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 ● ● ● ● 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 ● ● ● ● 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 ● ● ● ● 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. 2. 3. 4. 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.