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PubMed2001

Health for All in the Twenty-First Century, World Health Organization renewal, and equity in health: a commentary.

Health for All in the Twenty-first Century is the document presenting the global health policy adopted by the World Health Organization (WHO) in 1998, which reaffirms and updates the vision of Alma-Ata. This article provides a synopsis of the document and a commentary, concentrating on the issue of equity, which is central to WHO policy, and discussing cultural differences that underpin the notion of equity. The meaning of "equity" implies measurement, and the authors develop an approach to definitions of social strata and data issues that are used to quantify health differences. Finally, they discuss the way in which policies invoking equity are implemented into programs and present a rights-based approach as a case study of one way in which policy is being translated into action.

Health Plan Implementation↗

PubMed1980

Optimism on attaining health care equity.

In spite of persistent problems, progress of the last 40 years gives grounds for optimism about trends toward equity in health care. In the United States, substantial improvements have been achieved in the coverage of insurance providing economic access to medical care, in the extent of group medical practice, in health manpower resources, in the supply and distribution of hospital beds, in the scope of preventive public health services, in medical care of the poor, in the surveillance of medical care quality, in the availability of sound patterns of health care delivery, in comprehensive planning of health resources and services, and in the health status of the population. All these gains have made against the bitter opposition of conservative interests. With continued and determined efforts, one may be optimistic about achieving further progress toward health care equity.

Delivery of Health Care↗

PubMed2003

Research and equity in child health.

In this article, I address 3 questions about research in the area of health inequities for children: why continue to do research, where should research efforts focus, and how best can we facilitate the development of research in the area of health equity? I was prompted to consider these issues by colleagues who think that doing research into child health inequalities is a waste of time. They say that not because they come from a right-wing perspective; on the contrary, they say, "Listen, we know about this stuff, why don't you just get on and do something about it and stop worrying about the research?" Therefore, we must rethink the relevance of the why and the what before we consider the how.

Child↗

PubMed2001

Improving equity in health: a research agenda.

Equity in health and health care have become important priorities for the world. If efforts at achieving equity are to have any basis in evidence concerning which strategies are likely to work, a research agenda is necessary. An adequate research agenda requires a knowledge of what the problem is, an understanding of the genesis and correlates of the problem, methods to measure these correlates, and rigorous testing of alternative explanations and interventions. This article presents a working definition of equity in health and health services, a conceptual framework in which to view the various types of influence on health and distribution of health in populations, a summary of evidence on the effects of some of these categories, and a research agenda for guiding efforts to improve knowledge on which to base interventions that enhance the attainment of equity. Because of their relative neglect in the existing literature on equity in health, the special roles of political forces and of primary care as a particularly key element of health services are stressed.

Developed Countries↗

PubMedDate not supplied

[Health reform, equity and the right to health in Colombia].

The author develops a long-term perspective to assess advances in equity and the right to health in the Colombian health system reform. In a restricted political system, actors in the field of health in Colombia have chosen individualistic alternatives to legalize inequities in individual purchasing power for services. Despite the complex regulations established in the General System for Social Security in Health, there is a trend towards consolidating traditional inequities and to further restrict opportunities for achieving the right to health with full, equitable, universal guarantees.

Colombia↗

PubMed2002

Equity in health care from a communitarian standpoint.

Equity in health and health care is an important issue. It has been proposed that the pursuit of equity in health care is being hampered by the dominance of individualism in health care practices. This paper explores the way in which communitarian ideals and practices might lend themselves to the pursuit of equity. Communitarians acknowledge, respect and foster the bonds that unite and identify communities. The paper argues that, to achieve equity in health care, these bonds need to be recognised and harnessed rather than ignored. The notion of individual autonomy in the context of the community is examined. Alternative concepts of autonomy--social autonomy and community autonomy--are seen to be more respectful and nurturing of both the individual and the community. Moreover, these concepts appear desirable for the pursuit of health care equity goals. The paper concludes with some thoughts about how equity in Australia's health care system can reasonably progress within a communitarian vision. Disadvantaged communities are discussed throughout, in particular, Australian Aboriginal communities.

Australia↗

PubMed1993

Health research, a key to equity in health development.

This paper reinforces the idea of integrating more closely the social and medical sciences with an emphasis on people. The nexus between health and development is examined together with national research capability building as part of essential national health research progress. Suggestions are made identifying the most urgent requirements for further action.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Is reasonable access what we want? Implications of, and challenges to, current Canadian policy on equity in health care.

Considerations of equity in the context of health care systems are often related closely to the presence or level of prices incurred by users of health care services. Some politicians and commentators have suggested that the removal of user charges under the Canadian health care system has led to equal access to care. But it is not clear that the equity principle inferred from these claims corresponds to the equity goals of current Canadian health policy. In this article the authors identify the precise equity principle that lies behind current health policy in Canada and consider the extent to which that principle is reflected in the performance of the system. They then consider other approaches to equity in health care in the context of the stated objectives of Canadian health policy and identify the implications of pursuing reasonable access in future health policy. The authors suggest that the implications of the current equity goals have not been recognized by policy makers, and if they were to be recognized it is not clear that they would be acceptable to Canadian populations and/or policy makers. Moreover, some of the implications would appear to be incompatible with other stated objectives of public policy.

Canada↗

PubMed1989

The demand for effectiveness, efficiency and equity of health care.

Effectiveness, efficiency and equity in health care are discussed in this article against the background of concerns that 'cost containment' may lead to reductions in quality of care. It is suggested that effectiveness is best seen from the patient's point of view and that it relates to more than simply improved health status. Efficiency and equity are better viewed from a societal stance. The paper discusses the role of the medical profession in effectiveness, efficiency and equity and argues that the role of medical doctors needs to be constrained.

Cost Control↗

PubMed2002

Annotated Bibliography on Equity in Health, 1980-2001.

The purposes of this bibliography are to present an overview of the published literature on equity in health and to summarize key articles relevant to the mission of the International Society for Equity in Health (ISEqH). The intent is to show the directions being taken in health equity research including theories, methods, and interventions to understand the genesis of inequities and their remediation. Therefore, the bibliography includes articles from the health equity literature that focus on mechanisms by which inequities in health arise and approaches to reducing them where and when they exist.

Journal Article↗

PubMed1988

The consequences of health service privatisation for equality and equity in health care in South Africa.

The trend towards the privatisation of health services in South Africa reflects a growing use of private sources of finance and the growing proportion of privately owned fee-for-service providers and facilities. Fee-for-service methods of reimbursement aggravate the geographical maldistribution of personnel and facilities, and the competition for scarce personnel resources aggravates the difference in the quality of the public and private services. Thus the growth in demand for these types of providers may be expected to increase inequality of access in these two respects. The potential expansion of medical scheme coverage is shown to be limited to well under 50% of the population, leaving the majority of the population without access to private sector health care. Even for members of the medical schemes, benefits are linked to income, thus clashing with the principle of equal care for equal need. The public funds needed to overcome financial obstacles to access to private providers could be more efficiently deployed by financing publicly owned and controlled health services directly. Taxation also offers the most equitable method of financing health services. Finally, attention is drawn to the dilemma resulting from the strengthening of the private health sector; while in the short term this can offer better care to more people on a racially non-discriminatory basis, in the long term, health care for the population as a whole may become more unequal and for those dependent on the public sector it may even deteriorate.

Black People↗

PubMed1997

In search of human dignity: gender equity, reproductive health and healthy aging.

This paper analyzes the nine pillars of human dignity (sufficient food, potable water, shelter, sanitation, health services, healthy environment, education, employment and personal security), which humankind tries to establish by following nine approaches to reality (scientific, cultural, religious, ethical, economical, ecological, socio-critical, philosophical and political) in a world drastically changed by nine revolutions (demographic, scientific, technological, communication, global identity, environmental, contraceptive, reproductive health and gender equity). The author's generation participated in these revolutions and contributed to the global intellectual process by which gender equity and reproductive health assumed a central role in world affairs. A rapidly aging world population constitutes another major challenge. Its likely impact on the very fundaments of our future social, economical, health and even political infrastructures is--as yet--incompletely comprehended by the international community. The International Federation of Gynecology and Obstetrics (FIGO) has and will continue to have an indispensable role in assisting humankind to reach its ultimate goal : human dignity.

Aging↗

PubMed1978

Health planning: the equity of the health systems agency funding allocation formula.

The funding formula for HSAs prescribed by P.L. 93-641 is based on population. As a result, the amounts HSAs receive range from $175,000 to several million dollars. Yet all are expected to perform essentially the same tasks and the time, cost and staff expertise required are not proportional to population. There are 40 HSAs with populations of under 500,000. Of these, 14 cover over 20,000 square miles and 8 between 10,000 and 20,000 square miles. There are 9 HSAs with populations of 500,000 to 1,000,000 that also have land areas of over 20,000 square miles and densities of under 50 people per square mile. An additional 14 HSAs in this population range (10 with populations of under 600,000) and with low densities cover 10,000-20,000 square miles. It is suggested that a new funding formula based on both population and land area be devised.

Financing, Government↗

PubMed2006

A novel training model to address health problems in poor and underserved populations.

Health disparities are increasingly common and many U.S. practitioners have informal experience working in resource-poor settings. There are, however, few graduate medical education programs that focus on health equity. A graduate medical education program in health equity was developed at Brigham and Women's Hospital based on a review of existing literature and on a survey of junior faculty who have had informal health disparities experience. The Howard Hiatt Residency in Global Health Equity and Internal Medicine was developed as a four-year program to provide intensive training in internal medicine and health disparities. Participating residents are matched with a mentor who has clinical and research experience in the field of global health. In addition to a series of didactic teaching sessions and longitudinal seminars that focus on issues of global health equity, residents take graduate level courses in epidemiology, health policy, ethics, and medical anthropology. Residents also carry out an independent research project in a geographic area that suffers from health disparities. Two residents are selected for training per year. Participating faculty are multidisciplinary and come from diverse Harvard-affiliated institutions. Graduate medical education in the United States with a focus on health equity is lacking. It is hoped that the novel training program in health equity for internal medical residents developed at Brigham and Women's Hospital can serve as a model for other teaching hospitals based in the United States.

Curriculum↗

PubMed1998

Equity is out of fashion? An essay on autonomy and health policy in the individualized society.

It is widely recognized that there is a discrepancy between principle and practice with respect to the health equity aim of public policy. This discrepancy is analyzed from two theoretical perspectives: the individualization of society and the fact that individual beliefs and values are connected to one's position in the social structure. These mechanisms influence both the choice of health policy measures and the normative judgements of preventive efforts, both of which tend to be consonant with the views of dominant social groups. In particular, we focus on the treatment of the ethical principle of autonomy and how this is reflected in health policy aimed at influencing health-related behaviour. We examine the current trend towards targeting health information campaigns on certain socio-economic groups and argue that it entails an ethical dilemma. The dominant discourse of the welfare state is contemplated as a means to understand why there tend to be a lack of emphasis on measures that are targeted at socio-economic inequalities. It is argued that there is no substantive basis in the individualized society for perceiving health equity as an independent moral principle and that the driving force behind the professed health equity goal may be in essence utilitarian.

Ethics, Medical↗

PubMed2005

Global health and equity. Part 1: setting the context.

Equity is considered one of the prerequisites and conditions for health. The pursuit of global health and equity is a relevant goal for nursing, based on the belief that health is a core phenomenon of interest to the discipline. In this article, the first in a two-part series, global health, equity and globalization are analysed. In addition, factors that contribute to global health inequity, including their relevance for nurses and nursing, are examined.

Altruism↗

PubMed1995

Equity of health care in Australia.

This paper examines the equity characteristics of health care financing and delivery in Australia and compares its performance with recent findings on systems in Europe and the United States. Vertical equity of finance is evaluated with income and payment concentration indices derived from published survey data on taxes and expenditure by income decile. Horizontal equity of health care delivery is assessed with standardized expenditure concentration coefficients for three measures of health status and four types of health services, derived from household survey data on health care utilization, health status, income and demographics. Health cover is available to the entire population. Results show the financing system is slightly progressive despite the fact that 30% of payment comes from private sources, which are regressive. The equity index compares favorably to many European countries and is much better than the U.S. which has a regressive financing system. The Australian system fares less well in terms of equity of health care delivery. Several features favor privately insured higher income persons in use of health care and this is reflected, for some health status measures and types of service, in inequity favoring the better off. This contrasts with inequity favoring the less well off in many European countries and the U.S. This analysis provides a benchmark for monitoring the equity of the Australian system and provides information on the equity of a mixed private and public financing system that covers the entire population. This is relevant to the U.S. which is moving in this direction by extending private cover to the uninsured and to European countries that are increasing private sector involvement in health care financing.

Australia↗

PubMed2006

Building health research systems to achieve better health.

Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS) provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics related to the above priorities on which we hope to feature further articles in HARPS and thus contribute to an informed debate on how best to achieve such progress.

Editorial↗