G

lobalization has never been short of critics, especially in today’s political climate. But it’s worth remembering the good that globalization has brought about, particularly in terms of health. Without it, we may never have eradicated smallpox, or reduced childhood mortality by half.

The shift inward by many countries now threatens to undermine this progress and could prevent the world from realizing what could prove to be one of humanity’s most defining accomplishments — the achievement of universal health coverage. Both country leadership and globalism are needed to get there.

Generations from now, people will look back at universal health coverage as a critical turning point in human history. Ensuring that everyone has access to affordable, quality health care — no matter who they are or where they live — will prevent 10 million deaths by 2035 and contribute to a grand convergence in health in which rates of infant and maternal mortality and deaths caused by infections in the poorest countries fall to levels now seen only in wealthier parts of the world. Universal health coverage will also offer benefits that go well beyond health, helping us reduce poverty and threats to global security, and create global economic stability.

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Stronger health systems not only reduce the threat of infectious epidemics, like Ebola and Zika, but can also help lift individuals, communities, and countries out of poverty. Just as disease impoverishes, health enriches. Healthy individuals improve economic productivity. Among America’s current top 15 trading partners, 12 were once recipients of U.S. foreign aid. And seven of the 10 of the fastest-growing economies are developing countries.

Universal health coverage is first and foremost a political choice for countries themselves to make. A World Health Organization study released this week showed that 85 percent of the funding gap to achieve universal health coverage could be met by countries themselves, although up to 32 of the poorest countries will require development assistance. There is no one-size-fits-all model of universal health coverage, and different countries will choose different services to support.

It is impossible to imagine universal health coverage without childhood immunization. Every year, 1.5 million children die from easily preventable diseases, like pneumonia and measles. The good news is that more than 86 percent of the world’s children are currently receiving vaccinations during the most vulnerable year of their life, often even when there is no primary health care infrastructure in place. While not “universal,” this does demonstrate the feasibility of reaching a significant proportion of the global population, including many of the hardest-to-reach communities, with essential life-changing services.

What this means is that, as daunting as universal health care might seem, it is achievable. If the aim is to provide services to all, then in those countries where resources are limited, it’s important to focus first on the most cost-effective solutions, especially those that most benefit poor people. If we take this approach, known as progressive universalism, then in fact we already have a well-defined first step towards universal health coverage in the form of childhood vaccinations. Through the immunization platform, communities are already accessing a range of additional health services, from malaria prevention and nutritional supplements to neonatal and maternal health care and sexual and reproductive health and education. Of course, there may be other entry points in health systems as well, and we want to maintain a holistic approach to universal health coverage.

The challenges to universal health coverage will only increase. In Africa, for example, where the population is expected to double by 2050 and quadruple by 2100, land degradation, rising seas, drought, famine, and conflict are expected to displace tens of millions of people in the coming decades. This will inevitably drive more people towards cities. In 1950, two-thirds of the world’s population lived in rural areas, and just a third in urban areas. By 2050, that ratio is forecast to reverse.

As ministers met in New York at the High-Level Political Forum, it was essential to nurture an increased spirit of international cooperation. We need global leaders to highlight and benchmark best practices across geographies and across incomes, to secure political commitment, and to make the case for the resources needed, by showing where and how it has worked. We also need the international community to help countries tailor these best practices to fit their needs. Let’s use the opportunity this week and at the next United Nations General Assembly in September 2017 to make universal health coverage a reality.

Seth Berkley is chief executive officer of Gavi, the Vaccine Alliance. Tedros Adhanom Ghebreyesus is director-general of the World Health Organization.

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  • We need to define what is country national health system leadership and how this is can be strengthened when globalization has fragmented, undermined and weakened national and WHO global public health systems based on dependency on external financing. How do we deliver sustained high coverage with immunization integrated within child heath and maternal programs and community and primary health care and district health systems.

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