universal health coverage for non-communicable diseases and health equity: reflections on the role of ideas and democratic decision-making comment on “universal health coverage for non-communicable diseases and health equity: lessons from australian primary healthcare

Fisher et al have published a thought-provoking article exploring the complex relationship between universal health coverage (uhc) and equity. this commentary builds on two of the lessons they highlight: the importance of ideas in determining how exactly uhc advances equity, and the political difficulties of addressing the commercial determinants of health. i argue that equity in uhc can be advanced through interventions that address popular prejudices against public health systems, greater emphasis on structural and commercial drivers of ill-health in health professionals’ training, and by ensuring meaningful public participation in decision-making about the institutionalisation and management of uhc. these strategies are important for ensuring that the political, power-laden nature of concepts such as “universality,” “health” and “care” are explicitly acknowledged and publicly debated – rather than continuing the current trend of allowing technocrats to reduce uhc to a matter of efficiently and expeditiously financing curative healthcare services.