Tanzania is on track to meet Millennium Development Goal (MDG) 4 for child survival, but is making insufficient progress for newborn survival and maternal health (MDG 5) and family planning. To understand this mixed progress and to identify priorities for the post-2015 era, Tanzania was selected as a Countdown to 2015 case study. The authors analysed progress made in Tanzania between 1990 and 2014 in maternal, newborn, and child mortality, and unmet need for family planning, in which they used a health systems evaluation framework to assess coverage and equity of interventions along the continuum of care, health systems, policies and investments, while also considering contextual change (eg, economic and educational). In the past two decades, Tanzania's population has doubled in size, necessitating a doubling of health and social services to maintain coverage. Trends along the continuum of care varied, with preventive child health services reaching high coverage (≥85%) and equity (socioeconomic status difference 13–14%), but lower coverage and wider inequities for child curative services (71% coverage, socioeconomic status difference 36%), facility delivery (52% coverage, socioeconomic status difference 56%), and family planning (46% coverage, socioeconomic status difference 22%). Mixed progress in reproductive, maternal, newborn, and child health in Tanzania were found to indicate a complex interplay of political prioritisation, health financing, and consistent implementation.
Equity in Health
This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. The authors describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behaviour, environmental, and selection explanations. Concepts of relative versus absolute; dose–response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. The authors close by reflecting on what conditions make health inequalities unjust, and consider the merits of policies that prioritise the elimination of health disparities versus those that focus on raising the overall standard of health in a population.
While inequities in health protection are increasingly recognized as an important issue in current policy debates on universal health coverage (UHC) and in the post-2015 agenda, the rural/urban divide is largely ignored. This paper presents global estimates on rural/urban disparities in access to health-care services. The report uses proxy indicators to assess key dimensions of coverage and access involving the core principles of universality and equity. Based on the results of the estimates, policy options are discussed to close the gaps in a multi-sectoral approach addressing issues and their root causes both within and beyond the health sector.
Progress towards global vaccination targets for 2015 is far off-track with 1 in 5 children still missing out on routine life-saving immunizations that could avert 1.5 million deaths each year from preventable diseases. WHO issued this statement calling for renewed efforts to get progress back on course in the lead-up to World Immunization Week in April 2015.
The report delivers both promising and disappointing messages about the situation in low- and middle-income countries with respect to reproductive, maternal, newborn and child health indicators. Within-country inequalities have narrowed, with a tendency for national improvements driven by faster improvements in disadvantaged subgroups. 

However, inequalities still persist in most reproductive, maternal, newborn and child health indicators. The extent of within-country inequality differed by dimension of inequality and by country, country income group and geographical region. The patterns of change in inequality over time varied by health indicator, and according to country and dimension of inequality. The report observes that while national averages and improvements over time are important indications of progress on a global level, reporting inequalities within countries shows how any progress in national averages is realized by population subgroups. Establishing goals and targets that specify a reduction in inequality encourages the orientation of policies, programmes and practices to promote health in disadvantaged subgroups. Without a dedicated focus on equity, efforts to improve health can risk perpetuating or intensifying within-country inequality, even as increases in national coverage are achieved.
The author argues that eliminating malaria seems like a straightforward issue. Decades of malaria control efforts show there is more to the story. Much of the vulnerability to malaria, it turns out, is determined by human actions. The conditions in which people are born, grow, work, live, and age define to a great extent who is vulnerable to malaria and who is not. Malaria is both a result and a cause of a lack of development. The author asserts that we know that it is those countries with the lowest levels of human development that are most affected by malaria. And within populations, those living in the poorest circumstances also suffer disproportionately. This year 2015 is argued to mark a turning point in the world’s response to malaria with adoption of the new global framework Action and Investment to defeat Malaria (2016-2030) that places the management of the disease as a development issue. Under this plan, countries will for the first time report their progress on incorporating non-health sector interventions into their malaria control efforts.
This conference reports on work on the integration of social determinants of health – socioeconomic and structural factors – into immigrant health research and policy. A cross-national framework was used to consider issues of place, migration and health. In addition to public health, it drew upon the fields of economics, sociology of immigration, and social epidemiology, and incorporated three theoretical frameworks: the life-course framework from social epidemiology, the ‘push-pull’ factor theories from geography and economics, and transnational theory from sociology. It built upon recent academic literature, including a Social Sciences and Medicine (SSM) supplement on immigration and health, to formulate areas where more research is needed and to recommend potentially fruitful program interventions and policy changes. It integrated work with North American Latino immigrants, Asian and South Asian immigrants, African and Afro-Caribbean immigrants, and Arab immigrants, and research linking the migration to Europe of Arab, Turks and other populations, and to the Middle East of immigrants from Africa.
Accurate measurement of health inequities is indispensable to track progress or to identify needs for health equity policy interventions. A key empirical task is to measure the extent to which observed inequality in health – a difference in health – is inequitable. Empirically operationalising definitions of health inequity has generated an important question not considered in the conceptual literature on health inequity. Empirical analysis can explain only a portion of observed health inequality. This paper demonstrates that the treatment of unexplained inequality is not only a methodological but ethical question and that the answer to the ethical question – whether unexplained health inequality is unfair – determines the appropriate standardization method for health inequity analysis and can lead to potentially divergent estimates of health inequity.
A focus on social determinants of health provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of risk factors related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, the authors elaborate on how focusing instead on the language of “social determination of health” has led to application of more equity-sensitive approaches to research and related policy and praxis. The authors briefly explore the epistemological and historical roots of epidemiological approaches to health and health equity that have emerged in Latin America to consider its relevance to global discourse. In this region marked by pronounced inequity, context-sensitive concepts such as “collective health” and “critical epidemiology” have been prominent, albeit with limited acknowledgement by the Global North. The authors illustrate attempts to apply a social determination approach (and the “4 S” elements of bio-Security, Sovereignty, Solidarity and Sustainability) in five projects within their research collaboration linking researchers and knowledge users in Ecuador and Canada, in diverse settings (health of healthcare workers; food systems; antibiotic resistance; vector borne disease [dengue]; and social circus with street youth). The authors argue that the language of social determinants lends itself to research that is more reductionist and beckons the development of different skills than would be applied when adopting the language of social determination. They conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts. It follows that “reverse innovation” must not only recognise practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.
Despite the relentless efforts to reduce infant and child mortality with the introduction of the National Expanded Programmes on Immunization in 1974, major disparities still exist in immunization coverage across different population sub-groups. In Kenya, while the proportion of fully immunized children increased from 57% in 2003 to 77% in 2008–9 at national level and 73% in Nairobi, only 58% of children living in informal settlement areas are fully immunized. This study aimed to determine the degree and determinants of immunization inequality among the urban poor of Nairobi, using data from the Nairobi Cross-Sectional Slum Survey of 2012 on full immunization status among children aged 12–23 months. The wealth index was used as a measure of social economic position for inequality analysis. Immunization inequality was found to be mainly concentrated among children from poor families. Decomposition of the results suggests that 78% of this inequality is largely explained by the mother’s level of education. The author suggests that efforts to reduce this inequality should aim at targeting mothers with low levels of education during immunization campaigns.