The COVID-19 pandemic has forced the global community to recognize that when human health suffers, our economies, our political systems, and our communities all suffer as well. Health is integral to well-functioning, equitable societies where individuals are productive and safe. Climate change poses another fatal threat to that vision, not only exacerbating the spread of disease leading to pandemics such as COVID-19, but also disrupting daily life by compromising access to nutritious food, water, and clean air.
In order to develop more resilient, sustainable societies as the Sustainable Development Goals (SDGs) have prescribed, the global health community should understand that providing Universal Health Coverage (UHC) goes far beyond achieving SDG 3 (good health and well-being). Progress on UHC, while inherently supportive of SDG 3, is equally a metric of success for countless other SDGs, from life on land (SDG 15) to gender equality (SDG 5).
The Access Challenge and Harvard Global Health Institute recently launched the report ‘Africa Leads the Way: Harnessing Multi-sectoral Collaboration to Achieve Universal Health Coverage,’ which highlights the collaborations necessary to achieve UHC by drawing the connection between food, water, and air, and human health. The report demonstrates how, at all levels of society, African leaders have already begun the innovative work of addressing these areas, often more than one at once, to build person-centered, equitable health systems. This work may serve as a guide for others to achieve SDGs not only in Africa, but globally as well.
From before birth, nutritious food is fundamental to ensuring a healthy life. Proper nutrition of mothers and children leads to improved development, which in turn reduces the incidence of multiple non-communicable diseases (NCDs). These diseases can be better managed not only through the elimination of hunger, as SDG 2 calls for, but by ensuring that food is nutrient-rich and that food systems are resilient to climate change. Strategies that consider how food is grown, addressing SDG 15, are therefore equally essential to good nutrition and human health. Crop diversification, a strategy consistently applied throughout Zambia, involves the cultivation of indigenous and drought-resistant crops. Meanwhile, the African Soil Partnership is applying sustainable soil management techniques in order to restore micronutrients in soil throughout sub-Saharan Africa. These strategies ensure a wider variety of nutrients in food, and ultimately make nutritious food more readily available to those who need it most.
Another example of linkages between UHC and other SDG issues can be found in efforts to eliminate air pollution, which requires addressing the air quality at the source. The burning of fossil fuels is associated with 780,000 premature deaths annually in Africa as well as rising rates of asthma and cancer. SDG 7 (affordable and clean energy) is therefore essential to UHC. Private innovation, such as the air quality monitoring program, AirQo, can encourage more sustainable energy use, while government regulations on energy, environment, transportation, and infrastructure all help protect communities from primary causes of air pollution, such as motor vehicle emissions and using natural gas, wood, or coal for indoor cooking. Air pollution disproportionately affects low-income populations. Therefore, improving air quality is essential for promoting equitable health outcomes.
Institutionalization of WASH (water, sanitation, and hygiene) will also create greater health equity in society. Not only does clean water (SDG 6) have a range of health benefits, from decreasing the incidence of waterborne illnesses to enhancing quality of care in healthcare settings, widespread WASH programs also address inherent gender disparities (SDG 5) in water accessibility, as women shoulder the largest burden in water collection. Many countries across Africa have made WASH a priority, focusing on rural areas and underserved urban slums. Countries such as Ethiopia have relied on coordination between water, environment, infrastructure, health, and education sectors to effectively provide WASH services. It is this kind of multi-sectoral collaboration that will allow WASH programmes to be more resilient to the challenges to water access that climate change will bring.
The Great Green Wall is an exemplar of a single strategy that addresses all of these intervention areas. This initiative has generated a commitment from more than 20 African countries to reforest the Sahel region. Reforestation can promote food security and sustainable agriculture, while protecting ecosystems from land degradation. It also combats desertification, thereby simultaneously increasing air quality and water security.
Through this initiative, the communities of the Sahel are emerging as global leaders as they proactively address the threat of climate change and seek to create more sustainable settlements (SDG 11). This initiative represents the vision of UHC: a multinational, multi-sectoral, community-driven approach to creating sustainable environments for safe and healthy individuals.
The ‘Africa Leads the Way’ Report and its Multi-sectoral UHC Services Framework promote this vision of healthy communities and demonstrate how the intervention areas of food, air, and water, have multiplying cost-saving and health-promoting effects throughout the health system. This Framework assembles the above programme areas into one interconnected system of health, which moves beyond tackling singular diseases, and towards promoting healthy societies as whole.
While the Framework does not use the language of the SDGs, it is clear that the goal of UHC is interwoven with the SDGs. Both aim to set a sustainable, cost-effective course for building equitable societies by prioritizing the fundamentals of life: the food we eat, the air we breathe, and the water we drink.
The authors of this guest article are Stefanie Friedhoff, Harvard Global Health Institute, and Théa Klement, The Access Challenge.
To read more on multi-sectoral efforts to attain UHC in Africa, see the 2020 One by One: Target 2030 UHC report, ‘Africa Leads the Way: Harnessing Multi-Sectoral Collaboration to Achieve UHC,’ launched on 5 June 2020 by The Access Challenge and Harvard Global Health Institute. Read the report here: https://www.onebyone2030.org/report2020-africa-leads-the-way
If you or your organization has initiatives that support person-centered, equitable, and sustainable UHC in Africa, please send information to kelly_phouyaphone@harvard.edu.