In search of a language beyond disciplines and literatures

During the 20th century, providing care to the sick and improving the wellbeing of populations have emerged as central concerns for many policy actors including governments, independence movements, private foundations, and international organizations. Before World War II, some states in Latin America were already considering access to medical care as an entitlement of citizenship (Moyn, 2018, p 58). The Soviet Union was proud of its approach to health and design of health systems, willing to share its model with anyone interested. In Europe, the narrow focus on the sick and poor was transformed, in the context of the world wars, into a concern for building national solidarity, and was in no small part motivated by countering the Soviet influence. After World War II, a greater willingness to share risks and uncertainties supported the universalist arguments in favour of improving access to health care services (Titmuss, 2000; Marshall, 1964; Goodin and Dryzek, 1987). There is a small but rigorous literature on the contested nature of universalism as a theoretical and normative concept (Anttonen et al, 2012; Béland et al, 2019; Thompson and Hoggett, 1996), but most of the attention has centred on the broader social policy debates, with limited connections to conversations on health systems.

By the 1970s, it was clear that the geopolitical and social divisions were shifting from the empires – subjects and colonizers – colonized towards a hierarchy that reflected levels of ‘development’ – conceptualized in a manner prioritizing a certain path to modernization – without an acknowledgement of the historical patterns of power and distribution of resources.