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Published on January 9, 2026

On November 12, Dr. Ramya Kumar, a Senior Lecturer and medical doctor at the University of Jaffna, and Dr. Anne-Emanuelle Birn, Professor of Global Development Studies and of Social and Behavioural Health Sciences at the Dalla Lana School of Public Health at the University of Toronto, discussed their book, titled “Going Public: The Unmaking and Remaking of Universal Healthcare,” at the Dahdaleh Institute for Global Health Research.

Birn began by introducing the background of their volume, which aims to highlight the role of corporate players in universal health coverage ideologies and implementation.

Their research was guided by three central questions: How have dominant understandings of primary health care (PHC) and of universal health evolved under the shifting constellation of actors and forces shaping global health policy since the late 1970s? What are the implications of social innovation-driven primary care initiatives rolled out in underserved areas of World Bank-defined low-income countries (LICs)? And thirdly, what can we learn from alternative public sector-driven models of PHC that exist in World Bank-defined low- and middle-income countries (LMICs)?

Prior to delving into their findings, Birn explained the study’s critical political economy of health framework, centered around power relations and the role of political and economic systems, key actors, and their accompanying values and priorities that shape health and health inequity. A central aim of Kumar and Birn’s book is to unpack the forces and “rules of the game” in order to understand who and what drives and perpetuates health inequity.

Subsequently, Birn provided a brief history to contextualize the refashioning of  international and global health over the past half-century. This includes the 1978 Declaration of  Alma-Ata, and its clarion call for comprehensive, socially grounded “Health for All” by the Year 2000, its displacement by a technical reductionist variant  –so-called selective primary health care–, followed by healthcare’s  marketization via a neoliberal model, then a re-emergence of philanthrocapitalism in the 2000s, and into the current era of universal health coverage (UHC) under accelerated corporatization of health and healthcare.

In addition, Birn noted that UHC is defined ambiguously, on one hand implying that everybody is covered, albeit without specifying which services are included (that is, how comprehensive the coverage actually is); and on the other hand leaving the door wide open to private insurance and other private actors, and the associated profiteering at the expense of people’s well-being.  As such,  aspirational universal rhetoric associated with UHC masks a highly problematic reality that departs from Alma-Ata’s goal of universal health care (as opposed to health coverage).

Next, Kumar addressed the implications of social innovation-driven primary care initiatives rolled out in underserved areas of World Bank-defined LICs. The book’s analysis of case studies from the Social Innovations for Health Initiative hosted by WHO/TDR found them to be “cost-effective” (low-cost), technology-based solutions that target lower-end niche markets, involve task-shifting and often linked to corporate social responsibility initiatives. Thus, although these so-called social innovations are presented as locally grown “disruptive” solutions to complex health problems, many of them draw on external business models and help expand markets for corporate actors, and simultaneously dehumanize places and people by perpetuating a colonial double-standard of inferior PHC for LICs.

Following this, Kumar addressed the third question by examining three case studies of publicly financed and delivery PHC systems in LMICs: Sri Lanka’s universal and public maternal and infant care system; Thailand’s long-standing national effort to retain rural health workers; and Cuba’s Family Doctor and Nurse program.

Many common themes were found across these three countries, characterized by their extensive measures to improve the geographic and economic accessibility of universal PHC. For instance, healthcare professionals are trained locally in government-subsidized diploma or degree programs, and healthcare is still “free” to different extents, with no user charges at points of delivery. In addition, all three countries directed substantial investment into rural development long before WHO’s 2008 Social Determinants of Health report. However, ongoing restructuring of the PHC systems, alongside funding cuts, public sector downsizing, and privatization are having damaging impacts on public health in each of these settings.

To conclude, Kumar and Birn proposed a renewed call for universal health justice guided by a vision to build public, equitable, and solidarity-based healthcare systems for all. This effort needs to be supported by state-led redistribution, scaling-up of rural services, and shifting from curative to preventative healthcare services, all while upending power asymmetries to address the structural determinants of health.

Connect with Ramya Kumar

Connect with Anne-Emanuelle Birn

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