# Correlation between structural determinants and universal health coverage in 2010 and 2019: An analysis of the global burden of disease study

## TL;DR

This study finds that better governance and economic conditions are linked to higher universal health coverage in countries worldwide from 2010 to 2019.

## Contribution

The study provides new evidence on the consistent relationship between structural determinants and health coverage across 204 countries over a nine-year period.

## Key findings

- Governance, GDP, and SDI showed strong and consistent positive correlations with UHC in both 2010 and 2019.
- Persistent disparities in UHC highlight the need for policies addressing social and economic inequalities.
- Government expenditure remained significantly correlated with UHC in both years.

## Abstract

To assess the correlation between structural determinants - governance, macroeconomic policies, culture/societal values, and public and social policies - and the Universal Health Coverage (UHC) Effective Coverage Index in 2010 and 2019, in 204 countries and territories.

This ecological study analyzed UHC effective coverage in 204 countries and territories using estimates from the Global Burden of Disease (GBD) 2019 study. Structural determinants were examined across five dimensions. Spearman’s correlation was used to examine the correlations.

UHC showed a positive correlation with structural determinants in both years. In 2010, moderate correlations were observed for governance (ρ = 0.61), GDP (ρ = 0.69), SDI (ρ = 0.62), and government expenditure (ρ = 0.58). In 2019, governance (ρ = 0.56), GDP (ρ = 0.71), SDI (ρ = 0.66), and government expenditure (ρ = 0.48) remained significantly correlated with UHC. GDP and SDI consistently showed the strongest correlations in both periods.

Countries with more favorable structural conditions had greater UHC, emphasizing the influence of governance and socioeconomic context on health systems performance. Persistent disparities highlight the need for policies targeting social and economic inequalities to achieve universal health coverage globally.