Director-General's Office

Towards Universal Health Coverage: Tackling the Health Financing Crisis to End Poverty

Dr Tedros Adhanom Ghebreyesus
Director-General of the World Health Organization

Washington DC
23 April 2018

Good evening.

Your Excellency President Kersti Kaljulaid, President of Estonia,

My sister, former President of Chile Michelle Bachelet,

Excellencies, ministers, distinguished guests, ladies and gentlemen,

It's wonderful to be here, and wonderful to see so many finance ministers coming together to talk about health and universal health coverage.

I agree with Deputy Prime Minister Taro Aso that finance ministers should play a leading role in universal health coverage. I fully endorse that slogan. As you know, universal health coverage is WHO's top priority.

But it's not a pipedream for the future; it's a reality now. In the past 12 months I have had the privilege to visit many countries that already have universal health coverage, or something very close to it.

But everywhere, I'm reminded that UHC is not something that only rich countries can afford. And the rich countries that do have it weren't necessarily rich when they started the journey.

Japan is a great example, as the Deputy Prime Minister said. Its modern health system is the envy of the world. But Japan does not have a high-performing health system because it's a wealthy country. In fact the opposite is true: Japan is a wealthy country at least partly because of its high-performing health system.

I had some details of the performance of Japan, but since the Deputy Prime Minister already said it, I will skip it. But I would like to encourage you to read the Lancet article that he published, which summarises three important issues.

One, UHC is possible at all levels of economy, in any country;

Two, domestic resources have to be mobilized;

And third, external resources have to be considered as a supplement, not to replace domestic resources.

With those principles that he outlined, and the central role of finance ministers, UHC is possible in any country. We count on you.

Indonesia, with its massive population spread over hundreds of islands, faces unique challenges in its journey towards universal health coverage.

But since 2005, Indonesia has made great efforts to extend coverage to the poor, and to reduce fragmentation by merging different insurance schemes and harmonizing benefit packages.

There is still a long way to go, but I congratulate the Finance Minister for the steps she has taken to move Indonesia further along the path towards universal health coverage.

The point is clear: strong health systems are a foundation for strong economies.

When people are healthy, entire communities and nations thrive.

When children survive to adulthood, they become productive members of society.

When communities are freed from pollution, harmful products and other causes of disease, they prosper.

The health sector is not a cost to be contained. It's an investment to be nurtured.

And the return on investment in health is compelling: about one quarter of full-income economic growth between 2000 and 2011 in low- and middle-income countries is estimated to be because of improvements to health.

A new WHO study shows that UHC can more than pay for itself because of the impact of improved health on a country's workforce, and the long-term gains from investments in infrastructure.

The health sector is also a growing source of jobs. Among OECD countries, employment in the health and social sectors grew by 48% between 2000 and 2014, while jobs in industry and agriculture declined.

And because 70% of the global health workforce is female, jobs for health workers are jobs for women. So it's also an investment in gender equality.

Investments in UHC are not only investments in a healthier and fairer future, they're also a bulwark against epidemics that can have potentially catastrophic social and economic consequences. We've learned this the hard way.

In 2003, SARS caused losses of up to USD $59 billion, according to the Asian Development Bank.

In 2009, the H1N1 pandemic wiped USD $2.8 billion off Mexico's tourism industry.

In 2014, the economic impact of West Africa's Ebola epidemic on the three affected countries was estimated by the World Bank at USD $2.8 billion.

Universal health coverage, based on strong health systems and primary care, can not only prevent health disasters, it can prevent economic disasters.

For example, just in the past 12 months, WHO and our partners have responded rapidly to outbreaks of Marburg virus disease in Uganda, Ebola in the Democratic Republic of the Congo and plague in Madagascar.

Maybe you weren't even aware of these outbreaks. That's because in each case the outbreak was contained before it became a humanitarian or an economic catastrophe.

The surveillance systems in these countries worked - they did the job they were set up to do, by detecting outbreaks early, which enabled a rapid response.

Yes, financial investments are needed to set up the systems that to detect outbreaks and to provide quality health care services.

But UHC is both affordable and achievable, with domestic resources.

There's no magic number for what countries should spend on health. But countries at all income levels can make progress with the resources they have.

In fact, WHO's estimates show that in 67 low- and middle-income countries that account for 75% of the world's population, 85% of the costs of reaching the SDG health targets can be met with domestic resources.

Those investments could prevent 97 million premature deaths globally by 2030, and add more than 8 years of life expectancy in some countries.

Ultimately, investments in health are investments in human capital. I would particularly like to congratulate my brother Jim Kim for the way he continues to hammer home this point: human capital.

Infrastructure is of course important, but the best returns come from investments in human capital, health and education.

Ladies and gentlemen,

UHC would be the right thing to do even if it had no other benefits, because health is a rights issue. But the payoffs of UHC both economically, and in terms of health security, make it a no-brainer.

The question therefore is not whether countries can afford to make these investments. The question is, can they afford not to?

Thank you so much.