Universal and Targeted Policy for Health Equity in the Neoliberal Era; A Response to the Recent Commentaries

Document Type : Correspondence


1 Stretton Health Equity, University of Adelaide, Adelaide, SA, Australia

2 Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, NSW, Australia

3 School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia


Growing socioeconomic inequalities globally1 are likely to exacerbate health inequities within and between countries.2 National governments can influence social determinants of health within their own borders, in order to promote health and reduce inequities. Questions about how to do this effectively include debate on use of universal or targeted policies to improve equitable access to health care and other determinants.3-5 In 2021 we published research in this journal6 examining the merits of universal and targeted policies for health equity, drawing on case studies of Australian policy in primary health care, Indigenous health, telecommunications, and land use planning.7 ...(Read more...)

  1. Christensen MB, Hallum C, Maitland A, Parrinello Q, Putaturo C. Survival of the Richest: How We Must Tax the Super-Rich Now to Fight Inequality. Oxford: Oxfam GB; 2023.
  2. Commission on the Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Geneva: WHO; 2008.
  3. Bergh A. The universal welfare state: theory and the case of Sweden. Polit Stud. 2004;52(4):745-766. doi:1111/j.1467-9248.2004.00506.x
  4. Carey G, Crammond B, De Leeuw E. Towards health equity: a framework for the application of proportionate universalism. Int J Equity Health. 2015;14:81. doi:1186/s12939-015-0207-6
  5. Sanders D, Nandi S, Labonté R, Vance C, Van Damme W. From primary health care to universal health coverage-one step forward and two steps back. Lancet. 2019;394(10199):619-621. doi:1016/s0140-6736(19)31831-8
  6. Fisher M, Harris P, Freeman T, et al. Implementing universal and targeted policies for health equity: lessons from Australia. Int J Health Policy Manag. 2021;11(10):2308-2318. doi:34172/ijhpm.2021.157
  7. Harris P, Fisher M, Friel S, et al. City deals and health equity in Sydney, Australia. Health Place. 2022;73:102711. doi:1016/j.healthplace.2021.102711
  8. Mead R, Pickin C, Popay J. Policies for social and health equity: the case for equity sensitive universalism: Comment on “Implementing universal and targeted policies for health equity: lessons from Australia.” Int J Health Policy Manag. 2022;11(12):3151-3154. doi:34172/ijhpm.2022.7573
  9. Raphael D, Bryant T. Resisting the effects of neoliberalism on public policy: Comment on "Implementing universal and targeted policies for health equity: lessons from Australia.” Int J Health Policy Manag. 2022;11(12):3148-3150. doi:34172/ijhpm.2022.7354
  10. Friel S, Townsend B, Fisher M, Harris P, Freeman T, Baum F. Power and the people's health. Soc Sci Med. 2021;282:114173. doi:1016/j.socscimed.2021.114173
  11. Fisher M, Mackean T, George E, Friel S, Baum F. Stakeholder perceptions of policy implementation for Indigenous health and cultural safety: a study of Australia's ‘Closing the Gap’ policies. Aust J Public Adm. 2021;80(2):239-260. doi:1111/1467-8500.12482
  12. Jessop B. The rise of governance and the risks of failure: the case of economic development. Int Soc Sci J. 1998;50(155):29-45.
  13. Harris P. Illuminating Policy for Health: Insights from a Decade of Researching Urban and Regional Planning. Springer; 2022.
  14. Pierre J. Models of urban governance: the institutional dimension of urban politics. Urban Aff Rev. 1999;34(3):372-396. doi: 1177/10780879922183988
  15. Fogarty W, Bulloch H, McDonnell S, Davis M. Deficit Discourse and Indigenous Health. Canberra: Lowitja Institute, Australian National University; 2018.
  16. George E. “Bandaid for a Bullet Wound”: The Inconsistent Recognition of Indigenous Rights and Social Determinants of Indigenous Health in ‘Closing the Gap’ Policy Implementation in Early Childhood. Adelaide: Flinders University; 2020.