A/HRC/38/37 to participation. Reaching first those who are furthest behind and leaving no one behind calls for their equal prioritization along with other health concerns relevant to the population as a whole. (c) Universal health coverage 32. The 2030 Agenda endorses a commitment to achieve universal health coverage for all, which remains an important challenge. According to the International Labour Organization (ILO), 46.3 per cent of the global population and 56 per cent of the global rural population lack health coverage. Approximately 48 per cent of the population, and more than half of older persons worldwide, have no access to long-term care as a result of insufficient numbers of the skilled workers needed for service delivery. 45 Largely ignored in health policy, long-term care is widely perceived as free care, to be provided by unpaid female family members. However, such unpaid care does have economic implications, such as loss of income opportunities and the resulting risk of impoverishment. 46 33. There is a broad diversity of views regarding what universal health coverage entails, and the traditional role played by the private sector in voluntary insurance schemes has been very influential in the conception of health coverage in general. Although target 3.8 of the Sustainable Development Goals refers to financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all, universal health coverage is not defined in the 2030 Agenda, nor is there any mention of the need to prioritize marginalized and vulnerable populations and groups, such as those living in poverty. 47 34. In the absence of a clear definition of universal health coverage in the Sustainable Development Goals, the international human rights framework and the right to health framework can provide guidance and standards to improve health outcomes for all people, without discrimination. The Special Rapporteur on health cautions that not all paths to universal health coverage are consistent with human rights standards, noting in particular the risk of entrenching inequalities where, for instance, Governments prioritize the expansion of coverage to privileged groups in the formal sector. 48 A human rights-based approach to universal health coverage, recommended by the High-Level Working Group on Health and Human Rights, 49 fundamentally requires that availability, accessibility, acceptability and quality be ensured, and that persons in vulnerable situations who are mostly excluded from universal health coverage be prioritized. A human rights-based approach to universal health coverage calls, among other requirements, for the creation of conditions that would ensure to every person all appropriate medical service and medical attention in the event of need,50 universal coverage of quality primary health services for children51 and the elimination of discrimination in health care and services, especially in relation to the core obligations of the right to health. 52 Thus, universal health coverage refers not merely to an expansion of coverage for health services but also to access, for every person throughout the course of life, to the full complement of necessary and appropriate health care and services on the basis of non-discrimination.53 45 46 47 48 49 50 51 52 53 International Labour Organization (ILO), World Social Protection Report 2017–19: Universal social protection to achieve the Sustainable Development Goals (2017), pp. 104–109. Ibid., p. 108. See A/71/304, para. 76. Ibid. WHO, Leading the realization of human rights to health and through health: Report of the HighLevel Working Group on the Health and Human Rights of Women, Children and Adolescents (2017), p. 34, recommendation 2. See International Covenant on Economic, Social and Cultural Rights, art. 12 (2) (d). See Committee on the Rights of the Child, general comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health, para. 73 (b). See Committee on Economic, Social and Cultural Rights, general comment No. 14, para. 19. WHO, Leading the realization of human rights to health and through health: Report of the HighLevel Working Group on the Health and Human Rights of Women, Children and Adolescents (2017), p. 15. 11