Question

Why is it important for people in public and community health to be aware inequality in access to health care? (What does inequality entail?)

Answer 1

There is ample evidence that social factors, including education, employment status, income level, gender and ethnicity have a marked influence on how healthy a person is. In all countries – whether low-, middle- or high-income – there are wide disparities in the health status of different social groups. The lower an individual’s socio-economic position, the higher their risk of poor health.

Health inequities are systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies.

Health inequalities go against the principles of social justice because they are avoidable. They do not occur randomly or by chance. They are socially determined by circumstances largely beyond an individual’s control. These circumstances disadvantage people and limit their chance to live longer, healthier lives.

In low-resource settings, health-care costs for noncommunicable diseases (NCDs) can quickly drain household resources, driving families into poverty. The exorbitant costs of NCDs are forcing millions of people into poverty annually, stifling development.

Nationally, the focus should be on implementing the measures which are most likely to be effective in reducing health inequalities. This means trying to discontinue or modify measures which have been shown to widen, or potentially widen, inequalities.

There is also an important role for national agencies, including public and third sector organisations, to support local delivery through advocacy and evidence building.

Public health programmes that reduce health inequalities can also be cost effective. The case can be made to give priority to such programmes (for example, improving access to cervical cancer screening in low income women) on efficiency grounds. On the other hand, few programmes designed to reduce health inequalities have been formally evaluated using cost effectiveness analysis.