Exclusive Report: Universal Health Coverage – The Moral Dimension

Photo of Jeffrey Sachs - February 2015

“Nothing has been easy. Everything has been a fight,” economist Jeffrey Sachs told a packed auditorium yesterday at the Johns Hopkins School of Medicine.

His subject: The long fight to improve the health of the world’s poor.

Sachs, who led the formation of the Millennium Development Goals, is now pushing for universal health coverage.  And he’s ready for another fight. “Resources for the poorest people in the world do not come easily,” Sachs said.

He warned that market forces and the political process will never solve the poor’s problems since they do not have a voice in the market or in government: “Don’t ever believe these problems will take care of themselves. If we want universal health care coverage and want basic equity and basic human rights … we have to decide consciously to do it. This is not about markets. This is not about businesses at the bottom of the pyramid. This is about deciding that what [health experts] know and can deliver should be available everywhere.”

Concerted and funded efforts make a difference. For example, bed net distribution, new artemisinin treatment and rapid diagnostics have driven malaria deaths from more than 1 million to perhaps 400,000 in recent years, said Sachs. That success is encouraging but not good enough. “Malaria is absolutely a disease that should have no deaths any more,” he said.

Sachs, who founded the Millennium Villages project, argued that great gains in health can be achieved by a relatively small investment. Though impoverished countries in Africa can afford perhaps only $15 a year in health spending per capita, a rudimentary health system costs about $80 per year per capita. While that gap is huge, the overall global costs for bringing very basic health care to everyone is only $50 billion, he said—a tiny portion of the $100 trillion global economy. (He noted that his macroeconomist friends mock him for pleading for billions, while they talk in trillions.)

One answer: Encourage the world’s 1,645 billionaires with their $6.4 trillion net worth to create an endowment fund. “Just the billionaires could provide universal health coverage. No sweat. And not even notice it,” he said, noting that Bill Gates and former New York City Mayor Michael Bloomberg (and eponymous benefactor of the Johns Hopkins Bloomberg School of Public Health) provide great examples of what can be done.

“We need to engage them but I want you to realize that the issues are not ‘Can we afford this? or ‘What is sustainable?’—the only issue is fundamentally a moral issue in terms of the finances. Is it worth it to save the lives and health of poor people? The financial issue is an embarrassingly small issue.”

Brian W. Simpson, MPH, is Editor-in-Chief of GHN.

Editor’s Note: Sachs’s talk was followed by a terrific panel discussion—including Tolbert Nyenswah, Liberia’s assistant minister of health—but your correspondent was not able to stay for it. Apologies.—Brian W. Simpson, MPH

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