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PubMed2004

[Health, equity, and the Millennium Development Goals].

In September 2000 representatives of 189 countries met for the Millennium Summit, which the United Nations convened in New York City, and adopted the declaration that provided the basis for formulating the Millennium Development Goals (MDGs). The eight goals are part of a long series of initiatives that governments, the United Nations system, and international financial institutions have undertaken to reduce world poverty. Three of the eight goals deal with health, so the health sector will be responsible for implementing, monitoring, and evaluating measures proposed to meet targets that have been formulated: to reduce by two-thirds the mortality rate in children under 5 years of age between 1990 and 2015; to reduce by three-quarters the maternal mortality rate between 1990 and 2015; and to halt and begin to reverse the spread of HIV/AIDS by the year 2015, as well as to halt and begin to reverse the incidence of malaria, tuberculosis, and other major diseases. The health sector must also work with other parties to achieve targets connected with two other of the goals: to improve access to affordable essential drugs, and to reduce the proportion of persons who do not have safe drinking water. Adopting a strategy focused on the most vulnerable groups-ones concentrated in locations and populations with the greatest social exclusion-would make possible the largest total reduction in deaths among children, thus reaching the proposed target as well as producing greater equity. In the Region of the Americas the principal challenges in meeting the MDGs are: improving and harmonizing health information systems; designing health programs related to the MDGs that bring together the set of services and interventions that have the greatest impact, according to the special characteristics of the populations who are intended to be the beneficiaries; strengthening the political will to support the MDGs; and guaranteeing funding for the measures undertaken to attain the MDGs.

Goals↗
PubMed2003

Defining equity in health.

STUDY OBJECTIVE: To propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept. DESIGN: Conceptual discussion. Setting, Patients/Participants, and Main results: not applicable. CONCLUSIONS: For the purposes of measurement and operationalisation, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage-that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The proposed definition of equity supports operationalisation of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health.

Bioethics↗
PubMed2003

[Drug consumption and health equity in the Metropolitan Area of Buenos Aires, Argentina].

OBJECTIVE: To assess the level of equity in drug consumption patterns in the Metropolitan Area of Buenos Aires, Argentina, given the transformation of the Argentine pharmaceutical market since the deregulation of the country's economy in 1991. METHODOLOGY: For this study, data from secondary statistical sources were processed and analyzed. The secondary sources used were two household surveys that contained a module on the utilization of health services and the associated expenditures. The surveys had been designed by the Ministry of Health and were applied in the Metropolitan Area of Buenos Aires in 1989 and 1995. RESULTS: There was a socially regressive increase in out-of-pocket expenditures on drugs between 1989 and 1995, in a market where average drug prices doubled in the midst of relaxed price controls and more open imports. The regressive character of drug expenditures was shown in the growth in direct spending for drug purchases, the increase in the proportion of private health expenditures devoted to drugs, and the unequal increase among the different economic strata in the proportion of family income going toward drugs. CONCLUSIONS: Out-of-pocket expenditures on drugs are an efficient indicator of equity for studying the financial protections that urban Argentines have when they become ill. This kind of indicator of financial equity could help improve the regulatory framework of the pharmaceutical market by incorporating social evaluation criteria along with analyses of pharmaceutical safety and therapeutic efficacy.

Argentina↗
PubMedDate not supplied

[People of African descent in the region of the Americas and health equity].

The Region of the Americas and the Caribbean has a complex demographic profile from an ethnic and racial perspective. One of the largest groups is composed of persons of African descent, who in some countries, such as Brazil and the Dominican Republic, comprise 46 and 84% of the total population, respectively. Recent analyses of the statistics available in some countries of the Region show wide gaps in terms of living conditions and health in these communities, as well as gaps in access to health services. PAHO, through its Public Policy and Health Program, under the Division of Health and Human Development, supports sectorial efforts and those of civil organizations that aim to improve health conditions in this segment of the population, while taking into account their sociodemographic and cultural characteristics. This article briefly summarizes health conditions and access to health services in selected countries, as well as some aspects of the recent changes to the legislation in those countries. Finally, collaborative activities on the part of United Nations agencies and international financial institutions for the benefit of people of African descent and other ethnic minorities are described.

Africa↗
PubMed2003

Examining health equity through satisfaction and confidence of patients in primary healthcare in the Republic of Trinidad and Tobago.

Surveys of patient satisfaction are widely used for identifying priorities and problems in healthcare reforms. The present study examined satisfaction and confidence of patients in public healthcare in Trinidad and Tobago. Data were gathered by interviewing a random sample (n = 280) of primary healthcare (PHC) patients. Level of patient satisfaction was high but not constant. Results of interviews showed that patients with a higher monthly income (p = 0.032) and patients who most recently used private medical care (p = 0.037) had lower levels of satisfaction with health services. Employment had an effect on satisfaction (p = 0.065), significant among patients who had recently accessed private medical care (p = 0.039). Patients using PHC clinics preferred private care to public care. Confidence in public care decreased with increasing complexity of the medical condition. These preliminary results support continued efforts in health-sector reforms and call for the enhancement of data on satisfaction through more comprehensive qualitative data-collection methods.

Adolescent↗
PubMed2005

Prevention of chronic kidney and vascular disease: toward global health equity--the Bellagio 2004 Declaration.

Chronic kidney disease (CKD) not only reflects target organ injury in systemic vascular disease in the general population and in association with diabetes, hypertension, and smoking, but it is recognized as one of the major risk factors in the pathogenesis and outcome of cardiovascular disease. Recent surveys have revealed that the prevalence of CKD, particularly the hidden mild form (mildly elevated levels of serum creatinine or urinary albumin excretion), is surprisingly high in the general population. In recent years, the global epidemic of type 2 diabetes has led to an alarming increase in the number of patients with CKD. Most patients with CKD (over 50 million individuals worldwide) succumb to cardiovascular events, while each year over 1 million develop end-stage renal failure, which requires costly treatment and in many countries of the world, unaffordable renal replacement therapy by chronic dialysis or renal transplantation. Alarmed by the immense challenge to human morbidity and the economic burden of CKD and ensuing systemic cardiovascular disease, the International Society of Nephrology convened a multidisciplinary group of expert physicians and public health leaders from around the world to develop strategies to delay and avert this bleak future by effective prevention of CKD based on awareness, early detection, and effective treatment.

Cardiovascular Diseases↗
PubMed2006

Meeting report on the Bellagio Conference 'prevention of vascular diseases in the emerging world: An approach to global health equity'.

Representatives from five international organizations (International Society of Nephrology, World Heart Federation, International Diabetes Federation, International Atherosclerosis Federation, and International Society of Hypertension) participated in a strategic planning workshop in December 2005 in Bellagio, Italy sponsored by the Rockefeller Foundation. There were equal representatives from developed and developing countries. Global perspectives on diabetes and cardiovascular and renal diseases were presented, with special emphasis on China, India, Latin America, and Africa. The rationale and effectiveness of preventive measures were discussed. It was apparent that measures for primary prevention and early intervention for all the chronic vascular diseases are similar. The five organizations agreed that an integrated global approach to chronic vascular diseases is needed. They resolved to collaborate and work towards an integrated approach to chronic vascular diseases with the establishment of a 5-year plan for the prevention and treatment of chronic vascular diseases, including public advocacy, advising international and national agencies, and improving education and the practice of established approaches.

Chronic Disease↗
PubMed1995

No real progress towards equity: health of migrants and ethnic minorities on the eve of the year 2000.

The paper reviews the available evidence on access to health care and two health outcomes, perinatal mortality and accident/disability, for migrant and ethnic minorities in selected receiving industrialized countries. The health of these communities is analyzed using the entitlement approach, which considers health as the product of both the individual's private endowments and the social environment he or she faces. Migrants, especially first and second generations, and ethnic minorities often have reduced entitlements in receiving societies. Not only are they exposed to poor working and living conditions, which are per se determinants of poor health, but they also have reduced access to health care for a number of political, administrative and cultural reasons which are not necessarily present for the native population. The paper argues that the higher rates of perinatal mortality and accidents/disability observed in many migrant groups compared to the native population are linked to their lower entitlements in the receiving societies. Policies aimed at reducing such health gaps need to be accompanied by a more general effort to reduce inequalities and to promote full participation of these groups in the mainstream of society.

Accidents, Occupational↗
PubMed2026

The Network of National COVID-19 Data Portals: public health equity through collaboration.

The network of the national COVID-19 Data Portals was developed and linked to the COVID-19 Data Portal (https://www.covid19dataportal.org/)inresponsetothe need for rapid data sharing and analysis during the 2020-2022 SARS-CoV-2 pandemic. Built on open-source code developed by the Swedish COVID-19 Data Portal (now the Swedish Pathogens Portal, www.pathogens.se) the network included 12 national portals addressing demand for local open data sharing and access, across data types and resources. It provides a robust case study of national initiatives for FAIR (Findable, Accessible, Interoperable and Reusable) resources and a foundation for future pandemic preparedness across pathogens globally. In this paper we outline the structure of the origins of the network of National COVID-19 Datal Portals, the technical aspects and code originating from the Swedish Portal and provide an overview of the services and tools offered by each Portal. The paper showcases the process and operation of four Portals: Sweden, Poland, Spain, Norway and The Netherlands. In this study, we observe that pandemic response greatly benefits from an established infrastructure that can be quickly mobilised, developed and extended. Collaborations and preparation built on solid foundations over several years, supported by investment in the form of national and international research grants, is key for sustainability, continuation and readiness to deploy such efforts.

COVID-19↗
PubMedDate not supplied

[Information, communication, and equity: dilemmas in health].

Equity, which is a form of justice, is the absence of inequalities that are evitable or unjust or that stem from preventable causes. In the area of health, it is linked to prudence that should prevail in the exercise of the health professions. Information, like any other social commodity, can be distributed in an inequitable way among different groups or populations due to technological barriers or cultural factors. However, knowledge is not just information; it is information that is aimed at a specific social purpose. Inequity in knowledge can be reduced by means of genuine communication, as Habermas proposed. This article deals with scientific communication as much as it does with public knowledge and the way information is disseminated.

Bioethics↗
PubMed2003

Secular trends in physiological capital: implications for equity in health care.

Over the past three centuries, there has been a rapid accumulation of physiological capital in Organisation for Economic Cooperation and Development (OECD) countries. Enhanced physiological capital is tied to long-term reduction in environmental hazards and to the conquest of chronic malnutrition, since both nutritional status and the quality of the external and intrauterine environments appear to be linked to the quality of organ development and to the onset of chronic diseases later in life. Data on heights and birth weights suggest that physiological capital has become more equally distributed, thereby reducing socioeconomic disparities in the burden of disease. These developments have a number of health care policy implications: (1) enhanced physiological capital has done more to reduce inequities in health status than has wider access to health care; (2) the main contribution of more advanced medical treatment so far has been to retard depreciation in individuals' physiological capital; (3) prenatal and early childhood care and environmental issues are key for interventions aimed at enhancing physiological capital and at affecting its rate of depreciation; (4) lifestyle change is the most important issue affecting health equity in rich countries; and (5) greater access to clinical care should be promoted through aggressive outreach, since expanded insurance coverage by itself is inadequate.

Female↗
PubMed2003

Monitoring equity in health and healthcare: a conceptual framework.

This paper aims at articulating a conceptual framework for monitoring equity in health and healthcare. The focus is on four main questions: What is health equity? What is monitoring? What are the essential components of a system for monitoring health equity? and Why monitor health equity? Monitoring equity in health and healthcare requires comparing indicators of health and its social determinants among social groups with different levels of underlying social advantage, i.e. groups who occupy different positions in a social hierarchy. A framework is presented for formulating the key questions, defining the social groups to be compared, and selecting the health indicators and measures of disparity that are fundamental to monitoring health equity. Although monitoring health equity is a scientific endeavour, its fundamental objective is guided by values; technical challenges should be addressed as part of a broader strategy to confront the political obstacles to greater equity.

Health Care Rationing↗
PubMed1990

Equity objectives in Portuguese health policy.

The health-equity debate has generally given far more attention to empirical rather than conceptual matters. However, empirical work on equity is at its most useful when it can be related to a specific normative framework, such as that provided by public pronouncements. This paper, therefore, aims to extract the precise equity objectives of one health care system, that of Portugal. Three seemingly distinct objectives in Portuguese health policy are identified: (i) access to health promoting commodities; (ii) equal access to NHS care for equal need; and (iii) equal access to both public and private health care. The final section attempts to find common threads running through these definitions and presents suggestions for future research. Though referred specifically to Portugal, the paper should be of interest to researchers in other countries, where a great deal of health-equity investigation continues to put the cart before the horse, by identifying unequal distributions without considering if they are simultaneously inequitable.

Health Policy↗