Theoretical and practical challenges of proportionate universalism: a review

Abstract

Objective. In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it. The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues. Methods. We searched for all articles published until 6th of February 2020, mentioning “Proportionate Universalism” or its synonyms “Targeted universalism” OR “Progressive Universalism” as a topic in all Web of Science databases. Results. This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs. Conclusion. This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.

Middle Managers’ Views on Participation in a Home Visiting Program for First-Time Parents in Scania, Sweden

“…This means that interventions should be universal and not targeted, but that the scale and intensity of the intervention should be proportionate to the level of need (e.g. Carey et al, 2015;Francis-Oliviero, Cambon, Marmot & Alla, 2020). An example of an intervention based on proportionate universalism is a Swedish extended postnatal home visiting program for first-time parents in Rinkeby, an area in Stockholm, where many families are exposed to social disadvantages.…”

“…Advocates of targeted interventions have argued that universal approaches may increase inequalities and lead to significant costs for society (Francis-Oliviero et al, 2020). Conversely, arguments in favour of universalism are that targeted interventions might miss individuals in need of support and lead to the stigmatization of individuals (Horton & Gregory, 2010;Marmot, 2010;Marmot, 2014).…”

Sociedades justas: una nueva visión de la equidad en la salud en la Región de las Américas después de la COVID-19

“…Esta acción es doble. Por un lado, incluye un espectro amplio de compromisos dentro del sector de la salud, como la atención primaria de salud y la protección social en materia de salud para garantizar la cobertura universal de salud y el acceso universal a la salud dentro de un marco de universalismo proporcional ( 18 ). Por el otro, incluye compromisos de trabajar más allá del sector de la salud para abordar los determinantes sociales de la salud, lo que incluye medidas para mejorar las condiciones en las cuales las personas nacen, crecen, viven, trabajan y envejecen, estableciendo un sistema integral de protección social y bienestar basado en la solidaridad y haciendo realidad el potencial redistributivo del gasto social para abordar los determinantes sociales de la salud, tema al que también se refirió el Secretario General de las Naciones Unidas ( 19 ).…”

Just societies: A new vision for health equity in the Americas after COVID-19

“…This action is two-fold. On the one hand, it involves a broad spectrum of commitments from within the health sector, including primary health care and social protection in health to ensure both universal coverage and access within a proportionate universalism framework (18). On the other, it involves commitments to work beyond the health sector to address the social determinants of health, including action to improve the conditions in which people are born, grow, live, work and age, enacting comprehensive social protection and welfare system based upon solidarity, and realizing the redistributive potential of social spending to address the social determinants of health-as has also been addressed by the United Nations Secretary General (19).…”