At the time of study, Martin Gorsky and Christopher Sirrs were with the Centre for History in Public Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Am J Public Health. 2018 Mar;108(3):334-342. doi: 10.2105/AJPH.2017.304215. Epub 2018 Jan 18.
The UN Sustainable Development Goals of 2015 have restored universal health coverage (UHC) to prominence in the international health agenda. Can understanding the past illuminate the prospects for UHC in the present? This article traces an earlier history of UHC as an objective of international health politics. Its focus is the efforts of the International Labor Organization (ILO), whose Philadelphia Declaration (1944) announced the goal of universal social security, including medical coverage and care. After World War II, the ILO attempted to enshrine this in an international convention, which nation states would ratify. However, by 1952 these efforts had failed, and the final convention was so diluted that universalism was unobtainable. Our analysis first explains the consolidation of ideas about social security and health care, tracing transnational policy linkages among experts whose world view transcended narrow loyalties. We then show how UHC goals became marginalized, through the opposition of employers and organized medicine, and of certain nation states, both rich and poor. We conclude with reflections on how these findings might help us in thinking about the challenges of advancing UHC today.
联合国 2015 年可持续发展目标将全民健康覆盖（UHC）重新置于国际卫生议程的显著位置。了解过去能否为当今 UHC 的前景带来启示？本文追溯了 UHC 作为国际卫生政治目标的早期历史。其重点是国际劳工组织（ILO）的努力，该组织的《费城宣言》（1944 年）宣布了包括医疗保健在内的全民社会保障的目标。第二次世界大战后，国际劳工组织试图将这一目标纳入一项国际公约，由各国批准。然而，到 1952 年，这些努力失败了，最终的公约被如此淡化，以至于无法实现普遍性。我们的分析首先解释了关于社会保障和医疗保健的观念的巩固，追溯了超越狭隘忠诚的专家之间的跨国政策联系。然后，我们展示了 UHC 目标是如何通过雇主和有组织的医疗保健行业以及一些富有的和贫穷的国家的反对而被边缘化的。最后，我们思考了这些发现如何帮助我们应对当今推进 UHC 的挑战。
