The world is witnessing a groundbreaking transition to universal health coverage. Yet few researchers have explained why nations as distinct as Rwanda and Thailand, for example, have chosen to implement universal coverage within the last decade or so. An analysis of international politics can help illuminate why the idea that everyone has a right to health has materialized into concrete health policies. This paper argues that both international norm construction and domestic conditions of

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... dual states influence whether or not countries adopt universal health coverage. As a principle norm creator and agenda setter, the World Health Organization's (WHO) pragmatic, evidence-based framing of universal coverage has enabled it to make a strong argument for UHC. Rather than characterize the WHO as the sole determinant of the transition to UHC, this paper asserts that it serves a catalytic role in shaping countries' decisions to reform their health systems—global and local limitations also constrain its mandate. National governments have unique economic and political conditions that work to enable or disable policy change. Thus, the powerful convergence of effective norm construction in international networks and greater local capacity has encouraged countries across the globe to reform their health systems.