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Commentary
Income security in times of ill health: the next frontier for the SDGs
  1. Knut Lönnroth1,
  2. Lou Tessier2,
  3. Gunnel Hensing3,
  4. Christina Behrendt2
  1. 1Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
  2. 2Social Protection Department, International Labour Organization, Geneve, Switzerland
  3. 3School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
  1. Correspondence to Professor Knut Lönnroth; knut.lonnroth{at}ki.se

https://doi.org/10.1136/bmjgh-2020-002493

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    Summary box

    • Universal health coverage (UHC) is at the forefront of the discussions on how to achieve the health-related Sustainable Development Goals (SDG).

    • A prominent part of the UHC agenda is to ensure that people are not impoverished due to high healthcare expenditures. While this is crucial, it is not sufficient to protect people from hardship in times of ill health, as illustrated in the ongoing Covid-19 pandemic where lack of income security creates barriers for people to adhere to infection control measures.

    • Social protection systems ensuring income security when unable to work due to sickness are as important as schemes designed to reduce out-of-pocket healthcare expenditure. Yet, this is not part of the UHC framework and not sufficiently visible in the SDG Target on social protection.

    • This contrasts sharply with the high prioritisation of income security in times of ill health when universal social protection systems were built in the last century in many of today’s high-income countries.

    Introduction

    Poor health can trap individuals, families and communities in a vicious disease-poverty cycle. While ensuring universal access to affordable healthcare in times of need is essential to break this cycle, income security in time of sickness or injury for all is equally important. Recent evidence indicates that people who cannot work or are not allowed to work due to illness face high indirect costs linked to income loss, which can be compounded by the opportunity cost of time spent seeking and staying in care. For example, the ongoing Covid-19 pandemic illustrates that lack of income security leads to economic hardship for individuals and creates barriers for adhering to infection control measures,1 2 and similar challenges have previously been well-documented concerning tuberculosis.3

    Both access to healthcare services and income security in case of illness are enshrined in the human rights to health …

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