Abstract
The presumed global consensus on achieving Universal Health Coverage (UHC) masks crucial issues regarding the principles and politics of what constitutes “universality” and what matters, past and present, in the struggle for health (care) justice. This article focuses on three dimensions of the problematic: 1) we unpack the rhetoric of UHC in terms of each of its three components: universal, health, and coverage; 2) paying special attention to Latin America, we revisit the neoliberal coup d’état against past and contemporary struggles for health justice, and we consider how the current neoliberal phase of capitalism has sought to arrest these struggles, co-opt their language, and narrow their vision; and 3) we re-imagine the contemporary challenges/dilemmas concerning health justice, transcending the false technocratic consensus around UHC and re-infusing the profoundly political nature of this struggle. In sum, as with the universe writ large, a range of matters matter: socio-political contexts at national and international levels, agenda-setting power, the battle over language, real policy effects, conceptual narratives, and people’s struggles for justice.
Highlights
How did we get here? An emerging and re-emerging concern: historical context matters The call for Universal Health Coverage (UHC) is not new
This stance, advanced by the dominant players around UHC (WHO, the World Bank, the Rockefeller Foundation, etc.), means that almost all of the focus has been around the language of universal and coverage, with little attention paid to health per se
In taking deliberations around UHC to the stratospheric, level, we propose, and will circle back to, the need to revive a broad understanding of health while recognizing the deeply political and politicized nature of the struggles inherent to advancing universal health justice as the core of the global health agenda
Summary
UHC is everywhere: agendas matter Since (re)appearing on the global health agenda in 2005 through a timid World Health Assembly resolution on sustainable health financing, universal coverage, and social health insurance [1], and vigorously bolstered circa 2010, Universal Health Coverage (UHC) seems to be everywhere. The most critical analysts have advocated for broadly addressing (not just rhetorically invoking) the political, commercial, and other societal determinants of health [12, 13] instead of the exclusive emphasis on UHC [14], the terms of the debate remain framed by a reductionist healthcare-centered vision. This stance (i.e. that health derives from health care), advanced by the dominant players around UHC (WHO, the World Bank, the Rockefeller Foundation, etc.), means that almost all of the focus has been around the language of universal and coverage, with little attention paid to health per se. In taking deliberations around UHC to the stratospheric, level, we propose, and will circle back to, the need to revive a broad understanding of health (not solely as healthcare access, even as this remains a critical component) while recognizing the deeply political and politicized nature of the struggles inherent to advancing universal health justice as the core of the global health agenda
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