Universal Health Coverage (UHC) began as a disarmingly simple yet profound idea: that everyone should be able to receive the health care they need without being pushed into financial hardship.
I first engaged with it in the post-Millennium Development Goals debates, as the global community started to rethink its goals for the next phase of development – discussions that would eventually lead to the Sustainable Development Goals (SDGs).
The question then was whether we could move away from a narrow, disease-by-disease focus and instead build a delivery platform that adapts to local epidemiology, economic realities and community priorities – while treating access to essential services as a right, not a privilege.
For me, justice in health is not a personal interest but a social responsibility. The elevation of UHC to a global commitment at the United Nations remains one of the most significant attempts at fairness in health policy.
It has shaped my work in very different settings – from Southern Tehran, Somalia and Sudan to First Nations communities in north-western Ontario, and now coastal communities in south-east England – where the central question is always the same: what would it actually take for everyone here to be genuinely covered?
What is Universal Health Coverage, and why does it matter for public health?
At its core, UHC means that all people can use an effective range of preventive, curative, rehabilitative and palliative services without being driven into financial distress. It is not a single global package, but a commitment that services should reflect patterns of disease, demographic change and social priorities.
Yet global monitoring still paints a starkly unequal picture.
Around half of the world's population lacks access to essential health services, and this has not improved in any meaningful way over the past decade. The 2025 global monitoring report, launched in the first week of December, once again underlines how far we remain from "health for all". Its charts may appear to show steady progress, but on closer inspection, many of the patterns look familiar, and each time one has to ask what has really changed since the last edition.
This is more than a domestic policy issue. The capacity to prevent and manage non-communicable diseases, protect mental health, and respond to climate-related health risks all depend on the strength of health systems.
When large parts of the world lack even a basic level of care, the implications for population health, economic stability, and countries' ability to adapt to climate change are clear. In that sense, UHC is not only a social contract within countries; it is also a form of collective risk management.
What is your main research aim, and how does it build an interdisciplinary agenda?
Since UHC and the SDGs were first articulated, my work has focused on how health systems function under pressure – from war and sanctions to structural deprivation, including the kinds of disadvantage visible in coastal communities – and on what UHC can realistically mean in those environments.
Over time, the emphasis has shifted from explaining why UHC matters to exploring how it can be designed and delivered when conditions are far from ideal.
That inevitably requires an interdisciplinary approach. Health systems science – spanning financing, governance, service delivery, medicines and technology – has to sit alongside human rights, law, political economy and public ethics.
In settings where people have little or no influence over geopolitical decisions, yet live with the health consequences of war, sanctions or organised violence, UHC is as much about protection as it is about provision: who holds which responsibilities, and through which legal and financial arrangements those responsibilities are fulfilled.
What are the biggest challenges?
The barriers are not primarily technical; they are political, economic and social. Today, more than two billion people live in areas affected by war, sanctions or organised violence. Levels of conflict and military mobilisation are higher than at any point since the Second World War. In many countries, defence spending is displacing investment in health and social protection.
Internationally, development assistance is being reduced or repurposed under geopolitical pressures, despite the well-recognised fact that the breakdown of basic services in one setting can have effects far beyond its borders. Nationally, rising living costs and constrained public budgets are reshaping how justice is enacted in practice. Public willingness to welcome migrants and asylum seekers has diminished, let alone guarantee their access to health care.
In such a context, justice in health will not remain at the centre of decision-making by default; new frameworks for collective responsibility are needed.
There is also a question of honesty in how progress is described. Many global reports point to modest improvements, but a closer reading shows that only a minority of countries have moved forward on both service coverage and financial protection since 2015.
If the reassuring tone of our narratives continues to diverge from the reality experienced in communities, the very idea of UHC risks losing credibility.
Given this context, what is happening now – and how can colleagues engage?
At the University of Essex, equity in health is one of the core themes that links our research, teaching and policy engagement, and UHC could be a key part of that work. Each year, on 12 December, we mark International UHC Day with a public lecture and discussion.
In 2024, we focused on UHC in situations of war and polycrisis; in 2025, we will turn to the role and implications of public–private partnerships, aligned with the NHS 10-Year plan.
Colleagues can engage in a range of ways: by collaborating on research in challenging settings; by contributing to ethical and legal debates around UHC; by taking part in our UHC Day events; and by ensuring that questions of coverage and health equity are reflected in their own teaching and scholarship across health, law, economics and politics.
If UHC is to be more than a slogan, it will require a deliberate commitment by researchers, policy-makers, practitioners and communities to hold themselves – and one another – to account for whether people actually receive the care they need, without incurring financial hardship, particularly in those places where the promise of “health for all” still feels most remote.
