Universal health coverage: progressive taxes are key

www.thelancet.com Vol 386 July 18, 2015 227 On Dec 12, 2012, a UN General Assembly Resolution was passed unanimously which called on all countries to move their health systems towards universal health coverage (UHC). Interestingly, this resolution was cosponsored by the USA—a country not known for having achieved this goal. With UHC now a common objective for all health systems, the debate is shifting to how countries should achieve it. Particularly since publication of the 2010 World Health Report, there has been growing interest in how countries should fi nance their health systems to reach the twin goals of universal coverage of eff ective health services and fi nancial protection from the costs of these services. Most recent research evidence in this area is now showing that public fi nancing is the key to achieving UHC. For example, in the 2012 Lancet Series on UHC, Moreno-Serra and Smith showed that pooled public fi nancing resulted in improved health outcomes; private voluntary insurance had no eff ect on indicators, and a greater share of out-of-pocket expenditure was associated with higher mortality rates. In The Lancet, Aaron Reeves and colleagues reinforce these fi ndings on the benefi ts of public fi nancing, but now provide new research evidence on which specifi c public fi nancing mechanisms have the greatest eff ect on UHC indicators. Using longitudinal data from 89 low-income and middle-income countries from 1995 to 2011, they show that increasing general taxation fi nancing was associated with increased Universal health coverage: progressive taxes are key plausible, suggestion that low grip strength represents poor health. This explanation is not entirely consistent with the fi ndings of other studies that show long-term associations between grip strength in young people and subsequent mortality. An intriguing implication is that grip strength might act as a biomarker of ageing across the life course. This is not a new idea, but fi ndings from PURE add support. Loss of grip strength is unlikely to lie on a single fi nal common pathway for the adverse eff ects of ageing, but it might be a particularly good marker of underlying ageing processes, perhaps because of the rarity of muscle-specifi c diseases contributing to change in muscle function. Interestingly, similar age-related changes have been reported in other species, such as Caenorhabditis elegans. Life-course normative data have been described in a UK setting, and birth and ageing cohort studies, particularly those with long-term longitudinal data, provide ideal opportunities to explore this hypothesis. Furthermore, linkage of epidemiological fi ndings to new approaches in muscle biology could yield informative insights into the nature of human ageing.