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November 2, 2011
How To Advance Global Health Equity

Despite some improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. This is especially evident in the dichotomy of rich and poor nations. However there are five general areas of priority to enhance health equity regardless of a social or economic status.

Health equity has also emerged as an important theme in research and advocacy. Pursuing equity in health "reflects a concern to reduce unequal opportunities to be healthy associated with membership in less privileged social groups, such as poor people; disenfranchised racial, ethnic or religious groups; women; and rural residents. In operational terms, pursuing equity in health means eliminating health disparities that are systematically associated with underlying social disadvantage or marginalization.

The unequal distribution of the social and economic determinants of health, such as income, employment, education, housing and healthy environments remains the primary policy problem for reducing health inequities.

One primary factor in the success of global health equity is removing profit driven mechanism for success and focusing on humanitarian efforts. Thus, the highest priority should be given to research in five general areas:

(1) Global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders.

Example: Dismantling regulatory health agencies that hinder the advancement of health due to biased structures, systems and employees who have agenda based funding from corporate entities that rely on profit driven marketing and business strategies. Key example: remove all phamaceutical involvement from all regulatory health agencies.

(2) Societal and political structures and relationships that differentially affect people's chances of being healthy within a given society.

Example: Incorporating education, resources and opportunities for all members of a specific society so that shared knowledge of optimal nutrition, clinical procedures, physical activity and services and equipment for each of these is available and offered either pro bono or at extremely affordable and agreeable rates acceptable by that society's standards of living. Societal and political structures should not in any way interfere with these processes, relationships or hinder the progress of a healthy society. Key example: Complementary practitioners, personal trainers and nutritionists would offer their services free of charge in a public facility which would allow them to promote their services in exchange for those of their clients on an acceptable bartering system.

(3) Interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health.

Example: Family or income commitments that would prevent a family from achieving good health. Barriers or obstacles that do not allow families to progress and maintain good health would be removed by societal processes. Key example: Adults would have a wide range of access to fitness facilities, nutritional counseling at their work place and would be compensated during these activities, thus removing lack of time or motivational hindrances from the equation.

(4) Characteristics of the health care system that influence health equity.

All types of health insurance and medical care based on a pay-in system would cease to exist. There would be no discrepancy or discrimination based on any variable besides a person's initiative and will towards better health. Key example: Abolishing any type of Medicare system where fees are collected for unknown services rendered and where their expectations for progress are vague or ambiguous.

(5) Effective policy interventions to reduce health inequity in the first four areas.

Example: Health care systems based on imbalanced priorities and inflated fees would be obsolete and research would be oriented toward policy solutions that can effectively link priority health programmes; strengthen the broader health system; and act on the social determinants of health. Key example: Policies which strengthen to power of people, their skills and resources and undermine matters related to profits and control of revenue.

Inequalities in health arise at a number of levels: in the economic, social and environmental determinants of health, in the policies that influence the distribution of these determinants and in the political and economic interests that shape these policies. It will be the position and best interest of those who cater to the success of the above model to focus on policy interventions which remove all inequalities.

Any research process that seeks to explain and understand the sources and drivers of this inequality would need to take account of these determinants, and of the policies, interests and imperatives that influence them. More importantly, a research process driven by values of equity and goals of justice, would need to generate knowledge that can be used to confront these trends and promote public, population health interests in a way that preferentially benefits the worst off members of society.


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