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Universal health coverage (UHC) rests on a simple yet powerful idea: everyone should be able to access the healthcare they need without falling into financial hardship. For the close to 600 million people worldwide living with diabetes, and the millions at risk of developing the condition, this principle is not abstract. It is a matter of daily survival.
Diabetes care is not a one-off diagnosis or a single prescription. Treatment involves regular access to insulin, blood glucose monitoring, education, and the care of trained healthcare professionals, along with regular follow-up to prevent or delay diabetes-related complications. When any one of these elements is missing, the consequences can be swift and devastating.
As Emma Klatman, global policy and advocacy manager at Life for a Child, puts it: “Type 1 diabetes is survivable everywhere, but not everywhere is survival guaranteed.” In too many countries, children and young people never get the chance to “get started in life” because the systems designed to support them simply are not there.
For the close to 600 million people worldwide living with diabetes, and the millions at risk of developing the condition, this principle is not abstract. It is a matter of daily survival
In addition to early diagnosis and prevention, the global debate around diabetes has also focused on insulin affordability, and rightly so. But Klatman argues that this focus often obscures a deeper problem. “Insulin without monitoring is unsafe,” she says.
In low- and middle-income countries (LMICs), blood glucose test strips, HbA1c testing, education and workforce support are all essential, yet they are frequently unavailable or unaffordable. Families may have access to insulin but no way to measure blood glucose safely. Without test strips, using insulin becomes a matter of guesswork. According to Klatman, that this is not a technical failure but a systemic one.
Universal health coverage, when implemented effectively, addresses this gap by embedding diabetes care into health systems rather than treating it as an individual burden. Thailand offers a striking example. Since introducing UHC in 2002, the country has ensured that people living with diabetes can access regular check-ups, essential medicines and monitoring tools. For Khun Ni, a 26-year-old with type 1 diabetes, this has meant managing her condition while caring for her newborn daughter. For Sip, a schoolboy, it has meant coordinated care between his family and school, ensuring timely responses to episodes of low blood glucose.
Yet access alone is not enough. What health systems choose to cover, and who they include, matters just as much. Klatman points to a troubling lack of transparency: in many countries, it is simply unclear what components of diabetes care are included in national health benefit packages.
“We don’t even know what’s being provided in most LMICs,” she says. While global tools such as the Diabetes Atlas count cases and deaths, they often fail to capture whether people are receiving human insulin or analogue insulin, whether diagnostics are included, or how much people with diabetes must pay out of pocket.
The absence of data brings consequences. Long-acting analogue insulins, which are considered routine in high-income countries, can sometimes be dismissed as a “luxury” elsewhere. Klatman challenges that framing. Analogue insulins have existed for more than two decades; what makes them inaccessible is not clinical uncertainty, but policy decisions. “Why should a young person in Zimbabwe be denied what is routinely provided in Sydney?” she asks.
Life for a Child has worked to close this information gap by building a global equity repository that compares health system provision of diabetes care. The goal is to make coverage gaps visible, and therefore harder to ignore.
The absence of data brings consequences. Long-acting analogue insulins, which are considered routine in high-income countries, can sometimes be dismissed as a “luxury” elsewhere
As of 2021, about 4.5 billion people, more than half of the world’s population, were not fully covered for essential health services. If access and coverage define whether care exists, financial protection determines whether people can actually use it. Here, the failures of non-universal systems become clearly apparent.
In Germany, public insurance caps out-of-pocket costs for chronic conditions at 1% of household income. Katie West, an American living with type 1 diabetes, was paying roughly $11 every three months for insulin, compared with 70 USD per month in the US, even with good insurance. That financial security was life-changing.
The absence of such protection can be fatal. In the US, 26-year-old Alec Raeshawn Smith died after rationing insulin he could no longer afford once he aged out of his mother’s insurance plan. His monthly costs exceeded 1,300 USD. He is far from alone: one in six insulin users in the US report rationing due to cost.
Klatman argues that test strips are an even greater, if less visible, financial threat. In many countries, even two test strips a day can consume a family’s entire income. “Test strips often cost more than insulin,” she says, “yet they are almost never provided by governments.”
UHC shifts this burden away from individuals and towards collective systems. Where early diagnosis, routine monitoring and follow-up are embedded into public care, people are less likely to experience catastrophic health spending and more likely to stay alive.
Critics of expanding diabetes benefits under UHC often cite cost. Klatman acknowledges that long-acting analogue insulins do cost more upfront. But she warns against short-term thinking. Evidence from programmes supported by Life for a Child shows that improved treatment leads to better glycaemic control, fewer complications and fewer hospitalisations.
“The real question isn’t whether we can afford better care,” she says. “It’s whether we can afford the inequity if we don’t provide it.”
Countries such as Rwanda and Costa Rica have demonstrated that even with limited resources, integrated and equitable care is possible when political commitment is strong. Others, including Kenya and Chile, show both the promise of UHC and the risks of underinvestment, particularly for non-communicable diseases.
As of 2021, about 4.5 billion people, more than half of the world's population, were not fully covered for essential health services. If access and coverage define whether care exists, financial protection determines whether people can actually use it.
In humanitarian settings, the stakes are even higher. In the past decade, Syrian families living with diabetes in refugee settlements in Lebanon often faced irregular insulin supplies and could not afford test strips. Clinicians reported children arriving with dangerously high glucose levels because care is fragmented and funding is uncertain.
UHC is not a panacea. But as Life for a Child’s work and global evidence show, it is one of the most powerful tools available to turn diabetes from a death sentence into a manageable condition. As the world moves towards the 2030 deadline for achieving UHC, the message is clear: diabetes must be fully integrated into national health plans. UHC is not just a financing mechanism. It is a statement of values—a decision to build systems that allow people not just to survive, but to thrive.
