Universal health coverage access to what

							               Editorial




                                          Universal health coverage: access to what?
                                          One of global health’s biggest aims—universal                 health systems, progress is likely to be limited. User fees,
                                          health coverage—received a boost last week at the             human resources for health (see the letter by Campbell
                                          Commonwealth Heads of Governments’ meeting in                 and colleagues in today’s issue), and the role of the private
                                          Trinidad and Tobago. 54 Commonwealth countries                sector are just a few of the complex factors involved in
                                          committed themselves to achieve universal coverage            health systems in which there is little consensus on a
                                          of health services free at the point of use. Leaders also     practical way forward. Also, emergency services, a crucial
                                          agreed on a Commonwealth Health Compact, proposed             component of health systems, are often overlooked.
                                          by UK Prime Minister Gordon Brown, which calls on             For example, if a woman in sub-Saharan Africa obstructs
MCAI




       See Correspondence page 1966
                                          donor countries to deliver existing commitments for           during labour she may find that there is no doctor, no
                                          health financing and to identify new ways to increase          functional operating theatre, no blood, and sometimes,
                                          international resources for health.                           even no water at the nearest public hospital—if she
                                           This Commonwealth initiative follows on from the plan,       makes it there. And while a child might have access to
                                          announced by Gordon Brown last September, in which            free vaccinations, if he or she gets an acute respiratory
                                          the UK, Austria, Norway, and the Netherlands committed        tract infection, there are likely to be no workable oxygen
                                          £3 billion to expand free health-care coverage in several     cylinders at the local hospital—an often fatal omission.
                                          countries. And the G8 process is also in step: at a recent      Universal health coverage means health system
                                          meeting in Bellagio, Italy, experts agreed on a research      strengthening (often referred to as “HSS”) and vice versa.
                     For more on the
       Commonwealth Communiqué
                                          initiative to support evidence-based advocacy and policy      But to become a tangible reality, perhaps HSS could
       and Health Compact see http://     making to attain universal health coverage.                   also mean “Health service solutions.” Many poor people
       www.thecommonwealth.org/do
       cument/177370/216904/2009_
                                            It is encouraging to see global agendas converging. But,    continue to die because their local hospital cannot provide
            chogm_communique.htm          since universal health coverage relies on robust public       them with the health services that they need. ■ The Lancet


                                          An opportunity to improve health in the European Union
                                          Many health professionals in the 27 member states of the      to reliable information about prescription-only medicines
           The printed                    European Union (EU) might feel the inner machinations         by allowing the drug industry to provide this information.
           journal                        of the European Commission—the executive body of the          Although effective campaigning has meant this legislation
           includes an                    EU—irrelevant to their work. But on Nov 27, an important      has changed from its initial form (eg, prior approval of
                                          change was made in the Commission by its President—           drug-industry information by a competent authority has
           image merely
                                          José Manuel Barroso—which could bolster public health.        been included, and allowing drug information in general
           for illustration                 Bowing to long-term pressure from civil society groups      print media has been excluded), the directive effectively
AP




                                          and public health activists, Barroso transferred the          legalises direct-to-consumer advertising.
       José Manuel Barroso
                                          control of drugs and medical devices, and the European          Some groups also believe that the management of
                                          Medicines Agency (EMEA), from the enterprise and              EMEA by the enterprise and industry directorate has
                                          industry directorate to the health and consumer policy        been far from perfect. The International Society of Drug
                                          directorate. The change means that legislation relating       Bulletins and Medicines in Europe Forum want the
                                          to drugs can now favour patients rather than industry,        reorganisation of EMEA’s functioning and funding to
                                          which has not always been the case.                           be a priority for the health directorate to improve the
                                            Under the enterprise and industry directorate, the          agency’s transparency and accountability to the public.
                                          Commission adopted a Pharmaceuticals Package in draft           The change of portfolios within the Commission is a
                                          form last year to address pharmaceutical innovation,          chance to amend existing directives, such as the direct-
                                          inequalities in the availability of patients’ information,    to-consumer advertising proposal, and put patients
       For more on direct-to-consumer
              advertising in the EU see
                                          and counterfeit medicines. The patients’ information          at the centre of health policy making in the EU. This
       Editorial Lancet 2008: 371: 1972   directive aims to ensure that EU citizens have equal access   opportunity should not be squandered. ■ The Lancet

       1946                                                                                                                 www.thelancet.com Vol 374 December 12, 2009