PHA-Exchange> Can Research Fill the Equity Gap?

[Claudio Schuftan]

The following has been extracted from EQUINET Policy Series no 1
Co-published by EQUINET (www.equinet.org.zw) and Training and Research
Support Centre, Harare (www.tarsc.org). The full document can be downloaded
from http://www.equinet.org.zw/policy.html

Can Research Fill the Equity Gap?

Weak delivery on equity implies that it needs to be given greater profile as
a health priority and more sustainable ways found of delivering on it.
Research can build constituencies that pressure for equity in health.

Disparities in access to health inputs and healthcare have widened between
population groups everywhere. Inequalities exist in relation
to health inputs, such as literacy, educational status - particularly in
women -income, household savings and assets, housing tenure and standards,
access to safe water, sanitation and reliable energy supplies. They also are
striking with regard to health status and health care. In both cases, low
income, rural communities have been shown to be comparatively disadvantaged.

The burden of disease of the poor with its impact on mortality weighs public
and household budgets, increasing chronic and potentially intergenerational
poverty.

What drives inequity?
Why have these problems of health inequity persisted despite aspirations to
the contrary?

It would appear that our economies continue to have weak mechanisms for
distributing health and other resources towards those who have greater need,
least power and least access. Macro-economic and health reforms have enabled
more powerful medical and middle class interest groups to exact concessions
at the cost of the poorer, less organised rural and  urban  poor.

This situation has been encouraged by a number of policy developments,
including:

· Globalisation and related market-led policies, which have increased the
concentration of wealth in fewer hands and chronic poverty in the south.
Poor communities have suffered heavily in globalisation's drive towards
satisfying the profit motives of the biggest players in the market.
· Structural adjustment reforms which condone declines in public spending on
health and education.
· In the area of health policy, with an over-optimistic preoccupation with
technical management tools, at the expense of the real equity issues.

Challenging Inequity
Within health, we need to ensure that those with the greatest health needs
obtain and access greater public inputs for improved health.
This implies that it is not only how much governments spend on health, but
also how they spend and who they target with resources, that determines the
health status of their populations.
It is precisely when resources are scarce that even greater importance
should be given to ensuring that health care resources are allocated
progressively, and reach those who most need them.

Public health and health services, cannot be an area of activity that is
provided through the market.

We need
§ to egotiate changes in global institutions, policies, rules and
standards that subordinate human development to profit, or that unfairly
distribute the returns from markets.
§ to giv higher profile and attention to national policies that more
effectively allocate public resources towards those with greatest health
needs. Equity should become one of the most important targets of practical
attention in resource allocation systems.
§ to involve population groups more actively in defining, shaping and
implementing health  policies. The amount of resources that
people get depends on the extent to which they are able to make and
articulate their choices.

Researchers need to focus more on health equity issues; expose the
differences in health status that are unnecessary, avoidable and unfair;
propose ways of more effectively addressing differences in need;
assess the extent to which different groups in society have the power and
means to make choices over health issues; monitor health equity levels, the
impact of globalisation and macro-economic policies on health;  enable
participation by beneficiaries in their  research by using participatory
research methods that involve the affected groups more directly; and more
direct link research and action on problems in te affected communities.

Research can give direction to the changes being called for by communities
by empowering people for effective participation
in all economic and social processes that affect them.

Adapted from
Dr Renee Loewenson