An abstract of the World Health Organization’s definition and programmatic focus on approaches to equity.
Definition
According to the WHO, equity is “the absence of avoidable or remediable differences among populations or groups defined socially, economically, demographically, or geographically” (WHO Glossary). WHO’s 2008 report, Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health, emphasizes the way that social factors concerned with health manifest in health consequences. These factors go beyond health issues and include “conditions in which people are born, grow, live, work and age”. WHO’s perspective addresses discriminatory health practices and all types of discrimination. WHO believes that exclusion ultimately correlates with and reinforces exclusionary health outcomes.
Determinants
WHO cites unequal distribution of power, income and access to goods and services as underlying determinants of inequity. Determinant factors of equity, they believe, involve the confluence of overlapping deprivations stemming from gender, age, circumstances under which people work, the physical nature of the place people live and disproportionate vulnerability to the natural environment and the systems put in place to deal with illness. With respect to the health sector, Closing the Health Equity Gap notes that the way health services are administered also impact equity. Impeded access to information and services, including barriers of cost linked to that, availability, accessibility, contact and effective coverage of health services all affect universality of care. Equity outcomes are also influenced by the way that the health sector coordinates with other social services, the way in which health inequities are measured and the involvement of marginalized groups in decision-making.
Manifestations
At its core, life expectancy at birth and vulnerability to illness are the central concerns of WHO. The determinant factors manifest as impeded access to healthcare, education, material conditions, conditions of work and leisure, security and the chance of leading a flourishing life. This is reflected in households, communities, towns and cities.
Characteristics of the WHO Equity Approach
WHO Constitution avers its commitment to equity. The Constitution calls for the enjoyment of the highest attainable standard of health as a fundamental right of every human being, without distinction of race, religion, political belief, economic or social condition.
WHO’s concerns for equity and social justice are expressed in its emphasis on universal health coverage, which helps to reinforce the links between health, social protection and economic policy. In practical terms, WHO focuses on responding to the groundswell of demand from countries worldwide that seek to advance this agenda in their own nations.
WHO promotes a holistic view involving the whole government and focuses not just on the health sector. It advises that a supporting health ministry can champion the social determinants of health approach by modeling and promoting integrated campaigns. The 2008 World Health Report emphasizing primary health care reiterates the health sector’s charge to pursue social justice values that recognize the right of universal primary health care and participation. The WHO’s endorsement of The Rio Declaration on Social Determinants of Health and its main action areas reflect WHO’s chief aims in reorienting health systems for greater equity. These areas are: “to improve daily living conditions, to tackle the inequitable distribution of power money and resources, and to measure and understand the problem and assess the impact of action”. Programs and policies aimed at improving access to quality housing and shelter, clean water and sanitation, and achieving basic needs for healthy living are deemed human rights that are essential aspects of the WHO approach.
Target Demographic
Universal Health Coverage (UHC) is designed to ensure that all people have access to preventive, curative, rehabilitative and palliative health services. This access must be of sufficient quality and ensure that the use of these services not expose the user to financial hardship. WHO highlights the importance of early childhood development in its social determinants approach and strives to improve the conditions into which a child is born, creating “equity from the start” (Closing the Gap 4). It also addresses gender equity as a socially determined dynamic and calls for comprehensive interventions in social, political, legal and economic realms.
Theory & Justification for the Equity Approach
WHO holds that the daily conditions that people live in have a strong influence on health equity and, further, that inequities in these circumstances are unfair and avoidable (Social Determinants of Health 6). Efforts by WHO to reorient the public health sector widely and influence policymakers beyond healthcare, so that health and equity are universal considerations, are embodied in WHO’s Priority Public Health Conditions Network. This network aims to re-frame the way public health entities define health intervention, to include social determinants and an equity lens. Ultimately, WHO argues that social policies can change poor health outcomes, and its production of practical tools and manuals reinforces this belief.
• Reference 1: Closing the gap in a generation: health equity through action on the social determinants of health, 2008.
• Reference 2: WHO: Closing the Health Equity Gap: Policy Options and Opportunities for Action, 2013.
• Reference 3: WHO Glossary: Equity.
• Reference 4: Tanahashi Bulletin, 1978.Health Service Coverage and Its Evaluation.
• Reference 5: Rio Political Declaration on Social Determinants of Health. 2011.
• Reference 6: Knowledge Network for Early Childhood: International Perspectives on Early Childhood Development. 2005.
• Reference 7: Priority Public Health Conditions Network. 2007.
• Reference 8: Gender mainstreaming for health managers: a practical approach. Facilitators Guide. WHO 2011.