Five Questions With…Dr Tedros Ghebreyesus

1.      What does Universal health coverage (UHC) mean to you?

First, health is a rights issue, which is reflected in both WHO’s Constitution and the Universal Declaration of Human Rights. An increasing number of countries also enshrine the right to health in their national constitutions.

That’s because health is fundamental for individuals, families, communities and nations to thrive. UHC is the best way to guarantee the right to health for everyone in a society. It has the power not only to transform the health of populations, but to transform economies and change the trajectory of nations. It means ensuring that all people can use the promotive, preventative, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

But today, more than half the world’s population lacks access to essential health services, such as the ability to see a health worker, or vaccination, or treatment for HIV. Even when services are available, using them can mean financial disaster – almost 100 million people are pushed into extreme poverty every year by the costs of out-of-pocket health spending. And all too often, the services people can access are of low quality. If services are poor quality, it’s not UHC.

Better health helps to reduce poverty by stimulating productivity, creating jobs and contributing to inclusive economic growth. More importantly, it restores dignity and gives hope for the future. It helps people and communities to thrive. So the question is not whether countries can afford to invest in UHC, it’s whether they can afford not to.

The bedrock of UHC is primary health care, with an emphasis on health promotion and disease prevention. Although hospitals are a vital part of every health system, primary health care helps to keep people out of hospitals, where the costs are higher and the outcomes can often be worse because diseases have progressed.

2.      Could you tell us a bit about your own journey – what inspired you to become a global health leader?

WHO has been part of my life since I was a child. I remember walking through the streets of Asmara with my mother as a small boy and seeing posters about a disease called smallpox. I remember hearing about an organization called the World Health Organization that was ridding the world of this terrifying disease, one vaccination at a time.

The first time I had health insurance was a student in Denmark during the 1980s. Even as a foreign student, all my medical needs where covered. That experience left a lasting impression on me. It made me ask why we couldn’t do the same thing at home in Ethiopia. Later in life, I received a scholarship from WHO to do my Master’s degree at the London School of Hygiene and Tropical Medicine. I wonder if the person who awarded me that scholarship could have imagined where it would lead.

It set me on a path that enabled me to serve my country at the highest level, and which has now given me the opportunity to serve the world to advance the health of the world’s population.

3.      How did you come to know Eldryd and in what ways do you think that organisations like THET can contribute to UHC in meaningful way?

I first met Eldryd as a Master’s student in London in 1991. Because of his links with Ethiopia he had a special affinity with the Ethiopian students and went out of his way to give us advice and make sure we were comfortable. We then had the opportunity to work together when I was Minister of Health and he was Chief Executive of THET. We have had an enduring friendship and collaboration and he has introduced me to other friends and colleagues such as Lord Nigel Crisp.

I have always had enormous respect and admiration for Eldryd. His dedication, selflessness and humility are inspiring and have always been an example I have tried to follow.

THET made a vital contribution to improving health in Ethiopia and continues to be an invaluable partner for WHO. We cannot even dream of addressing the world’s health problems on our own. It’s only through partnerships that we can tap global expertise to find local solutions, build the capacity of health workers and boost health systems. Through its partnerships, THET has a proud history of working to make the dream of UHC a reality, particularly when it comes to delivering quality health services.

4.      What are the greatest barriers to achieving UHC?

The biggest barrier is political will. I know from my own experience that with commitment from the highest levels of government, anything is possible. Without it, transformative change is very difficult.

Significant investments are required to build strong health systems that deliver quality services, but UHC is not a luxury that only rich countries can afford. All countries at all income levels can make progress with the resources they have. We also need to help countries see that health spending is not a cost, it’s an investment.

We cannot ignore gender norms that, for example, drive the poverty that affects women more than men and makes health care unaffordable for many.

We need to see UHC as a key driver of all 17 Sustainable Development Goals. It is much more than SDG 3 (the health goal). It also helps to reduce poverty (Goal 1), improve gender equality (Goal 5) and drive inclusive economic growth (Goal 8). In fact, health is connected to all the goals in different ways.

5.      What do you hope to see evolve during your time as Director General of the WHO?

Our top priority is universal health coverage, so that all people receive the quality health services they need, without facing financial hardship. WHO is committed to working with all countries to strengthen their health systems and support them on the path towards UHC. Some countries are further along that path than others, but all countries have room for improvement. No health system is perfect and evolving disease patterns and health needs mean that health systems must evolve with them. One of my priorities is to ensure WHO is engaging in strategic policy dialogue with all countries, rich and poor, to identify weaknesses and identify solutions.

For all countries, the bedrock of universal health coverage is quality primary health care, which can address the full range of health issues, including communicable diseases, noncommunicable diseases, family, child and adolescent health.

Health workers are a crucial part of every health system. So one of the ways we are supporting countries to reach universal health coverage is by encouraging them to make smart investments to ensure they have the right number of health workers, with the right skills in the right places.

Universal health coverage doesn’t just improve health, it’s also the best defence against outbreaks and other emergencies. Strong health systems built on robust primary health care are better able to prevent and respond quickly to health crises, and mitigate their effects. That’s why I always say that health systems and health security are two sides of the same coin.

But we also know that we must do more than treat disease and respond to emergencies. The best way to promote healthy populations is to prevent disease by creating the conditions in which people can stay healthy. That’s why addressing the social, economic, environmental and commercial determinants of health is so vital, including the air people breathe, the food they eat, the houses they live in, and so on.

As an evidence-based organization, one of WHO’s main roles is to give countries reliable advice, based on the best science. To strengthen that role, we’ve recently created a new division, the Office of the Chief Scientist, to ensure WHO stays ahead of the latest scientific developments.

Another key area in which countries are looking to WHO for support is the area of digital health, which is opening unprecedented opportunities, and raising new challenges. To help countries take advantage of the opportunities and avoid the pitfalls, we’ve also created a new Department of Digital Health that will enhance our role in assessing digital technologies, and support countries to make decisions about how to prioritise, integrate and regulate them.