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Perspectives on health inequity
  1. H S J Picavet
  1. National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands

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    E Harris, P Sainsbury, D Nutbeam, editors. (Pp 159; A$20.) Australian Centre for Health Promotion, 1999. ISBN 1-86487-313-2.

    The book presents the views of experts of different backgrounds on causes and solutions of health inequity. These views are given as a reaction on data on health inequalities using the 1994 New South Wales Health Promotion Survey (New South Wales is a large region in the south east of Australia, including Sydney). The presented survey data focus on health differences by sociodemographic characteristics, and by education, employment status and a not further specified socioeconomic classification based on usual residence. No attention was paid to differences by income levels or by the often used manual/non-manual work distinction. The presented rates were corrected for age differences but unfortunately not for differences by gender. It is clear that there are health equalities. Health inequity is not the same as health inequality. Equity, as is said in the book, describes differences that are unfair and unjust, which are largely beyond the individual's control and that are avoidable. The presented data give, however, not insight in the proportion that is “unfair and unjust, beyond the individuals control and that are avoidable”.

    The perspectives from the point of view of health promotion, behavioural epidemiology, general practitioners, health economics, sociology, public policy and the commentaries of representatives from a governmental organisation, the university, the social service council and a minority commission give a nice overview how we can think about health equalities. Perspectives from the point of view of ethics could have made it more complete.

    Intervention stategies could include (1) strengthening individuals in disadvantaged circumstances, (2) strengthening disadvantaged communities, (3) improving access to essential facilities and services and (4) encouraging macro-economic and cultural change. But, it is clear that we are still at the beginning of a very long road to address health inequities.

    The book can help students, public health workers and (junior) researchers to beginning to understand the complex field on health inequalities and inequities.

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