What are health disparities?
Health disparities are preventable health inequalities between populations within countries and between countries. This injustice results from inequalities within and between communities. Social and economic conditions and their impact on people’s lives determine the risk of developing diseases in people and actions aimed at preventing their development of diseases or their treatment in case of illness.
Examples of health disparities between countries:
- the infant mortality rate (the risk of a child dying during the first year of life) is 3 per 1000 live births in Iceland and more than 110 per 1000 live births in Mozambique;
- the lifetime risk of maternal mortality during or shortly after pregnancy is only 2 in 18,100 in Sweden and 1 in 9 in Afghanistan.
Examples of domestic health disparities:
- in Bolivia, the mortality rate of infants born to women without education 90 per 1000 live births, while the mortality rate for infants born to mothers with at least secondary education is less than 50 cases per 1000;
- life expectancy is much lower among Aboriginal Australia (55 years for men and 65 years for women) than non-indigenous Australians (77 and 81, respectively);
- the life expectancy of men in Calton, Glasgow, is 55 years, 29 years less than that for men in Lanzi, a few kilometers away;
- the prevalence of long-term disabilities among European men over the age of 80 is 58.8% among less educated men and 40.2%
What does social gradient mean?
The poorest people in the world have the worst health conditions. Within countries, evidence suggests that the lower the person’s socioeconomic status, the worse their health. There is a social gradient of health that runs through the entire socioeconomic spectrum from top to bottom. This is a worldwide circumstance observed in low, middle and high-income countries. The social gradient of health means that health inequities affect everyone.
For example, if you look at mortality rates for children under five years of age depending on the level of family affluence, you will see that within countries the relationship between socioeconomic level and health has a gradation. The highest mortality rates for children under the age of five are observed in the poorest families, and in families located in the second top indicator, there is a higher mortality rate for children than in families whose level corresponds to the highest indicator. This is a social gradient of health.
What are the social determinants of health?
The social determinants of health are the conditions in which people are born, grow, work and age, and health systems. In turn, these conditions are formed under the influence of various forces: the economy, social conditions and politics.
What are the drivers of health disparities?
The well-being of communities depends on the situation in the world affecting international relations and domestic norms and policies. They, in turn, shape how society, organize its activities, leading to the formation of forms of social position and hierarchy, which organize population groups in accordance with income, education, employment, gender, race / ethnicity and other factors. The place occupied by a person in the social hierarchy determines the conditions in which he or she grows, studies, lives, works and ages, the degree of his or her protection against poor health and the consequences of such a state.
The benefits of economic growth over the past 25 years are unevenly distributed. In 1981, the gross national income of wealthy countries, in which 15% of the world’s population is concentrated, was 70 times higher than that of poverty-stricken countries, where 11% of the world’s population lives. By 2006, this ratio increased to 123.
The expansion of international aid flows – largely inadequate and not reaching the promised levels – is hindered by the size of many poor countries’ debt obligations. As a result, in many cases there is an alarming state of things: a net outflow of funds from poorer to richer countries.
Over the past 15 years, many countries have seen a decrease in the share of the poverty-stricken population in national consumption. For example, in Kenya, the average poor family will not get out of poverty until 2030. Doubling the income share of the poor in Kenya would mean that poverty would decrease by 2013.
Gender disparities in authority, resources, rights, norms and values, as well as in the way organizations are structured and implemented, are detrimental to the health of millions of females. The position of women in society is also related to the health and survival of children – boys and girls.
Health equity largely depends on empowering people to overcome and change the unfair and sharply differentiated distribution of public resources, for which everyone has equal rights. Injustice in authority manifests itself in four main areas – political, economic, social and cultural, which constitute a spectrum in which population groups are included in various ways in society or excluded from it.
What is health equity in politics in different sectors?
Every aspect of governance and economics has the potential to impact health and equity in health. It is enough to list only six of them: money matters, schooling, housing development, the condition of having paid work, transportation and the state of being free from illness or injury. Although health may not be the main policy objective in these sectors, they are largely associated with health and equity in health.
Policy coherence is crucial – the policies of the various departments of government should supplement rather than deny each other with regard to equity in health. For example, trade policies that actively encourage the production, sale, and consumption of fatty foods to the detriment of fruit and vegetable production are contrary to health policies.
Obesity is becoming a real a public health problem in countries with economies in transition as it has already become in high-income countries. To prevent obesity, approaches are needed that ensure a sustainable supply of nutritious food in sufficient quantities; housing suitable for easy consumption of healthier foods; participation in physical activity; and the environment in the family, school and at work that actively promotes a healthy lifestyle. Only a few of these actions are within the capacity or responsibility of the health sector. Undoubtedly, successes have been achieved – for example, a ban has been imposed on the advertising of foods high in fats, sugars and salt while showing children’s television programs. However, if we want to put an end to the global epidemic of obesity, there is still much to be done: to engage numerous sectors outside the health sector in areas such as trade, agriculture, employment and education.