The missing right to health

2 Addressing the Global Health Crisis: Universal Health Protection Policies

2. The dimensions of the global health crisis

2.1. The missing right to health

Legal health coverage informs about entitlements to benefits prescribed by national law. They are a prerequisite to universal health protection that is rights-based and not just a privilege of the wealthiest part of the populations. However, nearly four-tenths 38.9 per cent of the world ’s population are without any form of legal health coverage figure 1. The most substantial gaps are found in Africa, particularly in Sub-Saharan Africa, where some 80 per cent of the population is excluded from legal coverage. Moreover, major gaps exist in Asia. For example, in India, more than 80 per cent of the population is not legally covered. Figure 1: Proportion of population affiliated to national health services, social, private or micro- insurance schemes, by region, latest available year percentages Note: Global average weighted by population. Sources: http:www.social-protection.orggimigessRessourceDownload.action?ressource.ressourceId=36977. In 44 countries across the world more than 80 per cent of inhabitants remain without coverage as they are not affiliated to any health system or scheme. These countries include Azerbaijan, Bangladesh, Burkina Faso, Cameroon, Haiti, Honduras, India and Nepal figure 2. 17.0 24.7 55.2 58.0 72.9 81.7 85.6 91.6 99.7 61.1 37.0 52.0 10 20 30 40 50 60 70 80 90 100 Sub-Saharan Africa Africa North Africa Asia and the Pacific Middle East Latin America and the Caribbean North America Central and Eastern Europe Western Europe World of total population covered Excluding China Total health coverage Addressing the Global Health Crisis: Universal Health Protection Policies 3 Figure 2: Proportion of population affiliated to national health services, social, private or micro- insurance schemes, globally, latest available year percentages Note: Global average weighted by population. Sources: OECD Health Statistics database; national sources for non-OECD countries for more detailed figures, see Annex II. Link: http:www.social-protection.orggimigessRessourceDownload.action?ressource.ressourceId=38197. Analyses further show that the most significant gaps and thus inequities in legal health coverage are found in those countries with the highest poverty levels among the population, whereas the highest coverage rates are achieved in countries with low poverty levels, such as those in Western Europe figure 3. A close relationship between coverage rates and income levels of countries is also apparent: the lower a country’s income, the more likely it is to experience coverage gaps in social health protection. Figure 3: Legal health coverage and poverty, latest available year percentages Notes: Poverty is defined as daily per capita income of US2 or less. R2 = 0.5684 Sources: Social health protection coverage data from the ILO Social Protection Department database; poverty data from World Bank, World Development Indicators; OECD; ADB. Link: http:www.social-protection.orggimigessRessourceDownload.action?ressource.ressourceId=36980 North Africa Sub-Saharan Africa Latin America and the Caribbean North America Western Europe Asia and the Pacific Middle East World Low-income Lower-middle-income Upper-middle-income High-income 10 20 30 40 50 60 70 80 90 100 10 20 30 40 50 60 70 80 90 100 o f p o p u la ti o n in p o v e rt y Health coverage as of total population 4 Addressing the Global Health Crisis: Universal Health Protection Policies

2.2. The impoverishment due to high costs of health care