Social inequalities in health within countries: not only an issue for affluent nations
Section snippets
Background: wide and widening health inequalities within low- and middle- as well as high-income countries
Over the past decade, there has been a growing body of research and commentary on socioeconomic inequalities in health in western Europe and the United States (Bartley, Blane, & Montgomery, 1997; Braveman, Oliva, Reiter, & Egerter, 1989; Braveman, Egerter, & Marchi, 1999; Gilson, 1998; Kaplan, Pamuk, Lynch, Cohen, & Balfour, 1996; Kennedy, Kawachi, & Prothrow-Stith, 1996; Krieger, Williams, & Moss, 1996; Kunst & Mackenbach, 1994; Lynch, Everson, Kaplan, Salonen, & Salonen, 1998; Mackenbach &
What is equity in health?
Equity is an ethical concept that is as challenging to define precisely as its near-synonym social justice, which may mean different things to different people in different societies at different times. Inequity refers not to all inequalities, but to those inequalities that are considered unfair and avoidable (Whitehead, 1990). Equity implies that need rather than privilege be considered in the allocation of resources; as with equity and fairness, it is difficult to define need in precise terms
Why care about equity—in general or in health in particular?
Evidence is accumulating in industrialized countries of a relationship between the magnitude of socioeconomic inequalities and poor health that cannot be explained by differences in absolute levels of income or poverty (Lynch et al., 1998; Kaplan et al., 1996; Kawachi & Kennedy, 1997; Kennedy et al., 1996; Kennedy, Kawachi, Glass, & Prothrow-Stith, 1998; Smith, 1996; Wilkinson (1992a), Wilkinson (1992b), Wilkinson (1996), Wilkinson (1997). Some researchers have raised methodologic concerns
Global pressures are making it difficult for countries of every income level to achieve greater equity in health
In the face of powerful global economic, social, and political trends, many countries are finding it difficult to implement and sustain equity-promoting policies in sectors with major influences on health. Recent UNDP Human Development Reports have noted widening income inequalities in many countries, including Argentina, Bolivia, Brazil, Peru, Venezuela, Bangladesh, Thailand, Bulgaria, the Czech Republic, the Baltic States, Australia, the United Kingdom, and the United States of America (
Conclusion: the need for international and national organizations to focus explicitly on equity in health and its basic determinants, within as well as between countries
International agencies could play an important role in supporting research and action on social inequalities in health that is relevant to the needs of low- and middle-income countries. For example, international agencies can encourage and support national researchers from low- and middle-income countries to apply their talents to work in this area, and can support exchange among researchers from different countries as well as efforts to translate research into policy. Research methods and
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Formerly, Director, Division of Analysis, Research, and Assessment, World Health Organization, Geneva, Switzerland.