This book has endeavoured to understand the significance of universal health coverage (UHC) in our thinking about health systems. It has done so in the context of evolving approaches to social and economic development in a particular world context shaped by major shifts in capitalism. I explore UHC's journey through interviews, reports and global declarations, and proceedings of workshops and UN high-level meetings, to identify the key dynamics that constitute UHC as a significant idea, indeed probably the most prominent idea in the field of global health, since the Alma Ata Declaration of 1978.

The significance of UHC as a policy idea is evident in its status as an SDG target, influencing the contents and framings of reforms in many countries, or in descriptions of it as ‘an anchor of the work of WHO’ (WHA, 2012, p 4). A recent WHO report recognized that ‘global progress towards the SDG target for UHC is not on track’ but argued that the results were still promising given ‘around 30% of countries have increased both service coverage and financial protection, showing progress is possible even in difficult fiscal conditions’. This corresponds to ‘nearly 430 million more people [since 2018 who] have gained access to health services without financial hardship’ (WHO, 2024a, p 21).

However, seen from the historical-sociological perspective adopted in this book, UHC's significance also lies in its foundations that consist of movements – such as the social medicine tradition and vertical approaches to health systems or broader debates on social and economic development – with different origins and rhythms.