Academic journal article Bulletin of the World Health Organization

Poverty and Health Sector Inequalities (*). (Theme Papers)

Academic journal article Bulletin of the World Health Organization

Poverty and Health Sector Inequalities (*). (Theme Papers)

Article excerpt

Resume

Pauvrete et inegalites dans le secteur de la sante

Pauvrete et mauvaise sante vont de pair. Les pays pauvres tendent a avoir de plus mauvais resultats dans le domaine de la sante que les pays plus nantis, et a l'interieur d'un meme pays les pauvres ont une moins bonne sante que les riches. Cette association revele une relation de causalite a double sens: la pauvrete engendre la mauvaise sante, et la mauvaise sante entretient la pauvrete. Le present article expose les faits concernant les inegalites de sante entre pauvres et non-pauvres et les consequences des depenses de sante sur l'appauvrissement et les inegalites de revenus. Il fait brievement le point des connaissances sur les causes des inegalites et sur l'efficacite des politiques destinees a les combattre. D' apres l'auteur, on ne connait pas assez l'impact de telles politiques, malgre la variete des techniques de mesure et l'abondance des donnees sur l'etendue des inegalites et sur leurs causes.

Resumen

Pobreza y desigualdades en el sector de la salud

La pobreza y la mala salud son fenomenos interrelacionados. Los paises pobres tienden a presentar peores resultados sanitarios que los mas pudientes, y dentro de cada pais las personas pobres tienen mas problemas de salud que las acomodadas. Esta asociacion refleja una relacion de causalidad que funciona en los dos sentidos: la pobreza genera mala salud, y la mala salud hace que los pobres sigan siendo pobres. En este articulo se examina la evidencia disponible respecto a las desigualdades sanitarias entre las personas pobres y las que no lo son, asi como respecto a las repercusiones que en forma de empobrecimiento y desigualdad de ingresos pueden tener los gastos en atencion de salud. Se hace una exposicion sucinta de los actuales conocimientos sobre las causas de las desigualdades y sobre la eficacia de las politicas destinadas a combatirlas, y se senala que es demasiado poco lo que se sabe acerca de los efectos de esas politicas, pese a las abundantes tecnicas de medicion disponibles y a los muchos datos obtenidos sobre la magnitud y las causas de las desigualdades.

Introduction

Poverty and ill-health are intertwined. Poor countries tend to have worse health outcomes than better-off countries. Within countries, poor people have worse health outcomes than better-off people. The association between poverty and ill-health reflects causality running in both directions. Illness or excessively high fertility may have a substantial impact on household income (1, 2) and may even make the difference between being above and being below the poverty line (3). Furthermore, ill-health is often associated with substantial health care costs (4). But poverty and low income also cause ill-health (5). Poor countries, and poor people within countries, suffer from a multiplicity of deprivations that translate into high levels of ill-health (6, 7). Poor people are thus caught in a vicious circle: poverty breeds ill-health, ill-health maintains poverty (Fig. 1).

[FIGURE 1 OMITTED]

Several key international organizations and bilateral donors now have the improvement of the health outcomes of the world's poor as their primary objective (8-10). This reflects an increasing tendency of such organizations to define their goals in terms of poverty reduction (11, 12) and an ever broader interpretation being given to the term "poverty" (6, 13). However, it also reflects growing agreement that inequalities in health outcomes between rich and poor are unjust and unfair (14), not because the poor are somehow more deserving than the better-off but because these inequalities evidently correspond to widely differing constraints and opportunities facing the poor and better-off rather than a tendency for the two groups to make different choices (15-20). The deleterious effects that ill-health has on household living standards are also increasingly seen as an issue of social justice, possibly reflecting a view that the income losses and health care payments associated with ill-health are involuntary and simply the consequence of unwanted health "shocks" (21). …

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