Public health through universal health coverage can help to attain many SDGs

This article was exclusively written for the Sting by Ms Rosemary James, a fourth year medical student at the National University of Ireland, Galwa. She is co-chair for the Association of Medical Students Ireland (AMSI) in Galway. Ms James is affiliated to the International Federation of Medical Students Association (IFMSA). The opinion expressed in this piece belongs to the writer and does not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one. As medical students of the twenty-first century, we are witnessing a rapid shift in our education – it is adapting toward care of preventable disease. With non-communicable disease accounting for more than half the global burden of disease, and injuries for 11%, the way medicine is taught has clearly got to change. However, education in prevention and early detection of such diseases seems to be lacking. There are seventeen Sustainable Development Goals (SDGs), which countries worldwide are aiming to attain by the year 2030. Each of these goals are interconnected in some way to SDG three, Good Health and Wellbeing. If countries are to be successful in this ambitious feat, they should be advancing their public health services at a national and local level. The prevention, early detection and management of chronic disease such as diabetes and heart disease is crucial for attaining the SDGs. Investing in public health services is the way forward, toward a brighter future for all. Universal Health Coverage (UHC) is a perfect means of doing so. Valuing UHC improves overall health outcomes while cost-effectively strengthening health systems and aiding to attain other SDGs.  There are sixteen health services used to measure UHC attainment. In mapping the criteria used to monitor SDG and UHC attainment against public health services, I have found that the ten Essential Public Health Operations (EPHOs) directly contribute to the attainment of five SDGs and to UHC achievement, as outlined in Figure 1.0. Unfortunately for us, there is yet to be a global framework for measuring UHC coverage ‐ due to unique health needs of each country, and lack of available service coverage data. In spite of this, there are various tracer indicators which WHO suggests member states use. In 2016 there was sixteen proxy tracer indicators proposed, to be the monitoring framework for UHC. These indicators fall under four categories: Service capacity and access, Reproductive, maternal, newborn and child health, Infectious Diseases, and Non‐Communicable diseases (NCDs). However, as disease burden is shifting, there has been pressure to add more comprehensive tracer indicators. Such that could monitor access to preventative services, for example. Did you know that mental health or substance abuse services, nutrition, occupational safety, health literacy, self‐management of chronic disease, and injury prevention are currently not a measure of UHC? Devoting resources toward treatment more so than prevention of disease is no way forward. Rather than trying to plug a hole in a bath with the tap running, let us tighten this tap. As future healthcare professionals, let us equip ourselves with the tools for disease prevention, health protection and health promotion, to ensure we are knowledgeable about diseases we are going to see increasingly worldwide. UHC has the potential to improve health outcomes if public health services are invested in using the EPHO’s. We just need to be sure the way we are measuring it is well thought out and agreed upon worldwide. References

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2. New York: United Nations, Revised list of global Sustainable Development Goal indicators, 2017
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5. Tracking universal health coverage: First global monitoring report. Joint WHO/World Bank Group report, June 2015
6. Boerma T, AbouZahr C, Evans D, Evans T. Monitoring Intervention Coverage in the Context of Universal Health Coverage. PLoS Medicine. 2014 Sep 22;11(9):e1001728.

About the author Rosie is a Canadian-British student from Vancouver. She is in her fourth year of her medical degree at the National University of Ireland, Galway. She is passionate about improving global health through health promotion and disease prevention projects. Rosie is a co-chair for the Association of Medical Students Ireland (AMSI) in Galway. She is also national coordinator for Universities Allied for Essential Medicines (UAEM) Ireland, an organization that is committed to changing the R&D system for better access to medicines. Recently, she took an internship with the World Health Organization where she was able to become familiar with the Sustainable Development Goals, an area that has since sparked great interest in her.