Achieving equity in health continues to be a major challenge in the Region of the Americas. Although health inequalities have seen some limited improvements across the Region and certain countries that have made notable progress in reducing inequalities, trends are not improving overall. According to the Organization for Economic Cooperation and Development, countries of the Americas consistently rank among the lowest in terms of average well-being and social and economic inequalities.
These inequalities are not the result of innate differences among people but rather have deeper roots related to determinants such as systemic discrimination and institutional policies that contribute to poverty and unacceptable environmental and other living conditions, meriting a social justice-based response. The continued realities of social and health inequities have been further exposed and exacerbated more recently by the unprecedented COVID-19 pandemic that is testing governments, communities, economies, and individuals in ways previously unimagined.
Hence, health equity is a central tenet of the Pan American Health Organization’s (PAHO) mission “to lead strategic collaborative efforts among Member States and other partners to promote equity in health, to combat disease, and to improve the quality of, and lengthen the lives of the peoples of the Americas.” The Organization’s current commitment to achieving health equity through policy and programs is guided both by the mandates of the 2030 Sustainable Development Goals and PAHO’s own Sustainable Health Agenda for the Americas 2018-2030 and Strategic Plans 2014-2019 and 2020-2025. These mandates present a strategic agenda to be executed jointly by Member States and the Organization.
This special issue of the Pan American Journal of Public Health on health equity seeks to enhance the body of public health literature and evidence on the realities of inequities in health in the Americas, their underlying causes, and, especially, the options for policy responses and action.
The variety of analysis that is expressed in this special issue’s articles reflects a need for multiple consolidating approaches to health equity. Their focus ranges from the need for an equity focus in national health plans (Kavanagh et al.), in public health infrastructure (Benjamin), and in access to technology (Mayer-Foulkes et al.); the urgency of action on the social determinants of health as well as on structural drivers, including gender inequality and structural racism (González Vélez et al., Viáfara et al.), including through approaches such as intercultural approaches and traditional medicine (Gallego-Pérez et al.). They also demonstrate the importance of accountability mechanisms, such as the roles of civil society and collaborative research (Castro et al., Hassell et al.) among other equity-related themes.
The Journal appreciates the support of the Editorial Board—Anna Coates, Pan American Health Organization, Washington DC, United States of America; Arachu Castro, Tulane University School of Public Health and Tropical Medicine, New Orleans, United States of America; Michael Marmot, Institute of Health Equity at the University College London, London, United Kingdom; Oscar J Mújica, Pan American Health Organization, Washington DC, United States of America; Gerry Eijkemans, Pan American Health Organization, Washington DC, United States of America; and Cesar G Victora, Universidade Federal de Pelotas, Pelotas, Brazil—for the planning of the special issue and the selection of articles. Their contributions helped make the manuscripts more interesting, more accurate, and more useful to our readers and all others who work to improve the health of the peoples of the Americas.
The Journal acknowledges the contribution of the Robert Wood Johnson Foundation for its financial support to the production of this special issue.