Viewpoint

Public health, universal health coverage, and Sustainable Development Goals: can they coexist?

Achieving universal health coverage (UHC) is one crucial target of the Sustainable Development Goals. However, consistent trends data for UHC evaluation in China are still scarce. The aim of our study was to provide a comprehensive assessment of UHC in China.

In this serial cross-sectional study, we collected nationally representative data from the latest four rounds (2003, 2008, 2013, and 2018) of the National Health Service Surveys, with the aim of evaluating UHC in China. These surveys used multistage stratified cluster sampling covering all 31 provinces, autonomous regions, and municipalities in mainland China. Within each household, all members aged 15 years and older were interviewed. For children and adolescents aged younger than 15 years, their adult family members answered the questions for them. We constructed a UHC index following the WHO-recommended framework that included service coverage (nine prevention indicators and five treatment indicators) and financial protection (three indicators) dimensions. Bayesian regression models were done to investigate the trends in and projections of UHC index and indicators, with average annual percentage change (AAPC) and probabilities of achieving the 2030 WHO targets. Based on trends and projections, we counted population equivalents with UHC coverage. To examine the potential efficiency of financial investment, we quantified UHC performance based on government health expenditure (GHE) per capita. Finally, we explored the association between each UHC indicator and macroeconomic and health systems characteristics by using multiple regression.

We sampled 57 023 households from 95 counties between September and October, 2003; 56 456 households from 94 counties between June and July, 2008; 93 613 households from 156 counties between August and October, 2013; and 94 076 households from 156 counties in September, 2018. A total of 901 182 individuals were involved in this study (193 689 in 2003, 177 501 in 2008, 273 688 in 2013, and 256 304 in 2018). Although the overall UHC increased from 44·0% (95% CI 43·0–44·9) in 2003 to 79·8% (79·2–80·3) in 2018 and is predicted to meet the 80% global target by 2030, the progress towards UHC has steadily slowed down nationally. Based on current projections, an estimated 105·8 (95% CI 27·3–189·1) million population equivalents would still not have UHC coverage in 2030. The treatment index showed a large increase over time from 2003 to 2018 (AAPC 4·9%, 2·9–7·2), with minimal disparities and all subgroups will achieve the target in the treatment domain by 2030 (possibilities higher than 90%). However, the prevention index presented poor performance with a small increase over time from 2003 to 2018 (AAPC 1·4%, 0·3–2·5) and sizable disparities across regions, urban–rural areas, and income (all p<0·0001). To achieve at least 80% UHC coverage, provinces would need to reach at least ¥445 in GHE per capita per year under maximum efficiency. However, large gaps between the observed and frontier UHC index, especially in several western provinces, indicated inefficiency. Furthermore, we found that primary health-care institutions were closely and positively related to UHC indicators especially in the prevention domain.

Although considerable achievements have been made, the progress towards UHC is not keeping pace with the rapid society development in China. Considering an increased burden in non-communicable diseases and an ageing population, prioritising the efficacy of financial investment and optimising resource allocation by strengthening primary health care are necessary to achieve UHC in China.

National Natural Science Foundation of China and National Health Commission of the People's Republic of China.

The damage caused by the COVID-19 pandemic is immeasurable. While the pandemic disrupted the supply and demand of several businesses, the impact on society raised questions over international labor standards, worker health and safety, ethical sourcing, and corporate social responsibility. On the demand side, most of the discretionary spending by consumers has come down, while on the supply side, companies are short of inventories. Many companies cut down on expenditure through pay-cuts and reduced workforce during the pandemic. Further, the psychological and social effects of the healthcare disaster resulted in emotional and behavioral changes in society. Reduced earnings due to prolonged social isolation, confinement measures, trade restrictions, and “working from home” have marred the efforts put in to achieve the sustainable development goals (SDGs). Students, scholars, instructors, administrators, and parents have all been severely impacted by unexpected school closures as a result of the government lockdowns. Further, environmental quality has improved during the lockdown. In this chapter, four SDGs are discussed in relation to COVID-19’s social impact. These SDGs are SDG 3: Good health and well-being, SDG 4: Quality education, SDG 8: Decent work and economic growth, and SDG 13: Climate action. Each SDG is individually important for the society; however, an integrated viewpoint enhances our scope to address the pros and cons of the pandemic to the society.

Sectors like manufacturing, construction, and others had a reduced demand with excess resources. On the contrary, the sectors like healthcare and pharmaceuticals had a surge in demand, which often resulted in a lack of resources. In this chapter, the social impact of COVID-19 is studied in six sectors: employment, education, healthcare, family, social media, and environmental quality. These sectors have been identified from the social progress index of 2020. The importance of responsible countries for reducing the social divide during large-scale disruptions is observed. Improvement through coordination and collaboration rather than competition among stakeholders is the way forward for a safe, inclusive, and respectful workforce.

Nowadays, public health and sustainable development go hand in hand towards the renovated perception of the former. Indeed, “ensuring healthy lives and promoting the well-being for all at all ages”, which established one of the United Nations (UN) Sustainable Development Goals (SDGs), seeks to ensure that this conception is not only reinforced, but also that saving lives takes into account the physical, mental, and social well-being of populations whose “development meets the needs of the present without compromising the ability of future generations to meet their own needs”. Accordingly, it is useful to interpret and convey information pertaining to this multidimensional concept in a way that encapsulates all its facets. Since this can be achieved through a composite indicator (CI), we propose a sustainable public health index framework, based on the 13 targets of the UN’s SDG 3 between 2016 and 2020. For this reason, using the popular CI-generating ‘Benefit-of-the-Doubt’ approach while considering desirable and undesirable indicators, we apply this framework to 181 World Health Organization Member States. We show that, from 2016 to 2020, less than 28% of them remained efficient and the European Region clearly dominated the remaining regions, which tended to decrease their performance, on average. Finally, we also reveal the global efforts towards improving the Proportion of births attended by skilled health personnel and the Density of medical doctors per 10,000 population, and the failure in achieving an acceptable Neonatal mortality rate, Under-five mortality rate, and a Number of people requiring interventions against neglected tropical diseases.

During the COVID 19 pandemic, direct-to-consumer telehealth (DTC) services allowed patients real-time virtual access to healthcare providers, especially those with an established relationship. In Colombia, this care modality was implemented between 2019 and 2020, under national considerations, it was implemented for outpatient care in a highly complex university hospital in Cali, Colombia.

 A descriptive study with prospective information collection was used to describe the implementation of the outpatient teleconsultation care model for patients. We constructed the clinical and process indicators with which we evaluated the model.

A total of 56,560 patients from our institution were treated by virtual outpatient consultation during the first nine months of the health emergency declared by COVID 19 in Colombia. The strategy made it possible to achieve coverage more significant than 100% in Cali and the departments of Colombia. Attention by teleconsultation was 19% of the total ambulatory care. The effectiveness in carrying out scheduled teleconsultations had an overall result of 91.5%. The accessibility results demonstrated the need to strengthen connectivity and accessibility to payments and strengthen technology adoption in the institution, health personnel, and patients.

Implementing an outpatient teleconsultation model allowed the continuity of the management with comprehensive coverage nationwide from a highly complex hospital in southwestern Colombia. The indicators' analysis should help strengthen the policies of access to telemedicine, especially with the consequences of the pandemic in low- and middle-income countries. Latin American evidence is necessary to establish the safety profile of telemedicine and the costs associated with the provision.