Overview Universal health coverage and ageing Commonwealth Health Partnerships 2015 9 A recent Lancet series on ageing showed that, globally, people aged 65 years and more will outnumber children younger than five years within the next five years for the first time ever (Suzman et al., 2015; see page 38 and page 42 of this volume). The rate at which populations are ageing is also rising – the proportion of people aged 60 years or more increased by only two per cent (from eight per cent to ten per cent) over the last 60 years, but will increase by another 12 per cent in the next 40 years (Bloom et al., 2015). At that point two billion people will be aged 60 or over compared to 800 million now (ibid). This remarkable ageing of the world’s population extends to all countries. These global developments reflect substantial falls in infant and child mortality rates, linked to reductions in communicable diseases (Mathers et al., 2015) and improvements in overall living standards. However, since the 1970s there have also been clear signs that life expectancy at age 60 has been increasing as well, particularly in high-income countries, due to declines in non-communicable disease mortality during old age. The increase in life expectancy for the elderly shows no signs of declining: people will continue to live longer and, without increases in fertility, the proportion of elderly people in the world will continue to grow. What is universal health coverage and how far has the world come? Since the publication of the World Health Report 2010, titled Health Systems Financing: The Path to Universal Coverage, there has been a growing political consensus globally that universal health coverage (UHC) is an important guiding principal and goal for health-system development. This consensus has resulted in resolutions in the World Health Assembly1, World Health Organisation (WHO) Regional Committees2 and the UN General Assembly3. Between 2012 and 2013 a series of international declarations and conferences emphasised the importance of UHC to countries4, and there was even the first ever international UHC day on 12 September 2014 supported by a global coalition of more than 500 health and development agencies. All of this was influential in ensuring that UHC is accepted as one of the targets of the health goal in the proposed Sustainable Development Goals (SDGs). If this is endorsed during the 2015 session of the UN General Assembly, this will give added momentum to countries seeking to move closer to UHC over the next 15 years. To do this requires that health services of good quality be available to serve population needs across the lifespan and all levels of care (WHO, 2013a). Essential medicines and health technologies need to be available, with motivated health workers in the right numbers in the right places (Sousa et al., 2013; Tangcharoensathien and Evans, 2013). Data and evidence to inform decision-making in a timely manner must be available, and good systems of governance must be in place to set the direction and rules of the game, and ensure the desired outcomes are achieved. Sufficient funds for health must be available and these funds need to be raised largely through forms of prepayment rather than using direct out-of-pocket payments, with subsequent pooling of funds to spread risks across the population (WHO, 2010). The available resources also need to be used as efficiently and equitably as possible, and with avoidance of waste and corruption. A growing number of countries in all regions have made political commitment to UHC more explicit in their national policies over the last five years to meet these challenges. Many have made intensive efforts to raise more money for health, to reduce direct out-ofpocket payments, and/or to improve efficiency and equity in the way resources are used. As a result, there have been steady reductions in the extent to which countries have relied on out-ofpocket payments to fund their health systems throughout much of the developing world, although the results of a joint WHO/World Bank update on the number of people suffering financial catastrophe in the world due to out-of-pocket health payments will not be available until later in the year.5 The last estimate was that 150 million people suffer financial catastrophe each year and 100 million are pushed into poverty simply because they get sick, use health services and have to pay out of pocket (Xu et al., 2007). At the same time, coverage of some of the most essential health services has increased substantially, particularly those targeting the health-related Millennium Development Goals (MDGs). Although they have not all been fully achieved, the UN reports remarkable progress – 3.3 million deaths from malaria averted in 2000–12, 22 million deaths from TB averted since 1995 and 2.3 billion people gaining access to an improved drinking water source, for example (UN, 2014). Despite this, a great deal remains to be done. Even for services aimed at non-communicable diseases (NCDs), and maternal and child health, the focus of the current MDGs, coverage remains less than ideal, with substantial inequalities within and across countries.6 Population ageing and UHC Moving towards UHC is a dynamic process. The options for addressing people’s health needs are continually expanding as new David Evans From the keynote paper ‘Universal health coverage with an emphasis on aging’ for the Commonwealth Health Ministers Meeting, 17 May 2015, Geneva.
Commonwealth Health Partnerships 2015
To see the actual publication please follow the link above