Prevention is key in health coverage

This year’s International Universal Health Coverage (UHC) Day campaign theme is “Keep the Promise”. UHC day provides an opportunity to remind all stakeholders that Health for All is imperative to achieve our 2030 agenda for sustainable development. At the UN High-Level Meeting on September 23, 2019, member states demonstrated strong political commitment through a Political Declaration (PD) which reaffirms the role of NCD prevention and control and mental health promotion to attain wellbeing for all. If the trajectory of these diseases is not changed, the resulting call on resources can be catastrophic worldwide.

Definition of UHC implies providing access to promotive, preventive, curative, rehabilitative and palliative health services. Hitherto UHC efforts have largely focussed on treatment services, while health promotion and prevention strategies have been neglected. The need for promotion, prevention and control of NCDs and mental health services, has been underscored in the PD as well as in the recently released final report of WHO. The Independent Commission on non-communicable diseases said, “it’s time to walk the talk”.

This report emphasizes on reorienting health systems to include health promotion and the prevention and control of mental health services in UHC policies and plans. The report recommends that countries should invest in the prevention and control of NCDs and mental health is a key opportunity to enhance human capital and accelerate economic growth.

Recent global reports highlight that current rates of achieving the target of SDG 3.4 (one-third reduction in NCD mortality by 2030) is expected to be achieved for women in only 35 countries and for men in 30 countries. Most of these countries are high-income countries. In many other countries, the situation is either stagnant or trends are on the rise.

The potential of UHC to reduce health inequity will not be achieved without robust health promotion and prevention efforts. Investing efforts and resources only in treatment services is not a sustainable model and is a missed opportunity from a financing perspective.

Public health interventions offer a better return on investments than curative services and aid in establishing enabling environments. With its emphasis on promotion and prevention, adopting a people-centered approach and sustained investment in Primary Health Care (PHC) is an important way forward within universal healthcare.

Realising the power of investing in strengthening public healthcare under Ayushman Bharat aim to improve access to quality health services under UHC package. These centers are envisioned to provide an expanded range of services including treatments for communicable and non-communicable diseases as well as health promotion and wellness activities like Yoga apart from services already being provided for maternal and child Health including immunization.

A growing body of evidence demonstrates the cost-effectiveness of preventive measures and how these services can be delivered at low cost, through community-based programmes including digital health solutions and brief interventions. Training of health workforce on health promotion and prevention will empower them to disseminate these messages among their patients and also to take charge of their own health and of their families and social prescribing.

WHO considers taxation of tobacco and alcohol to be best for NCD prevention, and a similar rationale can be applied to the taxation of sugar and fossil fuels.

Adolescents have traditionally been seen as a healthy population and only recently in India, their health needs have been addressed comprehensively under Rashtriya Kishor Swasthya Karyakram. Adolescents should be
prioritized under UHC as healthy and empowered adolescents can contribute fully to society and ensure sustainable development. It may help to explore synergies between HWCs and Adolescent Friendly Health Clinics. Since NCD prevention and mental health promotion requires multi-disciplinary skills and community interaction, engaging Civil Society Organisations (CSOs) meaningfully under a multi-sectoral action plan can assist the government in ensuring services reach communities.

(The writer is Professor, Health Promotion Division, PHFI)