Equity in Health

Overall, child well-being as improved by 34% since 1990, but progress is slow. Leaders must consider how children are doing and how their decisions impact them. Children are doing worse in sub-Saharan Africa than any other region. Africa scores 35 in the Index, reflecting the high level of deprivation in primary schooling, child health and child nutrition. It is also making the slowest progress, improving child well-being by only 20% over 1990-2006. However, progress has been very mixed; some countries in Africa have done incredibly well, while others did spectacularly badly. Countries like Malawi cut child deprivation in half, enrolling more than 90% of primary school children. Some of the poorest children in Africa live in countries suffering from conflict and poor governance, such as Zimbabwe, Somalia and the Democratic Republic of Congo.

This report investigates the cause of a 24% drop in mortality in children under 5 years in Tanzania between 2000 and 2004. It investigated contextual factors that could have affected child mortality, in order to understand the likelihood of meeting the Millennium Development Goal for child survival (MDG 4). The observed reduction coincided with important improvements in Tanzania's health system, including a doubling of public expenditure on health, decentralisation and sector-wide basket funding, and increased coverage of key child-survival interventions, such as integrated management of childhood illness, insecticide-treated nets, vitamin A supplementation, immunisation and exclusive breastfeeding. The authors conclude that Tanzania could attain MDG 4 if this trend in improved child survival were to be sustained through increased investment.

In her speech, World Health Organization General Secretar Dr Margaret Chan referred to the current global economic crisis and its consequences for the health sector. The health sector had no say when the policies responsible for these crises were made, yet it bears the brunt. The remarks point to the high level of preventable disease and lack of access to health care services, and to massive inequalities in resources for health. For 5.6 billion people in low- and middle-income countries, more than half of all health care expenditure is through out-of-pocket payments. With the costs of health care rising and systems for financial protection in disarray, personal expenditures on health now push more than 100 million people below the poverty line each year. Last week, WHO issued its annual World Health Report which documents a number of failures and shortcomings that have left the health status of different populations, both within and between countries, dangerously out of balance. The WHO Commission on Social Determinants of Health report challenges governments to make equity an explicit policy objective in all government sectors. "Equity in access to health care comes to the fore as a way of holding globalization accountable, of channelling globalization in ways that ensure a more fair distribution of benefits, a more balanced and healthy world".

This paper analyses the concept of health equity, drawing on ideas of social justice, of rights and values, and of the social and economic determinants which define living conditions and power relations among social groups. It adopts the viewpoint of collective health and outlines the elements which are essential to the understanding of inequity: the role of social, economic, political, cultural and ideological determinants on the equity of health outcomes, access to services and quality of care. It concludes that theoretical/conceptual frameworks must be formally spelled out before we can advance our understanding of health equity. From a collective health perspective, we need to move beyond traditional approaches, a challenge which will enable better understanding of the social dynamics which, when expressed as inequalities in health, constitute social inequity.