CEO Chronic Illness Alliance, Moonee Ponds, Victoria, Australia.
Department of Social Inquiry, College of Arts, Social Sciences and Commerce, La Trobe University, Bundoora, Victoria, Australia.
J Eval Clin Pract. 2021 Oct;27(5):1027-1032. doi: 10.1111/jep.13445. Epub 2020 Jul 27.
Sturmberg and Martin in 2020 argue that universal health coverage (UHC) is mainly about financing, and primary health care (PHC) is about the right care at the right time to ensure health. They maintain that the World Health Organization has recently sent the wrong message about the "pillars" of PHC in their relationship to UHC. An understanding of political economy is required in order to come to terms with the bases of PHC and the fundamentals of UHC that dealing with inequities is not only an economic issue but fundamentally a political issue. Neoliberal decision-making can enhance inequities in society. Two chronic health conditions, diabetes and multiple sclerosis, are examples of conditions that lead to costly and debilitating consequences for patients but also lead to substantial economic costs in terms of lost workforce participation and lost productivity. These cases demonstrate the socio-political issues involved in the management of care for a number of illnesses. The upsurge of COVID-19 has placed an enormous strain on health and broader social and economic resources and challenged the pretext of UHC as health for all: substantial differences in equity and political commitment have emerged. Sturmberg and Martin argue that the joining of UHC and PHC needs leadership, which involves local communities and resourcing. PHC is a changing system based on power relationships involving funders and the health community. In Australia as in several countries, out-of-pocket costs have grown rapidly and have affected access for some groups to PHC and have challenged the pretext of equity in UHC. In the context of PHC and UHC, we support the position that health for all goes beyond health care for all, to embrace healthy lives promoting wellbeing.
2020 年,Sturmberg 和 Martin 认为,全民健康覆盖(UHC)主要是关于融资的,而初级卫生保健(PHC)则是关于在正确的时间提供正确的护理,以确保健康。他们认为,世界卫生组织最近在 PHC 与 UHC 的“支柱”关系方面传递了错误的信息。为了理解 PHC 的基础和 UHC 的基本原则,即解决不平等问题不仅是一个经济问题,而且从根本上说是一个政治问题,需要了解政治经济学。新自由主义决策会加剧社会的不平等。两种慢性健康状况,即糖尿病和多发性硬化症,就是导致患者负担沉重和衰弱后果,但也会导致劳动力参与和生产力丧失方面的巨大经济成本的疾病的例子。这些病例说明了在管理许多疾病的护理方面涉及到的社会政治问题。COVID-19 的爆发给卫生和更广泛的社会经济资源带来了巨大压力,挑战了全民健康的理念,即全民健康:公平和政治承诺方面的巨大差异已经出现。Sturmberg 和 Martin 认为,UHC 和 PHC 的结合需要领导力,这涉及到地方社区和资源。PHC 是一个基于涉及供资者和卫生界的权力关系的不断变化的系统。在澳大利亚和其他几个国家一样,自付费用迅速增长,影响了一些群体获得 PHC 的机会,并对 UHC 公平的前提提出了挑战。在 PHC 和 UHC 的背景下,我们支持全民健康不仅仅是全民医疗保健,而是要拥抱促进健康的健康生活的立场。