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”

This commentary reflects on an important article by Fisher and colleagues who draw on four Australian policy case studies to examine how universal and targeted approaches or a combination can be deployed to improve health equity. They conclude that universal approaches are central to action to increase health equity, but that targeting can improve equity of access in some situations including in the context of proportionate universalism. However, we argue that although target services may provide benefits for some populations, they are often stigmatizing and fail to reach may people they aim to support. Instead of accepting the dominant discourse about the key role for targeted approaches, we argue that those committed to reduce social and health inequities should consider the potential of Equity Sensitive Universalism (ESU). This approach focuses on achieving proportionate outcomes with equally provided resources rather than proportionate inputs and provides a ‘cohesion dividend,’ increasing social solidarity.