in health care spending and numbers of doctors
in access to health care can have far-reaching consequences.
Those denied access to basic health care may live shorter and
lives. A dramatic example of this is that inadequate access to
health care is thought to be the primary cause of the premature
deaths of 100 million "missing women" worldwide.
Sen estimated (1990) that 100 million more women would be alive
primarily in China, South Asia and North Africa, if women and
girls had equal access to health care and nutrition across
Here we examine
two aspects of access to health care: spending and the number
The page on
health care spending
makes two points. First, a graph of global population, ranked
by average country spending, shows that there are enormous differences
in health care spending across the globe. Health care spending
per head for the top 5% of world population is nearly 4,500 times
spending in the lowest 20%.
graphs examine the relationship between health care spending and
life expectancy. These graphs show that there is a correlation
but there are also some striking anomalies. Countries which spend
little on health care mostly have low life expectancies, and countries
with high health care spending generally have high life expectancies.
But there are anomalies in both directions. Some countries with
high health care expenditure, such as the United States, have
surprisingly low average life expectancy.
The page on
provides a map illustrating the density of physicians across the
globe in 1998. It shows that the industrialized countries have
more physicians per 100,000 people than the non-industrialized.
However, within those categories there are some striking differences.
For example, some formerly socialist countries have a high density
indices, health care spending and density of doctors, suffer
from at least two limitations as measures of access to health
First, they provide national average measures, and therefore
do not illuminate differences in access within each country,
as between rich and poor, and urban and rural populations. Second,
even at the national level, these indices provide only a crude
metric of health care. For example, paramedics, "barefoot" doctors,
nurses and midwives may be more significant health care providers
than physicians for much of the world's population.
several other factors influence life expectancy, including access
to safe water, and adequate nutrition. There is much to be done
to provide better global health statistics.
these indicators provide a rough guide to some of the glaring
global disparities in access to health care.