An estimated 400 million people worldwide lack access to at least one of seven essential health services, ranging from pregnancy care to clean water, according to a report released on Friday by the World Health Organization and World Bank. At the same time, more people have access to essential health services than ever before, the report said, though coverage gaps remain.

The report, which examined surveys from 37 nations conducted between 2002 and 2012, is the first to track progress toward universal health coverage. The goal of universal coverage, which would mean all citizens would have access to health services without experiencing financial hardship to pay for them, is likely to be included in the United Nations’ upcoming Sustainable Development Goals.

The report found a median of 1.8 percent of people had experienced “catastrophic health spending” – costs totaling more than one-quarter of household expenditures – in the previous year, while 6 percent tipped or fell further below the extreme poverty line of $1.25 per day because of healthcare costs. When the poverty measure was raised to $2, that number climbed to 17 percent. Still, a sub-survey of 23 countries accounting for one-eighth of the world’s population found the proportion of people suffering catastrophic payments dropped 29 percent between 2000 and 2011. Impoverishing payments fell 24 percent over the same period.

The report suggested universal health coverage is an achievable goal and showed that progress has been made toward it. The aim has been controversial, particularly in some advanced nations including the United States, where debate persists over the structure, funding and feasibility of a universal program.

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