PHA-Exchange> Social inequalities in health within countries

[Aviva]

> Social inequalities in health within countries: not only an issue for
> affluent nations
>
> Paula Braveman,  Department of Family & Community Medicine, University of
> California, USA
> Eleuther Tarimo, Consultant, Ministry of Health and Child Welfare, Harare,
> Zimbabwe
> Social Science & Medicine - Volume 54, Issue 11 Pages 1621-1635
> June 2002
>
> Available online at: Social Science & Medicine
>
> "............While interest in social disparities in health within
affluent
> nations has been growing, discussion of equity in health with regard to
low-
> and middle-income countries has generally focused on north¯south and
> between-country differences, rather than on gaps between social groups
> within the countries where most of the world's population lives.
>
> This paper aims to articulate a rationale for focusing on within- as well
as
> between-country health disparities in nations of all per capita income
> levels, and to suggest relevant reference material, particularly for
> developing country researchers. Routine health information can obscure
large
> inter-group disparities within a country. While appropriately
disaggregated
> routine information is lacking, evidence from special studies reveals
> significant and in many cases widening disparities in health among more
and
> less privileged social groups within low- and middle- as well as
high-income
> countries; avoidable disparities are observed not only across
socioeconomic
> groups but also by gender, ethnicity, and other markers of underlying
social
> disadvantage. Globally, economic inequalities are widening and, where
> relevant information is available, generally accompanied by widening or
> stagnant health inequalities. Related global economic trends, including
> pressures to cut social spending and compete in global markets, are making
> it especially difficult for lower-income countries to implement and
sustain
> equitable policies. For all of these reasons, explicit concerns about
equity
> in health and its determinants need to be placed higher on the policy and
> research agendas of both international and national organizations in low-,
> middle-, and high-income countries. International agencies can strengthen
or
> undermine national efforts to achieve greater equity.
>
>
> The Primary Health Care strategy is at least as relevant today as it was
two
> decades ago; but equity needs to move from being largely implicit to
> becoming an explicit component of the strategy, and progress toward
greater
> equity must be carefully monitored in countries of all per capita income
> levels. Particularly in the context of an increasingly globalized world,
> improvements in health for privileged groups should suggest what could,
with
> political will, be possible for all.