Health Services
Inequalities Demand Action

By Bachchu Kailash Kaini

HEALTH is the basic condition for quality life. All human beings should have the right to health. Health policy, health promotion and education, health care and health care services are means to ensure this fundamental human right. Patients have a right of access to health care, right to considerate care, right to informed consent and the right to information concerning the health services available.

Care

Health care should be based on community health standards and disease occurrence rates. It must incorporate social life, active working life, and living culture. The facilities are to be provided with the benefit of time and distance, with safety and amenity of environment and good access to related services. Patients should be treated as close to their homes as possible in the smallest, cheapest, most simply equipped unit that is capable of looking after them adequately.

Most, if not all, countries, all over the globe, are striving to cope with health care transformation. Epidemiological and demographic transitions have resulted in an increase of chronic and degenerative diseases. Accompanying this trend is the emergence and re-emergence of infectious diseases. Improved life expectancy has led to an increase in the number of the old people. Developments in information and communication technology have resulted in a better informed and more demanding populace. New technology and the expansion of scientific knowledge coupled with evidence-based medicine have resulted in changes in the way care and other services are provided. Persistent and/or increasing unemployment is leading to more poverty and poorer health. There is a universal trend towards greater decentralisation, pro-market economic policies, rapid expansion of the private health sector and so on.

Many health care providers and health experts are becoming increasingly concerned about the growing incidence of significant health inequalities between social groups, and in particular, the strong association between relative deprivation and poor health. There are many factors to influence an individual's health. They are often categorised as biological factors, the physical and social environment, personal lifestyle, and health services. The standard of living in a society can influence an individual's choice of housing, work and social interactions, as well as eating and drinking habits. Some environmental factors and governed by living and working conditons, others are the result of wider structural factors, for example, attitudes towards economic growth.

Most influences on health demonstrate a social gradient, the conditions conducive to health becoming less favourable with declining social status. There is, therefore, an uneven distribution of health hazards and risk factors across the population, resulting in groups with lower status, power or income carrying a heavier burden of ill health.

An association between poverty and ill health has long been recognised. It seems likely that cumulative lifetime exposure to health damaging or health promoting physical and social environments is the main explanation for observed variations in health and life expectancy with health-related social morbidity, health damaging or promoting behaviours, use of health services and genetic or biological factors.

A strategic approach is potentially important for tackling inequalities in health at different policy levels and from a variety of entry points. This should focus on certain age groups, specific diseases and particular determinants of health, such as living and working conditions, because the differentials are caused by interrelated social and economic factors.

Improving access to essential facilities and services tackle the physical and psychological conditions in which people live and work, ensuring better access to the pre-requisites for health: clean water, sanitation, adequate housing, safe and fulfilling employment, safe and nutritious food supplies, essential health care, educational services and welfare. Such policies are the responsibility of various sectors, often operating independently of each other but with the potential for cooperation.

Policies designed to equalise access to acute health services would clearly do nothing to tackle the underlying causes of inequalities in health status. They might, however, prove much more cost-effective in tackling the results of deprivation that health promotion programmes which attempt the profound task of changing the unhealthy behaviour of those living in deprived circumstances, or preventive measures of unproven effectiveness. Attention should be focused on the underlying socio-economic inequalities which contribute to the health status variations.

Inequalities in health are avoidable and judged to be unjust and unfair. Equity is concerned with creating more equal opportunities for health and reducing differentials to the minimum. Societies which have less inequality in income, less variations in housing standards, and better working conditions seem to have less health inequalities between different socio-economic groups.
An attempt should be made to establish and pursue targets for reducing disparities in both health status and access to health services between disadvantaged population groups, and the general population programmes should be directed towards those populations in a spirit of equity, inviting their active participation in the development and implementation of the strategies.

Equity

Political will is the key to implementing various health care policies, including the necessary budgetary and administrative implementations. Efforts should be undertaken to enhance the climate for development support, including policies that focus on social equity rather than economic considerations alone, that recognise the long-term nature of social development, and that promote wider understanding and acceptance of the development process.

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