The Role of Healthcare Universalism in Advancing Human Security

Amid a new generation of complex, interlinked threats in the Anthropocene era, the importance of universal healthcare systems in human security is increasing, not only in safeguarding against infectious diseases but also in addressing wider links between health and social inequalities. This paper examines the relationship between healthcare universalism and human security through an empirical analysis of cross-national variation in universal healthcare outputs across 195 countries from 1995 to 2017. It suggests a novel Healthcare Universalism Index (HUI) that combines three dimensions of universal healthcare provision into a single index: coverage, generosity and equity. The paper employs the index to assess the global development of healthcare universalism since 1995, and explores the association between the HUI and three key linkages through which healthcare universalism might contribute to human security: infectious diseases, poverty and inequality, and violence and conflict. Overall, the analysis leads to four main conclusions. First, healthcare is becoming more universal across the world, with improvements in relative terms that are particularly large in some low-income countries. Despite existing narratives around the marketization of healthcare and a declining role of the State, consistent and substantial improvements are evident in all dimensions of universalism in most countries around the world. Second, significant inequalities in healthcare provision remain with the absolute gap between the most and least universal regions even increasing over time. In many low and medium human development countries, a lack of generosity remains particularly problematic. Third, our regression analysis demonstrates a significant positive correlation between healthcare universalism and all dimensions of human security, including improved health outcomes, reduced inequality, and, to a lesser extent, lower probabilities of conflict. Emphasizing the multidimensional nature of universalism, we find that both generosity and equity play crucial roles across all linkages, particularly in shaping better and more equitable health outcomes. Fourth, variations between countries in the Global North and Global South are significant and demand a closer consideration of the political economy differences across the world, especially concerning the role of equity in garnering political support for the expansion of public healthcare systems.