Chloé Maurel

With the creation of the International Labour Organization (ILO), and then the United Nations, “social security became a fundamental human right and was codified as such in international treaties” such as the 1966 UN Covenant on Economic and Social Rights, as recalled by CETIM (Centre Europe-Tiers Monde, or the European Centre for the Third World), a research centre focusing on the roots of maldevelopment in the Global South. Yet, as CETIM observes, “80 per cent of the world’s population is totally or partially excluded from social security. Worse still, the implementation of neoliberal policies around the world over the last three decades has led to the dismantling, or at least the weakening, of social security in countries where it had been successfully institutionalised and universalised after the Second World War.”

What is the situation today and what are the trends for the future?

A new ILO report offers some answers. Under the title Universal social protection for climate action and a just transition, it brings together two crucial issues: climate change and social protection. The authors note that while more than half the world’s population is now covered by some form of social protection, 3.8 billion people, mainly in countries of the Global South, still have no coverage at all. Yet this is imperative, because it is one of the human rights recognised by the UN. The right to health and social protection is an economic and social right.

Environmental damage: a driver of social inequalities

The report identifies climate change, pollution and biodiversity loss as serious threats to the future of the world’s most vulnerable populations. It calls for an urgent response, “moving rapidly towards a just transition”, and more specifically by enabling the emergence of “universal social protection”. Poor countries – and their inhabitants – are less well equipped than rich countries to cope with extreme weather events and epidemics.

In privileged regions, such as Europe, social and environmental inequalities also reinforce one another, and the poorest people are often the hardest hit by environmental disasters or fuel poverty. They are more exposed to pollutants and environmental health problems. Mathilde Viennot, a specialist in inequality and social protection, points out that climate events such as floods, hurricanes, heat waves and droughts “have caused 142,000 additional deaths and cost Europe €510 billion over the last 40 years, according to the European Environment Agency. These figures continue to rise, putting pressure on protection models and healthcare systems”.

As part of the monitoring of the 2030 Agenda for Sustainable Development, the ILO report highlights the progress made in extending social protection around the world. Based on its findings, it calls on political leaders and social partners to step up their efforts, noting that effective social protection helps people become more resilient in the face of climate change.

The report notes that, for the first time, more than half of the world’s population (52.4 per cent) is now covered by at least one social protection benefit, compared with 42.8 per cent in 2015.

Regrettably, this means that if progress continues at the same pace globally, it will take another 49 years – until 2073 – for everyone to be covered by at least one social protection benefit.

The report therefore points to a “daunting prospect”: the countries most vulnerable to the climate crisis are extremely ill-prepared, with only 8.7 per cent of the population in the 20 countries most vulnerable to climate change covered by some form of social protection. In total, 364 million people have no protection at all.

Around 75 per cent of people in the 50 countries most vulnerable to climate change have no social protection coverage. This means that “2.1 billion people [are] currently facing the ravages of climate breakdown with no protection, relying on their own knowledge and their relatives to cope”.

The report underlines that today, among the 164 countries studied, 83.6 per cent of their populations have the right to access health services free of charge or almost free of charge. However, this proportion is below two thirds in low-income countries.

Out-of-pocket healthcare expenditure remains a major social justice issue. According to the report, it pushed 1.3 billion people into poverty in 2019. Universal health coverage (UHC) is therefore one of the responses proposed to address this problem. UHC is aligned with the objective of a social protection floor (SPF), promoted by the ILO in collaboration with the WHO since 2010, and which “creates a solid foundation for economic growth, provides societal insurance against persistent poverty and mitigates the consequences of economic shocks and crises”.

Countries of the South leading the push for UHC

Within the United Nations, there are forces pushing in a progressive direction in favour of UHC, an idea that has gained ground over the past fifteen years, particularly under pressure from countries of the South. In December 2012, the UN General Assembly resolution on global health and foreign policy, adopted by a very large majority, recognised the importance of UHC.

The resolution defines UHC as access for all to basic health services and affordable, quality medicines. It represents a major step forward, in which the WHO has played an important role, having stated in 2008 that out-of-pocket payments by patients or their families at the point of service were “the most inequitable method for financing healthcare services”. The WHO, which supports the introduction of UHC, has called for a major redistributive effort from rich countries towards poorer ones.

In her address to the 65th World Health Assembly in May 2012, Margaret Chan (then Director-General of the WHO) stated that “universal health coverage is the single most powerful concept that public health has to offer”.

Several governments have already started moving in this direction. China, Thailand, South Africa and Mexico are among the first emerging powers to have significantly increased their public health spending. Many countries of the South, such as Indonesia, India, Vietnam, Mali, Sierra Leone, Zambia, Rwanda, Ghana and Turkey, have included it in their national priorities and/or established systems providing free access to healthcare for part of the population – the first steps towards creating UHC.

Ecuador, in its new Constitution of 2008, affirmed the right to health and to free public health services, as highlighted by the Ecuadorian minister at the time, Carina Vance. Senegal, for its part, adopted UHC in 2013. Then, in 2015, UHC was included in the UN Sustainable Development Goals (SDG 3.8).

Complex implementation

Some governments, however, consider that its definition remains imprecise and its measurement uncertain. Implementation is left to the sovereignty of states (advised and supported by international organisations, but also NGOs, foundations, private companies, etc.), according to national priorities and contexts. Yet in many countries, healthcare is also a “market”, where many actors operate, with a vision divided between the public good and profit-driven interests.

As Nathalie Janne d’Othée points out in a 2016 report on social debt published by CADTM (Committee for the Abolition of Illegitimate Debt), it should also be remembered that many countries were forced to “cut public spending and liberalise public services” under pressure from the World Bank and the IMF, “through structural adjustment programmes imposed on developing countries struggling with the debt crisis in the 1980s and 1990s”.

“Barely a decade later, experts were already recognising the flaws of this model […]. Yet, despite the obvious failure of free trade and austerity, the same formula is still being promoted to address the economic crisis in Europe. The austerity plans imposed on Greece, for example, have had a direct impact on access to healthcare and therefore on the health of the Greek population,” wrote the researcher.

For all these reasons, the UN-backed UHC2030 initiative was launched. It provides “a platform where the private sector, civil society, international organisations, academia and governmental organisations can collaborate to accelerate equitable and sustainable progress towards UHC and to strengthen health systems at global and national levels”, alongside a global awareness day held every year on 12 December.

In conclusion, it is up to progressive forces to ensure that the concepts of the right to social protection and universal health coverage are shaped by the principles of social justice. The ILO’s 2024-2026 report on social protection, by adding the urgency of climate change, contributes to this objective.

First published: https://www.equaltimes.org/