C James Hospedales

In­ter­na­tion­al Uni­ver­sal Health Cov­er­age (UHC) Day 2025’s theme – “Un­af­ford­able health costs? We’re sick of it!” – high­lights mil­lions’ harsh re­al­i­ty: too many are pushed in­to pover­ty or debt while seek­ing the care nec­es­sary to live healthy, dig­ni­fied lives.

UHC means that the full spec­trum of health ser­vices—pro­mo­tive, pre­ven­tive, cu­ra­tive, and re­ha­bil­i­ta­tive is ac­ces­si­ble to all—with­out caus­ing fi­nan­cial hard­ship. UHC isn’t on­ly about hos­pi­tals or in­sur­ance. It’s about cre­at­ing a sys­tem that keeps peo­ple healthy, pro­tects from dis­ease, re­stores health, and sup­ports re­cov­ery.

Broad­er per­spec­tive on “un­af­ford­able costs”

UHC Day fo­cus­es on in­di­vid­u­al­ly borne costs, but a tru­ly just con­ver­sa­tion re­quires a broad­er view.

Be­fore pa­tients ar­rive, in­vis­i­ble, mount­ing costs cre­at­ed by cli­mate change dis­pro­por­tion­ate­ly fall on the poor, old­er adults, peo­ple with non­com­mu­ni­ca­ble dis­eases (NCDs), and those liv­ing in in­for­mal or haz­ard-prone com­mu­ni­ties, clear­ly seen across the Caribbean.

Ex­treme heat in­creas­es de­hy­dra­tion, kid­ney dis­ease, and heart fail­ure.

Drought re­duces wa­ter qual­i­ty, rais­ing gas­troen­teri­tis/oth­er in­fec­tion risks.

Stronger hur­ri­canes de­stroy homes, health fa­cil­i­ties, crops, and roads.

In­tense rain­fall and flood­ing spread vec­tor-borne and wa­ter-borne dis­eases.

Ris­ing food prices, as is hap­pen­ing in Ja­maica post-Hur­ri­cane Melis­sa, threat­en nu­tri­tion and in­crease chron­ic dis­ease risks.

These events cre­ate a vi­cious cy­cle: cli­mate shocks wors­en health, which wors­ens pover­ty, which wors­ens cli­mate change vul­ner­a­bil­i­ty.

The truth is un­avoid­able: UHC can­not ex­ist with­out cli­mate re­silience.

For­tu­nate­ly, many cli­mate ac­tions al­so strength­en health sys­tems.

Cli­mate-re­silient health sys­tems

De­sign­ing fa­cil­i­ties, sup­ply chains, and emer­gency pro­to­cols to with­stand storms, heat, and pow­er out­ages, keeps health sys­tems op­er­at­ing when they’re need­ed most. Ja­maica, Do­mini­ca and Grena­da have shown that cli­mate-smart health fa­cil­i­ties—en­er­gy-ef­fi­cient, so­lar-pow­ered, flood-safe—re­duce op­er­at­ing costs and re­main func­tion­al dur­ing dis­as­ters.

This is UHC in prac­tice: care that is avail­able, ac­ces­si­ble, and un­in­ter­rupt­ed.

Ear­ly-warn­ing sys­tems

Weath­er and cli­mate ear­ly-warn­ing sys­tems can help com­mu­ni­ties pre­pare for dis­ease out­breaks, ex­treme heat events, or flood­ing. With time­ly alerts, com­mu­ni­ties can act ear­ly, re­duc­ing hos­pi­tal ad­mis­sions, deaths, and costs.

As tem­per­a­tures rise, pre­serv­ing med­i­cines be­comes more dif­fi­cult and ex­pen­sive. More re­silient, low-en­er­gy, so­lar-pow­ered re­frig­er­a­tion pro­tects life-sav­ing vac­cines and es­sen­tial med­i­cines dur­ing storms or pow­er out­ages.

Fi­nanc­ing UHC in a chang­ing cli­mate

UHC re­quires pre­dictable, sus­tain­able fi­nanc­ing. But tra­di­tion­al do­mes­tic fund­ing sources—tax­es, in­sur­ance con­tri­bu­tions—are al­ready stretched. Cli­mate change of­fers both chal­lenges and new fund­ing op­por­tu­ni­ties, for ex­am­ple, health-sec­tor in­clu­sion in re­duc­ing na­tion­al emis­sions to meet cli­mate goals (Na­tion­al­ly De­ter­mined Con­tri­bu­tions (ND­Cs).

Most Caribbean ND­Cs still un­der-rep­re­sent health. By ex­plic­it­ly in­clud­ing health-sec­tor pri­or­i­ties—re­silient fa­cil­i­ties, cli­mate ear­ly warn­ing sys­tems, vec­tor con­trol, men­tal health sup­port and train­ing—the health sec­tor can ac­cess cli­mate fi­nance from the Green Cli­mate Fund, the Adap­ta­tion Fund, and mul­ti­lat­er­al de­vel­op­ment banks.

Coun­tries like Bar­ba­dos and Fi­ji are al­ready do­ing this, while T&T, Ja­maica, St. Lu­cia, etc. can ex­pand health in­clu­sion in up­com­ing NDC re­vi­sions.

Ad­di­tion­al­ly, the health sec­tor, one of the most af­fect­ed dur­ing cli­mate dis­as­ters, can and should sub­mit Loss and Dam­age Fi­nanc­ing pro­pos­als for:

Retro­fitting and re­build­ing dam­aged health fa­cil­i­ties to cli­mate-SMART stan­dards

Re­plac­ing de­stroyed med­ical equip­ment

Ex­pand­ing post-dis­as­ter men­tal health ser­vices

Sup­port­ing dis­placed or in­jured pop­u­la­tions

These le­git­i­mate loss-and-dam­age needs di­rect­ly sup­port UHC.

In­sur­ance for pre­ven­tion, not just treat­ment

Health sys­tems typ­i­cal­ly wait for pa­tients to need ex­pen­sive treat­ment in­stead of pay­ing for pre­ven­tion.  

So­cial se­cu­ri­ty sys­tems and health in­sur­ers should:

In­crease cov­er­age for screen­ing, coun­selling, nu­tri­tion, and phys­i­cal ac­tiv­i­ty pro­grammes

Re­ward clin­ics pre­vent­ing heart at­tacks and strokes

Sup­port dig­i­tal self-care tools for di­a­betes and hy­per­ten­sion

Ex­pand home-based care and re­ha­bil­i­ta­tion

Of­fer in­cen­tives for cli­mate-smart homes (cool roofs, ven­ti­la­tion) that re­duce heat-re­lat­ed ill­ness­es

Pre­ven­tive care, the cor­ner­stone of UHC, is in­ex­pen­sive; heart at­tacks, dial­y­sis, am­pu­ta­tions, and strokes are ex­pen­sive.

Peo­ple must be part­ners, not pas­sive re­cip­i­ents.

Com­mu­ni­ties re­spond first in dis­as­ters and in chron­ic dis­ease care. To move to­wards re­al UHC, gov­ern­ments must:

Cre­ate com­mu­ni­ty clin­ics and hubs in­te­grat­ing cli­mate pre­pared­ness, nu­tri­tion sup­port, NCD screen­ing, and men­tal health

Train com­mu­ni­ty health work­ers in ear­ly de­tec­tion of cli­mate-sen­si­tive dis­eases

Fund civ­il so­ci­ety or­gan­i­sa­tions work­ing on health, en­vi­ron­ment, and so­cial jus­tice

Fos­ter co-cre­ation, poli­cies de­signed with com­mu­ni­ties.

Tru­ly uni­ver­sal health sys­tems re­quire:

Stronger reg­u­la­tion of un­healthy prod­ucts with clear health warn­ing la­bels

Tax­es on to­bac­co, al­co­hol, sug­ary drinks to fund pre­ven­tion

Pub­lic health pol­i­cy­mak­ing pro­tec­tion from cor­po­rate in­ter­fer­ence

Pro­mo­tion of lo­cal, cli­mate-re­silient food sys­tems

Cli­mate change and NCDs are both root­ed in an eco­nom­ic mod­el that favours prof­it over peo­ple.

Con­clu­sion

Uni­ver­sal Health Cov­er­age isn’t sim­ply a tech­ni­cal goal;it’s a moral com­mit­ment root­ed in jus­tice, dig­ni­ty, and com­pas­sion. But in to­day’s world, UHC will on­ly be achiev­able if our health sys­tems are cli­mate-re­silient, com­mu­ni­ty-cen­tred, and pro­tect­ed from com­mer­cial harms.

On UHC Day 2025, re­mem­ber: cli­mate ac­tion is health ac­tion, and health ac­tion strength­ens

The fore­go­ing was a week­ly col­umn by Earth­Medic and Earth­Nurse NGO to help read­ers un­der­stand and ad­dress the cli­mate and health cri­sis.