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Analysis Universal Health Coverage

Climate change threatens the achievement of effective universal healthcare

BMJ 2019; 366 doi: (Published 23 September 2019) Cite this as: BMJ 2019;366:l5302

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  1. Renee N Salas, affiliated faculty1,
  2. Ashish K Jha, faculty director1
  1. 1Harvard Global Health Institute, 42 Church St, Cambridge, MA 02138, USA
  2. Correspondence to: A K Jha ajha{at}

Minimising the health harms of climate change and optimising universal health coverage will only be achieved through an integrated agenda and aligned solutions, say Renee Salas and Ashish Jha

Key messages

  • Climate change is threatening to undermine the achievement of universal health care (UHC) through negative health outcomes and healthcare system disruptions

  • Climate change and UHC agendas bolster each other as they both strive to improve health and achieve health equity

  • Many regions of the world with the highest vulnerability to climate change are also those with the lowest UHC coverage. These regions stand to have enormous gains through an integrated approach

  • UHC plans should work to improve the understanding of climate change, use novel climate sensitive financial frameworks, and incorporate the mitigation of greenhouse gases

  • They should strive for evidence based climate adaptation that protects health and prioritise health system climate resiliency

The sustainable development goals (SDGs) target many different aspects of human wellbeing; they are interconnected and some might seem to create tension (such as economic growth in SDG 8 and ecological stewardship in SDGs 12 and 15).1 These interconnections are particularly clear for universal health coverage (UHC) (SDG 3.8), which will be substantially harder to achieve without climate action (SDG 13). Climate change threatens the very tenets of UHC; the regions of the world most vulnerable to climate change face the greatest difficulties in achieving it.

United Nations countries agreed to achieve UHC by 2030, which requires optimal access to essential, high quality services without sacrificing affordability.2 This extends beyond merely providing “coverage” and has three main components: a broad set of healthcare services must be accessible, affordable, and of sufficiently high quality to improve health outcomes. To track progress on SDG 3.8, the World Health Organization (WHO) and World Bank created a service coverage index to …

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