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Globalization and Health
Published in: Globalization and Health 1/2019

Open Access 01-11-2019 | Care | Commentary

What matters in health (care) universes: delusions, dilutions, and ways towards universal health justice

Authors: Anne-Emanuelle Birn, Laura Nervi

Published in: Globalization and Health | Special Issue 1/2019

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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.
Footnotes
1
Here we use “them” in an “othering” sense, as UHC policies and schemes are rarely relevant or applicable to decision-makers, academics, and international agency experts.
 
2
The extreme segmentation of healthcare systems in Latin America is not a question of policy design: it is the product of structural economic heterogeneity. Within most countries in the region, there are vast differences in productivity levels and labor-market features by economic sector, resulting in enormous inequalities in remuneration, benefits, and, ultimately, relations among state, market, and population [17]. Although inequality has at times decreased (as during the first decade of this millennium), Latin America—with its historical and structural inequalities—remains the most unequal region of the world, followed by sub-Saharan Africa [18, 19].
 
3
It is essential to distinguish between nonconditional transfers going to all those who meet poverty criteria, and conditional cash transfers based on a mandatory and paternalistic quid pro quo, such as proof of school and health clinic attendance, regardless of the quality and accessibility of these services.
 
4
There is a vast literature analyzing the equity, efficiency, fairness, and health outcomes of for-profit versus non-profit healthcare delivery in the United States, including these two classic reviews [41, 42].
 
5
A crucial, if oft-ignored, dimension of UHC and even many UHS concerns the role of healthcare workers, who play a central role in any healthcare system, but are increasingly subject to authoritarian management, ever-deteriorating labor relations and work conditions, and precarious employment, particularly in LMICs. Despite this ongoing dehumanization of health workers, “attempts to incorporate social participation into health systems almost always bypass health workers” [51].
 
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Metadata
Title
What matters in health (care) universes: delusions, dilutions, and ways towards universal health justice
Authors
Anne-Emanuelle Birn
Laura Nervi
Publication date
01-11-2019
Publisher
BioMed Central
Keyword
Care
Published in
Globalization and Health / Issue Special Issue 1/2019
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-019-0521-7

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