Equity in Health

Communique: Meeting of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda in Monrovia, Liberia
High-Level Panel of Eminent Persons on the Post-2015 Development Agenda: 1 February 2013

The High-Level Panel of Eminent Persons on the Post-2015 Development Agenda has been tasked by United Nations Secretary-General Ban Ki-Moon to develop a framework for a post-2015 development agenda. This Communiqué reports on the Panel’s third meeting in Monrovia, Liberia from 30 January to 1 February 2013, where members took stock of the progress achieved so far towards the fulfilment of the Panel’s mandate. Members agreed to make every effort to achieve the Millennium Development Goals by 2015, while also framing a single and cohesive post-2015 development agenda that integrates economic growth, social inclusion and environmental protection. Economic growth alone is not sufficient to ensure social justice, equity and sustained prosperity for all people. The global community must pursue economic and social transformation leading to sustained and inclusive economic growth at the local, national and global levels. The protection and empowerment of people is crucial. Achieving structural transformations through a global development agenda will involve: sustainable growth with equity, creating wealth through sustainable and transparent management of natural resources; and partnerships with many actors, unified behind a common agenda.

Health in the Post-2015 Development Agenda: Report of the Global Thematic Consultation on Health: Draft for public comment
Task Team of the Global Thematic Consultation on Health: 1 February 2013

Placing health at the heart of the post-2015 development agenda will not only save lives and advance economic development, it will also protect environmental sustainability, and advance wellbeing, equity and social justice, according to this report. It makes a number of recommendations. Health goals should be equitable, holistic and people-centred. The post-2015 development agenda should be direct explicit attention to reducing health inequities between and within all countries, especially when considering the needs of the poor, marginalised, and those whom the efforts of the Millennium Development Goals (MDGs) have not reached. The right to health means that governments must generate conditions in which everyone can be as healthy as possible. A hierarchy of goals is needed to capture the increasing complexity of priority health challenges and the reality that efforts to prevent disease and disability and improve health and well-being require policies and actions both within the health sector and across many other sectors. Indicators need to measure impact, coverage of health services and health systems. Some qualitative indicators may be needed to measure quality of life and well-being, while assessing quality of health services may require qualitative as well as quantitative indicators. The MDG targets and indicators as well as those in other internationally agreed agendas should be revised for the post-2015 era and included under the relevant goals.

Results of the Consultation with Representatives of Local Governments, Indigenous Communities, Afro-Communities, and Civil Society Organizations about the Post 2015 Development Agenda on the topic of Health
PAHO, Antigua Guatemala, 12 to 14 February 2013

The commitment toward achieving universal coverage understood as access to quality, individualized healthcare for all, in a human rights framework, has been profiled as the Goal of the Post 2015 Development Agenda on the topic of Health. For this reason, the Pan American Health Organization proposed a consultation of the key social actors in this process and to hear their voices. The present document summarizes the debate and the agreements assumed by the representatives of civil society organizations, municipal authorities or mayors, indigenous authorities, afro descendants, and other civil society representatives.

Further details: /newsletter/id/37689
Health and social justice
Ruger JP: Oxford University Press, 2010

Societies make decisions and take actions that profoundly impact the distribution of health. Why and how should collective choices be made, and policies implemented, to address health inequalities under conditions of resource scarcity? How should societies conceptualise and measure health disparities, and determine whether they've been adequately addressed? Who is responsible for various aspects of this important social problem? In her book, Jennifer Prah Ruger elucidates principles to guide these decisions, the evidence that should inform them, and the policies necessary to build equitable and efficient health systems world-wide. This book weaves together original insights and disparate constructs to produce a foundational new theory, the health capability paradigm, in which all people should have access to the means to avoid premature death and preventable morbidity. Ruger's theory takes the ongoing debates about the theoretical underpinnings of national health disparities and systems in a new rights-based direction. She shows the limitations of existing approaches (utilitarian, libertarian, Rawlsian, communitarian), and effectively balances a consequentialist focus on health outcomes and costs with a proceduralist respect for individuals' health agency. Through what Ruger calls ‘shared health governance’, her approach emphasises responsibility and choice. It allows broader assessment of injustices, including attributes and conditions affecting individuals' ability to ‘flourish’, as well as societal structures within which resource distribution occurs.

Migration and health in South Africa: A review of the current situation and recommendations for achieving the World Health Assembly Resolution on the Health of Migrants
Vearey J and Nunez L: Forced Migration Studies Programme, University of the Witwatersrand, 2010

This paper focuses on migration in South Africa, and explores the links between health and the movements of people within the county and across its borders. The authors found that most migrants send remittances to their families back home or provide reciprocal care in times of sickness. Current health system planning within South Africa did not appear to adequately engage with the health of migrants in urban and transition areas. The authors emphasise the importance of engaging with a place-based approach to address the health of those affected by the migration process in South Africa. They argue that South Africa needs to develop, implement and monitor an evidence-based, coordinated, multi-level national response to migration and health, with an emphasis on the role of local government. Planning should address the needs of those who return home to die when they are too sick to work and government should also work towards developing a co-ordinated regional response to migration and health.

Reducing child mortality: A moral and environmental imperative
Rosling H: Gapminder, 20 September 2010

This presentation by Hans Rosling of Gapminder was presented on 20 September 2010 at an event reflecting on the progress made against the Millennium Development Goals, hosted by the Bill & Melinda Gates Foundation TEDxChange. Using United Nations data on child mortality, he pointed out the reduction in child mortality at an accelerating speed by African countries like Kenya, after poor performance in the 1990s. In this video of his lecture, he says that the time has come to ‘stop talking about sub-Saharan Africa as one place’, as statistics vary so widely between countries on the continent. He also questions the definitions of ‘developed’ and ‘developing’ countries, arguing that the distinction is no longer strictly valid given that countries with lower incomes have better performance on child mortality than others with higher incomes.

The movement of patients across borders: Challenges and opportunities for public health
Helble M: Bulletin of the World Health Organization 89(1): 68–72, January 2011

In a globalising world, public health can no longer be confined to national borders, the author of this paper argues. Recent years have seen an increasing movement of patients across international borders. The full extent of this trend is yet unknown, as data is sparse and anecdotal. If this trend continues, experts are convinced that it will have major implications for public health systems around the globe. Despite the growing importance of medical travel, little empirical evidence exists on its impact on public health, especially on health systems. This paper summarises the most recent debates on this topic. It discusses the main forces that drive medical travel and its implications on health systems, in particular the impacts on access to health care, financing and the health workforce. The author offers guidance on how to define medical travel and how to improve data collection. He advocates for more scientific research that will enable countries to harness benefits and limit the potential risks to public health arising from medical travel.

Universal health coverage with equity: what we know, don’t know and need to know
Frenz P and Vega J: Global Symposium on Health Systems Research, November 2010

In this paper, the authors review the extensive body of literature regarding health systems research on equity of access as it relates to universal health coverage, identifying the issues addressed, methods used and specific findings. Most of the studies that were reviewed interpreted equitable access as equal utilisation for equal need across socio-economic groups and report that poorer social groups experience less health care than their needs require. However, the authors noted that evidence on the causes and specific barriers to access faced by specific groups is often lacking in the literature. Only a few studies evaluated the impact of specific policies or interventions on equitable access, but they had significant methodological limitations. These findings suggest a need to strengthen policy relevant research, which should go beyond simply reporting inequities in health care utilisation and assess equity in the overall process of access to explain the causes of differential access. The framework devised by the authors is proposed as a useful reference scheme for future research, providing guidance on areas and methodological approaches.

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al: The Lancet 380 (9859): 2224-2260, 15 December 2012

The authors of this study estimated deaths and disability-adjusted life years (DALYs), years lived with disability (YLD) and years of life lost (YLL) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. They included estimates from published and unpublished literature, and data from the Global Burden of Disease Study 2010. Worldwide, the contribution of different risk factors to disease burden appears to have changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than five years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

Age-specific and sex-specific mortality in 187 countries, 1970—2010: a systematic analysis for the Global Burden of Disease Study 2010
Wang H, Dwyer-Lindgren L, Lofgren KT, Rajaratnam JK, Marcus JR et al: The Lancet 380 (9859): 2071-2094, 15 December 2012

In this study, researchers estimated life expectancy and mortality rates for children under five and adults for 187 countries from 1970 to 2010. Findings showed that from 1970 to 2010, global male life expectancy increased from 56.4 years to 67.5 years and global female life expectancy increased from 61.2 years to 73.3 years. Substantial reductions in mortality occurred in eastern and southern sub-Saharan Africa since 2004, coinciding with increased coverage of antiretroviral therapy and preventive measures against malaria. Globally, 52.8 million deaths occurred in 2010, which is about 14% more than occurred in 1990, and 22% more than occurred in 1970. Deaths in children younger than 5 years declined by almost 60% since 1970. Yet substantial heterogeneity exists across age groups, among countries, and over different decades. Greater efforts should be directed to reduce mortality in low-income and middle-income countries, the authors argue. Improvement of civil registration system worldwide is crucial for better tracking of global mortality.

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