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Forum: equity in access to health care. Introduction
Travassos, Claudia;
Cadernos de Saúde Pública , 2008, DOI: 10.1590/S0102-311X2008000500023
Abstract: the introduction outlines this issue's special forum on equity in access to health care, including three articles and a postscript. the forum represents a continuation of the debates raised during a seminar organized by the oswaldo cruz foundation in the city of rio de janeiro, brazil, in 2006, in collaboration with unicef, undp, world bank, the who special program for research and training in tropical diseases, and the united nations research institute for social development. the authors approach health care access and equity from a comprehensive and contemporaneous perspective, introducing a new conceptual framework for access, in which information plays a central role. trust is proposed as an important value for an equitable health care system. unethical practices by health administrators and health care professionals are highlighted as hidden critical aspects of inequities in health care. as a whole, the articles represent a renewed contribution for understating inequalities in access, and for building socially just health care systems.
Annotated Bibliography on Equity in Health, 1980-2001
James A Macinko, Barbara Starfield
International Journal for Equity in Health , 2002, DOI: 10.1186/1475-9276-1-1
Abstract: The purposes of this bibliography are to present an overview of the published literature on equity in health and to summarize key articles relevant to the mission of the International Society for Equity in Health (ISEqH). Equity, as defined by the ISEqH, is: "the absence of potentially remediable, systematic differences in one or more aspects of health across socially, economically, demographically, or geographically defined population groups or subgroups." [1]The intent is to show the directions being taken in health equity research including theories, methods, and interventions to understand the genesis of inequities and their remediation. Therefore, the bibliography includes articles from the health equity literature that focus on mechanisms by which systematic differences arise and approaches to reducing them where and when they exist. Because the International Society for Equity in Health is collaborating with SEIH (Socioeconomic Inequalities in Health) group in the Netherlands to make available an indexed bibliography on the literature of social disparities and social variations in health, many of these articles are not included in this review.This bibliography is the result of a literature search on the National Library of Medicine's PubMed database http://www.ncbi.nlm.nih.gov/entrez/query.fcgi webcite conducted in Summer 2001. As a first step, the search was limited to English-language articles from any year, published in peer-reviewed journals, and containing the terms "equity" or "inequity" in their titles. The first search yielded 672 references. Deleting duplicates and incomplete references, and inspecting titles for relevance left a total of 414 articles eligible for inclusion in the review. The list of eligible articles was further reduced by soliciting suggestions from several well-known researchers in the area of health equity.To a considerable extent, the final choice of articles included was dictated by a decision to provide examples of different a
Paying attention to gender and poverty in health research: content and process issues
?stlin,Piroska; Sen,Gita; George,Asha;
Bulletin of the World Health Organization , 2004, DOI: 10.1590/S0042-96862004001000008
Abstract: despite the magnitude of the problem of health inequity within and between countries, little systematic research has been done on the social causes of ill-health. health researchers have overwhelmingly focused on biomedical research at the level of individuals. investigations into the health of groups and the determinants of health inequities that lie outside the control of the individual have received a much smaller share of research resources. ignoring factors such as socioeconomic class, race and gender leads to biases in both the content and process of research. we use two such factors - poverty and gender - to illustrate how this occurs. there is a systematic imbalance in medical journals: research into diseases that predominate in the poorest regions of the world is less likely to be published. in addition, the slow recognition of women's health problems, misdirected and partial approaches to understanding women's and men's health, and the dearth of information on how gender interacts with other social determinants continue to limit the content of health research. in the research community these imbalances in content are linked to biases against researchers from poorer regions and women. researchers from high-income countries benefit from better funding and infrastructure. their publications dominate journals and citations, and these researchers also dominate advisory boards. the way to move forward is to correct biases against poverty and gender in research content and processes and provide increased funding and better career incentives to support equity-linked research. journals need to address equity concerns in their published content and in the publishing process. efforts to broaden access to research information need to be well resourced, publicized and expanded.
The Decalogue on the future of Public Health in Europe
Giuseppe La Torre,Giovanni Fadda,Gaetano Maria Fara,Roberto Gasparini
Italian Journal of Public Health , 2008, DOI: 10.2427/5821
Abstract: The following initiative is being made available to a wider national audience via the document entitled "10 Statements on the Future of Public Health in Europe". This document has been published in several European editions in their respective local languages. The aim of the 10 Statements is to allow a national audience to share the findings of a process of discussions, cultural and scientific exchanges. This process, focusing on the future of public health, began in 2002 within the European Public Health Association (EUPHA). EUPHA is an organization comprised of various public health associations in Europe. EUPHA currently consists of 48 members from 38 different nations and has the participation of more than 10,000 Public Health experts in Europe. This national society network is a tool that helps expand general knowledge about public health problems in Europe, as well as providing an analysis of the different policies and strategies adopted by different countries to address these problems. The Decalogue on the Future of Public Health in Europe is offered simultaneously in English and in Italian on the following journals of Hygiene and Public Health: Annals of Hygiene, Preventive Medicine and Community; - Modern Hygiene - Hygiene and Public Health, - Journal of Preventive Medicine and Hygiene - Italian Journal of Public Health.
Creditor Nations’ Equity Indexes and the U.S. Debt Downgrade  [cached]
Srinivas Nippani,Kenneth Washer
International Journal of Economics and Finance , 2012, DOI: 10.5539/ijef.v4n6p3
Abstract: On Friday, August 5, 2011 Standard and Poor’s rating agency downgraded long-term U.S. Treasury debt from AAA to AA+ for the first time in history. In this study, the impact of this downgrade on world stock markets is examined. We analyze the immediate effect of this downgrade on leading stock indices of 31 nations owning U.S. Treasury debt. We find that the downgrade had a marked effect on the first trading day following the announcement. It truly was a macroeconomic event. We further examine whether return differentials were partially explained by the level of U.S. debt that each country possessed (both on an absolute and relative basis). We find no evidence of this relationship, which suggests equity markets in countries owning considerable Treasury securities suffered no more or less than equity markets in countries with less U.S. Treasury debt.
Poverty, equity, human rights and health
Braveman,Paula; Gruskin,Sofia;
Bulletin of the World Health Organization , 2003, DOI: 10.1590/S0042-96862003000700013
Abstract: those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.
Poverty, equity, human rights and health  [cached]
Braveman Paula,Gruskin Sofia
Bulletin of the World Health Organization , 2003,
Abstract: Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.
Evidence, Analysis and Advocacy for Equity- The Perspective of the Malawi Health Equity Network
J Njunga, A Kasiya
Malawi Medical Journal , 2006,
Abstract: This paper presents a synopsis of experiences of Malawi Health Equity Network, in its work to deepen the evidence and strengthen the platform for civic participation in the promotion of equitable health services in Malawi. The Malawi Health Equity Network (MHEN) is a non-profit independent alliance of Civil Society Organizations and other interested parties promoting equity and quality in health for all people in Malawi, by influencing policy and practice, through research, monitoring, information dissemination, advocacy and civic education. MHEN's vision is for “All people in Malawi to have access to equitable, quality and responsive essential health care services by the year 2020 with Malawi Health Equity Network as the ‘Health Equity Watch'.” MHEN was formed in 2000 when the Health Advocacy Network and Malawi EQUINET merged, since both organizations had similar goals and objectives. The Network is legally registered under the laws of Malawi. MHEN seeks to address health inequalities that are avoidable and unfair. In line with this, the Network activities are geared towards influencing redistribution of social resources, which include skilled human resources within the Public Health Sector, and the power and ability of people at the grassroots level to make choices over health inputs, thus building their capacity to use these choices to improve their health status. Malawi Medical Journal Vol. 18 (2) 2006: pp. 53-54
Health Systems Governance for Health Equity: Critical Reflections
Labonté,Ronald;
Revista de Salud Pública , 2010, DOI: 10.1590/S0124-00642010000700005
Abstract: this article addresses several issues pertinent to health systems governance for health equity. it argues the importance of health systems using measures of positive health (well-being), discriminating in favour of historically less advantaged groups and weighing the costs of health care against investments in the social determinants of health. it cautions that the concept of governance could weaken the role of government, with disequalizing effects, while emphasizing the importance of two elements of good governance (transparency and participation) in health systems decision-making. it distinguishes between participation as volunteer labour and participation as exercising political rights, and questions the assumption that decentralization in health systems is necessarily empowering. it then identifies five health system roles to address issues of equity (educator/watchdog, resource broker, community developer, partnership developer and advocate/catalyst) and the implications of these roles for practice. drawing on preliminary findings of a global research project on comprehensive primary health care, it discusses political aspects of progressive health system reform and the implications of equity-focused health system governance on health workers' roles, noting the importance of health workers claiming their identity as citizens. the article concludes with a commentary on the inherently political nature of health reforms based on equity; the necessary confrontation with power relations politics involves; and the health systems governance challenge of managing competing health discourses of efficiency and results-based financing, on the one hand, and equity and citizen empowerment, on the other.
Health Research Profile to assess the capacity of low and middle income countries for equity-oriented research
P Tugwell, C Sitthi-Amorn, J Hatcher-Roberts, V Neufeld, P Makara, F Munoz, P Czerny, V Robinson, Y Nuyens, D Okello
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-151
Abstract: A multi-disciplinary team with coordinators from each of four regions (Asia, Latin America, Africa and Central and Eastern Europe) developed a questionnaire through consensus meetings using a mini-Delphi technique. Indicators were selected based on their quality, validity, comprehensiveness, feasibility and relevance to equity. Indicators represented five categories that form the Health Research Profile (HRP): 1) Research priorities; 2) Resources (amount spent on research); 3) Production of knowledge (capacity); 4) Packaging of knowledge and 5) Evidence of research impact on policy and equity. We surveyed three countries from each region.Most countries reported explicit national health research priorities. Of these, half included specific research priorities to address inequities in health. Data on financing were lacking for most countries due to inadequate centralized collection of this information. The five main components of HRP showed a gradient where countries scoring lower on the Human Development Index (HDI) had a lower capacity to conduct research to meet local health research needs. Packaging such as peer-reviewed journals and policy forums were reported by two thirds of the countries. Seven out of 12 countries demonstrated impact of health research on policies and reported engagement of stakeholders in this process.Only one out of 12 countries indicated there was research on all fronts of the equity debate. Knowledge sharing and management is needed to strengthen within-country capacity for research and implementation to reduce inequities in health. We recommend that all countries (and external agencies) should invest more in building a certain minimum level of national capacity for equity-oriented research.Today, globalization threatens the health of our society with an undesirable effect on equity in health for development. The notion that Essential National Health Research (ENHR) is a key strategy for equity in development within and between countries i
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