The COVID-19 pandemic has reached all parts of the world, affecting tens of millions of people: healthy and unhealthy, rich and poor. However, the parts of the world most affected are also those where access to healthcare is not universal and is often linked to financial capacity. This has clearly highlighted the weaknesses of health systems around the world, but especially those that provide universal health coverage (UHC) in legislation (de jure) rather than in practice (de facto) for their residents. It is important to highlight the fact that this disclosure is not new, as health challenges have always disproportionately affected those in weaker socio-economic statuses, especially in countries with less developed health systems.
Fortunately, at the end of 2020, several COVID-19 vaccines were approved and began to be distributed worldwide. However, the distribution presents its own set of challenges due to both cooling requirements as well as inequality. Richer countries have been, and are generally faster, to negotiate access to vaccines with providers. The World Health Organization has warned of “vaccine nationalism” because high-income countries are in a much better position than their less fortunate counterparts. The tragic truth is that it will take years to vaccinate poor parts of the world due to a lack of resources to negotiate the purchase and infrastructure for distributing vaccines.
This underscores the challenge of inequality and injustice and shows that there is still a giant step ahead for us to shift from health coverage to truly universal health coverage for most of the world. A biological infection in the form of SARS-CoV2 demonstrates the vulnerability of a polarized and dispersed global community to respond to a global pandemic. Moreover, a widespread lack of vaccination could spark pockets of new COVID-19 strains that existing vaccines may not protect against. Thus, this global health polarization may lead to new, repeated waves of COVID-19 not only in low-income countries but will also make its way into high-income countries. The time to act is now with the lessons learned from the COVID-19 pandemic. We need to put in place a coordinated approach to help 90% of the world’s population instead of just 10%. Most importantly, for global equality and equity, but also because it is a necessary component of efforts to reduce and / or eliminate the COVID-19 pandemic.
A 10/90 gap
In the early 1990s, I lived for two years in Brazil, where I spent part of my time working with street orphans, that is, the most vulnerable, forgotten, underprivileged part of the population, who had few opportunities for better living conditions within their lives. Her private life. The primary health component for them was to have the food to survive the day.
If we look at the historical investment in the health sector, it is clear that medical technologies have been developed to serve the more affluent parts of the population. While most of the world has gone from mortality from infectious diseases to deaths, from non-communicable diseases like cancer, large sections of the world’s population do not use advanced medical technologies such as cancer treatment because they suffer from infectious diseases like malaria. As early as the 1990s, the Global Forum for Health Research was created by the WHO’s Ad Hoc Committee on Health Research with the purpose of correcting the so-called 10/90 gap: the fact that only 10% of the world’s health uses research and development expenditures to conduct research in 90% of problems Health in the world.
Today, instead of looking specifically at health research and development, we can take a more holistic view of the problem and see that it is not only about R&D, but also about the type of health solutions that we are building. Around the world, most companies are developing solutions that will benefit the richest 10% of the population, while neglecting the other 90%. We need to create sustainable healthcare solutions for the 90% that are widely applicable outside the top 10%, bearing in mind that only about half of the world’s population has access to real healthcare.
Health is an essential pillar for the progress and prosperity of society
My wife is from Peru, which means that it has become my second home, as I witnessed first-hand the devastating effects of lack of access to healthcare, and how it is holding back society. Despite the immense wealth of natural resources, the benefits that these offerings provide cannot be reaped; The clearest and most recent example of this is the collapse of the health system due to COVID-19.
We need to achieve universal health coverage, but that in itself is not enough. The right to health, not just access to health care, requires a comprehensive understanding of how to provide a better quality of life and well-being for the individual and society. In short, health is largely a matter of improving living conditions, and this requires a focus on the determinants of health.
We urge decision-makers to consider all determinants of health, and to see health as something much broader than just health policy. Social, economic, digital, and infrastructure policies all affect health to varying degrees, and so reforms should be seen as investments in health, rather than just infrastructure costs. In other words, we must consider health in all policies, and we must invest in solutions that provide better health outcomes for the 90% of the world’s population that cannot be reached through better medical technologies alone.
At the Copenhagen Institute for Future Studies, we work with several projects that try to put the 10/90 approach into practice. Projects like Nordic Health 2030, which focuses on providing better health care in the Nordic region through cross-border cooperation, or Movimiento Salud 2030, which focuses on how to create de facto universal healthcare in Latin America and make technology and knowledge available for use by everyone.
We are also very focused on a project in Peru to create a pilot model of how these 10/90 solutions could be applied in practice and scaled to cover the entire region. Health is a fundamental pillar for the progress and prosperity of society, and its fairness, equality and equity. It is a necessary component of a fair and democratic society.
Boogie Eliasen is Director of Health at the Copenhagen Institute for Future Studies and a member of HIMSS Future50 community.