Academic journal article Bulletin of the World Health Organization

Priorities for Research to Take Forward the Health Equity Policy agenda/Promotion De Politiques D'equite En Sante : Priorites De la recherche/Prioridades De Investigacion Para Impulsar la Agenda De Politicas De Ecluidad Sanitaria

Academic journal article Bulletin of the World Health Organization

Priorities for Research to Take Forward the Health Equity Policy agenda/Promotion De Politiques D'equite En Sante : Priorites De la recherche/Prioridades De Investigacion Para Impulsar la Agenda De Politicas De Ecluidad Sanitaria

Article excerpt

Voir page 952 le resume en francais. En la pagina 952 figura un resumen en espanol.

Background

Equity has been a stated or implied goal of health policy in many countries and international health organizations for decades. At Alma-Ata in 1978, a global health strategy was launched by the World Health Organization's (WHO's) World Health Assembly with the goal of Health for All by the Year 2000 (HFA) (1). Health equity is an implicit priority in HFA, and was particularly prominent in WHO's HFA strategy for Europe (2). The European HFA strategy for the twenty-first century identified promotion of equity and improvement of health as guiding principles (3). WHO in Geneva launched a global initiative on Equity in Health and Health Care from 1995-1998 (4). Equity concerns were also prominent in parts of the 2000 Millennium Declaration, which gave rise to the Millennium Development Goals (5). Although impressive overall gains were achieved in life expectancy and child survival during the second half of the twentieth century, inequities in health status and in health systems between more and less privileged groups within and between countries have persisted, and in many regions and countries are widening (6, 7).

Health equity has also emerged as an important theme in research and advocacy (8, 9). Pursuing equity in health "reflects a concern to reduce unequal opportunities to be healthy associated with membership in less privileged social groups, such as poor people; disenfranchised racial, ethnic or religious groups; women; and rural residents. In operational terms, pursuing equity in health means eliminating health disparities that are systematically associated with underlying social disadvantage or marginalization" (10). The unequal distribution of the social and economic determinants of health, such as income, employment, education, housing and healthy environments remains the primary policy problem for reducing health inequities (11). Striving for equity in healthcare is one aspect of the wider concept of equity in health status, and implies that health care resources are allocated and received according to need, and financing is according to ability to pay (4, 12). Adequate progress in narrowing gaps, particularly where resources are limited, requires frameworks that will ensure attention to the needs of those with the greatest health needs and the least resources.

Over the last few decades WHO has considered health and health services in their social, cultural and economic context. WHO defines health systems as "all the activities whose primary purpose is to promote, restore or maintain health" (13). Health systems are not only producers of health and healthcare, but also "purveyors of a wider set of societal norms and values" (14).

Health systems in many countries, however, have been unable to introduce or sustain improvements in health equity. One obvious reason--as a recent synthesis of research on vulnerability to human immunodeficiency virus (HIV), tuberculosis and malaria infection has noted--is that health systems, and the people who use them, exist within social contexts that exert a powerful influence on people's chances to be healthy (15, 16). Social values and political processes determine the allocation of resources (wealth, power and opportunities to acquire them) for health. This makes it unlikely that equity will be achieved without confronting the entrenched interests and political and economic processes that give rise to inequalities in the distribution of health determinants. One measure of equity, therefore, is the extent to which public policy and authority are structured to serve public interests and justice, as reflected in part by the degree to which non-elite groups can influence the allocation of resources for health (7).

Research and interventions that focus only on the technical, clinical or financial dimensions of health interventions and systems generally lose sight of these structural (political and economic) and social dimensions. …

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