By Busani Bafana
BULAWAYO, Aug 2 2023 – Climate change is making us sick. It has become urgent to build resilient health systems to secure humanity’s well-being, says the special envoy for climate change and health of the World Health Organization (WHO).

“Climate change is unquestionably affecting our health every day,” says Vanessa Kerry– a renowned global health expert and medical doctor – who was appointed the WHO Director-General’s Special Envoy for Climate Change and Health in June.

She has a tall order to amplify WHO’s climate and health messaging and conduct high-level advocacy on tackling climate change to secure global health.

Increasing Disease Burden

“The climate crisis is a health crisis,” Kerry told IPS in an interview, calling for urgent action to mitigate and adapt to the climate challenge, which has increased the burden of disease around the world.

“Climate change poses a fundamental threat to our health. We are  looking at the growing burden of disease, so urgent action is absolutely needed at this  moment not only to address the pipeline of disease that is coming but to ensure that we can mitigate some of the causes of this poor health and  adapt to the complex challenge.”

Vanessa Kerry. Credit: Seed Global Health

According to the WHO, one in four deaths in the world currently is from preventable environmental causes. For example, around 7 million people die prematurely each year due to air pollution, which is more than the deaths during three years of COVID globally, Kerry said.

The  WHO is already estimating an extra 250 000 deaths per year linked to climate change.

Climate change-induced extreme weather has spiked the incidents of infectious and communicable, and non-communicable diseases, while extreme heat has triggered a rise in cardiovascular diseases and mental illnesses.

Malawi and parts of Southern Africa have suffered serious cholera outbreaks. India faced health heat-related illnesses, a  surge of malaria after the flooding in Pakistan last year, and a malaria outbreak in the United States, all linked to climate change.

Vector-borne diseases, including malaria, dengue, schistosomiasis, human African trypanosomiasis, Chagas disease, and yellow fever, are strongly affected by climatic conditions such as temperature, rainfall, and humidity. While water-borne and sanitation-related diseases, such as cholera, typhoid, and dysentery, are a major contributor to global disease burden and mortality, according to the WHO.

The World Meteorological Organization (WMO) forecasts a 90 percent probability of the El Niño event in the second half of 2023, which is set to trigger a rise in global temperatures and more extreme heat in many parts of the world and in the ocean, said WMO Secretary-General, Petteri Taalas.

“The declaration of an El Niño by WMO is the signal to governments around the world to mobilize preparations to limit the impacts on our health, our ecosystems, and our economies,” Taalas said.

El Niño – a naturally occurring climate pattern associated with warming of the ocean surface temperatures in the central and eastern tropical Pacific Ocean – occurs on average every two to seven years, and episodes typically last nine to 12 months.

The IPCC finds that there is a more than 50 percent chance that global temperature rise will reach or surpass 1.5 degrees C (2.7 degrees F) between 2021 and 2040 across studied scenarios, and under a high-emissions pathway, specifically, the world may hit this threshold even sooner — between 2018 and 2037.

According to the IPCC Assessment Report, climate change has adversely affected the physical health of people globally. Furthermore, extreme heat events have resulted in human mortality and morbidity, while climate-related food-borne, water-borne diseases, and vector-borne diseases have also increased.

Health at COP28

2023 is a crucial year for the intersection of climate change and health as the 28th Conference of the Parties of the United Nations Framework Convention on Climate Change (UNFCCC), more commonly referred to as COP28, will hold a  first-ever day dedicated to health at the climate change conference in the United Arab Emirates in December. This will serve as a critical opportunity to emphasize the profound significance of addressing climate change in relation to human health, Kerry said.

“My goal is to ensure our response to the climate crisis could be health-centered and try to mainstream it at COP negotiations, “ said Kerry, who believes in promoting public understanding of the climate crisis as a health crisis that must be managed now.

“I think people tend to associate climate change with just one aspect of health, like infectious diseases. But the truth is we see climate change impacting pretty much every aspect of health, communicable diseases to non-communicable diseases,” she said.

The Paris Agreement of 2015 is seen as a public health agreement with the WHO highlighting that health considerations are critical to the advancement of climate action, and meeting the Paris Agreement could save about a million lives a year worldwide by 2050 through reductions in air pollution alone.

Kerry said, for instance, investment in reducing air pollution would save lives and prevent a future loss of almost $50 trillion spent since 2010 in addressing this challenge.

“We also have an opportunity to reframe how we think about what being healthy means and how that impacts both our environment and how we live, ” said Kerry, stressing the importance of meaningful investment in stronger health systems and a workforce capable of meeting some of the climate burdens.

Investing in Health Systems

Kerry said building resilient health systems through training health workers and investing in infrastructure is key to responding to climate change. Many health systems around the world are already under-resourced and understaffed. They cannot deal with the current burden of disease and what will come as the impacts of climate change grow.

“We also have an opportunity to reframe how we think about what being healthy means and how that impacts both our environment and how we live, ” said Kerry, stressing the need for absolute dollars going into health and a health-centered climate smart response.

IPS UN Bureau Report

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By External Source
Aug 2 2023 (IPS-Partners)

The Rt. Hon. Andrew Mitchell was appointed as a Minister of State in the Foreign, Commonwealth & Development Office (FCDO) on 25 October 2022. He was previously Secretary of State for International Development from May 2010 to September 2012. He was elected Conservative MP for Sutton Coldfield on 7 June 2001.

Andrew was educated at Rugby School and Jesus College, Cambridge where he studied history and was President of the Union. He served in the Royal Tank Regiment before joining Lazard, where he worked with British companies seeking large-scale overseas contracts.

After serving as a government whip between 1993 and 1995, Andrew served as Minister for Social Security from 1995 to 1997. While in opposition, he was Shadow Minister for Economic Affairs from 2003 to 2004 and Shadow Minister for Home Affairs from 2004 to 2005. He then served as Shadow Secretary of State for International Development until the 2010 election.

ECW: The UK is ECW’s second largest donor with more than US$250 million in contributions to date. Why is investing in Education Cannot Wait a priority for the UK (especially for the more than 224 million crisis-affected girls and boys who urgently need our support)? Why should it be a priority for other public and private sector donors?

The Rt. Hon. Andrew Mitchell: The UK is proud to be a co-founding member and leading donor to ECW. As the global fund dedicated to education in emergencies and protracted crises, ECW shines a spotlight on the education needs of children caught up in emergencies and protracted crises around the world. We continue to support ECW because we refuse to give up on the 224 million children and adolescents affected by the horrors of war, natural disaster, and displacement. Today, approximately 2 billion people live in fragile and conflict-affected states. Education has a critical role to play in protecting children, especially girls, from the threats that crises pose. Education is too often neglected in humanitarian crises in favour of life-saving food and shelter. Education can, however, provide structure and stability for children and their families; and is a lifeline through to a better future. It is essential that we continue to support education for all those caught up in crises, wherever these may be.

ECW: In recent FCDO reports, the impact of the climate crisis on the education of 40 million children was underscored. Looking ahead to COP28 and beyond, how can ECW and the UK work together to join up on education and climate action to help address the impact of climate change and environmental degradation?

The Rt. Hon. Andrew Mitchell: In December last year, I launched FCDO’s new Position Paper “Addressing the climate, environment, and biodiversity crises, in and through girls’ education.” This Position Paper set out FCDO’s vision for bringing the relationship between education and climate change into sharper focus. Without providing an urgent emergency response to children living in contexts of extreme weather events and adapting education systems to climate shocks, education goals will continue to fall further out of reach. School infrastructure will be destroyed, agricultural land will be under water, and children will go hungry. Conversely, without harnessing the power of education, we are unlikely to solve the climate crisis. If we want to effectively tackle these priority issues, we must better understand and find integrated and holistic solutions.

I am pleased to see that ECW have increased their funding to support the First Emergency Response programmes at the onset of a crisis, particularly for recent climate shocks like the floods in Pakistan in 2022 and the ongoing droughts in Ethiopia and Somalia. The UK has advocated for increased attention to the educational needs of affected children, and we continue to work together to improve the emergency response in contexts of emergencies caused by climate and environmental change.

Through ECW’s Acceleration Facility, and their expertise as an emergency response provider, the UK and ECW are working together to advance learning on proven integrated solutions to deliver access to safe schools, quality of learning, and improved adaptation to climate and environmental change. We still however need more evidence of solutions that deliver these co-benefits that can be shared more widely to those in similar contexts and then delivered at scale.

ECW: On several occasions, you have highlighted the importance of mobilizing resources from the private sector towards the UK’s development goals. As ECW pursues its $1.5 billion target, what role could the private sector play in helping ECW reach 20 million crisis-affected girls and boys by the end of 2026?

The Rt. Hon. Andrew Mitchell: In a context of rising need, which is not matched by rising humanitarian funding, education is one of many sectors underfunded in the emergency response. This is why the UK was instrumental in establishing Education Cannot Wait: to shine a spotlight on education in emergencies. Since then, ECW has reached almost 7 million children affected by conflict and crises, including over 3 million girls. But we must do more to keep children in crises safe and learning. An average humanitarian crisis now lasts around nine years, but often much longer. The impact on children being out of school in a crisis context is staggering. It increases their vulnerability to child labour, abuse and exploitation and decreases their resilience to the significant challenges they face. Schools are valuable platforms for accessing information and services related to child protection, heath, food, and avoiding mines and unexploded ordnance, as well as other hazards in crisis contexts. Girls who are unable to access school are more likely to experience gender-based violence, early marriage and other gender-based harms. We also know that educational inequality is a strong predictor of civil war and violent conflict.

That is why I was proud to announce £90 million for education in emergencies and protracted crises, including £80 million for ECW at the Fund’s High-Level Financing Conference in Geneva in February this year. On the day, donors raised an impressive US$826 million, however this still falls short of the $1.5 billion target that is needed for ECW to reach 20 million crisis-affected girls and boys through its 2023–2026 Strategic Plan. It is critical therefore that we find innovative ways to close the funding gap to ensure these children have access to a quality education. That is where we see a role for private sector donors.

I have been impressed by the work of private and philanthropic organisations such as The LEGO Foundation, the Jacobs Foundation and Porticus, whom I had the pleasure of meeting in the margins of the High-Level Financing Conference. These strategic partnerships have a vital role to play in supporting education for children in crises and we need to see more of these organisations joining the sector.

ECW: Girls’ education is a key priority for the United Kingdom’s efforts to “project the UK as a force for good in the world.” How can we ensure that every girl – no matter who or where she is – has access to 12 years of quality education?

The Rt. Hon. Andrew Mitchell: In our new International Women and Girls Strategy, we are standing up for the right of every girl everywhere to secure the knowledge and skills she needs to reach her full potential. This includes standing up for the right of every girl to receive 12 years of quality education, including in emergency contexts, and ensuring that they have access to sexual and reproductive health education and are protected from gender-based violence. Our focus, as with all of our education support, is on foundational learning skills. Basic literacy, basic numeracy, and the socio-emotional skills that all children need to open up the doors to the 12 years of quality education. This is as relevant for children living in crisis as for those in more stable contexts. If not more so.

Girls living in countries affected by conflict are almost 2.5 times more likely to be out of primary school and 90% more likely to miss secondary schooling, compared to peers in stable contexts. Girls also face a set of interlinked barriers to accessing and remaining in education and learning, felt more acutely by marginalised groups, such as those with disabilities. As seen recently, and tragically, in Afghanistan, the rollback on women and girls’ rights can strike education and learning too.

In response, the UK is working in lockstep with international partners to challenge the rollback. We are also working closely with ECW and other partners to accelerate progress on reaching the most vulnerable in crises, including girls. We are a proud supporter of the Safe Schools Declaration, which aims to prevent gender-based and other violence in the school context. We are also prioritising better global data on education in emergencies, so that more financing is directed to education, there are better data to track results, and we can understand where and when crises become neglected.

At the country level, we are working, for example, in Afghanistan, Myanmar, Syria and Ethiopia to scale up our support to education in crisis situations. By improving coordination of this response with other partners we can maximise the number of children, and particularly girls, that UK funding can reach.

ECW: Recent analysis shows that the number of crisis-affected children in need of education support is increasing. At the same time, the public advance unedited version of the UN Secretary-General’s ‘Progress towards the Sustainable Development Goals’ report indicates we are falling behind on our promise of Education For All. How can we change course to deliver on the SDGs?

The Rt. Hon. Andrew Mitchell: Even if ECW’s $1.5 billion fundraising target is met, it will reach less than 10% of the estimated 224 million conflict and crisis affected children and youth worldwide. Furthermore, a recent report by UNESCO states that without $97 billion in extra funding per year, low and lower-middle-income countries will be unable to meet their 2030 national SDG 4 benchmark targets. It is clear that more progress is needed if we are to deliver the SDGs. That is why we want to work closely with our partners to reform the international humanitarian system to deliver on three priorities:

Firstly, to strengthen the resilience of education systems so that children can continue to learn, safely, during an emergency. Collectively, the humanitarian system needs to prioritise building preparedness and anticipatory action in education systems. The UK has invested in piloting work to support better anticipatory action in advance of climatic shocks, which is relevant to education. It focuses on adaptation, risk management, humanitarian action, and social protection.

Secondly, to improve the coordination between our development and humanitarian response. Providing education in emergencies is not only a humanitarian response but also a critical investment in the future of affected communities. It provides hope, structure, and a pathway to the future for the next generation. A joined-up approach between the humanitarian and development sectors is essential to enable long-term resilience in the face of crises. Greater coordination between the two global education funds, Education Cannot Wait and the Global Partnership for Education, is also a priority. Closer coordination between the funds will allow partners to focus on providing the most efficient and effective responses, in the context of scarce Official Development Assistance funding. It will also ensure they have maximum reach and impact without leaving children behind or duplicating efforts. In contexts including Myanmar and Afghanistan we are seeing closer alignment, with GPE and ECW working together to agree where they would add most value, while making the best use of donor funding.

Finally, we need better-designed emergency education programmes to mitigate gender-based violence risks and to keep girls safer. Currently, much of what is implemented in crisis situations is not evidence based and does not reach sufficient scale to benefit those who need it most. That is why we are advocating for the equivalent of what the UK calls ‘best buys’, in other words, research-based interventions proven to provide best impact and value for money. Such evidence relevant to humanitarian contexts, would help guide our investments in education in emergencies and protracted crises.

As I mentioned earlier, there is also a role for the private sector to help us deliver on our promise of Education for All. The UK is already working with the private sector to support girls’ education in developing countries. Launched by the Prime Minister last year, the Girls’ Education Skills Partnership (GESP) is an innovative partnership between FCDO, Generation Unlimited (a UNICEF partnership) and several major global businesses. By combining the resources of the private sector with the implementation experience of FCDO and UNICEF, GESP will provide high-quality training and market-relevant skills in manufacturing and STEM-related fields for 1 million adolescent girls and young women in Bangladesh and Nigeria. Private sector partners have a seat on the GESP Board and are making an important contribution towards addressing the skills deficit preventing adolescent girls from fulfilling their potential.

ECW: We all know that ‘leaders are readers’ and that reading skills are key to every child’s education. What are the two books that have most influenced you personally and/or professionally, and why would you recommend them to others?

The Rt. Hon. Andrew Mitchell: Professionally, the two books that have influenced me most are “The Bottom Billion” by Paul Collier and “An Imperfect Offering” by James Orbinski. Both offer a unique and fascinating perspective on international aid and development. And both shaped my understanding of the biggest development and humanitarian challenges we face today. Collier’s analysis takes place at the global level, identifying the global trends that affect a country’s development and the poverty traps UN agencies must overcome. Orbinski documents his personal experiences as a doctor working for Médecins Sans Frontières in the late ’90s, including postings in Peru, Afghanistan and Rwanda. His book offers extraordinary insight into the challenges faced by humanitarian workers on the ground as well the failures of the international community in those countries. I would recommend both these books to anyone working on education in crises. They shine a light on the realities faced by the people and communities we aim to support and remind us to keep them at the heart of all we do and how we do it.

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By Pearl Amina Karungi
UNITED NATIONS, Aug 2 2023 – In a groundbreaking turn of events, women in Bugiri District, Eastern Uganda, have defied societal norms and broken into the traditionally male-dominated fish farming industry.

Through the Women Economic Empowerment Programme launched by UN Women, these women have not only mastered the art of fishing but also revolutionized their economic prospects.

Rose Nakimuli, a resident of Bugiri, vividly recalls her journey into fish farming. “When I was selected to be trained in fish farming, I embraced the opportunity. I approached it as a job,” Ms. Nakimuli says with determination.

With the support of the UN Women project, she learned the ins and outs of aquaculture, swimming, and fishing, becoming a skilled fish farmer. Today, she proudly feeds her family and earns a descent livelihood from her newfound expertise.

Ms. Nakimuli is one of 1,400 women trained in fish farming. The Programme, initiated in 2019, has set ambitious goals to enhance women’s income security, promote decent work, and empower them with economic autonomy by 2025. The success achieved in the fish farming industry in Bugiri District stands as a shining example of the program’s impact.

With funding from the Government of Sweden and Standard Bank, UN Women partnered with the Bugiri District Local Government to support rural women in engaging in fish farming activities on the waters of Lake Victoria.

As a result, 28 cages brimming with Tilapia fish now stand as a testament to the women’s unwavering dedication and determination.

Amina Nakiranda, the project’s production manager, explains that it went beyond teaching women how to fish as the programme also equipped them with essential business management skills.

“Before this programme, many of us struggled with small businesses selling fresh produce or silver fish in local marketplaces,” Ms. Nakiranda reveals.

“However, through the comprehensive training provided by the project, we learned how to run our businesses efficiently, from start to finish.”

The cage fish project goes has strengthened the women’s capacity in governance, financial literacy, and the entire fish value chain. Inspired by their achievements, the women established a private company called “Women Economic Empowerment Bugiri (WEEB).”

Immaculate Were, the CEO of WEEB, proudly highlights the transformational journey of these women. “Although 85% of the beneficiaries are illiterate, they have become specialists in various aspects of fish farming, including feeding, harvesting, preservation, marketing, and trading,” Ms. Were remarks, adding that “Once a woman gets wealthy, that’s wealth for the whole nation.”

The project has also made significant strides in improving gender relations at the household level. With women contributing to the family budget and gaining financial independence, gender-based violence has notably reduced.

Judith, a member of the executive board of WEEB, shares her experience: “The project has reduced gender-based violence because we no longer sit home and beg our husbands for everything. We are no longer burdens; the project has empowered us.”

Beyond individual success stories, the fish farming project has made substantial contributions to the national GDP. With an impressive production of 508.5 tons of fish, the women have generated sales worth UGX 4.3 billion (approximately $1.15 million).

The project’s impact extends further, with UN Women providing essential support, including accommodations for working women, daycare services for their children, and necessary resources such as shelters, fish nets, life jackets, and a refrigerated truck for convenient market access.

“Thanks to UN Women, today we feel like heroes,” Ms. Nakimuli adds. ” Even the men view us as heroes, because fishing used to be a man’s job and we are excelling in it. It also gives us income to cater for our households.”

The journey of these resilient women serves as an inspiration, proving that with support and determination, barriers can be shattered, and new horizons can be explored.

Pearl Amina Karungi is Communications and Knowledge Management Officer, UN Women

Source: Africa Renewal: a United Nations digital magazine that covers Africa’s economic, social and political developments.

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By Guy Dinmore
ST DAVIDS, WALES, Aug 2 2023 – “My key message is really simple,” says Dr Simeon Ehui, the newly-appointed Director General of the International Institute of Tropical Agriculture (IITA), which works with partners across sub-Saharan Africa to tackle hunger, poverty and natural resource degradation.

“The clock is ticking,” Ehui tells IPS in an interview from Washington DC on his last day at the World Bank, urging Africa’s leaders to recognise the “absolute, paramount” importance of increasing funding for agriculture.

Dr Ehui, who also becomes Regional Director for Continental Africa, CGIAR, a global network of food security research organisations, says Africa’s food security is worsening. He lists the challenges: the climate crisis and extreme weather events that are presently causing floods in the west and central Africa and drought in the east; relatively high population growth; migration to urban areas; and specifically, the Ukraine-Russia war that triggered soaring prices of chemical fertilisers and grain.

As the African Development Bank recently noted, Russia’s invasion of Ukraine resulted in fertiliser prices rising two to three times over 2020 levels, creating serious supply gaps across the continent and driving food inflation. In sub-Saharan Africa, households spend up to 40% of their budget on food, compared to 17% in developed economies. Africa, the bank says, is over-reliant on food staples and agricultural inputs, importing over 100 million tonnes of cereals a year.

DG Simeon Ehui visits IITA Semi-Autotrophic Hydroponics (SAH) cassava multiplication section with Kenton Dashiell and Debo Akande, facilitated by Mercy Diebru-Ojo, Assistant Seed Specialist (right). Credit: IITA

Much of that food deficit and accompanying poverty is concentrated in several African states, led by Nigeria (where IITA is based in Ibadan), which is projected to overtake the US as the world’s third most populous country by 2050 with some 400 million people.

“My vision is thriving agricultural food systems in Africa,” says Dr Ehui, and, specifically for IITA and CGIAR, this means fostering the conditions to sustain centres of research excellence where scientists will be excited to work, with transparency of management and gender equality.

“We have to be able to respond quickly … We need to accelerate our research to respond to the needs of the people,” he adds.

While the global climate crisis is having a huge impact on food security, Dr Ehui agrees that political issues cannot be set aside. “We can’t divorce policy issues from the bigger agenda [climate change]. The two go together,” he says, singling out land tenure, land grabbing, and obstacles to women having access to land.

IITA will provide analysis and options for policy-makers to improve access to land and boost investments in agriculture.

Asked whether he is concerned that the Bill & Melinda Gates Foundation plays an overly dominant role in providing over half of IITA’s funding of “research and delivery” projects, Dr Ehui begins by expressing his appreciation of the foundation’s support, particularly in the development of Aflasafe to combat dangerous aflatoxin in maize, groundnuts and other crops. However, the new director general also says he wants to “diversify sources of funding and scale-up research”.

He also rejects criticism from some quarters of the “failure” of Africa’s Green Revolution as embraced by Bill Gates, saying India’s one-crop model of the “green revolution” and a lack of care for the environment had not been applicable to Africa and its own complex systems.

IITA and CGIAR are responding to the needs of smallholder farmers in Africa, Dr Ehui says, and that means agriculture that is sustainable and regenerative.

“The focus on regenerative agriculture reflects the importance of natural resource management and local eco-systems,” says Dr Ehui, a national of Cote d’Ivoire and the United States who worked for 15 years at CGIAR, managing multi-agricultural research development programs in Africa and Asia, and whose most recent post was World Bank Regional Director for Sustainable Development for West and Central Africa.

Asked if there was a genuine shift towards regenerative and sustainable practices for Africa, Dr Ehui said CGIAR had long been focusing on using local technologies for enhancing food security, for example, reducing reliance on chemical fertilisers for those who could not afford it and using locally available inputs instead. “When I was a young scientist, we were working on these technologies,” he notes.

The Dakar 2 summit on food security last January recognised how Russia’s invasion of Ukraine had exposed Africa’s over-reliance on imports of chemical fertilisers. “We have the resources to make it locally,” says Dr Ehui, who chaired a summit session.

At the summit, Senegal’s President Macky Sall, then head of the African Union, declared that “Africa must learn to feed itself” and that at least 10 percent of national budgets should be spent on agriculture.

Dr Ehui says it has been shown that every dollar spent on agricultural research brings a return of 10 dollars and that such investment will go a long way to help improve the socio-economic conditions of the people. Meeting basic needs will also help stem migration across the Mediterranean to Europe, he says.

Despite the challenges, agriculture is growing in much of sub-Saharan Africa and remains the mainstay of most African economies and a major employer. With 65% of the world’s remaining arable land in Africa and with a youthful and dynamic population, the African Development Bank believes Africa is capable of feeding itself as the world approaches a total population of nine billion people by 2050.

But have the pleas heard at the Dakar summit been heeded? “There has been a shift,” Dr Ehui replies. Funding for agriculture is still “below optimum”, but “a few countries” have responded, and he feels confident that, with work, numbers will soon increase.

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By Jomo Kwame Sundaram and Nazihah Noor
KUALA LUMPUR and BERN, Aug 2 2023 – To achieve universal health coverage, people need public healthcare systems providing fair access to decent health care. This should be an entitlement for all, regardless of means, requiring adequate, appropriate and sustainable financing over the long term.

Jomo Kwame Sundaram

Appropriate arrangements can help ensure a financially sustainable, effective and equitable healthcare system. However, insurance-based systems – both private and social – not only incur unnecessary costs, but also undermine ensuring health for all.

Private health insurance
Voluntary private health insurance (PHI) is not an acceptable option for both equity and efficiency reasons. Those with lower health risks are less likely to buy insurance. Paying the same rate will be seen as benefiting those deemed greater risks, especially the less healthy, often also those less well off.

Hence, PHI premiums are often ‘risk-rated’. This means those considered greater risks – e.g., the elderly or those with pre-existing conditions – face higher premiums. As these are often un-affordable, many cannot afford coverage.

This is clearly neither cost-effective nor equitable, but also socially risky, especially with communicable diseases. This typically means poorer health outcomes compared to spending. Also, various insurance premium rate arrangements have different distributional consequences.

‘Fee-for-service’ reimbursement encourages unnecessary investigations and over-treatment. This escalates costs, raising premiums, without correspondingly improving health. But limiting such ‘abuse’ requires monitoring, always costly.

Nazihah Noor

Unsurprisingly, many PHI companies use costly ‘managed healthcare’ services to try to limit rising costs due to such abuses. Thus, Americans spend much more on health than others, but with surprisingly modest, unequal and hardly cost-effective health outcomes.

With PHI, much public expenditure is needed to cover the poor and others who cannot afford the premiums, often also deemed to be at greater risk. Hence, achieving ‘health-for-all’ in such circumstances would require costly public subsidization of PHI.

Social health insurance
Unlike typically ‘voluntary’ PHI, social health insurance (SHI) is usually mandatory for entire national populations. Although often espoused with the best of intentions, SHI is invariably costlier due to its limitations and problems.

SHI incurs additional costs of health insurance administration to enrol, collect premiums, ascertain eligibility and benefits, make payments and minimize abuses. Revenue financed universal coverage need not incur such costs.

Compared to PHI, SHI seems like a step forward for countries with weak or non-existent public healthcare arrangements. But like PHI, SHI encourages over-treatment and cost escalation, as well as costly bureaucratic insurance administration.

Instead of such abuses inherent to insurance systems, a revenue financed health systems would incentivize prioritizing the health and wellbeing of those it is responsible for, thus emphasizing preventive health.

Such a health system contrasts with insurance systems’ emphasis on minimizing costs for the often unnecessary medical services it incentivizes, instead of improving the population’s health and wellbeing.

Government subsidies for health insurance, private or social, would inevitably go to the transnational giants which dominate health insurance internationally.

Financing SHI complications
Hence, SHI involves much more per capita health spending, raising it by 3-4%! But despite being much more costly than revenue-financed systems, there is no evidence health outcomes are improved by switching to SHI from government funding.

Germany’s SHI has been more cost-effective than the US with its PHI. But it is less cost effective than most other economies with revenue-financed healthcare. Nevertheless, healthcare financing consultants, continue to recommend versions of SHI, although it is clearly not cost-effective, appropriate, efficient or equitable.

SHI schemes remain in some rich countries for specific historical reasons, e.g., Germany’s evolved from its long history of union-provided health insurance. But more recently, even these economies rely increasingly on supplementary revenue financing. But again, such hybrid financing does not improve cost-effectiveness.

As SHI typically involves imposing a flat payroll tax, it discourages employers from providing proper employment contracts to staff. SHI is estimated to have reduced formal employment by 8-10% worldwide, and total employment in rich countries by 5-6%!

It is also difficult and costly to collect SHI premiums from the self-employed, or from casual, temporary and informal workers not on regular payrolls. Also, most working people in developing countries are not in formal employment, with far fewer unionized.

SHI schemes are always difficult to introduce as they would reduce take-home incomes. In most developing countries, most families cannot afford such pay-cuts. Hence, government revenue would still be needed to cover the uncovered to achieve health for all.

Many SHI proposals also recommend earmarking revenue from new ‘health’ taxes collected. Such earmarking creates likely conflicts of interest reminiscent of justifications for ‘sin taxes’ on addictive narcotics, smoking, alcohol consumption and gambling.

Will governments perpetuate unhealthy practices and behaviours to secure more tax revenue? Is there an optimum level of smoking or sugar consumption to be allowed, even encouraged, to get such earmarked funding?

Revenue financing
International evidence shows progressive revenue-funded public health financing to be much more equitable, cost-effective and beneficial than SHI. Hence, moving from revenue-financing to SHI would be a step backwards in terms of both equity and efficiency, or cost-effectiveness.

The late World Bank economist Adam Wagstaff and others have long advocated tax- or revenue-financed health provisioning due to the significant additional costs of managing health insurance systems, both private and social.

Revenue-financed public healthcare financing avoids the many insurance administration expenses incurred by both PHI and SHI. There will be no more need for such costly payments for unnecessary medical tests, procedures and treatments, and bureaucratic processes to manage insurance procedures and curb abuses, e.g., those associated with ‘moral hazard’.

Better financing and reorganization of preventive health efforts are needed. Public health programmes requiring mass participation, e.g., breast or cervical cancer screening, generally have much better outcomes with revenue-financing compared to SHI.

Better results can be achieved by improving tax-funded healthcare. More resources need to be deployed to improve preventive and primary healthcare. Strengthening public health services must include improving staff service conditions, morale and retention rates.

There is nothing inherently wrong with revenue-financed healthcare. Underfunding is largely due to political choices and fiscal constraints. These are typically due to externally imposed political limits.

Instead of dogmatically insisting on SHI, as is typical of health financing consultants, revenue financing of public healthcare should be reformed, strengthened and improved by:
* increasing and improving budget allocations.
* eliminating waste and corruption with competitive bidding, etc.
* increasing government revenue with fairer taxation, including wealth, ‘windfall’ and deterrent ‘sin’ taxes, e.g., of tobacco and sugar consumption.

IPS UN Bureau

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