Universal health coverage (UHC) and human development move together, but a new country-level analysis suggests the strength of that relationship depends heavily on which aspect of health coverage is being measured. A retrospective longitudinal panel study, drawing on publicly available data from 2000 to 2021, examined how the UHC service coverage index (SCI) and its four sub-indices relate to the Human Development Index (HDI) and its component indices for gross national income, education, and life expectancy.
The study, authored by Akira Hayasaka, Yasuhiro Nakanishi, Marika Nomura, and Eri Osawa, also quantified differences in the UHC SCI, its sub-indices, and the HDI across World Bank income groups and World Health Organization regions using population-averaged generalized estimating equation models.
Overall, UHC service coverage improved over time across income groups and regions, but the researchers found that progress was uneven. Persistent income-group disparities were observed for the overall UHC SCI, for the infectious diseases sub-index, for service capacity and access, and for the HDI itself. By contrast, disparities were smaller for reproductive, maternal, newborn, and child health (RMNCH) and less pronounced for noncommunicable diseases (NCDs).
Regional differences told a somewhat different story. After covariate adjustment, regional differences were generally smaller than income-group disparities. RMNCH showed little regional variation, whereas service capacity and access remained significantly lower in the African Region.
The central quantitative finding concerns the link between human development and coverage. Higher HDI was associated with better UHC performance after adjustment. For each 0.1-unit increase in the HDI, the UHC SCI rose by an estimated 6.8 points (95% CI 5.6–8.1). The association was strongest for service capacity and access, which increased by 11.7 points (95% CI 9.2–14.1) per 0.1-unit HDI increase, followed by infectious diseases at 6.2 points (95% CI 4.2–8.1) and RMNCH at 4.9 points (95% CI 3.2–6.7).
The noncommunicable disease sub-index showed a notably weaker association, rising by an estimated 2.2 points (95% CI 0.4–4.0) per 0.1-unit increase in HDI. This suggests that coverage of NCD services is less tightly coupled to overall human development than other domains of health coverage.
Breaking the HDI into its components revealed further nuance. The education index was not associated with the NCD sub-index after adjustment, whereas the gross national income index and the life expectancy index were both positively associated with NCD coverage, although the estimated increases were smaller than those for most other sub-indices.
The authors note that these findings may help policymakers interpret the UHC SCI and its sub-indices in the context of their countries’ broader development trajectories. Because the analysis is observational and country-level, it identifies associations rather than causal effects, and the estimates describe patterns across countries between 2000 and 2021 rather than outcomes of any specific policy intervention.
Subject of Research: Associations between the universal health coverage service coverage index and the human development index across countries
Article Title: Associations between the universal health coverage service coverage index and the human development index: A country-level longitudinal panel study
Article References: Hayasaka, A., Nakanishi, Y., Nomura, M., & Osawa, E. (2026). Associations between the universal health coverage service coverage index and the human development index: A country-level longitudinal panel study. PLOS Global Public Health, 6(10), e0007328. https://doi.org/10.1371/journal.pgph.0007328
Image Credits: AI Generated
DOI: 10.1371/journal.pgph.0007328
Keywords: universal health coverage, human development index, service coverage index, health policy, global health, noncommunicable diseases, infectious diseases, health systems, income disparities, longitudinal study, Associations, between
News Source: Ophelia Keating. (October 28, 2026). Higher Human Development Tied to Stronger Universal Health Coverage, Global Panel Study Finds. Scienmag.
