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.