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At least 19 recordsLinked to original sources
PubMed2002

Closing the gap: building the capacity of non-government organizations as advocates for health equity.

Seeking achievement of health equity has underpinned national government and global health policies for decades. However, major difficulties and challenges faced in the practice of achieving 'Health for All' has led to a recognition of the need to broaden the focus of efforts to improve health equity. Civil society groups have been identified as key stakeholders in attempts to achieve health equity, and the importance of strengthening their capacity to influence relevant government policy and practice has been highlighted. This paper presents the results of a qualitative study which examined the role of organizations outside government in advocating for health equity, and the capacities and conditions that were related to their success. In-depth, unstructured interviews were conducted with 26 non-government organizations (NGOs) who were active in three important health policy debates in Australia. The grounded theory method was used to direct data collection and analysis, and member checking was employed to ensure soundness and build ownership of the findings. Effective advocacy was found to be a dynamic process characterized by flexibility and opportunism within a framework of longer term goals. Two key ways of working were identified--in partnership and in conflict with government, with shifts in emphasis in response to organizational strengths and a changing environment. A number of domains of capacity, which together are termed 'capacity for advocacy', were also identified. It is clear that NGOs can learn a great deal from each other, but there needs to be investment by governments, international agencies and NGOs themselves if advocacy for health equity is to be strengthened.

Australia↗
PubMed2006

Achieving health equity in America.

Health disparities are both real and deadly, but disparities are not inevitable. The causes of health disparities are complex, and their elimination will require multi-dimensional interventions. We have developed a three-dimensional model for the elimination of health disparities. The foundation of public health is surveillance, which is the first dimension. We must continually measure racial-ethnic disparities in each specific disease, in its risk factors, and in outcome-relevant quality of care. The second dimension is research into the causes of disparities and potential intervention points to eliminate disparities. These causes and potential intervention points can be in the individual's biology or their behavior, or in their physical and social environment, or in the healthcare arena (quality and access). The third dimension is intervention, which requires moving from what we know to what we do. Translation must not only take knowledge from the bedside, but to the curbside and the countryside, into each community and into each home. We can achieve health equity in America, but first, we all must care enough, know enough, do enough, and persist long enough.

Cultural Characteristics↗
PubMed2004

Access to health care for all? User fees plus a Health Equity Fund in Sotnikum, Cambodia.

User fees in health services are a source of much debate because of their potential risk of negative effects on access to health care for the poor. A Health Equity Fund that identifies the poor and pays on their behalf may be an alternative to generally ineffective fee exemption policies. This paper presents the experience of such a Health Equity Fund, managed by a local non-governmental organization, in Sotnikum, Cambodia. It describes the results of the first 2 years of operations, investigates the constraints to equitable access to the district hospital and the effects of the Health Equity Fund on these constraints. The Health Equity Fund supported 16% of hospitalized patients. We found four major constraints to access: financial, geographical, informational and intra-household. The results of the study show that the Health Equity Fund effectively improves financial access for the poor, but that the poor continue to face many constraints for timely access. The study also found that the Health Equity Fund as set up in Sotnikum was very cost-effective, with minimal leakage to non-poor. Health Equity Funds managed by a local non-governmental organization seem to constitute a promising channel for donors who want to invest in poverty reduction. However, further research and experimentation are recommended in different contexts and with different set-ups.

Cambodia↗
PubMed2003

A step too far? Making health equity interventions in Namibia more sufficient.

BACKGROUND: Equality of health status is the health equity goal being pursued in developed countries and advocated by development agencies such as WHO and The Rockefeller Foundation for developing countries also. Other concepts of fair distribution of health such as equity of access to medical care may not be sufficient to equalise health outcomes but, nevertheless, they may be more practical and effective in advancing health equity in developing countries. METHODS: A framework for relating health equity goals to development strategies allowing progressive redistribution of primary health care resources towards the more deprived communities is formulated. The framework is applied to the development of primary health care in post-independence Namibia. RESULTS: In Namibia health equity has been advanced through the progressive application of health equity goals of equal distribution of primary care resources per head, equality of access for equal met need and equality of utilisation for equal need. For practical and efficiency reasons it is unlikely that health equity would have been advanced further or more effectively by attempting to implement the goal of equality of health status. CONCLUSION: The goal of equality of health status may not be appropriate in many developing country situations. A stepwise approach based on progressive redistribution of medical services and resources may be more appropriate. This conclusion challenges the views of health economists who emphasise the need to select a single health equality goal and of development agencies which stress that equality of health status is the most important dimension of health equity.

Journal Article↗
PubMed2001

Developing a UK health equity network.

The UK Health Equity Network (HEN) was established in 1999 to encourage and facilitate multidisciplinary and multi-stakeholder collaboration in health inequalities research. This paper briefly details the history, objectives and location of HEN.

Cooperative Behavior↗
PubMed2006

Priorities for research to take forward the health equity policy agenda.

Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. Our recommendations regarding research priorities for health equity are based on an assessment of what information is required to gain an understanding of how to make substantial reductions in health inequities. We recommend that highest priority be given to research in five general areas: (1) global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders; (2) societal and political structures and relationships that differentially affect people's chances of being healthy within a given society; (3) interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health; (4) characteristics of the health care system that influence health equity and (5) effective policy interventions to reduce health inequity in the first four areas.

Delivery of Health Care↗
PubMed2006

Health disparities and health equity: concepts and measurement.

There is little consensus about the meaning of the terms "health disparities," "health inequalities," or "health equity." The definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities that will be supported by resources earmarked to address health disparities/inequalities or health equity. This paper aims to clarify the concepts of health disparities/inequalities (used interchangeably here) and health equity, focusing on the implications of different definitions for measurement and hence for accountability. Health disparities/inequalities do not refer to all differences in health. A health disparity/inequality is a particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies); it is a difference in which disadvantaged social groups-such as the poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination-systematically experience worse health or greater health risks than more advantaged social groups. ("Social advantage" refers to one's relative position in a social hierarchy determined by wealth, power, and/or prestige.) Health disparities/inequalities include differences between the most advantaged group in a given category-e.g., the wealthiest, the most powerful racial/ethnic group-and all others, not only between the best- and worst-off groups. Pursuing health equity means pursuing the elimination of such health disparities/inequalities.

Delivery of Health Care↗
PubMed2006

Rapid assessment methods used for health-equity audit: diabetes mellitus among frail British care-home residents.

BACKGROUND: To perform a health-equity audit of diabetes care among elderly care-home residents. STUDY DESIGN: Health-need assessment using rapid-evaluation methods. SETTING: Residents of care homes in Newcastle upon Tyne, UK. PARTICIPANTS: All care-home residents in the city. OUTCOME MEASURES FOR DIABETES: To carry out health-need assessment, agree partners and issues, assess equity profile, and to agree high-impact local action to narrow the gap, according to the guidance on health-equity audit provided by the Department of Health. RESULTS: A combination of qualitative and quantitative methods were used to develop a methodology to complete the health-need assessment component of the health-equity audit. A number of criteria for an appropriate standard of care, and how the current service met these standards, were reported in a timely fashion to the primary care trust. The domains comprised national standards for care, diabetes prevalence, adequacy of coverage and standard of care delivered, and environment, including availability of equipment and knowledge and attitudes of care staff. The output was structured to identify a number of key issues: the diabetes register under-represents the number of cases of known diabetes mellitus (3.5% vs. 11.5%); weights and blood-pressure measurements were incorporated into the care-home environment; this population had inappropriately high rates of glucose monitoring, secondary care involvement and little evidence of co-ordinated eye screening; and staff needed training for diabetes care, which they recognized. Finally, recommendations were agreed for the immediate response and a local action plan agreed to narrow the health gap. CONCLUSIONS: It is feasible to use rapid-evaluation methodologies to initiate a health-equity audit of current diabetes services for care-home residents in a large health district, informing the primary care trust about health equity for this vulnerable group of patients. The tools developed can be used again to inform the iterative process of health-equity audit in the future. We would recommend the use of these methods and similar combined qualitative/quantitative techniques as valuable alternatives for a health-equity audit in the absence of extensive databases on which to assess health equity.

Aged↗
PubMed2001

Health equity and social justice.

There is consistent and strong empirical evidence for social inequalities in health, as a vast and growing literature shows. In recent years, these findings have helped to move health equity high on international research and policy agendas. This paper examines how the empirical identification of social inequalities in health relates to a normative judgment about health inequities and puts forward an approach which embeds the pursuit of health equity within the general pursuit of social justice. It defends an indirect approach to health equity, which views social inequalities in health as unjust in so far as they are the result of an unjust basic structure of society in Rawls' sense.

Health↗
PubMedDate not supplied

[Information for health equity in Chile].

OBJECTIVES: To estimate the magnitude of geographical health inequalities in Chile through key indicators based on data and information that are routinely collected and easily obtained, and to characterize the current situation with respect to the availability, quality, and access to information on health equity that official sources routinely collect. METHODS: A conceptual framework proposed by the World Health Organization was used to study health equity in terms of four dimensions: 1) state of health, 2) health determinants, 3) resources for and the supply of health system services, and 4) utilization of health system services. For each of these four dimensions, indicators were selected for which there was available information. The information was aggregated according to geographical and administrative units in the country: communes (342 in Chile), sanitary districts called "Health Services" (28), and regions (13). The aggregated information was analyzed using univariate analysis (distribution characteristics), bivariate analysis (correlations and frequency tables), and tabulation of values for selected indicators for the communes. RESULTS: With respect to the first dimension, state of health, we found an inverse relationship between mortality and average family income in the communes (r = -0.24; P < 0.001; n = 191 communes). With health determinants, there were important differences among the communes with regard to average household income, years of schooling, literacy, quality of housing, drinking water supply, and the wastewater disposal system. In terms of resources for and the supply of health system services, the municipal governments of the communes with higher average household incomes tended to contribute more funds per beneficiary (r = 0.19; P = 0.013). The financial contributions from the national government were targeted well, but they only partially compensated for the more limited resources available in poorer communes. With respect to the utilization of health care services per beneficiary in the different sanitary districts, we found some large differences. In terms of the ratio between the highest rate of utilization in any of the districts and the lowest rate in any other district, the ratio for primary-care visits per beneficiary was 2.8, the ratio for emergency-care visits was 3.9, and the ratio for hospitalizations was 2.0. CONCLUSIONS: There are important geographical differences in Chile with respect to mortality and other health outcomes, income and environmental conditions, and the financing and utilization of health care services. The information that is collected regularly and is available to characterize the health-related variables frequently has limitations in terms of quality, sustainability, and access. In Chile it would be pointless to focus the greatest efforts on reorganizing the information systems. The existing indicators showing marked inequalities are adequate to support the planning of interventions aimed at making urgently needed improvements in the situation of the worst-off Chileans.

Chile↗
PubMed2006

Beyond the sound of one hand clapping: experiences in six countries using health equity research in policy.

In an attempt to better understand the complex and sometimes tenuous relationship between health equity research and health policy, we undertook a collaborative comparison of six case studies with researchers from the United States, the United Kingdom, the Netherlands, China, South Africa, and Chile. Patterns in factors contributing to governments' interest in research included the role of domestic advocacy, interest in their international standing, and the existence of internal government champions. Strategies used by researchers to promote their findings included carefully crafting messages and selecting messengers in accordance with their audience's concerns, delaying publication until interactions with policy makers had occurred, monitoring public opinion, and a host of ideas relating to the style and content of government-sponsored commission reports. Most of the similarities crossed the developing/developed country divide, although it did appear that in the three case studies from the north, greater attention was paid to the professional legitimacy of institutions, individuals, and journals, while in the three developing countries the existence of trusted personal messengers appeared essential. While there are no prescriptions for ensuring the use of health equity research in policy, the comparison across such different international settings stimulated participants to question their assumptions about what works, when, and why.

Chile↗
PubMedDate not supplied

[The virtual library in equity, health, and human development].

This article attempts to describe the rationale that has led to the development of information sources dealing with equity, health, and human development in countries of Latin America and the Caribbean within the context of the Virtual Health Library (Biblioteca Virtual en Salud, BVS). Such information sources include the scientific literature, databases in printed and electronic format, institutional directories and lists of specialists, lists of events and courses, distance education programs, specialty journals and bulletins, as well as other means of disseminating health information. The pages that follow deal with the development of a Virtual Library in Equity, Health, and Human Development, an effort rooted in the conviction that decision-making and policy geared toward achieving greater equity in health must, of necessity, be based on coherent, well-organized, and readily accessible first-rate scientific information. Information is useless unless it is converted into knowledge that benefits society. The Virtual Library in Equity, Health, and Human Development is a coordinated effort to develop a decentralized regional network of scientific information sources, with strict quality control, from which public officials can draw data and practical examples that can help them set health and development policies geared toward achieving greater equity for all.

Caribbean Region↗
PubMed2005

Managing health inequalities locally: a baseline survey of primary care trusts' experience with health equity audit in the implementation year.

Health equity audit (HEA), a pragmatic policy tool to ensure that services and resources are focused on issues that have the highest impact on health inequalities, has now become embedded in the national strategy to tackle these inequalities through a new mandatory requirement that primary care trusts (PCTs) conduct one such audit annually. This study aimed to assess their experience through a national baseline survey in 2004, all PCTs (n = 303) being electronically mailed a questionnaire with non-respondent follow-up. Replies were received from 132 PCTs (44%), a representative sample of PCT diversity, most of whom had completed only a few steps in the audit cycle. Audit topics (most frequently coronary heart disease, smoking cessation, and access issues) and dimensions of inequity (mainly area and deprivation) were agreed through only limited engagement with local strategic partnerships. Local public health networks and multiagency teams were infrequent partners in undertaking the HEA. Most PCTs wanted comparator data, good practice examples, and specific methodological expertise. While significant progress has been made, this survey shows only limited use of HEA as a tool for multisectoral use by PCTs in partnership with others and a focus on intra-PCT comparisons at the expense of those with a wider pool of 'look-a-likes'.

Data Collection↗
PubMed2003

A framework linking community empowerment and health equity: it is a matter of CHOICE.

This paper presents a framework to explore the relationship between health equity and community empowerment. It traces the progression of the concept of participation to the present term of empowerment and the links among empowerment, equity, and health outcomes. It argues that the relationship can best be described by using the acronym CHOICE (Capacity-building, Human rights, Organizational sustainability, Institutional accountability, Contribution, and Enabling environment). Based on the concept of development as freedom put forward by Nobel Laureate Amartya Sen, the paper describes how each factor illustrates the relationship between equity and empowerment in positive health outcomes, giving appropriate examples. In conclusion, it is suggested that these factors might form the basis of a tool to assess the relationship between equity and empowerment and its impact on health outcomes.

Community Health Planning↗
PubMed2001

Harnessing genomics and biotechnology to improve global health equity.

With decisive and timely action, genome-related biotechnology can be harnessed to improve global health equity. In June 2002 in Kananaskis, Canada, leaders of the G8 industrial nations will develop an action plan to support implementation of the New African Initiative. By extending their discussion of health issues raised in the New African Initiative to include genomics, G8 leaders could signal their intention to increase global health equity by preventing a health genomics divide from developing. There are already some early and growing examples of genome-related biotechnology being applied successfully to health problems in developing countries. But how can genomics be systematically harnessed to benefit health in developing countries? We propose a five-point strategy, including research, capacity strengthening, consensus building, public engagement, and an investment fund.

Biotechnology↗
PubMed2001

Demographic surveillance and health equity in sub-Saharan Africa.

Accurate data are always needed to inform health policy, but are especially critical in tackling health inequities. The growing number of field research stations in sub-Saharan Africa are well-placed to generate relevant data and so support health policy action. Over the past 60 years, demographic surveillance systems have been crucial research tools for the evaluation of health interventions aimed at reducing socioeconomic differentials in mortality and morbidity in sub-Saharan Africa. The bulk of such work has been carried out by field research sites, often operating in remote, resource-constrained settings. The present paper reviews what we have learned since the pioneering work carried out in the field sites of Pholela (South Africa) and Niakhar (Senegal). It then focuses on current efforts to address health equity through INDEPTH, the international network of field sites with continuous demographic evaluation of population and their health in developing countries.

Africa South of the Sahara↗
PubMed2002

Health equity in transition from planned to market economy in China.

This paper examines the impact of economic transition and health sector reform on health equities in the urban and rural populations of China in the 1990s. Since 1980, China has experienced a rapid economic development and fundamental transformation of its society. Three secondary data sources were used as the basis for the analysis and discussion: mortality data from the National Death Notification System; infant mortality from the National Maternal and Child Health Surveillance System; and morbidity, health care utilization and financing data from the National Health Household Interview Surveys. The analysis revealed a very complex picture with: general mortality rates decreasing in both urban and rural populations, but the differences between urban and rural increasing; declining infant mortality rates with narrowing of the urban-rural gap; health care needs declining in both urban and rural populations, but more rapidly in the urban areas; health service payments increasing in both urban and rural areas, while, at the same time, health insurance coverage decreased. The analysis suggests that despite overall improvements in the population's health status, the economic and health system policy reforms are leading to increased inequities in health care. The lowest income quintiles in both urban and rural areas are receiving less health care compared with their needs in 1998 than in 1993, and the urban-rural divide, in particular with regard to receiving inpatient health care, is widening appreciably. The reform of the health insurance system, combined with the market setting of prices for care, have had profound implications for all population groups, in particular the lower income segments and the rural populations. During the period 1993-98 the proportion of the urban population that had to cover the increasing cost of medical care themselves doubled.

China↗