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SECTION 1 2 3 WHAT CAN BE DONE Within countries, decisions on how much governments spend on public services and who ultimately benefits, are shaped by power struggles between groups with competing interests. All too often, the needs of wealthy elites are put first and progressive public service reforms are resisted. In many Latin American countries, once health insurance was established for formal-sector workers, attempts to expand coverage were challenged by existing members who do not want to see their benefits ‘diluted’. Only 10% of pharmaceutical R&D spend... ...Is devoted to diseases that primarily Affect the poorest 90% of the global population 96
SECTION 1 2 3 WHAT CAN BE DONE THE HIGH ROAD: RECLAIMING THE PUBLIC INTEREST Governments must take back control of public policy and ensure that the design, financing and delivery of public services policy are done in the public interest, so they can meet their inequality-busting potential. There are countries around the world offering good examples and hope that the high road is possible. For governments to take this road, mobilized citizens must weigh in on policy choices that, to date, have been dominated by vested interests. Universal Health Coverage The growing momentum around Universal Health Coverage (UHC) – under which all people should get the healthcare they need without suffering financial hardship – has the potential to vastly improve access to healthcare and drive down inequality. In 2013, Margaret Chan, described UHC as ‘the single most powerful concept that public health has to offer’. 454 At the World Bank, President Jim Yong Kim has been unequivocal that UHC is critical to fighting inequality, saying it is ‘central to reaching the [World Bank] global goals to end extreme poverty by 2030 and boost shared prosperity.’ 455 Some governments are already taking action. China, Thailand, South Africa and Mexico are among the emerging economies that are rapidly scaling up public investment in healthcare. Many low-income countries have introduced free healthcare policies for some or all of their citizens as a first step towards UHC, for example by removing fees for maternal and child-health services. The countries making most progress towards UHC have prioritized public financing of healthcare from general taxation, rather than relying on insurance premiums or out-of-pocket payments by individuals. Every step on this road is a step that can reduce economic inequality significantly, giving everyone access to healthcare. Before Thailand’s Universal Coverage Scheme was introduced in 2002 nearly a third of the population had no health coverage; 456 most of them were employed informally and were too poor to pay insurance premiums. The Thai government moved to finance coverage from general tax revenues, and in just 10 years reduced the proportion of the population without health coverage to less than four percent. 457 This was a progressive reform; in the first year, the amount of money the poorest were spending each month on healthcare costs was more than halved. 458 The percentage of households forced into poverty through excessive health payments dropped from 7.1 percent in 2000 to 2.9 percent in 2009. 459 Infant and maternal mortality rates plummeted. 97
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JEFFREY SACHS Director of the Earth
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ACKNOWLEDGEMENTS The paper was writ
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