This year’s Universal Health Coverage Day will be, like so many other things this year, unprecedented. While calls for health care coverage for all are reiterated every year on this day, the COVID-19 pandemic has made the case for universal coverage even stronger: across the globe, the lack of access to quality, affordable and comprehensive health care has meant that the effects of the virus have hit marginalised communities the most. Lockdowns and restrictions have conflated a public health crisis with an economic crisis, thus intensifying structural inequalities while bringing forth the ever-pressing need for universal health care.

AN INTERNATIONAL COMMITMENT

 The human right to health is enshrined not only in international treaties and conventions, but also in most democratic countries’ constitutions and laws. What the shorthand term “right to health” stands for in reality is the idea that “[t]he enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”, as articulated in the Constitution of the World Health Organization and in the International Covenant on Economic, Social and Cultural Rights. In practice, however, the full enjoyment of this right remains out of reach for millions across the globe, notably women, people with disabilities, indigenous peoples, migrants, LGBT persons and, as the pandemic has underscored, people in detention. 

 ACCESSING HEALTH CARE IN PRISONS

Currently, almost nine months into the pandemic, most of the population is aware of the basic recommendations to combat the spread of the virus, and to a greater or lesser extent, frequent hand hygiene, social distancing, and facemasks have become part of our daily lives. For the incarcerated population, however, these seemingly straightforward guidelines are not always accessible. 

 Prison overcrowding is one of the most critical issues for penitentiary systems around the world: in more than 124 countries surpassing their maximum occupancy rates. While in a regular context it would be a factor compromising the provision of basic food, accommodation, and healthcare services in prisons, in the pandemic context it makes social distancing measures mostly impracticable. The combination of overpopulation with the ensuing underfunding and unsanitary conditions in most prisons results in a scenario that is perfect for the spread of communicable diseases, with COVID being just one example –tuberculosis, HIV and hepatitis have been ravaging prison systems for decades. The most evident consequence of these unsafe conditions is that around the world 300,000 people in detention have contracted the virus, and almost 3,000 are estimated to have died from it.

 THE INTERSECTION BETWEEN INCARCERATION, INEQUALITY AND CARE

 COVID has exacerbated a reality that has been patent for long: people in detention often lack access to the same standards of care available to the general population. This, considering that people in detention often enter the penitentiary system with underlying health problems –often derived from situations of poverty, substance abuse, homelessness, and prevalence of chronic illnesses– makes for a dangerous blend of pre-existing factors and lack of adequate care. 

 Public perceptions of imprisonment and punishment often dehumanise people in detention, to the point that people in prison are not seen as part of the community writ large and thus undeserving of basic services, hence the underfunding and under-resourcing of penitentiary systems. Advocates for incarcerated populations have been raising the voice of alarm since the early days of the pandemic: prison systems had reached a breaking point, leading to outbreaks in the US (where the incarcerated population is five times more likely to contract the virus than the general population), Mexico, or Brazil and widespread deaths across the world. 

This year, Universal Health Coverage Day is a powerful reminder that investing in comprehensive systems of care for all is not only an obligation of the international community, but also the smartest solution moving forward. Crises like this one aggravate inequalities and hardship, but they can also be an opportunity for thoughtful leadership to foster collaboration towards this goal.

Actions around this year’s Universal Health Coverage Day and the call to #ProtectAll will culminate in a 24-hour virtual rally on 12 December. More information can be found on: https://universalhealthcoverageday.org/

Amalia Ordóñez Vahí was previously a Fulbright scholar at New York University, where she graduated with an MA in International Relations. She spent most of 2020 interning at the Open Society Foundations' Justice Initiative working on cases related to COVID-19, human rights, and detention. She has also interned in refugee representation at Human Rights First, and holds an MA in Conference Interpreting from the University of Manchester. She is currently a cultural diplomacy fellow in New York, while she pursues an MA in Human Rights.

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