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Published in: 12/08/2015

Experts seek ways to boost public spending on health in Latin America and the Caribbean to achieve and sustain universal health

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Investing the necessary public resources to achieve universal health is a social, political and economic necessity that should no longer be delayed, said participants in a forum organized by the Pan American Health Organization/World Health Organization (PAHO/WHO) today, in the lead-up to Universal Health Coverage Day, Dec.12.

"We are at the point where there is no dispute: there is an overwhelming consensus that this is the right thing to do," said PAHO Director Carissa F. Etienne. "This generation will no longer tolerate a lack of access to health services to meet their health needs. Universal health is a right, not a privilege, and it's smart—like any good investment."

Approximately 30% of the population in Latin America and the Caribbean lack access to health care for economic reasons, and 21% do not seek care because of geographical barriers, according to PAHO/WHO estimates. This is despite considerable progress toward expanding access to health care over the past 15 years.

"Since the beginning of the 21st century, we have seen notable progress toward universal coverage," said Luis Almagro, Secretary-General of the Organization of American States (OAS). "An additional 46 million people in nine countries now have at least nominal guarantees of receiving affordable health services. There is progress, but latent gaps persist."

Recognizing the negative impact of these gaps on human well-being and countries' development, health leaders from throughout the Americas in 2014 adopted a regional Strategy for Universal Access to Health and Universal Health Coverage. Since then, PAHO/WHO has been providing technical cooperation to help countries improve efficiency and effectiveness in their health systems and to increase public spending on health to at least 6% of GDP, as agreed in the strategy.

Currently, average spending on health in the countries of the Americas is about 3.8% of GDP, noted Inés Bustillo, Director of the Washington office of the Economic Commission for Latin America and the Caribbean (ECLAC). "The region has made progress in increasing social spending, but on average allocations have risen faster for social security, welfare, and education than for health," she said, adding that the region has one of the highest rates of private, out-of-pocket spending on health. "This is a major source of inequity and limits countries' capacity to move towards universal health coverage."

Finding fiscal space for universal health

During the forum, PAHO/WHO presented a new report, "Fiscal space for increasing health priority in public spending in the Americas Region," which points out that Latin America and the Caribbean currently have a low tax burden (18% compared with 35% in OECD countries, according to ECLAC), which presents "a window of opportunity" for increasing public revenues to spend on health.

The report identifies a number of ways that countries can find resources to invest in health without taking away from other spending. It recommends increased general taxation but also taxes on harmful products such as tobacco and alcohol as well as reforms to improve tax collection and administration, control corruption, and increase efficiency in public spending for health.

"It's about good, efficient and fair taxation," said Agnes Soucat, Director of WHO's Department of Health Systems Governance and Financing. "We know that universal health coverage is feasible fiscally as well as technically." She said the challenge for countries is to build collective political will and social consensus around the value of universal health as a public good.

The two-day (Dec. 7 and 8) forum on "Universal health: An indispensable Investment for Sustainable Human Development" brings together experts on economics, development and health. It is part of the campaign for Universal Health Coverage Day 2015, cujo lema é "Universal Health Coverage: Right. Smart. Overdue."