Introduction

With the arrival of the new century, universalism re-emerged as a central concern in global health and development debates, with particular actors, institutions, and paradigms, and broader social, political, and economic factors taking a new shape – a new constellation – forming what will soon be called universal health coverage (UHC). At first glance, there are remarkable similarities in the acknowledgement of the challenges faced by health care systems in the Global North and Global South, such as cuts in social spending, the expansion of the private sector, decentralization, and growing demands for expanding choice and individual responsibility. However, the separate paradigms of health and development in the two regions appear quite resilient: the debate in advanced industrialized countries centres on evaluating the impact of neoliberalism on their diverse welfare systems and generally describes the implications in terms of the expansion of targeting, de-universalization, erosion, and even ‘the end of universalism’.

In stark contrast, the same neoliberal pressures are combined with perceptions of new opportunities for the proponents of horizontal health systems approach in international organizations and some countries, leading to an excitement around a novel concern with universalism that connects a new term – UHC – to earlier goals, such as Health for All (HFA), and new goals, such as the MDGs and, later, the SDGs.