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Journal of Health Politics, Policy and Law 28.2-3 (2003) 552-556



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Health Equities Worldwide


Timothy Evans, Margaret Whitehead, Finn Diderichsen, Abbas Bhuiya, and Meg Wirth, eds. Challenging Inequities in Health: From Ethics to Action.New York: Oxford University Press, 2001. 348 pp. $37.95 cloth.

Over the past fifty years, many countries have made significant gains in health status for their population groups due primarily to modern public health programs and public policies that led to improved living and working conditions. However, Timothy Evans and colleagues clearly and straightforwardly argue that claims in health status in many countries during this period do not portray an accurate picture and that "overall gains in a population's health frequently mask significant and worsening health outcomes for some population groups" (309). Why? One conclusion is that "health averages based on population averages are not reliable guides to what may be happening to the health of different groups in society" (312). Another is that unreported data skew results. Many poor population groups do not have easy access to medical care because of social, cultural, geographical, and financial barriers; subsequently, data for these do not emerge in the statistics. Furthermore, within many health care systems, the differential needs of men, women, children, and adolescents in health services are disregarded (181). Accordingly, there is a general lack of reliable data on health disparities, which poses a critical challenge for policy makers because responding to demands for improvements without persuasive accurate data is difficult (46). [End Page 552]

It is well recognized that many of the countries that report health inequities are the most marginalized. They are the ones with the lowest income, poorest household infrastructure, highest illiteracy, and the largest indigenous populations (6). These countries include Mexico, Tanzania, Chile, Kenya and South Africa. Accidents, injuries, and violence are also disproportionately concentrated in the poorer populations, particularly among the least educated in the same population group, as indicated by the study of Russia (145). As a result, health inequalities based on population groupings such as age, sex, race/ethnicity, education, income, and geographic area of residence (52) are common, and low social positions associated with occupation and housing lead to greater risk factors such as toxic exposure and disabilities (Schell and Czerwnyski 1998).

What does "health inequities" mean? Margaret Whitehead (1992) proposes that this be described as follows: that health inequities are distinguished from social inequities and are "those inequalities that are avoidable and unfair." Furthermore, we should be concerned with health equities because from a public policy perspective, one wholeheartedly embraces the social value that "our ability to learn, work, achieve our full potential and enjoy our lives depends on our health condition" (261). But the elimination of health inequities is not merely a social justice issue—it has a direct impact on a nation's economic situation. In Tanzania, for example, it is estimated that due to the very high incidence of HIV/AIDS among its population, the gross domestic product is between 14 and 24 percent lower than it would have been without the widespread existence of this dreadful disease (World Bank 1993). In Zimbabwe, by the year 2005, the cost of the response to HIV/AIDS is predicted to consume 60 percent of the health budget (19), leaving little for other public purposes that countries with better health status enjoy.

From another economic perspective, the authors found that serious health inequities are prevalent in developed countries also, including Sweden, Britain, the Netherlands, and the United States. In the United States, because "health inequalities are inextricably intertwined with social inequalities, it should not be surprising that the U.S. population's health is painfully unequal since the U.S. holds the dubious distinction of ranking first among industrialized nations in inequalities in both income and wealth" (105). Similarly, while the United States is ranked first in the world in its ability to fund health care programs, as measured by the percent gross national product spent on health care, average life expectancy from birth in the United States is below that of fifteen...

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