Health is a human right, but what about equity?

Washington, DC, December 12, 2002 (PAHO) -- "All men are equal, but some are more equal than others," goes the saying that makes fun of the common contradiction between the text of the law in many Constitutions and the reality that exists in many countries. Unfortunately, health is not an exception.

"It is impossible to discuss modern health care without equity appearing as a priority subject," said Dr. Abraam Sonis, winner of the Abraham Horwitz Award for Inter-American Health. "And where it does not appear, without doubt it has been ignored deliberately."

When discussing equity, there is a risk of dealing with the subject in idealistic terms and losing sight of the concrete terms to which it alludes. PAHO orients its activities toward the most vulnerable groups: mothers and children, workers, the poor, elderly and refugees and displaced people. It focuses on equity for those who lack resources to obtain health care.

Dr. Sonis pointed out the need for an operational definition of equity to carry out the objectives of PAHO and of the governments of the Region. "We can think of equity in health as encompassing at least three imperatives, since it implies: equal access to care for equal need, equal use of resources for equal need, and equal quality of care for all."

This concept of the equity is applicable at different levels: the differences within each country, be they economic, ethnic, political or of gender; differences between countries, and differences between regions.

"An operational definition is important for us, given the practical difficulties in implementing the recommendations on equity that have flooded the field of health in recent years. A review of resolutions from numerous international meetings and government programs in all the countries clearly shows the interest that exists in promotion of equity, which appears as an objective in health policies but only reaches a relatively minor weight when it comes time to make decisions," said Dr. Sonis.

This is even more evident, say experts, when analyses move beyond averages. A study conducted by Bernardo Kliksberg, of the Inter-American Development Bank and published by PAHO’s Pan American Journal of Public Health, says that in spite of considerable progress in health conditions of the Region, when data are analyzed separately there are notable differences among the countries and in each of the countries. These are clearly manifested in three principal public health indicators: differences in life expectancy, infant mortality, and maternal mortality.

"Various analyses indicate that behind the disturbing differences between various geographical areas and groups of population are, among other causes, marked deficiencies in crucial aspects of public health. Access to drinking water, health facilities, sewerage and electricity is limited for broad sectors. This creates risk factors that weigh heavily in health. It is estimated that 130 million people lack drinking water. On the other hand, the cost of water for the poor is much higher than for the middle and upper classes," according to Kliksberg’s study.

A joint report by PAHO and the Economic Commission for Latin America and the Caribbean (ECLAC) points out that "an increase in chronic noncommunicable diseases associated with the food and nutrition is observed in almost all the countries of the Region." The report indicated that "adjustment measures implemented by the countries have affected the national availability of food and have had negative impact on the purchasing power of poorer groups, threatening food security."

Health coverage is restricted for the sectors most affected by all these risk factors. PAHO has calculated that 130 million Latin Americans lack regular access to health services.

And, within this framework, the subject of ethnicity is not excluded. "Racial discrimination in the plane of health finds expression in difficulties of access to services, poor quality of available services, lack of adequate information for decision-making, or through indirect mechanisms such as lifestyles, place of residence, type of occupation, income bracket or status of the individuals", says Dr. Cristina Torres, sociologist and regional adviser on public policy and Health for PAHO.

Gender violence and problems of women, especially poor women, are also priorities for PAHO, which has as one of its goals the reduction of maternal mortality and of domestic violence, often associated with cultural patterns and situations of economic and feminine dependency.

A similar situation occurs with the mentally ill, whose situation in the Americas "requires immediate action in order to protect life and the physical and psychic integrity of thousands of adults and minors who are prisoners in psychiatric institutions or abandoned in the streets," said Dr. José Miguel Caldas de Almeida, coordinator of PAHO’s Mental Health Program, in a presentation to the Inter-American Commission on Human Rights.

PAHO, which also serves as the Regional Office for the Americas of the World Health Organization, was officially established in 1902. The oldest health organization in the world, PAHO works with all the countries of the Region to improve the health and raise living standards of their peoples.

For more information, please contact: Daniel Epstein, Office of Public Information, (202) 974-3459, e-mail: epsteind@paho.org.

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