The Intersections of
Universal Coverage and
Public Health
Ashley Cobb (MS4, MPH at UNC-Chapel Hill SPH)
Swathi Damodaran (MS4, MPH at Harvard SPH)
Overview
● Universal Health Coverage
o
History, Definition, Goals
● Public Health
o
Definition, Goals
● Complementary Systems
● Public Health in Practice
Definitions
Universal Coverage
The goal of universal
coverage is to ensure
that all people obtain
the health services
they need without
suffering financial
hardship when paying
for them - WHO1
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Access
Affordable
Quality
Capacity
Why Universal Coverage?
History
1883: The Bismarck Model
1945: End of WWII
1948: WHO Constitution
1978: Declaration of Alma Ata
1980s: HIV/AIDs outbreak
2005: World Health Assembly
http://www.rockefellerfoundation.org/uploads/files/23e4426f-cc44-4d98ae81-ffa71c38e073-jesse.pdf
Recent History
2010: WHO Report
2012:
- Lancet Series
- WHA
2013:
- Framework Convention on Global Health
- World Bank UHC Study Series
2014: Toward Universal Coverage by 2030
Margaret Chan on Universal Coverage“The single most powerful concept that public
health has to offer…..Universal coverage is the
best way to cement health gains made during
the previous decade. It is a powerful social
equalizer and the ultimate expression of
fairness”
Achieving Universal
2
Coverage
Current Status
Source: The Atlantic, 2012
Universal Coverage in the
US: A Brief Look
1880s-Medicare
1901-1909
1883-1912
1960s
1930s
1915: AALL Bill
1940s
2012: ACA
PNHP website: http://www.pnhp.org/facts/a-brief-history-universal-health-care-efforts-in-the-us
What is Public Health?
Public Health
2
is...
Tools of Public Health
The science of protecting
and improving the health of
families and communities
through promotion of
healthy lifestyles, research
for disease and injury
prevention, and detection
and control of infectious
diseases - CDC3
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Research
Policy
Education
Services
Universal Coverage
What are the core values?
Public Health
EQUITY
Margaret Chan...again:
"Universal health coverage is one of the most powerful social
equalizers among all policy options. It is the ultimate
expression of fairness,"
- Margaret Chan, WHO Director-General
Quoted on Tuesday at a two-day conference on universal health coverage, Singapore.
Single-Payer and Equity
● Increased access for primary care services,
but not specialty care5, 6
o
o
Socioeconomic differences in access
Education-based inequities7
● Geographic differences in access to resources
remain8
How Can Public Health Fill
the Equity Gap?
Public Health in Practice
Public Health in Practice
● Imagine that you are the Canadian minister
of health in Ontario.
● Everyone in your province has health
insurance coverage under the national
system.
● You still find socioeconomic based inequities
for specialty care services.
In particular, you
find an educationbased inequity
where those with
low levels of
education see less
ophthalmologists
than those with
high levels of
education7
Improving Eye Health
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How would you address the inequity?
Policies?
Programs?
Services?
Question: What do you see as
the biggest barriers to
Universal Coverage in the US?
What are the next steps?
Future of public health/UHC?
Thank you! Any questions?
References
1.
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5.
6.
7.
8.
World Health Organization. (2014). What is universal Coverage? Retrieved on 2/11/15 from
http://www.who.int/features/qa/universal_health_coverage/en/.
World Health Organization. (2013). WHO: The many paths towards universal health coverage. Retrieved on 2/11/15 from
https://www.youtube.com/watch?v=VQ3sHfYzcv8.
American Public Health Association. (2014). What is public health? Retrieved on 2/11/15 from https://www.apha.org/what-is-publichealth.
Centers for Disease Control. (2015). What is Public health? Retrieved on 2/11/15 from http://www.cdcfoundation.org/content/whatpublic-health.
Veugelers PJ and Yip AM. (2003). Socioeconomic disparities in health care use: Does universal coverage reduce inequalities in health?
J Epidemiol Community Health 57:424-428.
Gusmano MK, et al. (2009). Achieving horizontal equity: must we have a single-payer health system? Journal of Health Politics, Policy
and Law 34(4):617-33.
Glazier RH, et al. (2009). Universal health insurance and equity in primary care and specialist office visits: a population-based study.
Ann Fam Med 7(5):396-405.
Kreng VB and Yang C. (2011). The equality of resource allocation in health care under the National Health Insurance System in Taiwan.
Health Policy 100(2-3):203-210.