.1_Elevating_voices/2.1.4_State_of_UHC_Commitment/2022/SoUHCc_key_findings_final_EN.pdfDate accessed: December 7, 2023Google Scholar leaving governments unable to progress towards UHC in a manner which addresses people's needs effectively, in particular those of women, children, adolescents, and others in vulnerable situations. The protection of people from financial hardship caused by out-of-pocket payments for health services continues to be an increasingly challenging task. In 2019, about 2 billion people experienced financial hardship due to out-of-pocket spending on health, including 344 million people living in extreme poverty.1World Health OrganizationInternational Bank for Reconstruction and DevelopmentTracking universal health coverage: 2023 global monitoring report.https://www.who.int/publications/i/item/9789240080379Date accessed: December 7, 2023Google Scholar Since 2021, as the Coalition of Partnerships for UHC and Global Health, we have been at the forefront of advocating for our shared ambition of achieving UHC and other SDG3 targets—including reducing maternal, neonatal, and child mortality; ending the epidemics of HIV, tuberculosis, malaria, and neglected tropical diseases; ensuring universal access to sexual and reproductive health services; reducing premature mortality from non-communicable diseases; and addressing the growing burden of mental health conditions and others. Reaching UHC is critical for achieving these SDG3 and other relevant SDG targets. In light of the global stagnation in progress, our resolve to intensify our advocacy efforts and keep health at the top of the global agenda has only strengthened. Looking at the year ahead, with decisive moments for the 2030 Agenda for Sustainable Development on the horizon, our concern deepens regarding the notable absence of a health focus in the draft decision4 for the Summit of the Future next September. At the Summit of the Future, the international community could unite in consensus, dedicated to forging a better present and securing a sustainable future for all. Countries must acknowledge that people's health and wellbeing are an essential foundation of human development. Ensuring UHC for everyone, everywhere, is fundamental to achieving not only health parity, but also gender equality and women's and girls' empowerment, ensuring universal access to education, providing decent work and inclusive economic growth, and eradicating poverty in all its forms and dimensions. Health for all is paramount for ensuring that the world can fully benefit from scientific and digital innovation. Health is also fundamental to achieving stability and international security. In a world of interconnected crises, we need equitable and resilient health systems to address people's everyday health needs, even in the face of shocks such as climate change and humanitarian emergencies. If the Summit of the Future is to lay a foundation for multilateral co-operation which is fit for the future, it must cater to the needs and wants of the next generations. We call on young people to speak up about their right to health. Governments must hear that the young care as much about people's health as they care about the climate crisis, and that these are deeply interlinked. Together, we must hold decision-makers accountable for delivering health for all as a cornerstone for solving tomorrow's complex challenges. It is now up to Member States to choose whether they will live up to their shared responsibility for realising health for all. By failing to prioritise UHC, they will perpetuate a world of deeply entrenched inequalities and discrimination. In contrast, by listening and being responsive to the needs of their people, particularly the most vulnerable and marginalised, governments can provide an enabling environment to lead a life of dignity and with abundant opportunities. As we mark UHC day, we know that prioritising UHC and health for all will prepare us for a better future. We therefore urge governments to position health at the core of the Summit of the Future's agenda. The Summit is an important opportunity to shape the future. Let us seize it to shape a healthier, more equitable, more sustainable future for all. We declare no competing interests. We thank Laetitia Bosio and Helena Schmitt for their support in drafting and editing this Comment.