According to the World Health Organization (WHO), half of the world’s 7.6 billion people lack access to essential health and 100 million people are pushed into “extreme poverty,” which is defined by the World Bank as living on less than $1.90 per day in Purchasing Power Parity (PPP) terms. PPP is an economic theory that is utilized to compare economic productivity and standards of living between countries and across time by way of comparing different countries’ currencies through a “basket of goods” approach.

Equally gruesome, there are 800 million people, accounting for about 12 percent of the world’s population, that spent at least 10 percent of their household budgets in 2017 to pay for health coverage. Given these numbers, World Health Day, the universal day that emphasizes the importance of health issues across the globe, is using this year to bring up the debate on whether or not universal health coverage could turn out to be economically efficient. Despite the idea of universal health coverage looking good on paper, the issue has been criticized on many different levels.

Global health awareness has become an important topic of discussion throughout the years and has been on the forefront of many political and humanitarian conversations around the world, which has made World Health Day a more prominent part of global activism.

World Health Day first started in 1950 after the World Health Organization (WHO) held the first World Health Assembly in 1948.  During that initial meeting, the assembly decided that April 7 would be the annual day of celebration. Ever since its founding, World Health Day has been a global health awareness day under the WHO’s sponsorship, and it is also one of eight official global health campaigns put on by the WHO.

The WHO’s responsibility for World Health Day is to organize international, local and regional events based on each year’s theme, and the theme tradition has been occurring since 1995, when the first theme was Global Polio Eradication in response to the virus’ reaches across the world. This year, the theme is “universal health coverage,” which has become a major topic of political discussion in recent times due to the large number of global citizens without insured health coverage.

Universal health coverage, as described by the WHO, doesn’t necessarily mean that health coverage should be free. The term simply means that people and communities should be able to receive the health services that they need without suffering a financial burden. Also included in the WHO’s description of universal health coverage are quality health services like health promotion and prevention, as well as palliative care, health treatment and rehabilitation.

Fernando DeMaio, an associate professor of sociology and an expert in health disparities, believes that there is reason to be optimistic about global universal health coverage working out from a macroeconomic perspective.

“I would argue that it is not only economically possible, it is economically advantageous to expand health coverage around the world,” DeMaio said. “That was the key finding of a major World Health Organization Commission published in 2001, which argued that investing in population health was one of the most effective ways of reducing poverty.”

In fact, “the WHO model – developed by influential economists – showed that investments of about $60 billion per year in population health would produce a ‘return’ of more than $350 billion per year within a generation,” DeMaio said. As a result of the model’s findings, “the economic case for expanding (global) access to health services, particularly primary care, is clear.”

While DeMaio believes that universal health coverage is economically possible, there could potentially be too many economical and political disadvantages that would outweigh its effectiveness. To that end, William Sander, an economics professor who teaches a course covering the economics of low-income countries, believes the exact opposite of what DeMaio thinks.

“It would technically be feasible to have some type of universal health coverage,” Sander said. “However, it would not be possible from an economic or political perspective (because) wealthy countries like the U.S. would not provide more resources for foreign aid.” Therefore, he says, the idea of universal health coverage “is not popular politically.”

Aside from wealthier and developed nations potentially not wanting to provide the funds for lower-income countries, Sander mentioned that many low-income countries already have issues that would prevent the implementation of universal health coverage.

“In poor countries, there are two key issues. First, there has been an underinvestment in basic health care by governments although things have improved over time,” Sander said. “And second, one of the reasons for a lack of healthcare is poverty, especially in rural areas. Households cannot afford to demand healthcare, so health care providers don’t supply it.”

On top of poor countries already lacking the funds necessary for universal health care, scarcity often leads to long waiting times as health care shifts to being government-run instead of being controlled by the free market.

“The problem is one scarcity. There are limited resources to deal with almost unlimited healthcare demands,” Sander said. For example, “in the U.K., the government pays. For some problems, there is a wait to be treated.”

And those waits can be up to a year and a half in nations that have universal health care. Michael Miller, an economist, stated that the long waiting times prove to actually be costly for the patients seeking medical treatment.

“Countries that have government-run healthcare, they do it by quantity” instead of by price, like the U.S., Miller said. “That’s why in England people are told ‘I’m sorry you’re too old, you can’t have this.’ And in Canada, they’re told ‘yes, you can see a specialist – one will be available in a year and a half.’”

In addition, Miller pointed out that universal health coverage dismantles prominent economic factors such as incentives and self-interest.

“Without those two things guiding your decision making, when you’re spending other people’s money on other people, you don’t care about quality and you don’t care about efficiency. All you care about is getting a decision, and that’s not how it works,” Miller said. “It doesn’t work efficiently if you do that.”

Though World Health Day’s theme of universal health coverage could have economic and political consequences, that doesn’t mean that there aren’t solutions for health coverage to be made more affordable. In the case of the healthcare system in the U.S., it might need to be reevaluated altogether.

“The U.S. system, to be blunt, rations through discrimination. We don’t all have the same access to the health care system in this country – we ration based on income, based on race,” DeMaio said. “We have a real urgent need to provide more equitable access to the health care system in this country,” that aids all socioeconomic groups.

Without a doubt, U.S. health coverage is expensive. In December the National Conference of State Legislators reported that annual premiums reached a hefty cost of $18,764 in 2017, which is up three percent from 2015.

The final domestic conflict at hand is that the cost of U.S. private health insurance is based on risk, and “if healthy individuals don’t buy insurance, (then) average risk and the price of health insurance increases, making health insurance less affordable,” Sander said.