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25% of total household expenditure, a figure that puts people at risk of facing catastrophic
expenses, an issue which PAHO recommends that countries tackle. Dr. Fitzgerald also
emphasized that impoverishing health expenditure threatens the achievement of the United
Nations’ universal health and poverty elimination goals by 2030.

Achieving universal health requires the transformation of health systems, a sufficient number of
trained, well-distributed health professions, and the availability of affordable medicines and
technologies. Currently, 800,000 additional health workers are required to meet the needs of
health systems in the Region. The high cost of medicines, as well as the growing number of

people with chronic illness that require life-long medicines, are also a risk to the sustainability of
health systems.

Increasing public investment in health

Greater and more efficient investment in health is also required in order to achieve universal

health and is fundamental for the development of countries. In 2014, the Ministers of Health of
the Americas adopted the Strategy for Universal Access to Health and Universal Health
Coverage in PAHO. Since then, PAHO/WHO has provided technical cooperation to help
countries improve the efficiency and effectiveness of their health systems, and to increase

public investment in health to at least 6% of the Gross Domestic Product (GDP), the minimum
level agreed in the strategy. Currently, average investment in health in countries of the
Americas stands at 4.2% of GDP.

In countries where investment in health is 6% or more of GDP, coverage is better and universal
health is closer to being achieved. A PAHO report shoes that increasing public revenues for

health can be obtained through higher taxes overall, as well as higher taxes on harmful products
such as tobacco and alcohol. It can also be achieved through reforms to improve the collection
and administration of taxes, as well as through measures to control corruption, something that
requires both political will and social consensus.

World Health Day 2019 takes place at the halfway point between the World Conference on
Primary Health Care in Astana (Kazakhstan), and the High-level Meeting on Universal Health
Coverage, to be held in the United Nations General Assembly in September 2019.

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