SUSTAINABLE DEVELOPMENT GOAL 3: Ensure healthy lives and promote well-being for all at all ages

Target 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Health insurance is not a luxury it’s a requirement. When visiting a doctor or going to a hospital the first question asked is about insurance. Without coverage the availability of medical care goes down while the costs increase exponentially. The lack of affordable plans has caused many to forgo coverage and as a result many of these same people are at risk of bankruptcy or death from lack of care. 

Health Insurance Costs

According to the Commonwealth Fund1 the cost of the average employee’s premium contribution and deductible was 11.5% of median household income. That represents almost a 50% increase in insurance costs to the average worker.

The chart shows how over the past 10 years employers have kept premium increases in line with wages by offering insurance with higher deductibles.  Higher deductibles mean less insurance which reduces overall insurance costs. It also means families must decide between medical care or household expenses. And in more and more situations today’s middle income families cannot afford basic medical care because they cannot afford the deductible.


Health care cost is what increases the total cost of medical care across all health insurance markets. Employers and insurers keep premiums down by increasing deductibles and other cost-sharing gimmicks, which in turn leaves many underinsured and at great financial risk.

In 2008 American’s medical insurance costs (premium contribution + deductible) represented 5%-10% of median state income versus 10%-16.5% in 2018.  And for the people with income below the median level, but above the poverty line, medical insurance costs as a percentage of wages are even higher. So much higher, they are priced out of the medical marketplace even if they have insurance. This is known as having medical insurance with no medical access.

How well is the US achieving Goal 3?

UN Sustainable Development Goals have indicators which measure the progress a country or group make in achieving the stated goal target. In this case its Target 3.8: Achieve universal health coverage as measured by indicator 3.8.2.

Indicator 3.8.2: Proportion of population with large household expenditures on health as a share of total household expenditure or income. This indicator is defined as the proportion of population that spends a large portion of the total household income or expenditure on health-related expenditures. Two thresholds are used to define “large household expenditures on health” (1) greater than 10%; and (2) greater than 25% of total household expenditure or income.2

If we use the UN’s definition of universal health coverage, less than half of Americans are considered to have universal health coverage at the 10% threshold level and when you factor in out of pocket costs the results are even worse.


So, while the politicians fight over how to insure 100% of Americans, few are discussing how to make medical care affordable for the majority of American people with insurance. Remember medical insurance does not mean you have access to healthcare if you cannot afford the doctor visit.


The above article is intended to raise awareness that the 17 UN Sustainable Development Goals (SDGs) apply locally as much as globally and is not intended to present a solution. Solutions for SDGs are as diverse as the groups impacted, so I leave it to the reader to find their own SDG solution. Whether it’s activism, volunteering or investing, any contribution will make an impact.

For more information on this topic or impact investing contact ESGA at