It is a great honour to address a ministerial meeting on universal health coverage in Singapore, a city-state with an inclusive health system known for its affordable excellence. Last year, Bloomberg’s second annual ranking of countries with the most efficient health care placed Singapore at the top.

WHO also places Singapore at the top for key health indicators, especially maternal and infant mortality, two of the most sensitive indicators of a well-functioning health system. Through foresighted and visionary planning, Singapore achieved first-rate health care, with outstanding health outcomes, at a cost lower than in any other high-income country in the world.

This achievement was firmly anchored in a value system that places a premium on fairness and inclusiveness as a route to social cohesion, stability, and harmony.

Research guided individual strategies, but so did the wishes of the public, with opinion polls undertaken and conversations started to ensure that changes in the health system won public support and approval.

As we have just heard, Singapore’s version of universal health coverage balances the advantages of competitiveness and other market forces with the need for state intervention to steer these forces in the right direction. It balances freedom to choose providers, services, and facilities with an obligatory health savings account, the MediSave plan, with its emphasis on individual responsibility.

There is no free lunch. The plan works to protect against the over-consumption of care. To help inform responsible decisions, the Ministry of Health publishes hospital bills for common illnesses on its website.

Another innovation, MediShield Life, embodies the principle of collective responsibility through risk pooling. This is the safety net. It protects households from falling into financial ruin when medical bills are especially high. Studies conducted by WHO show that catastrophic medical bills force 100 to 150 million people below the poverty line every year. While many governments are working hard to lift people out of poverty, these efforts can be offset when the health system and its financing actually contribute to poverty.

As Singapore’s Minister of Health observed earlier this year, the scheme tells people that they “need not face life’s uncertainties alone, especially those who meet unexpected shocks in their life journeys.”

Of course, not all of these innovations can be applied elsewhere. UHC is intrinsically country-owned. To work well, it must be home grown in line with each country’s culture, domestic political institutions, the legacy of the existing health system, and the expectations of citizens.

In achieving UHC, Singapore had some distinct advantages. The huge challenge of extending health services to reach remote and impoverished rural areas was non-existent. Singapore has only one rural area, a small island and tourist attraction.

A tradition of cross-ministry collaboration makes it easier to address the upstream causes of ill health through environmental improvements and the use of fiscal and regulatory measures to encourage healthy lifestyles.

Singapore has also enjoyed political stability and a high level of public trust in government for decades. That helped as well.

With these advantages, UHC in Singapore has gone beyond providing and financing fair and inclusive health care. UHC in Singapore has worked as a strategy for building an inclusive, caring, and progressive society. These are assets for any country in the world.

Ladies and gentlemen,

Our world is in turmoil from multiple causes. The signs are there for anyone to see: fluctuating currencies, unstable economies, prolonged conflicts, ethnic clashes, and inexplicable acts of violence. Organized acts of terrorism are the newest omnipresent and unpredictable threat.

The climate is changing, antibiotics are failing, and health care costs are soaring. Inequalities, in income levels, opportunities, and access to social services, both within and between countries, have reached the highest levels seen in nearly a century.

Countries are losing their middle classes, the backbone of democracy. Last month’s Oxfam report on wealth distribution contains a startling statistic: just 80 rich and powerful people own more of the world’s total wealth than 3.5 billion people at the other end of the scale.

Many economists take optimism from the fact that several of the world’s fastest growing economies are in Africa, often fuelled by foreign extractive industries. But if you look at income distribution within these countries, what we are really seeing is more and more rich countries full of poor people.

An African medical blogger contrasted growths in GDP with weaknesses in health systems laid bare by the Ebola outbreak. He asked the following question. What good does it do to cover the ceiling of your house with golden paint when the walls and foundation have cracks?

Decades of experience tell us that this world will not become a fair place for health all by itself. Health systems will not automatically gravitate towards greater equity or naturally evolve towards universal coverage.

Economic decisions within a country will not automatically protect the poor or promote their health. Globalization will not self-regulate in ways that ensure fair distribution of benefits. International trade agreements will not, by themselves, guarantee food security, or job security, or health security, or access to affordable medicines.

All of these outcomes require deliberate policy decisions.

Universal health coverage is one of the most powerful social equalizers among all policy options. It is the ultimate expression of fairness. If public health has something that can help our troubled, out-of-balance world, it is this: growing evidence that well-functioning and inclusive health systems contribute to social cohesion, equity, and stability. They hold societies together and help reduce social tensions.

At a time when policies in so many sectors are actually increasing social inequalities, I would be delighted to see health lead the world towards greater fairness in ways that matter to each and every person on the planet.