Vulnerability, equity and universal coverage – a concept note

Universal coverage embodies a critical underlying social value; the recognition that those goods and services that support health, however we define it, have to be available and accessible to all. The choice of which of these goods and services are considered essential, the mechanisms by which they would be financed and so on are almost secondary to this basic consensus, that coverage has to be universal, leaving no one out. Inextricably linked to this understanding of universal coverage is therefore an imperative to ensure equity. Within the context of health and health systems, pursuing equity requires the identification and addressing of those determinants that systematically restrict or prevent access to particular groups. Pursing equity also requires the institution of processes that enable population groups to help to identify the systems that perpetuate inequities as well as possible solutions to reduce or eliminate disparities. The notion of vulnerability, although extensively used (and sometimes abused) in the public health and social sciences literature [1,2], provides a useful framework for identifying various population groups and systems against which achievement of universal coverage can be benchmarked. In this background paper, we attempt to bring to the fore, some of the issues that create vulnerability and that define the populations critical to universal coverage. We argue that contemporary discussions on universal coverage are often overwhelmed by considerations of financing to the detriment of the central tenet of what universal coverage tries to achieve: health for all.