Inequalities in Health
cornerstone of justice and equality is equal capability to
achieve health (Sen 2002). Those whose lives are cut short by
and social conditions are subject to a brutal inequality. For
this reason, measures of survival, such as life expectancy,
become key indicators of social progress. We examine five aspects
of health inequality: 1) inequalities of life and death between
countries, 2) causes of death 3) disease prevalence, 4) health care spending. 5) inequalities
of life and death between countries
child born in Swaziland is nearly 30 times more likely to die
before the age of five than a child born in Sweden. (There are
per thousand births in Swaziland compared to four in Sweden.)
A child in Cambodia is 17 times more likely to die in its first
years than a child in Canada.
These are differences between average child mortality rates in those countries.
(described below) mean that the difference between the mortality
of poor children
in Swaziland and of rich children in the US is considerably
larger. Inequalities of life expectancy, infant mortality
and under five
mortality are examined in Life
and death -- inequalities between countries.
Causes of death
Worldwide, one death in three is from a communicable
disease (see figure), yet almost all these deaths occur in the
Third World. The relative infrequency
of death due to communicable disease in the industrialized world
shows what world health equality could achieve. We examine these
contrasts in Causes of death.
In the section Disease and Immunization,
we examine national rates of disease incidence. Maps and graphics
show the global pattern of incidence, and levels of immunization,
for selected communicable diseases, generally for the last four
decades. These pages show the decline of communicable diseases and
the spread of immunization in many countries of the world (The figure
below shows the global reduction in the prevalence of measles associated
with the spread of immunization).
of health care spending and achievement
countries achieve high life expectancy while spending little on
health care. Others spend heavily while achieving relatively low
life expectancy. In the graph below, the most striking comparison
is between the US and Cuba. Cuba achieves virtually identical life
expectancy to the US while spending
less than $200 per person on health care, compared to $4,400
per person in the US.
In the section on Health care
spending we look at some of the factors explaining these contrasts,
and the "inverse care law" - the rich receive care while
the poor have most of the illness and death and do not receive care.
also exist within countries
health data usually overlooks inequality within countries. Governments
rarely collect systematic data on the differences between mortality
rates and life expectancies of rich and poor. The graph below
shows the Under Five Mortality of the children of the poor and
rich for 44 countries for which data is available. We examine
other examples in Within country inequalities.
Sen, A. (2002). "Why health equity?"Health Economics