The Lancet
Jul 18, 2015 Volume 386 Number 9990 p219-310 e1
http://www.thelancet.com/journals/lancet/issue/current
Comment
Measuring the SDGs: a two-track solution
Austen Davis, Zoe Matthews, Sylvia Szabo, Helga Fogstad
DOI: http://dx.doi.org/10.1016/S0140-6736(15)61081-9
Summary
The Millennium Development Goals (MDGs) expire in 2015 and substantial effort is being put into the negotiation of a new set of Sustainable Development Goals (SDGs). The SDG agenda is broader and goes further than that of the MDGs, and critics claim that it is unmeasurable and unmanageable. On the positive side, the consultation process has been far more inclusive and credible than for the MDGs. The resultant Open Working Group (OWG) proposal provides a global agenda for action that is relevant to all nations.

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Comment
Universal health coverage: progressive taxes are key
Robert Yates
Published Online: 14 May 2015
Open Access
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60868-6

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Articles
Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries
Dr Aaron Reeves, PhD, Yannis Gourtsoyannis, MD, Sanjay Basu, PhD, David McCoy, DrPH, Prof Martin McKee, MD, Prof David Stuckler, PhD
Published Online: 14 May 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60574-8
Open access funded by Wellcome Trust
Summary
Background
How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage.
Methods
We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011.
Findings
Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9·86 (95% CI 3·92–15·8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16·7, 9·16 to 24·3), but not for consumption taxes on goods and services (−$4·37, −12·9 to 4·11). In countries with low tax revenues (<$1000 per capita per year), an additional $100 tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6·74 percentage points (95% CI 0·87–12·6) and the extent of financial coverage by 11·4 percentage points (5·51–17·2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive.
Interpretation
Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax policies within a pro-poor framework might accelerate progress toward achieving major international health goals.
Funding
Commission of the European Communities (FP7–DEMETRIQ), the European Union’s HRES grants, and the Wellcome Trust.