Global political instability puts quest for universal health coverage in jeopardy

By Agnes Soucat, François Dabis and Marie-Paule Kieny of Santé mondiale 2030

For more information on crises facing global health and how to get progress towards UHC back on track, read our 2024 Stocktake Review. 

Mounting political instability on both sides of the Atlantic is casting a pall of uncertainty that could have dire consequences for the future of global health.

With the odds roughly even on a second Trump presidency and political deadlock threatening to grip France, we are deeply concerned that a brewing health crisis in low-income countries may catch the international community unprepared.

The prospect of deepening political turmoil in two of the world’s biggest providers of official development assistance (ODA) is bearing down on us just as fresh impetus is needed to restore progress in access to healthcare, especially in the poorest countries where momentum has stalled.

The writing is already on the wall for health policy makers. A report we authored for Global Health 2030 showed that a growing shortage of qualified healthcare professionals worldwide is holding back universal health coverage, leaving low-income countries dangerously exposed.

While health services once admired for their efficiency in UK, France, Germany and other rich countries are under strain, and waiting lists for doctor’s appointments and medical procedures lengthen, the position in low-income counties is infinitely worse. In rural Africa, nearly 80% of the population have no access to a full range of basic health services. Often there are no qualified doctors available for patients to see and even paramedics and nurses are scarce. Health workers face a daunting task.

Rich countries are concentrating medical firepower on a rising tide of non-communicable diseases, such as cardio-vascular illness, diabetes, cancer and dementia. In contrast, developing countries face a twin burden of ancient and emerging infectious illnesses and growing incidence of non-communicable diseases, our report finds. Most countries are very poorly equipped to deal with this challenge. In two-thirds of low-income countries, where 600 million people live, per capita public spending on public healthcare is less than $10 a year. While Europeans can on average call on 39.4 doctors for every 10,000 inhabitants, in sub-Saharan Africa the same number make do with just 2.3 doctors. Closing the gap remains elusive.

New strategic thinking and targeted financing are urgently called for in global health. The first decade of the twenty-first century saw health-related aid grow strongly but international funding has since stagnated. The bulk of health aid has gone to middle-income countries, reflecting the priority given to fighting AIDS. Relatively little has been invested in strengthening health systems and preparing the world for a growing environmental and social crisis.

Environmental threats pose a particularly grave danger for countries with fragile health systems. Air pollution already accounts for 5.1 million avoidable deaths a year globally. Rising temperatures and changes in rainfall patterns will fuel deaths from malnutrition, malaria, diarrhoea and heat stress. Globalization and accelerating deforestation force humans and animals to live closer to each other, contributing to the emergence of new infectious agents that can spread from animals to humans.

Inequity in access to screening and treatment of cancer is especially stark. Cancer patients can count on comprehensive treatment and a stream of innovation in most rich countries but only in a small minority of low-income countries.

Mobilizing domestic financial resources in all countries will prove critical to putting universal health coverage back on track. Health has declined as a priority in public funding almost everywhere over the past decade.

Reform of global health governance is also required in order to reduce fragmentation among global health agencies, ensuring a concerted effort and improved channelling of international aid.

Civil society has a part to play alongside governments in empowering people to make healthy lifestyle choices, as highlighted in a recent World Health Organization report. One way to do so is through evidence-based initiatives such as the Nutri-Score system in Europe, that rates the nutritional value of foods on labels.

It is tempting to engage in hand-wringing as insurgent nationalism and political polarization appear to hold back the capacity for calm and clear-headed policy-making in many rich countries.

We should not forget that rising incomes and medical technology, promoted by global health initiatives over the first two decades of the twenty first century, reduced child and maternal mortality and deaths from HIV/AIDS, malaria and tuberculosis, and boosted average life expectancy in Africa by 10 years. However, progress towards other universal healthcare targets has slowed significantly since 2015 and the 2030 health targets enshrined in the Sustainable Development Goals are unlikely to be met.

We need to correct a lop-sided approach to global health that privileges richer countries at the expense of poorer ones. It is time for official development assistance to focus more on delivering global public goods, and on institutional capacity-building rather than funding purchases of commodities.

Countries need renewed support to build tax-raising powers that help fund sustainable healthcare. They also require strong health institutions to underpin health initiatives with scientifically-based assessments.

The old adage: “Give someone a fish and you feed them for a day; teach someone to fish and you feed them for a lifetime”, should become one of the guiding principles of global health policy.

The turbulence of our own domestic politics is no excuse for ignoring the healthcare needs of the wider world.