Inequity and inequality: these terms are sometimes confused, but are not interchangeable, inequity refers to unfair, avoidable differences arising from poor governance, corruption or cultural exclusion while inequality simply refers to the uneven distribution of health or health resources as a result of genetic or other factors or the lack of resources.
Inequity is a result of failure
Inequity invokes moral outrage, it is unfair and indefensible, a result of human failure, giving rise to avoidable deaths and disease. Social justice in this case is literally a matter of life and death. Inequity is often measured in terms of the inequality of health or resources, which is appropriate where one might reasonably expect equality. For example, there is no reason for differences in access to health resources between men and women within a country other than cultural prejudice and or a failure of governance, basic health services should be available to all citizens within a community according to need.
Within every population there are differences in health status and it would be unrealistic to expect that health or health resources would reach the same level in poor countries as they do in countries with greater resources. However, as we are all global citizens with a human right to health there must at least be universal access to basic health services. Currently life expectancy varies from more than 80 years in some rich countries to less than 45 years in countries where health resources are lacking and governance is weak and often corrupt. Within countries life expectancy for disadvantaged groups is typically 10 or more years below the average. Given the state of health knowledge and resources the Commission on the Social Determinants of Health declared in 2009 that such differences are an affront to social justice that must be addressed within our generation.
Inequality constitutes Inequity
This raises the question “when does inequality in health or resources constitute inequity?” One possible answer is when differences are greater than might be expected on the basis of wealth, this is certainly the case, the relative burden of disease in poor countries is actually far greater than can be explained simply in terms of wealth.
Inequity is clearly apparent when rich countries give rise to a burden of disease for poor countries, as examples: by their impact on global warming, by supporting trade in products like tobacco and alcohol which harm health. And when rich countries operate policies such as copyright protection or the attraction of migrating health workers without recompense, that deprive poor countries of health resources they also give rise to inequity.
It can also be argued that global health inequity occurs when countries fail to meet their commitments to global health, for example, by continuing failure to meet the target for official development aid of 0.7% of GDP agreed at the United Nations in 1970, or by failing to meet the commitments agreed at Alma Ata in 1978 to provide access to primary care for all, or by the current failure to meet the Millennium Development Goals set in 2001.
Useful Web Sites
- WHO “Closing the Gap in a Generation” Commission on Social Determinants of Health a major WHO commission. There are several related web sites with many supporting papers.
- Measuring global health inequity, D. D. Reidpath and P. Allotey The International Journal for Equity in Health October 2007. The Journal web site provides a large number of relevant papers on health inequity.
- Health UC Atlas of Global Health Inequality produced by the University of California. The web site is a useful source of charts and maps on different aspects of inequality including health.