Universal Health Coverage between Universalism and Financialization

This paper focuses on an agenda to reform our health systems, Universal Health Coverage (UHC) that emerged in the 2000s as a key idea to build a strong and more equitable health care system. The paper aims to explore the political dynamics of its rise and impact in the global health and development agendas. Using historian Fernand Braudel’s conceptual tools, the paper traces the formulation of ‘universalism’ in a particular world context shaped by major shifts in capitalism. Through an exploration of its journey through interviews, reports and declarations, workshop and high-level meeting proceedings, I identify the key dynamics that constitute UHC as a significant idea, probably the most prominent idea, since the Alma Ata Declaration of 1978. This analysis suggests two processes between the broader dynamics in the global political economy and the specific debates about health systems. First, health systems are part of the effort, once again, to embed economic relations where UHC promotes financial protection against high out-of-pocket costs and improves access to essential services. By ensuring healthy populations, UHC also serves as an ‘investment’ because healthier children are more likely to attend school and become healthier adults. The second process involves the financialization dynamics that shape health care systems, especially with regard to the relations between the public and private sectors. Major shifts in the dynamics of capitalist accumulation, especially the growing influence of financial markets and transactions over trade and commodity production, have implications that reach beyond the markets into social realms. Financialization represents the latest transformations in capitalism, altering the purpose and tools of social policy with its emphasis on expanding demand and incorporating more areas into the market (hence, marketization).