Universal access vital to protect people from vulnerability: UN Report

While looking uniquely at causes of vulnerability and building resilience of people, this year’s Human Development Report (HDR) of the United Nations, released on Thursday, makes a strong case for universal access to essential services as opposed to the targeted approach advanced by a section of experts in India and elsewhere.

The point on “universalism” is important because many supporters of the erstwhile UPA government and the present Narendra Modi government want services to be targeted only to “those who need them”. They argue that Government support that helps people survive adverse conditions have to be converted into cash and given only to those pre-identified as the needy.

Universal access is exactly the opposite - services are universally available for everyone to access. Universal healthcare is an example.

The HDR says that “universalism should guide all aspects of national policies to ensure that all groups and sections of society have equality of opportunity.” It further says that universalism is a powerful way of directly addressing the uncertain nature of vulnerability of people.

If social policies have a universal aim, not only do they protect those who currently experience poverty, poor health or a bout of unemployment, but they also protect individuals and households who are doing well but may find themselves struggling if things go wrong in future. Further, they secure certain basic core capabilities of future generations.

In other words, universalism will protect people who are poor and deprived now, while taking care of those who might fall into poverty in future because of socio-economic shocks. For instance, during times of economic crisis, people might lose jobs in large numbers and may suddenly fall below the “poverty line”. A targeted system of entitlements will exclude them, while a universal model will include them.

“Everyone should have the right to education, health care and other basic services. Putting this principle of universalism into practice will require dedicated attention and resources, particularly for the poor and other vulnerable groups,” says the report.

A lower income country might start with basic education and health care and later expand to offer cash transfers or basic labour protection. A higher income country with already well established basic education, health care and conditional cash transfer programmes might expand eligibility for unemployment insurance to traditionally excluded populations such as agricultural or domestic workers, or expand family leave policies for new parents to include fathers, says the report. “Strong universal social protection not only improves individual resilience, it can also bolster the resilience of the economy as a whole.”

Does the market help?

According to the report, many global public goods have social value and can reduce vulnerability, but they are undervalued by markets.

International rules and norms often reflect private interests rather than providing public goods and prioritising social interests. Global public goods and universal social goods that would correct or complement markets for more inclusive and sustainable growth are mostly under-provided.

The HDR says how global agreements and pacts can help build a universal system. National initiatives for universal provision of services are more easily enacted when global commitments are in place and global support is available. Global agreements are essential because they can instigate action and commitment and generate financial and other support.

The report refers to healthcare expenses in India as an example, where paying for health care has become a major source of impoverishment for the poor and even the middle class. Ill health of the main wage earner can push households into poverty and keep them there. Recent data suggest that more than 40 percent of hospital patients either borrow money or sell assets and that close to 35 percent fall into poverty because of healthcare expenses.

This is one of the contexts where, the concept of human vulnerability to describe the prospects of eroding people’s capabilities and choices that the HDR introduces this year looks eminently appropriate. Looking at vulnerability through a human development lens, the report draws attention to the risk of future deterioration in individual, community and national circumstances and achievements, and put forward policies and other measures to prepare against threats.

People’s vulnerability and their ability to cope with it keep changing and the State needs to provide appropriate protection. Public provision of social services - which includes a minimum universal access to health care and education, and full employment and social protection - are essential elements of more sustainable and resilient human development.

India seriously needs to pay attention. Universal access is not populism as some hawks say, but is a holistic approach that is unavoidable if it’s serious of the welfare of its people.