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Social inequalities, regional disparities and health inequity in North African countries
Abdesslam Boutayeb, Uwe Helmert
International Journal for Equity in Health , 2011, DOI: 10.1186/1475-9276-10-23
Abstract: This study is based on data available for comparison between North African countries. The main data sources are provided by reports released by the World Health Organisation (WHO), United Nations Development Programme (UNDP), United Nations Children's Fund (UNICEF), the World Bank, surveys such as Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) and finally recent papers published on equity in different countries of the region.There is no doubt that education, health and human development in general have improved in North Africa during the last decades. Improvement was, however, uneven and unequally enjoyed by different socioeconomic groups. Indeed, each country included in this study shows large urban-rural disparities, discrepancies between advantaged and disadvantaged regions and cities; and unacceptable differences between rich and poor. Health inequity is particularly seen through access to health services and infant mortality.During the last decades, North African decision makers have endeavoured to improve social and economic conditions of their populations. Globally, health, education and living standard in general have substantially improved in average. However, North African countries have still a long way to go to reduce social inequalities and health inequity at different levels: rural-urban, advantaged-marginalised regions and cities, between groups of different level of income and wealth. The challenge for the next decade is not only to improve economic, social and health conditions in average but also and mainly to reduce avoidable inequalities in parallel.During the last decades, North African countries have seen a substantial improvement in the living standard of their populations. Life expectancy, literacy and per capita income improved in all countries and consequently, human development index has been steadily increasing. Beyond the global trend, however, improvement was not equally enjoyed. Indeed, urban-rural dispa
Social determinants of reproductive health in Morocco
B Abdesslam
African Journal of Reproductive Health , 2011,
Abstract: Moroccan population has known a growing demographic trend. However, beyond the global tendency, reproductive health remains characterised by inequalities and disparities between urban and rural, rich and poor, developed and deprived regions.In this study, we relied mainly on data and statistics provided by the last five censuses, the four Demographic Health Surveys, Multiple Indicator Cluster Surveys, reports of international bodies and publications dealing mainly with health and development in the Arab World. During the last decades, fertility declined due to different parameters. Infant mortality decreased and should reach the corresponding Millennium Development Goal whereas maternal mortality has stayed nearly constant. The achievements accomplished in reproductive health remain insufficient. Family planning and contraception policies need to reach more women; and antenatal and postnatal care should be enhanced especially towards poor women living in rural areas and deprived regions.
Social inequalities, labor, and health
Gomez, Carlos M.;Carvalho, S?nia Maria T. M. de;
Cadernos de Saúde Pública , 1993, DOI: 10.1590/S0102-311X1993000400010
Abstract: this article presents a brief analysis of the social inequalities expressed in the relationship between health and labor. it focuses on the brazilian context. it begins by approaching the conceptions present in the lines of investigation and intervention in this field of health. it considers an entire range of thinking, from the eminently biological and individual level to an understanding of the relationship between labor and health as a reflection of essentially social processes. the confrontation between conceptual advances, proposals for intervention, and the reality of health for brazilian workers is the parameter for analyzing the activity of state institutions, companies, and workers' organizations. based on the current situation outlined in this study, perspectives are identified for urgent and indispensable changes.
Measuring global health inequity
Daniel D Reidpath, Pascale Allotey
International Journal for Equity in Health , 2007, DOI: 10.1186/1475-9276-6-16
Abstract: Using global health data from the World Health Organization's 14 mortality sub-regions, a measure of global health inequality (based on a decomposition of the Pietra Ratio) is contrasted with a new measure of global health inequity. The inequity measure weights the inequality data by regional economic capacity (GNP per capita).The least healthy global sub-region is shown to be around four times worse off under a health inequity analysis than would be revealed under a straight health inequality analysis. In contrast the healthiest sub-region is shown to be about four times better off. The inequity of poor health experienced by poorer regions around the world is significantly worse than a simple analysis of health inequality reveals.By measuring the inequity and not simply the inequality, the magnitude of the disparity can be factored into future economic and health policy decision making.Inequity fuels the fire of moral outrage. It is justifiably and acutely observable in the area of global health. Global health researchers describe it, theorise about it, and look for solutions to it [1-4]. In all these endeavors however, there is a discomfort between knowing that inequity exists, "knowing" that it is a significant problem, and being able to say just how big a problem it is. At least a part of the difficulty arises from the unclear relationship between global health inequality and global health inequity.Health inequality refers simply to the uneven distribution of health in or between populations. Furthermore, some health inequalities are unavoidable [5]. Never can the situation arise in which an entire population has the same (i.e., equal) health status [6]. Nonetheless, health inequalities should be of particular interest when those inequalities are attributable to determinants that fall within the capacity of people and societies to moderate. When these kinds of disparities occur, the issue becomes one of health inequities – not simply unevenness but unfairness in
Social inequalities in health among the elderly
Barros, Marilisa Berti de Azevedo;Francisco, Priscila Maria Stolses Bergamo;Lima, Margareth Guimar?es;César, Chester Luiz Galv?o;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011001400008
Abstract: the aim of the present study was to assess social inequalities in health status, health behavior and the use of health services based on education level. a population-based cross-sectional study was carried out involving 1,518 elderly residents of campinas, s?o paulo state, brazil. significant demographic and social differences were found between schooling strata. elderly individuals with a higher degree of schooling are in greater proportion alcohol drinkers, physically active, have healthier diets and a lower prevalence of hypertension, diabetes, dizziness, headaches, back pain, visual impairment and denture use, and better self-rated health. but, there were no differences in the use of health services in the previous two weeks, in hospitalizations or surgeries in the previous year, nor in medicine intake over the previous three days. among elderly people with hypertension and diabetes, there were no differences in the regular use of health services and medication. the results demonstrate social inequalities in different health indicators, along with equity in access to some health service components.
Addressing Global Health, Development, and Social Inequalities through Research and Policy Analyses: the International Journal of MCH and AIDS  [cached]
Romuladus E. Azuine, DrPH, RN,Gopal K. Singh, PhD
International Journal of MCH and AIDS , 2012,
Abstract: One year after the birth of the International Journal of MCH and AIDS (IJMA), we continue to share the passion to document, and shine the light on the myriads of global health issues that debilitate developing countries.Although the focus of IJMA is on the social determinants of health and disease as well as on the disparities in the burden of communicable and non-communicable diseases affecting infants, children, women, adults, and families in developing countries, we would like to encourage our fellow researchers and policy makers in both the developing and developed countries to consider submitting work that examines cross-national variations in heath and social inequalities.Such a global focus allows us to identify and understand social, structural, developmental, and health policy determinants underlying health inequalities between nations.Global assessment of health and socioeconomic patterns reaffirms the role of broader societal-level factors such as human development, gender inequality, gross national product, income inequality, and healthcare infrastructure as the fundamental determinants of health inequalities between nations.This is also confirmed by our analysis of the WHO data that shows a strong negative association between levels of human development and infant and maternal mortality rates.Focusing on socioeconomic, demographic, and geographical inequalities within a developing country, on the other hand, should give us a sense of how big the problem of health inequity is within its own borders.Such an assessment, then, could lead to development of policy solutions to tackle health inequalities that are unique to that country.
The hidden inequity in health care
Barbara Starfield
International Journal for Equity in Health , 2011, DOI: 10.1186/1475-9276-10-15
Abstract: Inequity can be horizontal or vertical. Horizontal inequity indicates that people with the same needs do not have access to the same resources. Vertical inequity exists when people with greater needs are not provided with greater resources. In population surveys, similar use of services across population groups signifies inequity, because different population subgroups have different needs, some more than others. What is generally considered equity (equal use across population subgroups) is, in fact, inequity.Most industrialized countries have achieved both horizontal and vertical equity in the use of primary care services, meaning that people with greater health needs receive more primary care services. Although some countries have achieved horizontal equity in use of specialist services, very few have achieved vertical equity because socially-deprived populations have less access to specialist services than their needs require.There are no statistics on inequity in health in different countries. All standard health statistics describe average or "mean" health in the population - life expectancy, infant mortality, death rates from various diseases, and the like. Health indicators that are used to describe various aspects of population health and the impact of services on them are also useful for assessing equity in health. Producing them only requires stratifying the population into the social, economic, or geographic indicator and determining if there are differences in the rates of the indicator across the strata. As equity is an international priority, countries should be collecting data on inequities among groups in the population.Although equity in use of services is a worldwide imperative, an even more serious challenge is posed by the way of thinking about illness and its impact. The very underpinnings of modern-day health services are inequitable.Western health systems are dominated by a paradigm of illness that considers "diseases" to be the basic element
A review of equity issues in quantitative studies on health inequalities: the case of asthma in adults
Heather L Greenwood, Nancy Edwards, Amandah Hoogbruin, Eulalia K Kahwa, Okeyo N Odhiambo, Jack A Buong
BMC Medical Research Methodology , 2011, DOI: 10.1186/1471-2288-11-104
Abstract: A review was conducted of studies that identified social inequalities in asthma-related outcomes or health service use in adult populations. Data were extracted on use of equity terms (objective evidence), and discussion of equity issues without using the exact terms (subjective evidence).Of the 219 unique articles retrieved, 21 were eligible for inclusion. None used the terms equity/inequity. While all but one article traced at least partial pathways to inequity, only 52% proposed any intervention and 55% of these interventions focused exclusively on the more proximal, clinical level.Without more in-depth and systematic examination of inequities underlying asthma prevalence, quantitative studies may fail to provide the evidence required to inform equity-oriented interventions to address underlying circumstances restricting opportunities for health.Although sometimes used interchangeably, the terms 'health inequality' and 'health inequity' are not synonymous. Inequalities in health are only considered health inequities if they are deemed unjust and avoidable. While inequities in health are inequalities in that they reflect differences in status, capacity, or opportunity that shape risk factors and affect health outcomes, not all inequalities are inequities. The concept of inequity incorporates a values-based decision on whether differential findings by relevant social category (e.g. gender, class, race) are unfair and unjust [1]. Similarly, while 'health disparities' may incorporate inequities, not all disparities are inequitable [2]. These distinctions have important consequences for the way differences in health are understood and interventions are designed and measured [2-4]. Quantitative studies provide essential measures of health status that can inform action on health inequalities. However, a number of authors have suggested that some areas of quantitative research have not adequately discussed or interrogated the equity issues underlying such inequalities [5
Social inequalities in health: measuring the contribution of housing deprivation and social interactions for Spain  [cached]
Urbanos-Garrido Rosa M
International Journal for Equity in Health , 2012, DOI: 10.1186/1475-9276-11-77
Abstract: Introduction Social factors have been proved to be main determinants of individuals’ health. Recent studies have also analyzed the contribution of some of those factors, such as education and job status, to socioeconomic inequalities in health. The aim of this paper is to provide new evidence about the factors driving socioeconomic inequalities in health for the Spanish population by including housing deprivation and social interactions as health determinants. Methods Cross-sectional study based on the Spanish sample of European Statistics on Income and Living Conditions (EU-SILC) for 2006. The concentration index measuring income-related inequality in health is decomposed into the contribution of each determinant. Several models are estimated to test the influence of different regressors for three proxies of ill-health. Results Health inequality favouring the better-off is observed in the distribution of self-assessed health, presence of chronic diseases and presence of limiting conditions. Inequality is mainly explained, besides age, by social factors such as labour status and financial deprivation. Housing deprivation contributes to pro-rich inequality in a percentage ranging from 7.17% to 13.85%, and social interactions from 6.16% to 10.19%. The contribution of some groups of determinants significantly differs depending on the ill-health variable used. Conclusions Health inequalities can be mostly reduced or shaped by policy, as they are mainly explained by social determinants such as labour status, education and other socioeconomic conditions. The major role played on health inequality by variables taking part in social exclusion points to the need to focus on the most vulnerable groups. JEL Codes H51, I14, I18
Health Equity: Conceptual Models, Essential Aspects and the Perspective of Collective Health
Nivaldo Linares-Péreza,Oliva López-Arellano
Social Medicine , 2008,
Abstract: This paper analyzes the concept of health equity, drawing on ideas of social justice, of rights and values, and of the social and economic determinants which define living conditions and power relations among social groups. Differing schools of thought concerning health inequality and inequity in health are considered, highlighting contemporary approaches and the conceptual and operational diversity of definitions. We adopt the viewpoint of collective health and outline the elements which are essential to the understanding of inequity: the role of social, economic, political, cultural and ideological determinants on the equity of health outcomes, access to services and quality of care. We conclude that theoretical/conceptual frameworks must be formally spelled out before we can advance our understanding of health equity. The use and interpretation of terminology is made problematic by the abundance of definitions, although there appears to be a consensus on the need to further explore - in a varied, complementary and integrated manner - aspects of health care itself and of its environment. From a collective health perspective, we need to move beyond traditional approaches, a challenge which will enable better understanding of the social dynamics which, when expressed as inequalities in health, constitute social inequity.
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