 Much current global debate, as well as a great deal of political rhetoric, about global health and healthcare is characterized by a renewed emphasis on the goal of universal access throughout the world. While this goal has been achieved to varying extents in the United Kingdom, Canada and many countries in Europe. The challenge is much greater in low and middle-income countries that lag behind, especially if aspirations to universal access go beyond primary care. This article was authored by Solomon Benatar and Stephen Gill.