Universal health coverage and capital accumulation: a relationship unveiled by the critical political economy approach
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ORIGINAL ARTICLE
Universal health coverage and capital accumulation: a relationship unveiled by the critical political economy approach Mario Herna´ndez-A´lvarez1 Luis Edgar Parra-Salas1
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Juan Carlos Eslava-Castan˜eda1 • Liliana Henao-Kaffure1 • Jose´ Orozco-Dı´az1
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Received: 4 February 2020 / Revised: 8 July 2020 / Accepted: 13 July 2020 Swiss School of Public Health (SSPH+) 2020
Abstract Objectives To analyze the fundamentals of the global health agenda from 1944 to 2018, especially regarding Universal Health Coverage, in order to unveil its relations with capital accumulation in health services and to contribute to world social mobilization to change this tendency. Methods A historical study was carried out based on a purposeful selection of primary sources on the global health agenda from multilateral organizations and secondary sources about the changes of capitalism from the study period. Results The global health agenda changed from the state responsibility for health to an insurance healthcare system based on markets. The medical–industrial complex pressured national economies, broke postwar pacts, and urged economic globalization. The neoliberal, neoclassical, and neo-institutional discourse that promoted a new state–market relationship eased the new capital accumulation in healthcare into financial and cognitive capitalism. Conclusions Understanding these relationships allows us to provide elements for social mobilization geared to transform the healthcare sector toward a new vision of health with a nature–society relationship that contributes to socially constructing human and environmental health, rather than gaining profits based on illness and chronic suffering. Keywords Universal health coverage Healthcare systems Medical–industrial complex Healthcare financialization Cognitive capitalism Global health agenda
Introduction In Kazakhstan 2018, the Global Conference on Primary Health Care promulgated the Declaration of Astana in commemoration of the 40 years since the Declaration of This article is part of the special issue ‘‘Market-driven forces and Public Health’’.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00038-020-01437-9) contains supplementary material, which is available to authorized users.
Alma-Ata. There the global health agenda was exposed, and its title, ‘‘From Alma-Ata towards universal health coverage and the Sustainable Development Goals,’’ evidences the centrality of the proposal of Universal Health Coverage (UHC). UHC was introduced at the joint meeting of the World Bank (WB) and the World Health Organization (WHO) in 2000, by Joseph Kutzin (2000). Fifteen years later, the UHC was included in objective three of the Sustainable Development Goals (SDG). It was thus proposed to guarantee access to health services, technologies, and medicines through the ‘‘providing protection against financial risk’’ (WHO 2005, p. 124) that involves paying
´ lvarez & Mario Herna´ndez-A
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