Income security in times of ill health: The next frontier for the SDGs

Abstract

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 and social security and in international standards on social protection.4 5 Income security acts on both the social determinants and the adverse consequences of ill health. The provision of sickness benefits is the primary responsibility of the State, usually implemented by social protection institutions under the joint stewardship of the health, social and labour sectors. Yet, while access to healthcare services is at the forefront of the 2030 Agenda through a dedicated Target on Universal Health Coverage (UHC), income security in case of ill health has limited visibility within the Sustainable Development Goals (SDGs) and is underresearched, especially in low-income and middle-income countries (LMICs).