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It’s now just over two years since the UN endorsed the goal of universal health coverage (UHC). The first ever global day focusing on UHC was held last month (12 December). The principle is simple: people should receive the healthcare they need without having to suffer financial hardship. But making that happen involves lots of development work, such as building and equipping health facilities, training staff, and designing healthcare systems and financing mechanisms suitable for local conditions.

As we begin an important year for global development — a year when UHC commitments look set to be adopted as part of the UN’s Sustainable Development Goals — it’s worth reflecting on progress towards UHC. Philosopher and economist Amartya Sen did just that last week in a piece in The Guardian, writing that “there is … plenty of evidence that not only does universal healthcare powerfully enhance the health of people, its rewards go well beyond health”. [1]

So there are good ethical and economic arguments for working towards UHC. But, as this happens, will some groups be left behind? In particular, will people with disabilities benefit?

“Universal health coverage must be understood to include rehabilitation and treatment of impairments as essentials, not added extras.”

Hannah Kuper

There is scant research about the extent to which disabled people are being overlooked by NGOs and others working towards UHC so far. But they almost certainly are.

Up to one in seven people in the world has a disability. My research group has repeatedly found that people with disabilities have greater healthcare needs. [2] They also find it harder to access healthcare, as the WHO has shown in their World Report on Disability. [3] People with disabilities give many reasons for this. The health centres are too far away. They worry that staff will mistreat them. Many can’t afford services or transport. This means people with disabilities often receive less healthcare than other people, and pay more for it. That same WHO report showed that households in poor countries with disabled members spend a third more of their income on healthcare compared with other households. [4]
Put simply, people with disabilities are the ones who need UHC the most, yet if they remain overlooked they are least likely to get the benefits.

There are clear, practical solutions. For instance, health services need to be designed to be accessible for people with disabilities. UHC must be understood to include rehabilitation and treatment of impairments as essentials, not added extras.

Cataract surgery is one example. Cataracts cause half the world’s blindness and can be cured with a simple operation, but many people don’t have surgery because they can’t afford it. Why? They may need financial help, but for UHC to work there are broader issues for governments and aid organisations to consider too: for example organising transport to hospitals.

We also need to collect data on disability as well as health indicators, so countries can monitor whether UHC is reaching everyone. WHO director-general Margaret Chan may well be right when she said that “universal coverage is the single most powerful concept that public health has to offer”. [5] Good health drives development, and UHC protects people from poverty.

But countries will not achieve UHC or meet other health-related development goals without recognising that ‘universal’ means disabled people too.

Hannah Kuper is codirector of the International Centre for Evidence in Disability at the London School of Hygiene & Tropical Medicine, United Kingdom. The centre is on Twitter as @ICED_LSHTM, and Hannah can be contacted on [email protected]


[1] Amartya Sen Universal healthcare: the affordable dream (The Guardian, 6 January 2015)
[2] Hannah Kuper and others The impact of disability on the lives of children; cross-sectional data including 8,900 children with disabilities and 898,834 children without disabilities across 30 countries (PLOS One, 9 September 2014)
[3] World report on disability (WHO, 2011)
[4] Lena Morgon Banks and Sarah Polack The economic costs of exclusion and gains of inclusion of people with disabilities (International Centre for Evidence in Disability, 2014)
[5] Margaret Chan Universal coverage is the ultimate expression of fairness (WHO, 23 May 2012)