On Universal Health Day, the Pan American Health Organization (PAHO) emphasized the urgent need for countries in the Americas to strengthen public investment and financial protection mechanisms to achieve universal health. Nearly one third of total health expenditure in the region comes directly from households, well above the recommended 20% threshold, placing millions at risk of impoverishment and financial hardship due to out-of-pocket health costs. PAHO Director Dr. Jarbas Barbosa warned that “no one should have to choose between their health and their basic needs,” highlighting the persistent financial strain on families.
The WHO and World Bank’s Tracking Universal Health Coverage: 2025 report shows that the Americas have seen one of the smallest reductions in health inequalities over the past decade. Globally, 2.1 billion people face financial difficulties accessing health care, including 1.6 billion pushed into poverty by direct health spending. In Latin America and the Caribbean, total health expenditure in 2023 averaged 6.6% of GDP, or roughly US$778 per person, with more than half coming from public funds. Despite this, direct household spending remains high, particularly on medicines and treatments, increasing the risk of unaffordable care for millions.
Public health investment in the region remains below the regional commitment of 6% of GDP, with expenditure dropping to 3.7% in 2023, returning to pre-pandemic levels. Economic constraints and fiscal pressures make it difficult for countries to sustain or expand health financing, placing a disproportionate burden on lower-income families. Dr. Barbosa stressed the need for resilient health systems rooted in strong primary health care, capable of integrating services and organizing care around people, families, and communities.
PAHO noted that fiscal priority for health varies across the region, influenced by both national income and policy choices. Some higher-income countries allocate a relatively low share of public spending to health, while others with fewer resources dedicate more to ensure access and continuity of services. PAHO calls on governments to increase health investment and strengthen primary health care, essential steps to reduce inequities and advance universal health. Universal Health Day, observed annually on December 12, underscores that access to health services should not create financial hardship, highlighting the urgent need to reform health financing systems to protect families across the Americas.
