INTEGRATING RESPONSES TO INEQUALITIES AND DISEASE BURDENS 8.2
care without hardship. It ensures a level of income that allows people to live a healthy life in dignity. Yet four billion people still lack any kind of social protection. When health emergencies occur, many people – often the poorest of the poor – risk falling further into poverty because of unanticipated health spending. Even essential everyday health expenses can push families and vulnerable populations over the edge financially, particularly in rural areas. High health costs, combined with inadequate income security often lead them to forgo vital health care, reinforcing a vicious cycle of poverty and ill health. In his 2021 report, Our Common Agenda, United Nations secretary-general António Guterres committed the UN system to promote and sustain universal social protection floors, including universal health coverage. The objectives, functions and principles of social protection systems are grounded in a series of ILO international labour standards. The ILO is also proud to lead work on social protection through the Global Accelerator on Jobs and Social Protection for Just Transitions, launched in September 2021 by the secretary-general. Every year, around 2.9 million workers die due to occupational accidents and diseases, and at least 402 million people suffer from
non-fatal occupational injuries. Estimates by the ILO and the World Health Organization indicate that work-related diseases are responsible for 81% of all work-related deaths. Occupational safety and health policies developed through social dialogue and backed by well-resourced labour institutions are essential for the protection of life and health at work. An important step forward was the decision by the International Labour Conference in 2022 to include a safe and healthy working environment in the ILO’s framework of fundamental principles and rights at work. Health services cannot be delivered without enough adequately trained, supported and protected health and care workers. Yet there is an unequal distribution of health workers globally and within countries. In low-income countries, health workforce shortages are as high as 84%, while the shortage in upper-middle-income countries is around 23%. In some Asian and African countries, almost 90% of the population does not have access to health care. Labour force survey data from 56 countries has shown that the majority of health and social care workers live in urban areas, and almost half of the world’s population lives in rural areas. Many countries face severe challenges in the recruitment, deployment and retention of health and care workers. Dissatisfaction with working conditions due to low wages, insufficient resourcing, work overload, long hours, unsafe working environments, exposure to violence and harassment, stress, burn-out, limited access to social protection and weak career prospects have led to high turnover and attrition rates of health workers in many countries. The health sector has been significantly disrupted by the Covid-19 pandemic. This has demonstrated the need for increased sustainable investments in health systems, including in decent working conditions for health and care workers. A VITAL CONTRIBUTION In 2016, the UN High-Level Commission on Health Employment and Economic Growth recognised the vital contribution of the health sector to economies, investments and job creation, especially for youth and women. The ILO, WHO and the Organisation for Economic Co-operation and Development are working together on the Working for Health programme and its Multi-Partner Trust Fund, to provide assistance to countries, social partners and key stakeholders, so they can develop strategies to scale up health workforce investments based on improved health labour market data, multi-stakeholder involvement and social dialogue. Policymakers need to make health a political priority by taking a social justice approach to investments in health and care. This includes investments in social protection, occupational safety and health, and decent work for health and care workers. They need to promote policies that ensure access to affordable and high-quality care for all. It is not only for the ILO to advocate such policies and to take action within the scope of its own mandate – it is a shared responsibility across the UN system and its constituents. For this reason, the ILO is developing a Global Coalition for Social Justice, which will bring together a wide range of multilateral bodies and stakeholders to position social justice as a global policy imperative, through strengthened cooperation and policy coherence. I firmly believe that such a coalition can enable the international system to better help countries tackle policy areas where social justice is lacking, so we can make good health and well-being a reality for all. ▪
GILBERT F HOUNGBO Gilbert F Houngbo started his term as director-general of the International Labour Organization on 1 October 2022. He was president of the International Fund for Agricultural Development from 2017 to 2022. He previously served as deputy director- general of the ILO where he led field operations in more than 100 countries. From 2008 to 2012, he was prime minister of the Republic of Togo. He has also held numerous leadership positions at the United Nations Development Programme. X-TWITTER @GHoungbo ilo.org
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Health: A Political Choice – From Fragmentation to Integration
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