The Global Health Issue of Health Inequality

Introduction:

The global issue of healthcare inequalities has been a subject of discussion in many health conferences, forums, and even classroom. But, according to Martin & Kaufman (2008), a consensus has been built around the role that healthcare inequalities affect the delivery of primary healthcare. Ideally, primary healthcare emerges to be the element of concern in the subject of global healthcare inequalities because it is arguably the first point of entry into the healthcare system. Whereas primary healthcare has traditionally been organized around family care and/or family physicians, observations by Keleher (2001) indicate that nurses, as well as other health practitioners, are also increasingly participating in it. The importance of primary care has triggered key policymakers to advocate for a system redesign, particularly for the purpose of introducing a multidisciplinary approach to it (Romanow, 2002). Consequently, from nearly a decade ago, various provincial, territorial and federal governments have increased their investments in the infamous Primary HealthCare Transition (Fund Health Canada, 2007) as part of the on-going reforms targeted at improving the provision of primary healthcare through better management of common diseases, improving communication and reducing the patient waiting time duration (British Medical Association, 2006). However, according to Ashworth & Armstrong (2006), these reforms have largely not yielded the expected levels of improvements, especially in some countries such as the United Kingdom where unintended results (including increasing of health disparities or generating little or no effect) have been experienced. Consequently, a renewed debate has emerged on the issue of expanding the breadth of primary care and increasing the accountability with which the primary healthcare services are delivered, albeit with little attention to the reduction of healthcare inequalities and social determinants of health (Ballem, 2007).

Background and Literature Review

According to Smeeth & Heath (2001), countries such as Canada, the United States, and the UK have made, and are continuing to make several efforts towards addressing the social determinants of healthcare as well as health inequalities. Yet, existing empirical evidence still indicates that the strategies aimed at bringing reforms in the primary healthcare services within those countries have not been effective in addressing health inequalities (McLean et al, 2007).

A range of empirical evidence from various countries such as the UK and Canada indicate that the health status or mortality of individuals is more influenced by their economic and social circumstances that health care. According to Raphael (2006), these circumstances play a determining role in the success of interventions aimed at changing personal behaviours such as diet, smoking, and alcoholism, or, according to Bottle et al (2007), improving the management of chronic diseases. Therefore, there is a significant association between healthcare inequalities and improvement of healthcare outcome.

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Raphael (2006) argues that the health of populations is directly affected by social determinants of health, and these determinants are invariably the best predictors of population and individual health, as well as lifestyle, all which interact to produce health. Besides, it is common knowledge among researchers that various disparities in the economic and social status of different population groups within a particular population has a great effect on the health status of the entire population, in the sense that when the gap is larger, there is a lower health status of the entire population – and vice versa (Marmot, 2005).

Defining Health Inequities

World Health Organization (1978) defined health as “the extent to which an individual, community or family can realize their aspirations and satisfy their needs for coping with their environment.” Therefore, when there is a systematic social, economic, demographic or geographic disparity in one or more aspects of health across a population group, it is termed as a health inequality (Pan American Health Organization, 2005).

In a broader context, social determinants of health may include literacy and education, social status, working conditions, unemployment, or physical environment. Nonetheless, other determinants of health include personal coping skills, genetic endowment, culture, gender, and health practices. Besides, the Public Health Agency of Canada (2007) considers the availability and quality of health services as determinants of health.

Our Argument

Various policy change proposals have been made to address the political, social, and economic determinants of health and enhance equality in the access of quality health care, especially at primary care level (Sanders 2004). But, (Kunst et al 1998 and Melzer et al 2000) argue that there is still an apparently trivial difference in the mortality rates between the poor and the rich that clearly indicates a substantial difference in the quality of life and life expectancy. This is particularly evident in the UK where men from the first and second tier social classes ages between 65 to 69 years expect to live a disability-free life of 14 years compared to their counterparts from third and fourth tier social classes who live an average of 11 – 5 disability-free life (Perry, 2002).

Hence, in this essay, we argue that when effective and detailed socioeconomic policy measures are implemented, health inequality in Scotland can be reduced. We argue from the political philosophy or theory of society point of view that justice and ethical frameworks should be given greater consideration when developing policies to address health inequalities in Scotland. By applying the political philosophy or theory of society, we disagree with the ideas of Olive et al (2002, p. 566) that:

“Many differences in health across socioeconomic groups would not always be seen as inequitable if we remember that people have informed choice over diet, alcohol consumption, levels of exercise, etc.” We raise fundamental questions regarding the role of the state versus individuals in addressing the issue of health inequality by arguing that the fight against health inequality in Scotland cannot only be won by advocating for rational decision-making among the Scottish population regarding diet and lifestyle but also solid policy measures were taken by the Scottish government to address the issue.

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References

  • Ashworth M, Armstrong D. The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5. BMC Fam Pract. 2006;7(1):68.
  • British Medical Association . Quality and outcomes framework, 2006. London, Engl: British Medical Association; 2006.
  • Ballem P. Guaranteeing accountability for quality care. Healthc Pap. 2007;7(4):61–5. Bottle A, Gnani S, Saxena S, Aylin P, Mainous AG, 3rd, Majeed A. Association between quality of primary care and hospitalization for coronary heart disease in England: national cross-sectional study. J Gen Intern Med. 2008;23(2):135–41. Health Canada. Primary Health Care Transition Fund. Funded initiatives. Ottawa, ON: Health Canada; 2007.
  • Keleher H. Why primary health care offers a more comprehensive approach to tackling health inequities than primary care. Aust J Prim Health. 2001;7(2):57–61.
  • Kunst AE Groenhof F Mackenbach JP et al.for the EU Working Group on Socioeconomic Inequalities in Health Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. BMJ. 1998; 316: 1636-1642
  • Melzer D McWilliams B Brayne C Johnson T Bond J Socioeconomic status and the expectation of disability in old age: estimates for England. J Epidemiol Community Health. 2000; 54: 286 292.
  • Martin M. & Kaufman T. Addressing health inequities, A case for implementing primary health care Can Fam Physician. 2008 Nov; 54(11): 1515–1517.
  • McLean G, Guthrie B, Sutton M. Differences in the quality of primary medical care for CVD and diabetes across the NHS: evidence from the quality and outcomes framework. BMC Health Serv Res. 2007;7:74.
  • Oliver A. Healy A. & Le Grand J. Addressing health inequalities. Lancet. 2002; 360: 565-567
  • Public Health Agency of Canada. Determinants of health. Ottawa, ON: Public Health Agency of Canada; 2007. Perry J. Adressing Health Inequalities, Correspondence| Volume 360, ISSUE 9346, P1692, November 23, 2002. Romanow RJ. Building on values. The future of health care in Canada. Final report. 2002. Ottawa, ON: Commission on the Future of Health Care in Canada; 2002.
  • Raphael D. Social determinants of health: an overview of concepts and issues. In: Raphael D, Bryant T, Rioux M, editors. Staying alive. Critical perspectives on health, illness, and health care. Toronto, ON: Canadian Scholars’ Press; 2006. pp. 115–38.
  • Raphael D. Social determinants of health: present status, unanswered questions, and future directions. Int J Health Serv. 2006;36(4):651–77.
  • meeth L, Heath I. Why inequalities in health matter to primary care. Br J Gen Pract. 2001;51(467):436–7. World Health Organization. Primary health care. Report of the International Conference on primary health care, Alma-Ata, USSR, 6–12; September 1978. Geneva, Switz: World Health Organization; 1978.

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