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".
Equity in Health
Civil society organizations and scientists from around the world are calling for 'a new development paradigm' to address the toxic combination of climate change, growing poverty and inequality and poor health. The new report, Global Health Watch 2, says that unfair social and economic policies combined with bad politics are to blame for the poor state of the health of millions of people in the world. The report makes stinging criticisms of key global actors, and calls on governments to stop the Bank from meddling in health politics. Global Health Watch 2 provides examples of civil society mobilization across the world for more equitable health care and more health promotion, although more is needed to bring about significant improvements in health.
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.
Significant progress towards reducing child and maternal mortality is being made, but to meet the Millennium Development Goals (MDGs) 4, 5 and 6, strategies aimed at reaching the world’s most inaccessible, marginalised and vulnerable populations will be required, according to Ethiopia’s Minister of Health and the heads of four leading global health organisations – the GAVI Alliance, UNAIDS, the Global Fund to Fight AIDS, TB and Malaria and UNICEF. Many countries are committed to achieving the MDGs but rely largely on donor support for its national health plan to continue its progress. Increased funding has seen improved immunisation rates, more programmes against malaria (by providing insecticide-treated bed nets) and the expansion of anti-retroviral access to two million in sub-Saharan Africa have contributed to an improving health picture for the continent, with reductions in mortality and morbidity rates.
Why a renewal of primary health care (PHC), and why now, more than ever? Globalization is putting the social cohesion of many countries under stress, and health systems are clearly not performing as well as they could and should. People are increasingly impatient with the inability of health services to deliver. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. PHC can do that.
This report is based on a master set of data that has been compiled by an inter-agency and expert group on Millennium Development Goal (MDG) indicators, led by the Department of Economic and Social Affairs of the United Nations Secretariat, in response to the wishes of the General Assembly for periodic assessment of progress towards the MDGs. The group consists of representatives of the international organisations whose activities include the preparation of one or more of the series of statistical indicators that were identified as appropriate for monitoring progress towards the MDGs. This report summarises progress towards the Goals in each of the regions. However, any such synthesis inevitably masks the range and variety of development experiences in individual countries since the goals were adopted.
In its report, the Commission calls for increased public finance for programmes and policies to support the social determinants of health, including child development, education, improved living and working conditions and health care, recognising the failure of markets to supply vital goods and services equitably. It also calls for progressive taxation at the national level, a major increase in aid, improved aid quality and greater debt cancellation. It sees an urgent need for a global economic system that supports renewed government leadership to balance public and private sector interests, and identifies quantifying the impact of supra-national political, economic, and social systems on health and health inequities within and between countries as an important research need. Stronger global management of integrated economic activity and social development is needed as a more coherent way to ensure fairer distribution of globalisation's costs and benefits. The entrenched interests of some social groups and countries are seen as ‘barriers to common global flourishing’, and transnational companies should become accountable to the public good, not just to private profit.
This World Health Organisation report takes a broad look at inequality and health. The report issues a call to arms, stressing the need to tackle the inequitable distribution of power, money and resources through better governance, transparency, support for civil society and more equitable economic policies. Some claim the report offers a way out of the ‘sterile debate’ about whether poor health causes poverty, or vice versa. Critics point out that it downplays the link between income (as opposed to inequality) and health. One example of the correlation between money and health is from South Africa, where the health of older people improved after receiving pensions at the age of 65. But whether people are well or sick also depends on factors and policies that lie far beyond the remit of any health minister. For example, the Health Ministry may try to encourage handwashing, but it is unlikely to happen unless there is running water - which is beyond the Ministry’s control.
Publish What You Fund is the Global Campaign for Aid Transparency, which brings together leading NGOs and NGO coalitions to draft a first set of consultation materials – the Publish What You Fund principles, which were released in July 2008. These five principles are designed to be signed by all public and private bodies engaged in funding and delivering aid: 1. Information on aid should be published proactively. 2. Everyone can request and receive information on aid processes. 3. Information on aid should be timely and accessible. 4. Information on aid should be comparable. 5. The right of access to information about aid should be promoted. The principles will be reviewed in the run-up to the Accra High Level Forum, following an initial consultation period.
The Final Report of the Commission on Social Determinants of Health sets out key areas of daily living conditions and of the underlying structural drivers that influence them in which action is needed. It provides analysis of social determinants of health and concrete examples of types of action that have proven effective in improving health and health equity in countries at all levels of socioeconomic development. Part 1 sets the scene, laying out the rationale for a global movement to advance health equity through action on the social determinants of health. It illustrates the extent of the problem between and within countries, describes what the Commission believes the causes of health inequities are, and points to where solutions may lie. Part 2 outlines the approach the Commission took to evidence, and to the indispensable value of acknowledging and using the rich diversity of different types of knowledge. Parts 3, 4, and 5 set out in more detail the Commission s findings and recommendations. The chapters in Part 3 deal with the conditions of daily living the more easily visible aspects of birth, growth, and education; of living and working; and of using health care. The chapters in Part 4 look at more structural conditions social and economic policies that shape growing, living, and working; the relative roles of state and market in providing for good and equitable health; and the wide international and global conditions that can help or hinder national and local action for health equity. Part 5 focuses on the critical importance of data not simply conventional research, but living evidence of progress or deterioration in the quality of people s lives and health that can only be attained through commitment to and capacity in health equity surveillance and monitoring. Part 6, finally, reprises the global networks the regional connections to civil society worldwide, the growing caucus of country partners taking the social determinants of health agenda forward, the vital research agendas, and the opportunities for change at the level of global governance and global institutions that the Commission has built and on which the future of a global movement for health equity will depend.”