Tax reforms can bridge public financing shortfall: UNAIDS

Gaps in public financing can be met by implementing progressive taxation


Health should not be a privilege for the rich and gaps in public financing for health can be met by eliminating tax dodging and implementing progressive taxation, the UNAIDS said on Tuesday.

"The right to health is eluding the poor and people trying to lift themselves out of poverty are being crushed by the unacceptably high costs of health care.

"The richest 1 per cent benefit from cutting-edge science while the poor struggle to get even basic health care," said UNAIDS Executive Director Winnie Byanyima, who is here to attend the World Economic Forum (WEF) annual summit.

UNAIDS called on governments to ensure that the right to health is realized by all by prioritising public investments in health.

At least half of the world's population cannot access essential health services, it said.

"Every two minutes a woman dies while giving birth. Among the people being left behind are women, adolescents, people living with HIV, gay men and other men who have sex with men, sex workers, people who inject drugs, transgender people, migrants, refugees and poor people," the agency said.

Nearly 100 million people are pushed into extreme poverty (defined as living on USD 1.90 or less a day) because they have to pay for health care, and more than 930 million people (around 12 per cent of the world's population) spend at least 10 per cent of their household budgets on health care.

In many countries, people are denied health care or receive poor quality health care because of unaffordable user fees.

Stigma and discrimination denies poor and vulnerable people, especially women, their right to health. Every week, 6,000 young women around the world become infected with HIV.

"Publicly financed health care is the greatest equalizer in society," said Byanyima. "When health spending is cut or inadequate, it is poor people and people on the margins of society, especially women and girls, who lose their right to health first, and they have to bear the burden of caring for their families."

Delivering health care for all is a political choice that too many governments are not making.

Countries such as Canada, France, Kazakhstan and Portugal have strong publicly financed health systems, yet some other richer countries do not, the UNAIDS said.

Health investments in many countries remain very low compared to their gross domestic product. The United Nations Conference on Trade and Development estimates that developing countries lose between USD 150 billion and USD 500 billion every year owing to corporate tax avoidance and profit shifting by big companies.

If this lost money were invested in health, health expenditure could triple in low-income countries and could double in lower-middle-income countries, it added.

"The race to the bottom on corporate tax cheats denies developing countries of much needed revenue and robs ordinary people of vital health services," UNAIDS said in a statement.

"It is unacceptable that rich people and big companies are avoiding taxes and ordinary people are paying through their ill health," said Byanyima.

"Big companies must pay their fair share of taxes, protect employee rights, provide equal pay for equal work and provide safe working conditions for all, especially women."

According to the International Monetary Fund (IMF), as of April 2019 half of low-income countries in Africa were either in debt distress or at a high risk of being so.

According to the World Bank, more than one billion women lack legal protection against domestic violence and close to 1.4 billion women lack legal protection against domestic economic violence.

In at least 65 countries, a same-sex sexual relationship is a crime. In recent years in some countries, crackdowns and restrictions on lesbian, gay, bisexual, transgender and intersex people have increased.

Reeling out data, the agency further said sex work is a criminal offence in 98 countries. Forty-eight countries and territories still maintain some form of HIV-related restrictions on entry, stay and residence.

A recent study of sex work policies in 27 countries concluded that those that decriminalized some aspects of sex work have signi?cantly lower HIV prevalence among sex workers.

In 91 countries, adolescents require the consent of their parents to take an HIV test and in 77 countries they require the consent of their parents to access sexual and reproductive health services, creating barriers to protect young people from HIV infection.

One of the consequences of this is that the HIV incidence rate among young women and girls in eastern and southern Africa is twice that of their male peers.

"In the next decade, we can end AIDS as a public health threat and achieve universal health coverage. Governments must tax fairly, provide publicly funded quality health care, guarantee human rights and achieve gender equality for all - it is possible," Byanyima said.

UNAIDS is participating in several events at the 2020 World Economic Forum Annual Meeting in Davos, Switzerland, to highlight the need for governments to fulfil their commitments to realize universal health coverage and ensure that no one is left behind.