Shocks, stresses and universal health coverage: pathways to address resilience and health

Submitted by Anna Hickman | published 15th Dec 2017 | last updated 10th Jan 2020
Universal health coverage


Achieving universal health coverage (UHC) is critical to ensuring sustainable and resilient lives for all, and therefore to meeting the goals set out under the Sustainable Development Agenda. But health and wellbeing are also subject to other risk drivers, such as climate change and disasters, which disrupt the health and financial benefits that UHC can offer.

This report* explores:

  • Why UHC is important for health and wellbeing, sustainable development and resilience.
  • How disasters and drivers of risk, such as climate change, negatively impact health and wellbeing and disrupt the desired health and financial benefits of UHC.
  • The potential of UHC to offer a platform to more actively address shocks and stresses to health and wellbeing through governance, financing and the implementation of services.

*Download the full report from the right-hand column.

Key messages

The key messages of the report are summarised as follows:

Disasters, emergencies and climate change compound health risks and aggravate existing health inequalities.

  • Health inequities disproportionately affect the most marginalised people because their geographical location, their socioeconomic conditions or their political contexts limit their access to resources that would otherwise help them protect their health, and provide opportunities to benefit from healthcare.

Without adequate financial protection mechanisms following disasters, impacts on health and wellbeing can lead to potentially impoverishing health expenditures in the short and long run.

  • Shocks disproportionately impact the poorest and most vulnerable, requiring redress through sustained access to medicines and financial support after initial response measures have lapsed.

Moving towards UHC can contribute to achieving SDG 3 and improved health and wellbeing for all – providing that efforts acknowledge the risks and vulnerabilities of societies and their health systems.

  • Achieving SDG 3 requires supportive governance and financing mechanisms, as well as adequate delivery of health services, that take into consideration the additional threats posed by disasters and risk drivers such as climate change.

Political will needs to support UHC.

  • The achievement of UHC is only feasible as a government- coordinated mechanism that distributes collectively raised funds to create public goods for the health and wellbeing of citizens. This makes it an inherently political issue, thus requiring political commitment to implement health reforms, as well as mechanisms to assess the economic efficiency of policies and to support effective activities of institutions that impact the health and wellbeing of societies.

Domestic financing needs adaptability for UHC.

  • Fiscal spending, out-of-pocket expenditure, public and private donations, and insurance mechanisms make up most financing streams available to support the implementation of UHC. Recent estimates point out the need for a significant increase in total public and private health expenditure if SDG 3 is to be achieved.
  • This is challenging in resource-constrained settings, especially since the estimates do not consider shifts in price dynamics or the predicted increase in direct and indirect hazard impacts posed by disasters and climate change.
  • However, governments can acquire funding for UHC efforts through redistributing existing fiscal and political restrictions, while international financing can support through, for instance, lowering interest rates, assisting with payments on existing debts or through targeted impact bonds.

Health services must be implemented adaptively.

  • Quality health services should be delivered efficiently, taking into account and addressing potential weaknesses in the complex chain of services, supplies and infrastructure to implement UHC.
  • Cascading effects from poor practice augment the difficulty, and value, of delivering healthcare in disasters and emergency scenarios.
  • A dynamic workforce, one that is effectively trained, distributed and retained among the population, is also crucial for measures such as long-term resilience, surge capacity support and prevention of chronic disease complications during shocks and stresses.
  • Finally, access to medical supplies and support for technological innovation must serve all individuals whose health is directly or indirectly impacted by shocks and stresses.

Lessons Learnt

The main conclusions of the report are:

Disasters and climate change compound health risks and aggravate existing health inequalities.

  • Meanwhile, health inequities disproportionately affect the most marginalised people, because their geographical location, their socioeconomic conditions or their political contexts limit their access to resources that would otherwise help them protect their health, and offer opportunities to benefit from healthcare.

UHC aims to ensure that everyone has access to quality healthcare without enduring financial hardship.

  • Progress towards UHC creates a ‘no regret’ dividend whereby healthier populations with improved quality of life are also more resilient to the emergence and impacts of disasters and emergencies.
  • Targeting the inclusion of the most vulnerable in society ensures that the needs of all are known and can be addressed during crises.

Horizontal improvements to health systems are favoured by moving towards UHC, which will improve prevention and response capacities to mitigate outbreaks of disease which can lead to, or be caused by, disasters.

  • Dealing with health systems failures created by a focus on vertical interventions (i.e. Ebola) or concurrent crises (i.e. Cholera) are closely associated with the measures required under UHC.