“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.” Aneurin Bevan, founder of the NHS
It’s arguably the UK’s greatest achievement. The National Health Service (NHS) was born on 5 July 1948 – a time when the country was facing severe post-war economic challenges.
At its heart is the principle – expressed by Aneurin Bevan above – of universal healthcare, free at the point of access, delivered according to need rather than ability to pay. 77 years on, that principle has become part of the national DNA.
But what about the rest of the world? Globally 4.5 billion people – about half of the world's population – cannot access essential health services. A lack of free healthcare has driven 2 billion people into financial hardship and almost 350 million into extreme poverty.
Global consensus...
In 2019, the UN General Assembly declared its commitment to universal health coverage (UHC) by 2030, reaffirming this in 2023. This recognises every human being’s right to “the highest attainable standard of physical and mental health”. UHC is fundamental to achieving that right for all.
...But progress is slow
While there has been progress towards UHC in the past two decades, this has slowed in recent years and remained stagnant since 2019. Since 2022, some countries have even reversed their annual health funding commitments.
While most countries have made some improvements to service and population coverage, few advances have been made in financial protection. The cost of healthcare remains a barrier to accessing treatment for far too many people. Recent cuts in official development assistance risk compromising UHC progress even further.
Leave no one behind?
Progress on UHC is hugely unequal across the world, reflected in health outcomes of the poorest and most vulnerable communities. For example, under-five mortality is nearly 20 times higher for a child in sub-Saharan Africa than an Australian child.
Even within countries that have made progress towards UHC, poorer and rural residents are likely to find it harder to access healthcare compared with their richer or urban counterparts. It is always the most marginalised people who experience ever-deepening poverty because of out-of-pocket spending on health. Women and girls, older people, indigenous groups, and displaced communities are likely to face more barriers in accessing care and experience worse health outcomes as a result.
Children pay the price
Without UHC, what happens to children’s health? Parents may be forced to choose between visiting a doctor, buying medicine for themselves or their children, or feeding their families. Almost 5 million children died before their 5th birthday in 2023 – that’s more than 13,000 young children dying every day. Yet most of these deaths could have been prevented.
They tell a tale of unequal access to healthcare. These children’s deaths also reveal a wider story of poverty. Malnutrition affects poor children. If a child is malnourished, they are less able to fight infections such as pneumonia, malaria and diarrhoea. They will get sick more often and with greater severity. And if their parents cannot afford to visit the doctor, or buy medicines, the child will receive healthcare very late or not at all. Often, parents will prioritise their child’s treatment – after all, just like British parents, they value their children above all else – but then don’t have money for food, rent and other essentials. The child recovers but remains at risk of becoming malnourished and ill again.
Nearly half of children under five who die are newborn babies. To prevent these deaths, we need women to grow up healthy through childhood and adolescence, with access to family planning, antenatal services, and maternity and neonatal care.
Healthcare: A right and an investment
Health is a human right, not a luxury for the privileged few. In the words of Bevan, “No society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means.”
The right to health – and therefore to good-quality healthcare – is enshrined in the 1948 Universal Declaration of Human Rights (article 25), the UN Convention on the Rights of the Child (article 24) and the Constitution of the World Health Organisation. The UK is a signatory to all three.
Achieving UHC is a specified target under the Sustainable Development Goal for health and wellbeing. It’s also a vital economic investment. By protecting people’s health from their earliest years, we can build healthy, secure and economically thriving societies. Despite the clear economic case, significant funding gaps in the world’s poorest countries are preventing this becoming a reality.
Opportunities exist to change this and with the UK’s leadership in stepping up its assistance to global health, these gaps can be bridged. Tomorrow, the UK will celebrate the 77th birthday of the NHS – an incredible milestone.
But it’s time to make UHC a reality for all.
