Universal Health Coverage for Non-communicable Diseases and Health Equity: Reflections on the Role of Ideas and Democratic Decision-Making; Comment on "Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons from Australian Primary Healthcare".

Lauren Paremoer

doi:10.34172/ijhpm.2021.117

Abstract

Fisher et al have published a thought-provoking article exploring the complex relationship between universal health coverage (UHC) and equity. This commentary builds on two of the lessons they highlight: the importance of ideas in determining how exactly UHC advances equity, and the political difficulties of addressing the commercial determinants of health. I argue that equity in UHC can be advanced through interventions that address popular prejudices against public health systems, greater emphasis on structural and commercial drivers of ill-health in health professionals’ training, and by ensuring meaningful public participation in decision-making about the institutionalisation and management of UHC. These strategies are important for ensuring that the political, power-laden nature of concepts such as "universality", "health" and "care" are explicitly acknowledged and publicly debated – rather than continuing the current trend of allowing technocrats to reduce UHC to a matter of efficiently and expeditiously financing curative healthcare services.

Highlights

Fisher et al have published a thought-provoking article that explores the complex relationship between universal health coverage (UHC) and equity, equitable access to care for non-communicable diseases (NCDs)
I retain their definition of UHC (“a health financing scheme to enable people to access healthcare – especially primary healthcare – without suffering financial hardship”)[1] and comprehensive primary healthcare (CPHC) (“comprehensive first-level care that incorporates but extends beyond primary medical care to include health promotion, disease prevention, community engagement and action to address SDH [social determinants of health]; and public regulation of key social determinants of NCDs, such as the products and practices of tobacco, food and alcohol industries”).[1]
UHC financing mechanisms should ensure affordability of, and equitable access to health services. This financing regime should be supplemented by regulation of the commercial determinants that drive the emergence of conditions like NCDs which add to demand for healthcare services

Summary

Introduction

Fisher et al have published a thought-provoking article that explores the complex relationship between universal health coverage (UHC) and equity, equitable access to care for non-communicable diseases (NCDs).

Results

Conclusion