By Linda Kurti | 11 Nov 2016

Urbis’ Linda Kurti discusses ‘Health for All’ following the Health, Wellbeing and Society conference in Washington DC.

I was privileged to deliver the opening keynote address at the recent Health, Wellbeing and Society conference in Washington DC, and to spend two days with representatives of 17 countries – academics, policy makers, clinicians and practitioners – discussing issues relevant to the work of Urbis’ Economic and Social Advisory team. 

My address focused on the impact of universal health on population health and wellbeing, using the World Health Organization’s (WHO) definition of universal health access as: “That all people obtain the health services they need, of good quality, without suffering financial hardship when paying for them”.

In 2005, all WHO member states committed to a resolution that all countries should provide universal health coverage. According to the WHO this access includes three components: physical accessibility, financial affordability, and acceptability.

The reality is that health for all has not yet been achieved although 88 countries do provide health care for at least 80% of their populations, using tax or insurance mechanisms. 

Even so, the International Labour Organization (ILO) reported that nearly 40% of the world’s population did not have access to any form of legal health coverage.

The ILO’s analysis also suggests that internal access inequities correlate with a country’s income. Wealthy countries are more likely to have greater coverage for all people including the poor, whereas poorer countries are more likely to have greater inequities of health care access across the population. 

While global discourse has focused on disparities between countries, health equity within countries, including Australia, remains a focus for improvement. 

Although Australia is one of the world’s wealthiest countries, we experience three conundrums:

  • we have universal health access, but there are continuing disparities between population cohorts, particularly Aboriginal and Torres Strait Islander Australians, people from low socio-economic backgrounds, and new migrants
  • we have strong primary and community care sectors but we also have the 5th highest rates of obesity in the OECD, with higher than average preventable hospitalisation rates for several chronic conditions
  • most worryingly, while Australians generally report high levels of life satisfaction, the recently released Global Burden of Disease study has reported that self-harm is the 4th leading cause of death in Australia, the OECD reports that we are the 2nd highest consumer of anti-depressants in the OECD, and the WHO reports that neuro-psychiatric conditions are the largest contributor to years of life lost to mortality and disability in Australia

Universal health coverage still offers the best opportunity to redress the balance between those who have the resources to access health care and those who don’t

Australia has been implementing reforms to the health system for a number of years, and these statistics are well known to clinicians, health service managers, and policy makers. International experience suggests that addressing these conundrums could include the following:

  • reducing the level of out-of-pocket expenses for health services in Australia, which is higher than the OECD average, to assist those who struggle to pay for health care, including dental care
  • exploring the use of public-private partnerships to identify the most efficient and effective ways of utilising available resources
  • improving mental health services, and preventative mental health services to address the high levels of neuro-psychiatric conditions within the Australian population

Urbis’ Economic and Social Advisory team continues to assist governments to find solutions to these challenges in the following ways:

  • evaluating health and social services (eg the evaluation of a state-wide home-based palliative care service; an evaluation of a national mental health service to support people with severe and persistent mental illness)
  • undertaking cost benefit and social return on investment analyses (eg economic and cost benefit analyses for child protection, family functioning, and disability programs)
  • conducting primary research on broader structural factors influencing population health and wellbeing to inform the development of policy (eg the review of the transfer of a health clinic from government to Aboriginal community control; program mapping and gap analyses).

The world’s population has grown and aged, particularly in developed countries such as Australia. Population mobility has increased for a range of reasons including economic opportunity, war and environmental displacement, and shifts in family structures. There is an apparently unquenchable demand for health services, with 400 million people globally still lacking access to one or more essential health services.

Universal health coverage still offers the best opportunity to redress the balance between those who have the resources to access health care and those who don’t. Australia and other countries around the world continue to seek ways to ensure that Health for All is not just a slogan but a reality.