ROI on health investment
Illness is a symptom of poor health, meaning a broad spectrum of causes must also be accounted for if we are to maximise the returns that can be realised through universal health coverage
By Achim Steiner, UNDP administrator
Two decades ago, visionary Indian economist and philosopher Amartya Sen argued that freedom from avoidable ill health and ‘escapable mortality’ was one of the most important freedoms that development efforts should guarantee. Underpinning Sen’s statement is the premise that health is a human right – as well as an outcome, indicator and driver of sustainable development.
Today, the right to health is present in several international treaties, declarations and national laws. It is included in at least 115 national constitutions.
However, half of the world’s population still lack access to essential health services. Nearly six million children still die before their fifth birthday every year. More than 15 million people cannot access life-saving HIV treatment.
Climate change is changing the frequency, severity and types of challenges faced by health systems, and will disproportionately burden the vulnerable and most marginalised. Additional challenges include ageing, non-communicable diseases, health emergencies, anti-microbial resistance and growing demands for newer, more effective and higher-cost technologies.
In a time of increased attention to multidimensional inequality, political momentum towards universal health coverage offers leaders a concrete way of advancing equity, access and opportunity. Universal health coverage also delivers upon commitments articulated in the 2030 Agenda for Sustainable Development, and its central pledge to leave no one behind.
In particular, the scale-up of universal health coverage can accelerate sustainable development in a variety of critical areas. Improved health reduces poverty and inequalities, including gender inequalities, and advances educational outcomes. It also strengthens productive capacities and supports inclusive economic growth. One study estimated deaths amenable to high-quality health care globally and then modelled the macroeconomic impact in low- and middle-income countries – it found the value of lost output resulted in a projected cumulative loss of $11.2 trillion in these countries between 2015 and 2030.
Universal health coverage can also serve as an impetus to address environmental threats. Air, water and soil pollution are clear health risks. Climate change impacts transmission of vector-borne diseases. It affects health through increased heat exposure, loss of biodiversity, reduced water quality and food insecurity. It is crucial to support health systems and communities to manage and mitigate climate-related health risks.
In turn, addressing environmental threats can strengthen health systems, particularly in reaching those who are left furthest behind. For instance, UNDP’s Solar for Health initiative assists national governments to work with communities, local authorities and industry to increase access to quality health services by equipping health centres with solar panels. This innovation has contributed to reducing carbon dioxide emissions while providing reliable and clean energy to expand access to health services.
UNDP and Health Care Without Harm are collaborating to bring policy makers, technical experts, as well as United Nations suppliers and manufacturers, together to discuss improving environmental and social sustainability in the production of health commodities and the delivery of healthcare services. In Zimbabwe, South Sudan and Equatorial Guinea, a joint UNDP-HCWH project has promoted new packaging for anti-retroviral medications for HIV. It has resulted in a 55% increase in shipping capacity per container, 29% less packaging waste and a 57% reduction in carbon dioxide emissions.
The global HIV response provides important lessons for universal health coverage in different areas including inclusive governance, innovative financing, integrated service delivery, political mobilisation and the importance of human rights, multi-sectoral approaches and partnerships. To realise the promise of universal health coverage, principles of equity and inclusion, especially in terms of financial protection, must be placed front and centre.
In this area UNDP is working closely with civil society and our UN partners and has supported 89 countries to amend their laws and policies in line with the recommendations of the Global Commission on HIV and the Law.
Achieving and sustaining good health for all requires action within and outside the health sector. Enabling legal, policy and regulatory environments, built upon evidence and rights, can protect populations from exposure to risk, facilitate healthy behaviour, and remove legal, social and economic barriers to service access.
The report of the UN Secretary-General’s High Level Panel on Access to Medicines, highlights the urgent need to remedy policy incoherence between the right to health, trade rules and public health goals.
Political leadership and foresight are needed to intervene where the market-based models of innovation do not produce desired outcomes and where the high cost of some medicines, vaccines and diagnostics render them inaccessible to large segments of society, in rich and poor countries alike, thereby exacerbating inequalities. One of the most urgent examples of this is the global crisis of anti-microbial resistance. If not confronted, AMR could result in the loss of 10 million lives every year by 2050 – and cost the world up to $100 trillion.
Worldwide, there is significant space to review fiscal and regulatory policies on health-harming products to ensure coherence and to mitigate their costs and social harm. For example, today 6.5% of global gross domestic product goes on subsidising dirty fossil fuels. Air pollution, to a large extent caused by the burning of solid fuels, kills seven million people annually and costs economies over $200 billion in lost labour income.
The Addis Ababa Action Agenda on Financing for Development specifies the potential of tobacco taxation to avoid poor health and related costs, reduce burdens on health systems, and finance development. Increased taxation of tobacco, alcohol and sugary drinks could avert 50 million premature deaths and raise $20.5 trillion in revenue over the next 20 years, while delivering benefits across the Sustainable Development Goals.
UNDP and World Health Organization national investment cases on NCDs, also demonstrate the potential economic benefits of scaled-up NCD responses, even in the shorter term. Development assistance to health sectors can also build the capacity of countries to strengthen domestic financing through taxation and other means.
Universal health coverage also requires concerted efforts across the UN Development System, in line with the 2030 Agenda for Sustainable Development. UNDP, fulfilling its role as an integrator in the UN system, is committed to supporting countries and its UN partners to deliver better health and development results for the people we serve. One example of this close collaboration is a 2018 Memorandum of Understanding between UNDP and WHO, with universal health coverage being one of three priority areas. The other two – environmental health and health emergencies – are closely related to universal health coverage.
The figures remain stark. In 2019, 100 million people are still being pushed into extreme poverty because they have to pay for health care. Such situations can destroy people’s futures and often those of their children.
Echoing Amartya Sen’s sentiment that there is no greater inequality than whether people are afforded the opportunity to live longer lives they value or not – leaders must see health and well-being as an investment in sustainable development with very high rates of return.
All UN member must live up to their promise to achieve universal health coverage by 2030, as part of the Sustainable Development Goals. Universal health coverage is no longer a political choice – but a concrete promise that millions around the world are waiting impatiently for us to deliver on.
