Equity in Health

A detailed analysis of HIV-1 epidemiology in sub-Saharan Africa traces the spread of the virus to four factors: the subordinate position of women, poverty and the breakdown of social services, rapid urbanization, and war.

Journal Of Health Economics Vol. 21 (Issue3 - May 2002) pp. 497-513. Copyright (c) 2002 Elsevier Science B.V. Antoine Bommier, Guy Stecklov. Institut National d'etudes Démographiques (INED), INRA-Jourdan, Paris, France; and Department of Population Studies, Department of Sociology and Anthropology, Mount Scopus Campus, Hebrew University of Jerusalem, Israel. While there has been an important increase in methodological and empirical studies on health inequality, not much has been written on the theoretical foundation of health inequality measurement the authors discuss several reasons why the classic welfare approach, which is the foundation of income inequality analysis, fails to provide a satisfactory foundation for health inequality analysis. They propose an alternative approach which is more closely linked to the WHO concept of equity in health and is also consistent with the ethical principles espoused by Rawls [A Theory of Justice. Harvard University Press, Cambridge, MA, 1971]. This approach in its simplest form, is shown to be closely related to the concentration curve when health and income are positively related. Thus, the criteria presented in the paper provide an important theoretical foundation for empirical analysis using the concentration curve. They explore the properties of these approaches by developing policy scenarios and examining how various ethical criteria affect government strategies for targeting health interventions.

Paula Braveman, Department of Family & Community Medicine, University of California, USA; Eleuther Tarimo, Consultant, Ministry of Health and Child Welfare, Harare, Zimbabwe. Available online at the Social Science & Medicine website. While interest in social disparities in health within affluent nations has been growing, discussion of equity in health with regard to low- and middle-income countries has generally focused on north-south and between-country differences, rather than on gaps between social groups within the countries where most of the world's population lives. This paper aims to articulate a rationale for focusing on within- as well as between-country health disparities in nations of all per capita income levels, and to suggest relevant reference material, particularly for developing country researchers. explicit concerns about equity in health and its determinants need to be placed higher on the policy and research agendas of both international and national organizations in low-, middle-, and high-income countries. International agencies can strengthen or undermine national efforts to achieve greater equity. The Primary Health Care strategy is at least as relevant today as it was two decades ago; but equity needs to move from being largely implicit to becoming an explicit component of the strategy, and progress toward greater equity must be carefully monitored in countries of all per capita income levels. Particularly in the context of an increasingly globalized world, improvements in health for privileged groups should suggest what could, with political will, be possible for all.

Organized by the Rockefeller Foundation in collaboration with the World Bank and the World Health Organization. The growing efforts to combat HIV/AIDS, malaria and tuberculosis have the potential to bring major benefits to the disadvantaged, as well as produce an important reduction in overall disease burden. However, realizing this potential and securing better health among less favored populations will require a determined effort. There is need both to modify the inequitable patterns of disease risks and consequences and to pursue aggressively a more equitable distribution of benefits from programs dealing with HIV/AIDS, malaria and tuberculosis.