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POPLHLTH 210 - Dimensions and Trends of Inequalities

Terms in this set (18)

Health Inequities between countries
- In health services
- existence or not of primary health care
- access to hospital services
- quality of health care


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WHO report 2008
Called for reforms in primary health care internationally due to serious health service inequalities between countries
Four areas of reform
1. Service deliver
-what is delivered, where and how, quality of service delivery.

2. Universal coverage
- who has access

3. Public policy
- political support for health and social determinants infrastructure

4. Leadership
- who decides/ governance


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Health Inequities between countries
- In health outcomes
- life expectancy

- infectious/communicable diseases
e.g. TB, malaria

- non-communicable diseases
e.g. heart disease

- 'epidemiological transition'
from infectious diseases to non-communicable diseases

- double burden of disease


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Key message
The unacceptable health inequities within and between countries cannot be addressed within the health sector, by technical measures, or at the national level alone, but require global political solutions.


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Principles for action
Commission on the Social Determinants of health
1. Improve the conditions of daily life - the circumstances in which people are born, grow, live, work, and age.

2. Tackle the inequitable distribution of power, money, and resources
- the structural drivers of those conditions of daily life
- globally nationally and locally

3. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health


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...
Health impacts are experience most by those already vulnerable
Health inequities
are created and maintained by
- Differential access to the social determinants of health

- Differential access to health care

- Differences in the quality of care received.


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Median annual personal income
NZ european
- $25,400
Maori
- $20,900
Pacific
- $20,500
Educational attainment
NZ european
- 54%
Maori
- 37%
Pacific
- 29%
Unemployment
NZ european
- 4.9%
Maori
- 12.9%
Pacific
- 15.2%
International evidence
- The largest differences in health are international

- Life expectancy at birth ranges from 34 years in Sierra Leone to 81.9 years in Japan

- Under 5 mortality varies from 316 per 1000 live births in Sierra Leone to 3 per 1000 live births in Iceland

-- Social differences in health occur both between and within countries


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The UN millennium development goals
8 goals which range from halving extreme poverty rates to halting the spread of HIV/AIDS and providing universal primary education

- All goals by the target date of 2015
- Despite this goal, progress is variable across countries


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UN goals - uneven success
- Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a day: 47% in 1990, 14% in 2015

- Universal primary school education: out-of-school children of primary school age in 1990 = 100mil, 2015 = 57mil

- Reduce by three quarters, between 1990 and 2015, the maternal mortality rate: 380/100000 in 1990, 210/100000 in 2015


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Measuring inequality
Between countries:
- Gross domestic product (GDP), per capita income
- Gini coefficient, and other measures of income inequality
- Life expectancy at birth
- Child and maternal mortality
- Burden of disease

Within countries:
- Mortality rates or life expectancy (comparing by demographic factors such as ethnicity, income, etc
- Child and maternal mortality (by demographic factors)
- Disease incidence/prevalence rates (by demographic factors)


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Key Points
- Some similar measures within and between countries
- Inequalities only become visible when there is a point of comparison


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