Ministerial Meeting on Universal Health Coverage - Message

Foreword

Singapore's Ministerial Meeting on Universal Health Coverage looks at some of the most pressing issues facing health in the post-2015 development era. Under the umbrella of aiming for universal health coverage, the meeting takes a broad-based approach that tackles a number of growing and interacting trends. The sharp distinctions between health needs in wealthy and developing countries are dissolving. Health everywhere is being shaped by the same universal pressures, like the globalized marketing of unhealthy products, the ageing of populations, and rapid unplanned urbanization.

The meeting's agenda takes stock of the role played by the social determinants of health and anticipates the greater need for - and costs of - care as populations age. Populations are ageing fastest in low- and middle-income countries. A transition to an older society that took more than a century in Europe is now taking place in less than 25 years in countries like Brazil, China, and Thailand. Most older people experience multiple co-morbidities. In managing them, the boundaries between primary care and specialist care need to soften.

The meeting stresses the importance of building basic public health infrastructures, training sufficient numbers of doctors and nurses, and securing sustainable financing. But the main emphasis is on prevention, especially of chronic noncommunicable diseases. These are the diseases that break the bank. As a recent Lancet commission concluded, the costs of treating cancer are becoming unaffordable, even for the richest countries in the world.

Recommending a holistic life-course approach to NCDs is wise. Doing so makes it possible to identify multiple critical points, at different ages, for preventive interventions with the biggest impact. For example, recent evidence demonstrates that undernutrition during gestation and early life increases the risk for NCDs later in life. In Asia, diabetes is often precipitated by a much smaller weight gain than seen in Western nations.

Governments have another compelling reason to aim for universal health coverage. In the view of some experts, much of the world's current turmoil - wars, ethnic clashes, and terrorist acts - are rooted in vast and growing inequalities, in income levels, in opportunities, and in access to social services. Universal health coverage is one of the most powerful social equalizers among all policy options.

I warmly congratulate the government of Singapore for this well-conceived and highly relevant initiative. It addresses problems that are likely to dominate health, social, and political agendas for some time to come.

DR MARGARET CHAN
Director-General
World Health Organization