Conclusion
While UHC and its leadership should produce greater equality and
PHC should include social housing as Sturmberg and Martin argue,
this is patently not the case. Public policies about health currently
actively exclude economic policies that impact on people’s participation
in health-maintaining activities such as employment, nutrition, and
social engagement. These aspects are not considered part of PHC, to the
detriment of those accessing it, as we can see in the above examples.
Reform needs the leadership to drive these changes.
PHC and UHC become most effective when prevention and other public
health measures can lead to more equity for patients. Political economy
analysis says it involves economic and political decisions that are
often made favouring health/disease industry interests promoting further
inequity. For patients UHC has as a fundamental base goal of equality,
and this is foremost a political consideration. Groups such as
indigenous, refugee, migrant, the poor and disabled have somewhat
limited access to resources and to influence decision makers. For
diabetes and multiple sclerosis as well as other conditions there are
large costs for the economy and community in terms of productivity,
healthcare and wellbeing. People with these conditions in many cases
face diminished lifestyles and have less equality in terms of UHC.
The experience of the early stages of COVID–19 has shown that inequity
is endemic to many social, political and health systems and that it
needs to be addressed in future planning not only to provide effective
healthcare but to sustain employment and the provision of effective
social and economic supports.