**2. Universal health coverage**

The fundamental principle of UHC can be found in the 1948 United Nations Universal Declaration of Human Rights constitution; it states that, "Everyone has a right to a standard of living adequate for the health and well-being of himself and of his family, including food,

<sup>1</sup> Universal Health Coverage can be used synonymously with Universal Health Care—in this manuscript, UHC can in turn be used to reference either phrase.

clothing, household and medical care and necessary social services" [5]. Following this precedent, the Alma-Ata Declaration developed its "Health for All" agenda in 1978, declaring equity to be of utmost importance [5]. In order to make this system feasible, a number of components must be present.

**Keywords:** universal health care, universal health coverage, UHC, multipronged approach, multisectoral approach, environmental health, noncommunicable disease, NCD, chronic disease, communicable disease, morbidity, mortality, global disease burden, Millennium Development Goals (MDGs), Sustainable Development Goals

According to the World Health Organization (WHO), it is estimated that over 100 million people are forced into poverty every year due to out-of-pocket health care expenditures [1]. Although there are numerous factors, including but not limited to social status, environmental agents and cultural aspects, which may contribute to an individual's susceptibility to this

ish this number. By working toward this type of system to ensure good health, economic growth will also follow, benefitting communities holistically rather than unilaterally [2].

The objective of universal health coverage is to ensure that "all people can use health services without financial hardship" [1]. In order for this to be attained successfully, governmental health financing systems must be put into place and encourage collaboration among different governmental levels and agencies. Implementing a UHC system would lessen the gap between rich and poor communities by ensuring health equity, unlike the free market system. The ultimate purpose of UHC, therefore, would be to lower both the disease and financial burden at the community level by providing adequate preventive and clinical health care services to all. In terms of prevention, environmental health (EH) factors should be addressed within the service-oriented nature of UHC, due to their high attribution to disease [3]. Through counseling and behavioral change models, environmental health factors such as exposures to contaminated air and water can be prevented. Educating communities on these environmental exposures through UHC infrastructure is paramount in successfully addressing these issues and bettering community health. Furthermore, environmental epidemiology is a useful tool in providing evidence-based science to illustrate these successes; Water, Sanitation and Hygiene (WASH) programs via clinics have provided health education counseling on this practice,

The fundamental principle of UHC can be found in the 1948 United Nations Universal Declaration of Human Rights constitution; it states that, "Everyone has a right to a standard of living adequate for the health and well-being of himself and of his family, including food,

Universal Health Coverage can be used synonymously with Universal Health Care—in this manuscript, UHC can in

would undoubtedly help to dimin-

(SDGs), Bangladesh

statistic, implementing universal health coverage (UHC)<sup>1</sup>

therefore exponentially decreased infectious and enteric diseases [4].

**2. Universal health coverage**

turn be used to reference either phrase.

1

**1. Introduction**

130 Advances in Health Management

Firstly, the system must be robust and well developed in order to run efficiently and meet all of the priority health needs of its community members. It also must be focused on peoplecentered, integrated care with foci in both preventive medicine and clinical evaluation and treatment. Primary services should be focused on both communicable and noncommunicable diseases (NCDs), along with maternal and child health. This can be accomplished by: engaging community members through trusting relationships, screening/early detection methods, ensuring capacity to treat diagnosed diseases and providing therapeutic and/or rehabilitative services. The system must also be affordable so that financial hardships are alleviated and equity is achieved; different funding mechanisms to accomplish this are abundant and can be personalized per country. Consequently, a system cannot clearly be implemented without the accessibility to treatments; therefore, there must be access to crucial medicines and other technologies necessary to diagnose and/or treat conditions. Lastly, a sufficient team of trained and passionate healthcare workers, including but not limited to physicians, nurses, community health care workers and health educators (this team may vary depending on patients' needs), grounded in the best available evidence [5].

The UHC system also requires strategic interventions to address the most paramount causes of disease and mortality. As aforementioned, a wide array of quality health services should be covered involving health promotion, preventive care, clinical treatment, rehabilitation services and palliative care. In order to decide which area takes priority, epidemiological data and context are leveraged along with health systems, socioeconomic development and individuals' expectations [6].

Data have shown that over 83% of major diseases reported by WHO are environmentally mediated [3]. Considering this high attribution, environmental health has become a topic of utmost concern in addressing disease morbidity and mortality. In terms of UHC, preventive care and health promotion have become important foci to address these environmental health disease etiologies (see Appendix A for additional explanatory **Figures 6** and **7**). To better understand the role of environmental health and how to successfully address this disease burden, socioeconomic and racial factors contributing to health disparities much be investigated. Health literacy and access to clean air and water via an individual's built (surrounding) environment are major sources of exposure that have led to high morbidities in developing countries. The main objective in investigating environmental health is to decide which aspects to focus on in UHC, how to successfully communicate these practices and change detrimental behaviors and, lastly, to make the solutions sustainable.

The objective of this paper is to provide the analytical framework for health care systems to integrate environmental health into universal health care. As aforementioned, environmental health accounts for the vast majority of major disease etiologies, therefore, justifying the rationale for making it an imperative part of UHC. The current problem exists in the fact that UHC does not address environmental health; this will later be illustrated within the case study on UHC in Bangladesh. This paper will also provide the framework on how to incorporate environmental health into UHC using both the two-pronged approach and the multipronged/ multisectoral approach as feasible solutions.
