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[Editorial] Universal health care in 21st century Americas

Tags: General

Despite considerable progress, the Pan American Health Organization (PAHO) estimates that 30% of the population of the Americas still do not have access to the health care they need because of multifaceted barriers. On April 9, leaders, including Mexico's President Andrés Manuel López Obrador, PAHO director Carissa Etienne, and UN High Commissioner for Human Rights Michelle Bachelet, gathered with academics, activists, and representatives of social movements in Mexico City to hear the report of the Commission on Universal Health in the 21st Century.

The Commission emphasises that achieving health for all in the Americas will only be possible by ensuring effective financing, enshrining the right to health for all in legal and regulatory frameworks, and pursuing models of care that are based on primary health care. These care models must be people centred, account for human diversity, and facilitate genuine social participation. The Commission is unflinching in its acknowledgment of social inequality as a barrier to health. It recommends intersectoral interventions in economic, housing, and infrastructure conditions, and the creation of regulatory and oversight mechanisms for the private sector. However, it notes that the social determinants approach to health, although useful, can compartmentalise these factors without critically examining why these determinants have arisen and whom they are serving. The Commission criticises the consolidation of a worldwide economic model based on globalisation and increasing commercialisation and urbanisation, which it sees has led to climate change, migration, an increase in non-communicable diseases, mental health disorders, road traffic injuries, and violence.

In response to the Commission, López Obrador announced changes that would enshrine the right to health in the Mexican Constitution. PAHO also announced a new Regional Compact, PHC 30-30-30, which sets goals for countries to, by 2030, commit themselves to allocating 30% of the health budget to first-level care and to reduce health access barriers by 30%. By examining health beyond its social determinants, the PAHO Commission not only delivers actionable recommendations with regional impact but also presents the global order of the 21st century as a barrier to health for all.
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