L e a d e r s h i p , r e s o u r c i n g a n d g o v e r n a n c e The right to health specifies criteria of ‘availability, accessibility, acceptability and quality’, and these are reflected in the articulation of the first UHC goal regarding the provision of health care services. However, the approach taken to affordability as risk protection in the second goal tends to individualise costs, neglecting the key issue of how risk is socialised, as well as the concerns surrounding commercialisation, cost-containment, prioritisation and the public health dimension. The balance of costs and risks impact on the other stated UHC priorities regarding access to essential medicines and treatment, and also affect the issue of health worker capacity. Conclusion The current push for UHC as a global goal represents a partial return to an earlier transformative agenda for health equity and social justice under the banner of PHC. However, European countries that achieved equitable, rights-based UHC in earlier decades have experienced more than two decades of reforms in the opposite direction, changing the distribution of responsibility between the welfare state and the individual citizen. Ter Meulen and Maarse’s analysis (2008: p. 262) suggests that this redistribution points to ‘distanciation’ as one-tier universal systems have given way to two-tier systems, with increasing public ambivalence towards the principles of universality and solidarity in health care. The increasing currency of the human right to health appears to guarantee available, accessible, acceptable quality health care services to all, equitably, without discrimination and with special care towards the most vulnerable and disadvantaged. Nevertheless, several aspects of health solidarity come to light as important concerns. The health care gap, driven by increasing needs and a retreating welfare state, has translated into widening gaps between the well-off who can afford private insurance and care solutions, and lower-income groups who require income and risk solidarity in order to access care on an equitable basis. The global trend towards ageing societies makes strong demands on intergenerational solidarity, which cannot be taken as a given. Financial sustainability is impossible without social solidarity, but even these two together will not suffice. Health system reforms must look to environmental and ecological health and a genuinely multi-sectoral global agenda in order to sustain improvements in well-being. Individual responsibility must complement government action to preserve solidarity, in order for health rights to be equitably vindicated. 130 Commonwealth Health Partnerships 2015 References Craven, M. C. R., 1995. The International Covenant on Economic, Social and Cultural Rights: A Perspective on its Development. Oxford: Clarendon Press. Houtepen, R., ter Meulen, R., 2000. ‘New types of solidarity in the European welfare state’. Health Care Analysis, 8, pp. 329–340. International Conference on Primary Health Care and WHO (World Health Organization), 1978. Declaration of Alma- AtaInternational Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. IOM (Institute of Medicine), 2004. Insuring America’s Health: Principles and Recommendations. Washington, DC: IOM. Reichlin, M., 2011. ‘The role of solidarity in social responsibility for health’. Medicine, Health Care and Philosophy, 14 (4), pp. 365–370. Ter Meulen, R. and Maarse, H., 2008. ‘Increasing individual responsibility in Dutch health care: Is solidarity losing ground?’. Journal of Medicine and Philosophy, 33, pp. 262–279. Therborn, G., 2013. The Killing Fields of Inequality. Cambridge: Polity. WHO (World Health Organization), 2008. World Health Report 2008 – Primary Health Care (Now More Than Ever). Geneva: WHO. WHO (World Health Organization), 2010. World Health Report 2010 – Health Systems Financing: The Path to Universal Coverage. Geneva: WHO. WHO (World Health Organization), 2012. Positioning Health in the Post-2015 Development Agenda. Geneva: WHO. SU-MING KHOO is currently a visiting fellow in the human rights programme at Harvard University, where her research is on health solidarities, the right to social secuirty and the right to a functioning health system. She is a lecturer in the School of Political Science and Sociology, and vice-dean (internationalisation) for the College of Arts, Social Sciences and Celtic Studies at the National University of Ireland, Galway. Su-ming’s recent publications focus on public goods and democracy; health governance; global health; and social justice. In 2005–09 she was joint project leader (with Dr Diarmuid O’Donovan) of the Development Education and Research Network at NUI Galway, a programme funded by Irish Aid.
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