Health and social justice

More than half of all people have little to no access to essential health services, posing a whole new challenge for universal coverage

By Guy Ryder, director-general of the International Labour Organization

The majority of the world’s population is being left behind because people cannot afford quality health care and have no income security if they fall ill. Tackling this issue must be a priority, so that everyone can enjoy a healthy and dignified life – a condition for achieving sustainable development and social justice.

The figures are stark. More than half the world’s population have virtually no access to essential health services, despite significant progress in extending health coverage. More than half the population is not covered by at least one social protection benefit, and every year, millions of people end up in poverty after paying for health care out of their own pockets.

A person living in poverty is far more likely to be in poor health, whether because of infectious or non-communicable diseases.

The world can break this vicious circle by stepping up efforts to reach universal health coverage (Sustainable Development Goal 3.8) and building universal social protection systems, including floors (SDG 1.3).

Social protection systems

Universal health coverage is a key objective of social protection systems and achieving universal health coverage is essential if the right to health and social security is to become a reality. That is why it is an imperative for the International Labour Organization.

The United Nations General Assembly Resolution on Global Health and Foreign Policy, adopted in 2012, underlines “the importance of universal coverage in national health systems, especially through primary health care and social protection mechanisms, including nationally determined social protection floors.” Further, it acknowledges that the ILO Social Protection Floors Recommendation is an important step forward.

This recommendation calls for effective access to at least essential health care for all, including maternity care, as the first guarantee of nationally defined social protection floors. The recommendation complements standards adopted earlier on effective access to quality healthcare and financial protection in case of sickness.

The global partnerships UHC2030 and USP2030 are important platforms to mobilise political support for universal health coverage and universal social protection, helping accelerate the achievement of the 2030 Agenda for Sustainable Development.

Achieving SDG 8

If we are to achieve SDG 8 on productivity and employment, then ill health and the inability to seek care – for financial, geographical or social reasons – must be considered as a factor affecting productivity in the workforce. Households lacking financial protection often find themselves unable to invest in productive assets and create or maintain enterprises in case of sickness, eventually falling into poverty.

The realisation of SDG 8, and specifically targets on growth (8.1), productivity (8.2) and job creation (8.3), is closely linked to the availability of a healthy workforce able to engage fully in productive economic activities.

Additionally, achieving universal health coverage requires the development of the health sector, which is an important source of employment. Investments in the care economy to achieve the SDGs could mean some 475 million jobs by 2030, to a large extent for women, according to ILO projections. The High-Level Commission on Health Employment and Economic Growth believes the global economy could create 40 million new health sector jobs by 2030.

Sustained political and financial commitment

This is indispensable. Securing effective access to health care as an entitlement for all within universal social protection systems is a priority. Governments need to finance universal protection in a fiscally, economically and socially sustainable fashion, through a combination of taxes and contributions, reflecting the principles of risk sharing, equity and solidarity.

Many countries around the world have made rapid progress towards universal health coverage by combining social insurance schemes with non-contributory or subsidised schemes, with a view to accelerating coverage of the poor and vulnerable, as well as workers in informal employment and their families.

However, public expenditure on health and social protection is often under threat of curtailments, which undermine essential benefits and services, even though experience shows there are generally alternatives to expenditure cuts, even during adjustment periods and in the poorest countries.

Through social dialogue and multisectoral engagement, it is imperative that governments explore all possible alternatives to safeguard and sustainably expand fiscal space in order to attain universal health coverage and social protection for all.