Selected Topics - Inequalities and Health

• Centre for Health Equity
  The Centre for Health Equity is an association of academic and government bodies dedicated to developing and implementing programs to reduce healt

Events

• School of Public Health and Community Medicine, UNSW - Upcoming Events

Global policies and related documents

• Mapping global health inequalities: challenges and opportunities
  This paper by Peter Tugwell, Vivian Robinson, and Erin Morris and published in the Center for Global, International and Regional Studies ‘Mapping Global Inequalities’ conference papers (University of California - Santa Cruz – USA, 12 December 2007) states, “…Health inequalities both between and within countries persist, for almost all diseases and health problems. Between countries, both average life expectancy and child mortality have improved more in the richest countries than the poorest (Marmot 2007). Within countries, progress on redressing health inequalities is uneven, and data are not always available over time. Analysis of 22 countries with available data found that only five of 22 countries reduced health inequalities in childhood mortality across income from 1995 to 2000 (Moser 2005). Health inequalities are differences in health across population groups defined by socioeconomic, demographic, or geographic factors. These factors can be summarised using the acronym PROGRESS: Place of residence (urban/rural), Race/ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, and Social capital/resources …”.
• Upgrading Urban Communities: A Resource for Practitioners
  Prepared for the Thematic Group for Services to the Urban Poor, The World Bank and the Special Interest Group on Urban Settlement, School of Architecture and Planning, Massachusetts Institute of Technology, this site provides information and resources on practical slum improvement.

Reports, guidelines and projects

• A Methodology to Analyse the Intersections of Social Inequalities in Health
  An important issue for health policy and planning is the way in which multiple sources of disadvantage, such as class, gender, caste, race, ethnicity, and so forth, work together to influence health. Although ‘intersectionality’ is a topic for which there is growing interest and evidence, several questions as yet remain unanswered. These gaps partly reflect limitations in the quantitative methods used to study intersectionality in health, even though the techniques used to analyse health inequalities as separable processes can be sophisticated. In this paper, we discuss a method we developed to analyse the intersections between different social inequalities, including a technique to test for differences along the entire span of the social spectrum, not just between the extremes. We show how this method can be applied to the analysis of intersectionality in access to healthcare, using cross-sectional data in Koppal, one of the poorest districts in Karnataka, India. [author abstract] [Journal of Human Development and Capabilities, Vol. 10, Iss. 3, Nov. 2009, pp.397-415]
• A pan-European comparison regarding patient access to cancer drugs
  "The availability of modern cancer treatments varies widely from country to country. In order to inform the debate on to how to prioritise healthcare, it is essential to have as accurate as possible a knowledge base of the current distribution of resources and their uptake by the medical profession and patients. In this report, Wilking and Jönsson have surveyed access to and uptake of new anticancer drugs across the European states. They have reviewed data from 19 countries accounting for 447 million people, or 76% of the total population in Europe (excluding Russia and Turkey); after excluding Norway and Switzerland, this constitutes 96% of the total population of the 25 EU member states. Their report focuses on the treatment of common cancers such as breast, lung and colorectal cancer and non-Hodgkin’s lymphoma, and aspects of palliative medicine using the example of malignant metastatic bone disease..."
• A systematic review of inequalities in the use of maternal health care in developing countries: Examining the scale of the problem and the importance of context
  In this October 2007 review paper, Lale Say & Rosalind Raine find that inequalities in the use of maternal care in developing countries vary widely, highlighting the need to investigate and assess context-specific causes of use of maternal health care.
• Access: how do good health technologies get to poor people in poor countries?
  "This book explores the challenges and approaches to improving access to health technologies for poor people in poor countries. Our goals are to develop and illustrate a way to think systematically about the barriers to access and to identify strategies that can help improve access." [Harvard Series on Population and International Health, 2008]
• An Action Plan to Prevent Brain Drain: Building Health Systems in Africa
  This 2004 report from Physicians for Human Rights seeks to address the issue of Brain Drain from health care systems in Africa. The report's author Eric A Friedman defines Brain Drain as the exodus of health care workers from the often under-resourced health care systems in developing nations to the wealthier countries of the North resulting in severe shortages in health care workers in many African nations. The report proposes several means of addressing this problem, including improvements in health infrastructure, higher salaries, enhanced investment in training and reduced recruitment by wealthy nations.
• An Economic Framework for Analysing the Social Determinants of Health and Health Inequalities
  "Reducing health inequalities is an important part of health policy in most countries. This paper discusses from an economic perspective how government policy can influence health inequalities, particularly focusing on the outcome of performance targets in England, and the role of sectors of the economy outside the health service – the ‘social determinants’ of health - in delivering these targets." [CHE Research Paper 52 – Centre for Health Economics, University of York, October 2009]
• Analyzing Health Equity Using Household Survey Data Analyzing: A Guide to Techniques and Their Implementation
  "…Health equity has become an increasingly popular research topic during the course of the past 25 years. Many factors explain this trend, including a growing demand from policymakers, better and more plentiful household data, and increased computer power. But progress in quantifying and understanding health equities would not have been possible without appropriate analytic techniques. These techniques are the subject of this book. The book includes chapters dealing with data issues and the measurement of the key variables in health equity analysis (Part i), quantitative techniques for interpreting and presenting health equity data (Part ii), and the application of these techniques in the analysis of equity in health care utilization and health care spending (Part iii). The aim of the book is to provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity, with worked examples and computer code, mostly for the computer program Stata."
• Asymmetries of Poverty: Why Global Burden of Disease Valuations Underestimate the Burden of Neglected Tropical Diseases
  "…The disability-adjusted life year (DALY) initially appeared attractive as a health metric in the Global Burden of Disease (GBD) program, as it purports to be a comprehensive health assessment that encompassed premature mortality, morbidity, impairment, and disability. It was originally thought that the DALY would be useful in policy settings, reflecting normative valuations as a standardized unit of ill health. However, the design of the DALY and its use in policy estimates contain inherent flaws that result in systematic undervaluation of the importance of chronic diseases, such as many of the neglected tropical diseases (NTDs), in world health."
• Beyond the Numbers: Understanding the Institutions for Monitoring Poverty Reduction Strategies
  This book by the International Bank for Reconstruction and Development / The World Bank "concentrates on one of the cornerstones underpinning the new relationship: a monitoring system that guides the elaboration of the poverty reduction strategy, the design of policies, and the evaluation of the impacts. It focuses specifically on what has proven to be one of the most difficult aspects in the design and implementation of monitoring systems: the institutional arrangements, that is, the formal and informal processes, procedures, rules, and mechanisms that bring monitoring activities into a coherent framework. By drawing out the lessons and good practice from an analysis of 12 countries and proposing a diagnostic tool to assess country systems, this book equips policy makers and practitioners who struggle to design and run such systems and makes an important contribution to strengthening the effectiveness of development assistance and the quality of poverty reduction strategies."
• Building multisectoral partnerships for population health and health equity
  Poor performance in achieving population health goals is well-noted — approximately 10% of public health measures tracked are met. Less well-understood is how to create conditions that produce these goals. This article examines some of the factors that contribute to this poor performance, such as lack of shared responsibility for outcomes, lack of cooperation and collaboration, and limited understanding of what works. It also considers challenges to engaging stakeholders at multiple ecologic levels in building collaborative partnerships for population health. Grounded in the Institute of Medicine framework for collaborative public health action, it outlines 12 key processes for effecting change and improvement, such as analyzing information, establishing a vision and mission, using strategic and action plans, developing effective leadership, documenting progress and using feedback, and making outcomes matter. The article concludes with recommendations for strengthening collaborative partnerships for population health and health equity. [Prev Chronic Dis Vol. 7: No. 6, November 2010 (Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion)]
• Case studies on social determinants of health
  The case studies present successful examples of policy action aiming to reduce health inequities, covering a wide range of issues, including conditional cash transfers, gender-based violence, tuberculosis programmes and maternal and child health. The case studies were written by individual experts and are being circulated as draft background papers to inform discussions at the conference: Brazil: The Brazilian experience with conditional cash transfers: a successful way to reduce inequity and to improve health; United States of America: How can we get the 'social determinants of health' message on the public policy and public health agenda?; Solomon Islands: Gender-based violence in Solomon Islands: Translating research into action on the social determinants of health; Republic of Kiribati: Measuring and responding to gender-based violence in the Pacific: Action on gender inequality as a social determinant of health; Viet Nam: Gender-based violence in Viet Nam: Strengthening the response by measuring and acting on social determinants of health; Australia: Health in All Policies: South Australia's country case study on action on the social determinants of health; WHO Western Pacific region: Addressing social determinants of health through tuberculosis control programmes in Western Pacific Region; Malaysia: Health in All Policies: The Primary Health Care Approach in Malaysia. 50 years experience in addressing social determinants of health through Intersectoral Action for Health; India: India's country experience in addressing social exclusion in maternal and child health; India: Effective social determinants of health approach in India through community mobilization; Thailand: Health systems, public health programmes and social determinants of health; Egypt: Social participation in Egypt: Civil society's former experience and new opportunities; Morocco: Social determinants and health equity in Morocco; United States of America: A national partnership for action to end health disparities in the United States of America; Australia: Supporting public policy and action on the social determinants of health by providing evidence through the Social Health Atlases of Australia; Cambodia: Gender as a social determinant of health: Gender analysis of the health sector in Cambodia; WHO Western Pacific region: Gender mainstreaming in emerging disease surveillance and response; Iran: School Pupil Policy Officer (Hamyare Police) - A national initiative based on social participation to improve road safety; Jordan: National commitment to action on social determinants of health in Jordan: Addressing obesity; Namibia: Report on country experience: A multi-sectoral response to combat the polio outbreak in Namibia; Rwanda: Community performance-based financing in health: Incentivizing mothers and community health workers to improve maternal health outcomes; Uganda: Social determinants of health: Food fortification to reduce micronutrient deficiency - Strengthening the National Food Fortification Programme; Kenya: The national deworming programme: Kenya's experience; Zimbabwe: Intersectoral actions in response to cholera in Zimbabwe: From emergency response to institution building; Brazil: The Green Area of Morro da Policia: Health practitioners working with communities to tackle the social determinants of health; Chile: Steps towards the health equity agenda in Chile; and Pakistan: Heartfile Health Financing: Striving to achieve health equity in Pakistan. [Background papers: WHO - World Conference on Social Determinants of Health, 19-21 October 2011, Rio de Janeiro, Brazil]
• Challenges and Successes in Reducing Health Disparities: Workshop Summary
  "In early 2007, the Institute of Medicine convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, to further the development of programs and strategies to reduce disparities, to foster the emergence of leadership on this issue, and to track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities. The Roundtable’s first workshop, Challenges and Successes in Reducing Health Disparities, was held in St. Louis, Missouri, on 31 July, 2007, and examined: (1) the importance of differences in life expectancy within the United States; (2) the reasons for those differences; and (3) the implications of this information for programs and policy makers."
• Chances for Change: Dutch measures to improve the global distribution of health personnel
  "Shortages of health personnel are experienced worldwide. They exist in developing countries as well as in developed countries. When one country’s demand exceeds its supply of health personnel, a ‘pull’ is exerted for migration flows from other countries. This pull is not shaped by the burden of disease in a country, but by unequally distributed financial resources for health systems. Consequently, migration flows are directed towards more affluent countries and regions. This increases the global maldistribution of health personnel and inequities in health." [Wemos Foundation, Amsterdam, The Netherlands; Dutch Alliance for Human Resources for Health, 2011]
• Children on the Brink 2004: A Joint Report of New Orphan Estimates and a Framework for Action (PDF) 46pg
  Children on the Brink 2004 presents the latest statistics on historical, current and projected numbers of children under 18 who have been orphaned by AIDS and other causes. This edition of the biannual report underscores the changing needs of this vulnerable group as they progress through adolescence and calls for the urgent development and expansion of family and community support.
• Closing the gap in a generation: Health equity through action on the social determinants of health
  "The Final Report of the Commission on Social Determinants of Health sets out key areas of daily living conditions and of the underlying structural drivers that influence them in which action is needed. It provides analysis of social determinants of health and concrete examples of types of action that have proven effective in improving health and health equity in countries at all levels of socioeconomic development." The Executive Summary is available in Arabic, Chinese, English, French, Russian and Spanish.
• Closing the Health Inequalities Gap: An International Perspective
  "This report was authored by Iain K. Crombie, Linda Irvine, Lawrence Elliott and Hilary Wallace of the University of Dundee, Scotland, UK. It was commissioned by NHS Health Scotland and published by the WHO European Office for Investment for Health and Development. The report presents an analysis of official documents on government policies to tackle inequalities in health from 13 developed countries."
• Communicating research for evidence-based policymaking: A practical guide for researchers in socio-economic sciences and humanities
  "The social and economic challenges which we face require policymaking at all levels – regional, national and European – to move beyond traditional paradigms and create responses which offer sustainable solutions now and in the future. The European Economic Recovery Plan (1) and the EU 2020 strategy (2) create the broad policy context for this approach. ‘Smart’ investment, which focuses on the skills that are needed for the future, is seen as a major pillar of Europe’s strategy to respond to the challenges it faces. The research projects funded under the Framework Programmes can play a major role in giving shape to this approach. The Directorate-General for Research is supporting researchers and project coordinators in meeting these challenges. In wide-ranging discussions with policymakers and researchers it has explored how to best ensure dialogue between both areas. This dialogue is crucial if the policy messages provided by the research supported by the EU are to contribute to the development of the strategies and approaches necessitated by the realities we face. This guide is the most recent stage of this process of identifying needs and developing appropriate support. It builds on the work undertaken in our earlier publication ‘Scientific evidence for policymaking’ which identified the key priorities for deepening communication and strengthening the transfer of knowledge and experience between research and policymaking. This publication is designed to offer an easy-to-read guide which identifies the most important stages in the development of a dynamic communication strategy and which will ensure that the projects funded under the Framework Programmes make a real difference in enabling policymakers to respond to the significant challenges we face. Divided into three parts – Concept, Policy Briefs and Practical Means – this guide is intended to help exploit research concepts into genuine policy action." [publication summary] [Directorate-General for Research, Socio-economic Sciences and Humanities Publications Office of the European Union, Luxembourg 2010 (EUR 24230 EN)]
• Constructing the evidence base on the social determinants of health: A guide
  "This guide is designed for practitioners interested in developing and implementing policies and programmes to tackle the social determinants of health inequities. It sets out state of the art recommendations on how best to measure the social determinants of health and the most effective ways of constructing an evidence base which provides the basis for translating evidence into political action… The guide is divided into two parts: Issues and principles; and Tools and techniques."
• Counting and Multidimensional Poverty Measurement
  This Oxford Poverty & Human Development Initiative Working Paper (of 7 December 2007) by Sabina Alkire and James Foster "proposes a new methodology for multidimensional poverty measurement consisting of: (i) an identification method that extends the traditional intersection and union approaches, and (ii) a class of poverty measures that satisfies a range of desirable properties including decomposability. The identification step makes use of two forms of cutoffs: first, a cutoff within each dimension to determine whether a person is deprived in that dimension; second, a cutoff across dimensions that identifies the poor by counting the number of dimensions in which a person is deprived. The aggregation step employs the FGT measures, appropriately adjusted to account for multidimensionality. The identification method is particularly well suited for use with ordinal data, as is the first of our measures, the adjusted headcount ratio. The paper also provides illustrative examples from Indonesia and the US to show how our methodology might be used in practice."
• Coverage of Cervical Cancer Screening in 57 Countries: Low Average Levels and Large Inequalities
  "Effective coverage rates for cervical cancer screening services are very low outside of developed countries, and women at the highest risk of developing cervical cancer are among the least likely to be screened. Coverage rates decline with advancing age, when cervical cancer incidence rates are the highest. Poor women, who likely have higher exposure to known cervical cancer biological risk factors such as smoking and unsafe sex, also show much lower coverage rates. Improving the effective coverage of cervical cancer screening or developing alternative ways to decrease cervical cancer mortality worldwide would have a considerable impact on decreasing the disease's burden as well as overall health inequalities. No one strategy will work everywhere, making it important to consider multiple strategies across — and likely within — countries." [PLoS Med June 2008 - 5(6): e132]
• CPRC Chronic Poverty Report 2004-2005
  This report, presented by the Chronic Poverty Research Centre at the University of Manchester UK argues that if people in chronic poverty throughout the world are to benefit from economic development and have the chance of escaping from poverty they need targeted support, social assistance and social protection and political action that confronts exclusion.
• Declining Inequality in Latin America: Some Economics, Some Politics
  Latin America is known to have income inequality among the highest in the world. That inequality has been invoked to explain low growth, poor education, macroeconomic volatility, and political instability. But new research shows that inequality in the region is falling. In this paper we summarize recent findings on inequality, present and discuss an assessment of how the type of political regime matters and why, and investigate the relationship between changes in inequality and changes in the size of the middle class in the region. We conclude with some questions about whether and how changes in income distribution and in middle-class economic power will affect the politics of distribution in the future. [publication abstract] [CGD Working Paper 251. Washington, D.C.: Center for Global Development, June 2011]
• Defining equity in health
  The objective of the study described in this article by P Braveman and S Gruskin from The Journal of Epidemiology and Community Health Vol.57, No.4, April 2003, was to propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept.
• Determinants of Mortality
  ".Mortality rates have fallen dramatically over time. In just the past century, life expectancy has increased by over 30 years. At the same time, mortality rates remain much higher in poor countries, with a difference in life expectancy between rich and poor countries of also about 30 years. This difference persists despite the remarkable progress in health improvement in the last half century, at least until the HIV/AIDS pandemic. Published by Princeton University, this report reviews the determinants of these patterns: over history, over countries, and across groups within countries. While there is no consensus about the causal mechanisms, we tentatively identify the application of scientific advance and technical progress (some of which is induced by income and facilitated by education) as the ultimate determinant of health."
• Do Socioeconomic Gradients in Body Mass Index Vary by Race/Ethnicity, Gender, and Birthplace?
  "Despite the well-documented negative socioeconomic status (SES) gradient in body mass index (BMI; weight (kg)/height (m)2) among women in developed societies, the presence and strength of the gradient is less consistent among men. Far less clear is the SES patterning of BMI among racial/ethnic minorities and immigrants. Using data from the 2001 California Health Interview Survey, a cross-sectional representative sample of California adults, the authors examined whether the SES patterning of BMI varied across 4 major US racial/ethnic groups (n = 37,150) by gender and birthplace. The shape and strength of the relation between SES and BMI differed markedly by race/ethnicity; and within racial/ethnic groups, it varied by gender. Irrespective of race/ethnicity, there were negative income and education gradients in BMI among women; however, there was considerable variation among men. The effect of education on BMI differed by birthplace in some groups. A clear education gradient in BMI was found among all US-born participants, a quadratic education pattern in BMI was found among foreign-born Asian men, a flat pattern was found among foreign-born Asian women, and no clear pattern was found in the remaining foreign-born groups. There is substantial heterogeneity in the contemporaneous SES gradient in BMI. US social disparities in BMI require simultaneous consideration of race/ethnicity and SES, but also birthplace…" [authors’ abstract].
• Does it matter that we don't agree on the definition of Poverty?: a comparison of four approaches
  This working paper from Queen Elizabeth House, University of Oxford reviews four approaches to the definition and measurement of poverty - the monetary capability, social exclusion and participatory approaches. It points out the theoretical underpinnings of the various measures and problems of operationalising them.
• Economic growth and child poverty in the CEE/CIS and the Baltic States
  This report highlights the gaps between rich and poor within the 27 countries of Central and Eastern Europe and the Commonwealth of Independent States, as well as between the more prosperous countries of Central Europe and the poorer countries of the Caucasus and Central Asia. It argues that poverty cannot be determined by income alone and that a way of measuring additional factors that effect quality of life such as exclusion from society, the lack of respect for human rights, lack of choice and the scale and impact of discrimination must be found if the impact of poverty is to be measured accurately.
• Educational level as a contextual and proximate determinant of all cause mortality in Danish adults
  The objective of this study by M Osler and E Prescott, published in the Journal of Epidemiology and Community Health, March 2003; was to examine the educational level in the area of living as a determinant of all cause mortality. Pooled data from two population based cohort studies were linked to social registers to obtain selected socioeconomic information at parish and individual level. The author's conclude that educational level of an area influenced subject’s mortality, but first after adjustment for behavioural and other contextual risk factors.
• Effective Partnerships Key to Combating Gender-Based Violence
  UNIFEM Press Release, 19 November 2004, United Nations New York which asserts that partnerships between governments, the international system, civil society, the media and private sector offer real solutions to ending gender-based violence.
• Elder Mistreatment: Abuse, Neglect, and Exploitation in Aging America
  This report is meant to point the way toward better understanding of the nature and scope of elder mistreatment in America. It examines the characteristics, causes, consequences and effective means of preventing and managing elder abuse, neglect and exploitation.
• Eliminating Health Disparities: Measurement and Data Needs, online summary (PDF)
  This report examines data collection and reporting systems relating to the collection of data on race, ethnicity, and socioeconomic position and offers recommendations. Disparities in health and health care across racial, ethic and socioeconomic backgrounds in the United States are well documented. The reasons for these disparities are however not well understood. This report highlights the importance of a better understanding of health data collection and reporting systems in understanding and addressing health disparities.
• Employment Conditions and Health Inequalities
  This 2007 report by Joan Benach, Carles Muntaner, Vilma Santana on behalf of the Employment Conditions Knowledge Network, Commission on the Social Determinants of Health, World Health Organization, aims "to provide a rigorous analysis on how employment relations affect different population groups, and how this knowledge may help identify and promote worldwide effective policies and institutional changes to reduce health inequalities derived from these employment relations. Consequently, the report incorporates the political, cultural, and economic context to provide a comprehensive account of the current international situation of labour markets and types of employment conditions. How inequalities in health are understood and approached by any society is a political issue. They can be accepted as the inevitable result of individual differences in genetic determinants, individual behaviours, or market transactions, or they can be seen as an avoidable outcome that needs to be remedied. Inequalities in health derived from employment are closely linked to other kinds of social inequalities including inequalities in wealth, political participation, and education. Thus, through regulating employment relations, main political actors can not only redistribute resources affecting social stratification, but also have an impact on the life experiences of different social groups including opportunities for well-being, exposure to hazards leading to disease, and access to health care. Although there is abundant literature on specific employment and working conditions and health, the literature rarely focuses directly on the important role played by employment relations and conditions as a key social determinant in shaping health inequalities. This report is a contribution toward filling these gaps in knowledge, hoping that a better understanding of these mechanisms will facilitate the task of making well-informed political decisions over such a crucial issue. Employment relations, employment conditions and working conditions are different yet interrelated concepts. The first concept constitutes the relationship between an employer that hires workers who perform labour to sell a profitable good or service, and an employee who contributes with labour to the enterprise, usually in return for payment of wages…”.
• Equitable access: research challenges for health in developing countries: Report on Forum 11
  This Forum 11 report provides an overview and synthesis of the key issues discussed and conclusions reached in 2007, Beijing, People's Republic of China. Organized at the invitation of the Ministry of Health of the People's Republic of China, it drew 620 participants from close to 80 countries to discuss research issues, best practices and gaps in securing equitable access to health.
• Equity and Health Sector Reform in Latin America and the Caribbean from 1995-2005
  "The purpose of this report is to document the experiences and lessons learned in health sector reforms (HSR) initiated during the years of 1995 to 2005 and their effects on equity in the access and delivery of services. As a result, this report involved searching and compiling studies published in international journals, both in English and Spanish, as well as looking at grey literature. The evidence gathered reveals that for most countries, the implementation of HSR has not delivered the effects expected. In Colombia, even though there have been some achievements in reducing inequities in access and resource allocation, the health expenditures have also increased greatly (above 10% of GDP), which makes the extension of the benefits to the other half of the poor population who encounter themselves outside the system, unsustainable and unrealistic."
• Equity in Canadian health care: Does socioeconomic status affect waiting times for elective surgery?
  Waiting times for surgical and other procedures are an important measure of how well the health care system responds to patient needs. In a universal health care system such as Canada's, it is important to determine if waiting times vary by socioeconomic status (SES). The authors, Samuel E D Shortt, Shaw, Ralph A compared waiting times for elective surgery of patients living in low and high socioeconomic areas.
• Equity in Health Care Financing: The Case of Malaysia
  Background: Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective: The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods: Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani’s progressivity index. Results: Results showed that Malaysia’s predominantly tax-financed system was slightly progressive with a Kakwani’s progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Conclusions: Malaysia’s two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help shape health financing strategies for the nation. [International Journal for Equity in Health, June 2008, 7:15]
• Equity, social determinants and public health programmes
  "The work presented in this volume was carried forward with the conviction that achieving greater equity in health is a goal in itself, and that achieving the various specific global health and development targets without at the same time ensuring equitable distribution across populations is of limited value. Most literature on equity and the social determinants of health is based on data that are from high-income countries and that focus on possible causal relationships. Even in high-income countries there is limited documentation of experiences with interventions and implementation approaches to halt growing or reduce existing inequities in health. This shortfall is addressed within the World Health Organization (WHO) system by the Priority Public Health Conditions Knowledge Network, which aims to widen the discussion on what constitutes public health interventions by identifying the social determinants of health inequities and appropriate interventions to address the situation. The work of the Network has been focused on practice, establishing the knowledge base as a starting-point and then quickly and pragmatically moving on to exploration of potential avenues and options for action. While the scientific review of evidence has played a major role in the work of the Network, the main aim has been to expand the known territory and move, in a responsible and systematic way, into the unknown, by suggesting new paths of action for public health programmes. Effectively addressing inequities in health involves not only new sets of interventions, but modifications to the way that public health programmes (and possibly WHO) are organized and operate, as well as redefinition of what constitutes a public health intervention." [World Health Organization, 2010]
• Equity-Focused Health Impact Assessment: a literature review
  This report was undertaken as part of the Equity Focused Health Impact Assessment (EFHIA) Project conducted by the Centre for Health Equity, Training, Research and Evaluation at The University of New South Wales on behalf of the Australasian Collaboration for Health Equity Impact Assessment. The project aims to identify the rationale for developing an equity focused HIA framework.
• Ethics and governance of global health inequalities
  Research Aim: To study why global health inequalities are morally troubling, why efforts to reduce them are morally justified, how they should be measured and evaluated; how much priority disadvantaged groups should receive; and to delineate roles and responsibilities of national and international actors and institutions. Discussion and conclusions: Duties and obligations of international and state actors in reducing global health inequalities are outlined. The ethical principles endorsed include the intrinsic value of health to well-being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups. This approach does not seek to find ways in which global and national actors address global health inequalities by virtue of their self-interest, national interest, collective security or humanitarian assistance. It endorses the more robust concept of "human flourishing" and the desire to live in a world where all people have the capability to be healthy. Unlike cosmopolitan theory, this approach places the role of the nation-state in the forefront with primary, though not sole, moral responsibility. Rather, shared health governance is essential for delivering health equity on a global scale.
• Europe’s neglected infections of poverty
  Objectives: To review the prevalence, incidence, and geographic distribution of the major neglected infections of poverty in Europe as a basis for future policy recommendations. Methods: We reviewed the literature from 1999 to 2010 for neglected tropical diseases listed by PLoS Neglected Tropical Diseases (http://www.plosntds.org/static/scope.action) and the geographic regions and countries of (continental) Europe. Reference lists of identified articles and reviews were also hand searched, as were World Health Organization databases. Results: In Eastern Europe, the soil-transmitted helminth infections (especially ascariasis, trichuriasis, and toxocariasis), giardiasis, and toxoplasmosis remain endemic. High incidence rates of selected food-borne helminthiases including trichinellosis, opisthorchiasis, taeniasis, and echinococcosis also occur, while brucellosis and leptospirosis represent important bacterial zoonoses. Turmoil and economic collapse following the war in the Balkans, the fall of Communism, and Europe’s recent recession have helped to promote their high prevalence and incidence rates. In Southern Europe, vector-borne zoonoses have emerged, including leishmaniasis and Chagas disease, and key arboviral infections. Additional vulnerable populations include the Roma, orphans destined for international adoption, and some immigrant groups. Conclusions: Among the policy recommendations are increased efforts to determine the prevalence, incidence, and geographic distribution of Europe’s neglected infections, epidemiological studies to understand the ecology and mechanisms of disease transmission, and research and development for new control tools. [author abstract] [International Journal of Infectious Diseases (2011), doi:10.1016/j.ijid.2011.05.006]
• Exclusion in Health in Latin America and the Caribbean
  The purpose of this study is to obtain a clear panorama of the exclusion in health situation in the Latin American and Caribbean Region and advancing toward the identification of the most adequate strategies to combat it and to strengthen policies and strategies for the extension of social protection in health.
• Exploring the Pathways of Inequality in Health, Access and Financing in Decentralised Spain
  “The extent to which equality in accessing and financing health care reduces inequalities in health is a key policy question for health-care reform. Cross-country studies, when they exist, suffer from marked comparability limitations due to data heterogeneity and differences between organisational and financing systems. The Spanish devolved national health system offers a “unique field” for exploring these issues, and also for testing the effects of institutional reform, in the context of political decentralisation. This study uses data from 2001, the last year before decentralisation was extended to all regional governments or Autonomous Communities (ACs) in Spain. This Working Paper contributes to the literature by examining two questions: First, we evaluate the heterogeneity within regional inequalities in health, health-care access and health financing and examine whether these are associated with the political decentralisation of health care responsibilities. Second, we explore whether inequalities in health care between regional health services can be explained by inequalities in health-care use and health-care financing, using cross-correlation analysis along with other relevant variables. The results of the study suggest that inequalities in health are not associated with the regional uptake of health-care responsibilities. Instead they appear to be driven by income inequalities and regional health care capacity whilst the influence of inequalities in health-care use depends on quality of life adjustments.”
• For Public Service or Money: Understanding Geographical Imbalances in the Health Workforce
  Geographical imbalances in the health workforce have been a consistent feature of nearly all health systems, and especially in developing countries. In this paper we investigate the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analysing data obtained from contingent valuation questions, we find that household consumption and the student’s motivation to help the poor, which is our proxy for intrinsic motivation, are the main determinants of willingness to work in a rural area. We investigate who are willing to help the poor and find that women are significantly more likely to help than men. Other variables, including a rich set of psycho-social characteristics, are not significant. Finally, we carry out some simulations on how much it would cost to make the entire cohort of starting nurses and doctors choose to take up a rural post.
• Gender Equality, Work and Health: A Review of the Evidence
  This WHO publication documents the relationship between gender, inequality and health and safety problems. It reviews gender issues in research, policies and programmes on work and health, and highlights some specific issues for women, including the types of jobs they do, as well as their need to reconcile the demands of work and family. Biological differences between women and men also are considered in relation to hazards they face in the workplace. Implications of the findings and recommendations for legislation and policy are discussed.
• Global Employment Trends 2004
  "This report estimates that the number of unemployed grew by 20 million since the beginning of 2001 to reach about 180 million at the end of 2002, and that the increase was most severe among women. In addition an increasing number of young people entering the labour market were unable to find jobs."
• Global patterns of income and health
  The 2006 Wider Annual Lecture was presented by Angus Deaton, Dwight D Eisenhower Professor of Economics and International Affairs at Princeton University. The lecture argues that despite the decrease in international inequalities in life expectancy for many years after 1945, the apparent convergence in life expectancies is not as beneficial as might appear, and that, while economic growth is the key to poverty reduction, there is no evidence that it will deliver automatic health improvement in the absence of appropriate policy.
• Globalization and the Social Determinants of Health
  This analytic and strategic paper was prepared by the Institute of Population Health at the University of Ottawa.The paper defines globalisation, the nature of the evidence base, how the global market place affects social determinants of health, environment and resources and finally the next steps needed to address the issues raised.
• Groups, Social Influences and Inequality: A Memberships Theory Perspective on Poverty Traps
  "This essay by Steven N. Durlauf is intended to describe a perspective on poverty traps in which persistence in economic status is generated by group-level influences on individuals. What distinguishes this theory from other explanations of poverty is its emphasis on the role of social, as opposed to individual-level characteristics."
• Growing income inequality in OECD countries: What drives it and how can policy tackle it?
  "Reforming tax and benefit policies is the most direct and powerful instrument to increase redistributive effects. Large and persistent losses of low-income groups following recessions underline the importance of well-targeted income-support policies. Government transfers – both in cash and in-kind – have an important role to play to guarantee that low-income households do not fall further back in the income distribution. At the other end of the income spectrum, the relative stability of higher incomes – and their longer-term trends – is important to bear in mind in planning reforms of redistribution policies more broadly. It may be necessary to review whether existing tax provisions are still optimal in light of equity considerations and current revenue requirements. This is especially the case where the share of overall tax burdens borne by high-income groups has declined over recent years (e.g., because of non-compliance, cuts in marginal income taxes or because tax expenditures mainly benefit high-income groups). However, redistribution strategies based on government transfers and taxes alone would be neither effective nor financially sustainable. A key challenge for policy is to facilitate and encourage access to employment for under-represented groups. This requires not only new jobs, but jobs that enable people to avoid and escape poverty. Recent trends towards higher rates of in-work poverty indicate that job quality has become a concern for a growing number of workers. Policy reforms that tackle inequalities in the labour market, such as those between standard and non-standard forms of employment, are needed to reduce income inequality. Policies that invest in human capital of the workforce are needed. This requires better training and education for the low-skilled. The latter would serve to boost their productivity potential and future earnings. Over the past two decades, the trend to increased education attainment has been one of the most important elements in counteracting the underlying increase in wage inequality in the longer run. Policies that promote the up-skilling of the workforce are therefore key factors to reverse the trend to further growing inequality." [OECD Forum on Tackling Inequality, Paris, 2 May 2011]
• Growing Unequal? Income Distribution and Poverty in OECD Countries
  "Growing inequalities poses three challenges, economic, political and ethical. OECD Secretary-General Angel Gurría warned of the dangers posed by inequality and the need for governments to tackle it. “Growing inequality is divisive. It polarises societies, it divides regions within countries, and it carves up the world between rich and poor. Greater income inequality stifles upward mobility between generations, making it harder for talented and hard-working people to get the rewards they deserve. Ignoring increasing inequality is not an option.” A key driver of income inequality has been the number of low-skilled and poorly educated who are out of work. More people living alone or in single-parent households have also contributed… Growing Unequal? brings together a range of analyses on the distribution of economic resources in OECD countries. The evidence on income distribution and poverty covers, for the first time, all 30 OECD countries in the mid-2000s, while information on trends extending back to the mid-1980s is provided for around two-thirds of the countries. The report also describes inequalities in a range of domains (such as household wealth, consumption patterns, in-kind public services) that are typically excluded from conventional discussion about the distribution of economic resources among individuals and households. Precisely how much inequality there is in a society is not determined randomly, nor is it beyond the power of governments to change, so long as they take note of the sort of up-to-date evidence included in this report." Summaries are available in 21 languages.
• Health and Poverty in Guatemala
  The objective of this World Bank Policy Research document by Michele Gragnolati and Alessandra Marini is to provide up-to-date information on the characteristics and patterns of the health status of the Guatemalan population and recommend possible solutions to institutional, financing and implementation problems that exist within the health sector.
• Health and the Millennium Development Goals
  WHO's report, Health and the Millennium Development Goals, presents data on progress on the health goals and targets and looks beyond the numbers to analyse why improvements in health have been slow and to suggest what must be done to change this. The report points to weak and inequitable health systems as a key obstacle, including particularly a crisis in health personnel and the urgent need for sustainable health financing.
• Health Behaviours, Socioeconomic Status, and Mortality: Further Analyses of the British Whitehall II and the French GAZEL Prospective Cohorts
  Background: Differences in morbidity and mortality between socioeconomic groups constitute one of the most consistent findings of epidemiologic research. However, research on social inequalities in health has yet to provide a comprehensive understanding of the mechanisms underlying this association. In recent analysis, we showed health behaviours, assessed longitudinally over the follow-up, to explain a major proportion of the association of socioeconomic status (SES) with mortality in the British Whitehall II study. However, whether health behaviours are equally important mediators of the SES mortality association in different cultural settings remains unknown. In the present paper, we examine this issue in Whitehall II and another prospective European cohort, the French GAZEL study. Methods and Findings: We included 9,771 participants from the Whitehall II study and 17,760 from the GAZEL study. Over the follow-up (mean 19.5 y in Whitehall II and 16.5 y in GAZEL), health behaviours (smoking, alcohol consumption, diet, and physical activity), were assessed longitudinally. Occupation (in the main analysis), education, and income (supplementary analysis) were the markers of SES. The socioeconomic gradient in smoking was greater (p<0.001) in Whitehall II (odds ratio [OR] = 3.68, 95% confidence interval [CI] 3.11–4.36) than in GAZEL (OR = 1.33, 95% CI 1.18–1.49); this was also true for unhealthy diet (OR = 7.42, 95% CI 5.19–10.60 in Whitehall II and OR = 1.31, 95% CI 1.15–1.49 in GAZEL, p<0.001). Socioeconomic differences in mortality were similar in the two cohorts, a hazard ratio of 1.62 (95% CI 1.28–2.05) in Whitehall II and 1.94 in GAZEL (95% CI 1.58–2.39) for lowest versus highest occupational position. Health behaviours attenuated the association of SES with mortality by 75% (95% CI 44%–149%) in Whitehall II but only by 19% (95% CI 13%–29%) in GAZEL. Analysis using education and income yielded similar results. Conclusions: Health behaviours were strong predictors of mortality in both cohorts but their association with SES was remarkably different. Thus, health behaviours are likely to be major contributors of socioeconomic differences in health only in contexts with a marked social characterisation of health behaviours. [author abstract] [PLoS Med 8(2): e1000419. doi:10.1371/journal.pmed.1000419]
• Health Disparities and the Body Politic
  In the spring of 2005, the Working Group on Health Disparities at the Harvard School of Public Health held three international symposia addressing the issue of health disparities. Featuring senior governmental public health leaders and academic researchers from Latin America, Asia, Africa, Western and Northern Europe, as well as Canada and the US, the symposia explored both the successes and limitations of current policy approaches. By fostering frank cross-cultural discussion, the series also sought to inspire action on one of today's most urgent public health problems.
• Health Disparities in New York City
  This report finds that although much progress has taken place in reducing health disparities in New York City substantial disparities remain. Poor New Yorkers as well as African-American and Hispanic New Yorkers bear a disproportionate burden of illness and premature death, poor health is concentrated in certain New York neighbourhoods and factors associated with poor health such as poor access to medical care, unhealthy behaviours and poor living conditions are more common among certain economic and racial / ethnic groups.
• Health Equity Impact Assessment: A primer
  "HEIA [Health Equity Impact Assessment] is a tool used to analyze a new program or policy's potential impact on health disparities and/or on health disadvantaged populations. It is an adaptation of health impact assessment (HIA) with an explicit focus on equity. There are a few variations of HEIA tools…, but they share similar processes with the purpose of prospectively building health equity into the planning of new services, policies, or other initiatives. HEIA has also been used as a way to assess or realign existing programs. HEIAs may be conducted within an organization to aid decision making, by outside groups to influence decision-making, by potentially affected communities to voice their concerns, or collaboratively by a variety of stakeholders." [Toronto: Wellesley Institute (2010)]
• Health Equity Through Intersectoral Action: An Analysis of 18 Country Case Studies
  Recognition of the intersectoral dimensions of the determinants of health has stimulated international efforts on systematic learning about how the action of different sectors can positively influence health and health equity. The World Health Organization (WHO) and the Public Health Agency of Canada (PHAC) have supported the development of this collaborative work by jointly commissioning a set of 18 case studies from high, middle, and low income countries. The case studies outline diverse experiences of action across sectors with positive impacts for health and health equity. This paper… provides an analysis of key learnings from those 18 case studies. The case studies analyzed here represent a broad array of initiatives that ranged from relatively small-scale programs that used a community development approach with a marginalized group in one city, to broad, policy-focused initiatives from national governments. Socio-political, economic and cultural contexts are important in each of the case studies reviewed, creating the landscape within which intersectoral action was initiated and carried out.
• Health for Some: Death, Disease and Disparity in a Globalizing Era
  This report discusses the issue of equity and sustainability, one of the fundamental health challenges inherent in our contemporary global political economy. The authors argue that globalisation as we know it today is fundamentally asymmetric in that its benefits fall less on those in poor countries and on poor households in developing countries and that addressing this disparity calls for some form of market correcting system of wealth redistribution between as well as within nations.
• Health Inequalities: A Challenge for Europe
  "The primary aim of this independent report, which was commissioned by the UK Presidency of the EU, is to review national-level policies and strategies - that either have been or are in the process of being developed to tackle health inequalities - and to reflect on the challenges that lie ahead. In doing so, it primarily focuses on socio-economic inequalities in health."
• Health inequalities and inequities
  This is Chapter 1 of the book, “Unequal Lives: Health and Socioeconomic Inequalities” by Hilary Graham, Professor of Health Sciences at the University of York, UK. In this chapter, "...health inequalities can be cast as individual differences in health, differences in health between population groups and differences between groups linked to broader social inequalities. These definitions are distinguished by their focus on individuals (individual differences in health), the social groups to which individuals belong (health differences between population groups) and the unequal structures of which groups are part (health differences between unequal groups). The three concepts are used to describe within country inequalities: to capture health inequalities between individuals and groups living in the same country. They can also be applied to inequalities in health at the global level...".
• Health inequalities and the welfare state: Perspectives from social epidemiology
  “It might be assumed that welfare states that have done so much to reduce inequality of opportunity have also reduced inequality of health outcomes. While great advances have been seen in reducing the rates of many diseases in welfare states, disparities in health have not been eliminated. Is it the case that lowering risks overall will leave disparities that cannot be re-mediated, and that such efforts are at the point of diminishing returns? The evidence suggests that this is not true. Instead the lens of social epidemiology can be used to identify groups that are at unequal risk and to suggest strategies for reducing health inequalities through upstream, midstream, and downstream interventions. The evidence suggests that these interventions be targeted at low socioeconomic position, place-based limitations in opportunities and resources, stages of the life course and the accumulation of disadvantage across the life course, and the underlying health-related factors that are associated with the marginalization and exclusion of certain groups. In their commitment to the values of equity and social justice, welfare states have unique opportunities to demonstrate the extent to which health inequalities can be eliminated….” [author abstract]
• Health inequalities: progress and next steps
  This document outlines the UK Government’s approach to hit the 2010 health inequalities Public Service Agreement targets, assessing what has and has not worked, and setting the direction of travel beyond 2010. The partial Equality Impact Assessment sets out some of the current health inequalities and potential interventions to reduce and eliminate these inequalities.
• Health inequalities – Understanding the essentials
  In order to tackle health inequalities together, we need to share a common understanding of what we mean when we talk of "inequity" and unfairness in health and health care. This introduction to tackling health inequalities aims to explain some of the thinking behind policy and practice on tackling health inequalities. The London Health Observatory (LHO) has a national lead role on behalf of the Association of Public Health Observatories on health inequalities and ethnicity.
• Health Needs Assessment at a Glance
  Health needs assessment is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities. This guide is published by the UK, National Institute for Clinical Excellence.
• Health Poverty Index Tool
  The HPI aims to allow groups, differentiated by geography, social or economic position and cultural identity, to be contrasted in terms of their 'health poverty’. A group's 'health poverty' is a combination of both its present state of health and its future health potential or lack of it. The key justification for the selection of a particular set of groups is the expectation of an equal distribution of health and its determinants between the groups from the perspective of social justice.
• Hidden cities: unmasking and overcoming health inequities in urban settings
  "The World Health Organization (WHO) and United Nations Human Settlements Programme (UN-HABITAT) joint global report, Hidden cities: unmasking and overcoming health inequities in urban settings, exposes the extent to which certain city dwellers suffer disproportionately from a wide range of diseases and health problems. This report provides information and tools to help governments and local leaders reduce health inequities in their cities. The objective of the report is not to compare rural and urban health inequities. Urban health inequities need to be addressed specifically for they are different in their magnitude and in their distribution." [WHO/UN-HABITAT report – November 2010]
• HIV and Global Health: global inequality of life expectancy due to HIV/AIDS
  This paper deals with the growth in global health inequality, particularly in the light of the enormous impact of HIV/AIDS in Africa, asserting that this trend is not inevitable and can be reduced.
• How have Global Health Initiatives impacted on health equity?
  "This review examines the impact of Global Health Initiatives (GHIs) on health equity, focusing on low- and middle-income countries. It is a summary of a literature review commissioned by the WHO Commission on the Social Determinants of Health. GHIs have emerged during the past decade as a mechanism in development assistance for health. The review focuses on three GHIs, the US President's Emergency Plan For AIDS Relief (PEPFAR), the World Bank's Multi-country AIDS Programme (MAP) and the Global Fund to Fight AIDS, TB and Malaria. All three have leveraged significant amounts of funding for their focal diseases — together these three GHIs provide an estimated two-thirds of external resources going to HIV/AIDS. This paper examines their impact on gender equity. An analysis of these Initiatives finds that they have a significant impact on health equity, including gender equity, through their processes of programme formulation and implementation, and through the activities they fund and implement, including through their impact on health systems and human resources. However, GHIs have so far paid insufficient attention to health inequities. While increasingly acknowledging equity, including gender equity, as a concern, Initiatives have so far failed to adequately translate this into programmes that address drivers of health inequity, including gender inequities. The review highlights the comparative advantage of individual GHIs, which point to an increased need for, and continued difficulties in, harmonisation of activities at country level. On the basis of this comparative analysis, key recommendations are made. They include a call for equity-sensitive targets, the collection of gender-disaggregated data, the use of policy-making processes for empowerment, programmes that explicitly address causes of health inequity and impact assessments of interventions' effect on social inequities."
• How have the world’s poorest fared since the early 1980s?
  Shaohua Chen and Martin Ravallion, Research for Poverty, Development Research Group, World Bank , 2004 - This paper offers a new assessment of progress in reducing poverty over 1981-2001 using consistent data and methods — closely following the methods underlying the Attacking Poverty numbers.We draw on 454 surveys covering 97 developing countries representing 93% of the population of the developing world.
• How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries
  This 2010 survey examines the insurance-related experiences of adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United States, and the United Kingdom. The countries all have different systems of coverage, ranging from public systems to hybrid systems of public and private insurance, and with varying levels of cost sharing. Overall, the study found significant differences in access, cost burdens, and problems with health insurance that are associated with insurance design. US adults were the most likely to incur high medical expenses, even when insured, and to spend time on insurance paperwork and disputes or to have payments denied. Germans reported spending time on paperwork at rates similar to US rates but were well protected against out-of-pocket spending. Swiss out-of-pocket spending was high, yet few Swiss had access concerns or problems paying bills. For US adults, comprehensive health reforms could lead to improvements in many of these areas, including reducing differences by income observed in the study. [Health Affairs 29, no. 12 (December 2010) (Published online 18 November 2010)]
• How health systems can address inequities in priority public health conditions: the example of tuberculosis
  "The literature and case study synthesis undertaken by the Network showed that social determinants shape the spread of TB at multiple levels. These determinants are differentially distributed, with the poor and socially excluded disproportionately exposed. Government policies, global economic trends and other structural factors shape poverty and the strength of health care systems. These in turn contribute to downstream factors, such as the prevalence of TB in the wider community, living conditions, tobacco use and prevalence of diseases of the poor that increase TB vulnerability. Downstream factors interact with biology to shape the likelihood of exposure to TB droplets and, when exposed and infected, the likelihood of developing active disease… Analysis of these social determinants has policy implications. Current strategies need to be reinvigorated and combined with new strategies to directly tackle known social determinants. This requires: (i) strengthening and improving the coverage of existing TB programmes to reduce TB morbidity and mortality; (ii) taking a social determinants of health approach to better prevent and address the consequences of TB, including risk factors that lie outside of the health system; and (iii) strengthening health systems, particularly through a primary health care approach. Operationalization of these three principles might include improving universal social protection systems, using targeting only for those who fall through the cracks of universal services, and enhanced availability, accessibility, acceptability and quality of primary health care, TB and other services. Intersectoral action for health would also be required, entailing health impact assessments, providing examples of good practice to other sectors, supporting civil society groups to advocate for enhanced action by all on the social determinants of health and providing evidence regarding the relationship between health outcomes and social determinants." [WHO Regional Office for Europe, 2010]
• Huge poor–rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries
  This October 2007 paper by Tanja A J Houweling et al. found that poor–rich inequalities in maternity care in general, and professional delivery care in particular, are much larger than those in immunisation coverage or treatment for childhood illnesses.
• Human Development Report 2006: Beyond Scarcity: Power, poverty and the global water crisis
  "Throughout history water has confronted humanity with some of its greatest challenges. Water is a source of life and a natural resource that sustains our environments and supports livelihoods – but it is also a source of risk and vulnerability. In the early 21st Century, prospects for human development are threatened by a deepening global water crisis. Debunking the myth that the crisis is the result of scarcity, this report argues poverty, power and inequality are at the heart of the problem...."
• Hunger in America 2006: National Report Prepared for America's Second Harvest Final Report March 2006
  “…Despite America's great wealth, millions of Americans do not have enough food to eat each day. More than 25 million people use food banks and food-rescue organizations in America's Second Harvest -The Nation’s Food Bank Network (A2H), the nation’s largest network of emergency food providers - each year. This report presents the result of a study conducted in 2005 for Second Harvest. It provides a comprehensive profile of the incidence and nature of hunger and food insecurity in the U.S. The study provides extensive demographic profiles of emergency food clients at charitable feeding agencies and comprehensive information on the nature and efficacy of local agencies in meeting the food security needs. "
• Incentivising Research and Development for the Diseases of Poverty
  This paper from the International Policy Network "...provides an overview of proposals intended to improve the prospects of developing new drugs for the diseases of poverty. Part 1 considers the need for new medicines in the wider context of addressing the diseases of poverty. Part 2 examines barriers to innovation. Part 3 considers various mechanisms for funding R&D into new drugs."
• Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients – a systematic review
  Background: In all OECD countries, there is a trend to increasing patients’ copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+. Methods: Based on an online search (PubMed), 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed. Results: Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care. Conclusions: While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous. [author abstract] [International Journal for Equity in Health, August 2010, 9: 20]
• Income inequality, mortality, and self rated health: meta-analysis of multilevel studies
  Objective: To provide quantitative evaluations on the association between income inequality and health. Design: Random effects meta-analyses, calculating the overall relative risk for subsequent mortality among prospective cohort studies and the overall odds ratio for poor self rated health among cross sectional studies. Data sources: PubMed, the ISI Web of Science, and the National Bureau for Economic Research database. Review methods: Peer reviewed papers with multilevel data. Results: The meta-analysis included 59 509 857 subjects in nine cohort studies and 1 280 211 subjects in 19 cross sectional studies. The overall cohort relative risk and cross sectional odds ratio (95% confidence intervals) per 0.05 unit increase in Gini coefficient, a measure of income inequality, was 1.08 (1.06 to 1.10) and 1.04 (1.02 to 1.06), respectively. Meta-regressions showed stronger associations between income inequality and the health outcomes among studies with higher Gini (0.3), conducted with data after 1990, with longer duration of follow-up (>7 years), and incorporating time lags between income inequality and outcomes. By contrast, analyses accounting for unmeasured regional characteristics showed a weaker association between income inequality and health. Conclusions: The results suggest a modest adverse effect of income inequality on health, although the population impact might be larger if the association is truly causal. The results also support the threshold effect hypothesis, which posits the existence of a threshold of income inequality beyond which adverse impacts on health begin to emerge. The findings need to be interpreted with caution given the heterogeneity between studies, as well as the attenuation of the risk estimates in analyses that attempted to control for the unmeasured characteristics of areas with high levels of income inequality. [author abstract] [BMJ 2009; 339: b4471]
• Income redistribution is not enough: income inequality, social welfare programs, and achieving equity in health
  Income inequality is widely assumed to be a major contributor to poorer health at national and sub-national levels. According to this assumption, the most appropriate policy strategy to improve equity in health is income redistribution. This December 2007 paper published in the Journal of Epidemiology and Community Health ( 61: 1038-1041) considers reasons why tackling income inequality alone could be an inadequate approach to reducing differences in health across social classes and other population subgroups, and makes the case that universal social programs are critical to reducing inequities in health. A health system oriented around a strong primary care base is an example of such a strategy.
• Income-Related Inequality in the Use of Medical Care in 21 OECD Countries
  This OECD Health Working Paper updates and extends previous studies on equity in physician utilisation for a number of countries. The study finds no evidence of inequity in the distribution of GP visits in the majority of countries, although it does find that there is a significant pro-rich bias in terms of the number of visits, controlling for need differences, to both specialists and dentists.
• Inequalities in access to medical care by income in developed countries
  Most of the member countries of the Organization for Economic Cooperation and Development (OECD) aim to ensure equitable access to health care. This is often interpreted as requiring that care be available on the basis of need and not willingness or ability to pay. This study sought to examine equity in physician utilisation in 21 OECD countries for the year 2000.
• Inequalities in health in Scotland: what are they and what can we do about them
  In this October 2007 paper, Sally Macintyre outlines key facts about socioeconomic inequalities in health in Scotland. She recommends key principles for effective policies to reduce inequalities in health. These include: Maintaining and extending equity in health and welfare systems; Levelling up, not down; Reducing inequalities in life circumstances, especially education, employment, and income; and Prioritising early years interventions, and families with children. Summarising lessons learnt from research on how best to reduce inequalities in health, the paper recommends putting a high priority on changes in the physical and social environment (for example, building and planning regulations, fiscal policies, and reducing price barriers to health-promoting goods and services), rather than information-based campaigns or interventions which require people to opt in.
• Inequalities in young people’s health
  "This international report is the fourth from the Health Behaviour in School-aged Children (HBSC) study, a WHO collaborative cross-national study, and the most comprehensive. It presents the key findings on patterns of health among young people aged 11, 13 and 15 years in 41 countries and regions across the WHO European Region and North America in 2005/2006. Its theme is health inequalities: quantifying the gender, age, geographic and socioeconomic dimensions of health differentials. Its aim is to highlight where these inequalities exist, to inform and influence policy and practice and to help improve health for all young people. The report clearly shows that, while the health and well-being of many young people give cause for celebration, sizeable minorities are experiencing real and worrying problems related to overweight and obesity, self-esteem, life satisfaction, substance misuse and bullying. The report provides reliable data that health systems in Member States can use to support and encourage sectors such as education, social inclusion and housing, to achieve their primary goals and, in so doing, benefit young people’s health. Policy-makers and professionals in the participating countries should listen closely to the voices of their young people and ensure that these drive their efforts to put in place the circumstances – social, economic, health and educational – within which young people can thrive and prosper."
• Inequality, Poverty and Social Policy: Recent Trends in Chile
  This 2009 report aims to outline the main trends in income distribution and poverty in Chile, as well as the role of social policy in these areas. The report includes five sections: First, it discusses recent trends in income inequality and poverty, including a brief overview of the data available in the country. Second, it describes the country’s social protection programs, including with respect to coverage, financing and distributional impact. The third section examines how social policy has affected poverty reduction in recent decades, which is followed by an analysis of the relative stability of income inequality and its relation to public policy instruments. Section five presents future trends in social policy and their potential impact on inequality and poverty.
• Inequity in Cancer Care: A Global Perspective
  "There is enough evidence to assert that people with a lower socioeconomic status experience greater cancer incidence and shorter survival rates after diagnosis. Yet, socioeconomic status, a function of income, education and occupation, does not itself cause cancer or poor outcomes. Rather, it is a marker for the underlying physical and social factors that cause the disease, its recurrence and its eventual outcome. Lower socioeconomic status can lead to access problems along the entire spectrum of care, starting from early detection issues to the delays in diagnosis after the appearance of initial symptoms. Apart from logistical barriers to access, people of lower socioeconomic status are more likely to remain uninformed about early detection programmes and disease management, including the early signs, symptoms and availability of cancer treatment. Lastly, but certainly not least important, the quality of available care may vary with socioeconomic status… The present publication examines the issues related to disparities in cancer, focusing on socioeconomic factors, and addresses the problem of access to cancer therapy, in particular to radiation oncology services, underlining access to cancer therapy for women and children in particular." [Human Health Reports No. 3, International Atomic Energy Agency IAEA, Vienna, 2011]
• Levelling up (part I): A Discussion paper on concepts and principles for tackling social inequality in health
  Social inequalities in health are the major focus of this WHO Europe paper. The evidence points to the existence of extensive (and widening) social inequities in health in Europe today. The need to take action to reduce these inequities and their root causes is becoming ever more pressing as a major public health challenge. This calls for a new way of thinking about the direction of policy and also calls for renewed vigilance in monitoring impacts, to make sure that no segment of the population is excluded or loses out.
• Levelling up (part II): a discussion paper on European strategies for tackling social inequities in health
  "The purpose of the present report is to stimulate and facilitate the development of evidence-based strategies for reducing social inequities in health. The focus of the report is on the main determinants of social inequities in health, which differ typically from the main determinants of health for the population as a whole. The report pays special attention to policies and actions that either reduce or increase inequities in health, because the power balance between these forces determines the possibilities and constraints of achieving equity oriented health targets...".
• Literacy as Freedom - A UNESCO round table
  This paper describes literacy as one the fundamental instruments of freedom. In today's world the use of written communication is embedded in sociopolitical and economic systems at local, national and global levels and is part of the way institutions function and a key to learning opportunities. The report recognises that individuals and communities use a wide range of literacy practices, calling upon different 'literacies' in different contexts and for different purposes.
• Low socio-economic position is associated with poor social networks and social support: Results from the Heinz Nixdorf Recall Study
  Background: Social networks and social support are supposed to contribute to the development of unequal health within populations. However, little is known about their socio-economic distribution. In this study, we explore this distribution. Methods: This study analyses the association of two indicators of socio-economic position, education and income, with different measures of social networks and support. Cross-sectional data have been derived from the baseline examination of an epidemiological cohort study of 4.814 middle aged urban inhabitants in Germany (Heinz Nixdorf Recall Study). Bivariate and multivariate logistic regression [analyses] were carried out to estimate the risk of having poor social networks and support across socio-economic groups. Results: Socially disadvantaged persons more often report poor social networks and social support. In multivariate analyses, based on education, odds ratios range from 1.0 (highest education) to 4.9 (lowest education) in a graded way. Findings based on income show similar effects, ranging from 1.0 to 2.5. There is one exception: no association of SEP with close ties living nearby and regularly seen was observed. Conclusion: Poor social networks and low social support are more frequent among socio-economically disadvantaged people. To some extent, this finding varies according to the indicator chosen to measure these social constructs. [authors’ abstract]
• Measuring Disparities in Health Status and in Access and Use of Health Care in OECD Countries
  "Most OECD countries have endorsed as major policy objectives the reduction of inequalities in health status and the principle of adequate or equal access to health care based on need. These policy objectives require an evidence-based approach to measure progress. This paper assesses the availability and comparability of selected indicators of inequality in health status and in health care access and use across OECD countries, focussing on disparities among socioeconomic groups. These indicators are illustrated using national or cross-national data sources to stratify populations by income, education or occupation level. In each case, people in lower socioeconomic groups tend to have a higher rate of disease, disability and death, use less preventive and specialist health services than expected on the basis of their need, and for certain goods and services may be required to pay a proportionately higher share of their income to do so. Options for future OECD work in measuring health inequalities are provided through suggesting a small set of indicators for development and inclusion in the OECD Health Data database. Some indicators appear to be more advanced for international data collection, since comparable data are already being collected in a routine fashion in most OECD countries. These include the indicators of inequalities in self-rated health, self-rated disability, the extent of public health care coverage and private health insurance coverage, and self-reported unmet medical and dental care needs. Increased availability and comparability of data will improve the validity of cross-national comparisons of socioeconomic inequalities in health status and health care access and use. Harmonisation of definitions and collection instruments, and the greater use of data linkages in order to allow disaggregation by socioeconomic status, will determine whether health inequalities can be routinely monitored across OECD countries."
• Measuring Health Disparities
  "This interactive course focuses on some basic issues for public health practice -- how to understand, define and measure health disparity. This course examines the language of health disparity to come to some common understanding of what that term means, explains key measures of health disparity and shows how to calculate them. This computer-based course provides a durable tool that is useful to daily activities in the practice of public health. The material is divided into four content sections: Parts I and II review what health disparities are, how they are defined, and provide an overview of common issues faced in measuring health disparities; Parts III and IV introduce users to a range of health disparity measures, providing advantages and disadvantages of each, and discuss how best to use different measures to communicate and evaluate health disparity in our communities." [Michigan Public Health Training Center (MPHTC), Center for Social Epidemiology and Population Health, and Prevention Research Center of Michigan]
• Measuring Inequality of Opportunities in Latin America and the Caribbean
  "The problem is that we have never been able to systematically measure inequality of opportunity, in Latin America or anywhere else. The development community simply lacked the methodological tools to monitor equity, making it all but impossible to design, implement, and evaluate public policies that target human opportunity. While the citizens of the region feel the uneven playing field under their feet — that personal sense that one’s destiny is predetermined by circumstances over which one has no control or responsibility, such as skin color, gender, birthplace, or family wealth — their leaders have proved unable to do much about it."
• Meeting Basic Survival Needs of the World's Least Healthy People - Toward a Framework Convention on Global Health
  This article firstly examines the compelling issue of global health equity, and inquires whether it is fair that people in poor countries suffer such a disproportionate burden of disease and premature death; secondly, the article explains a basic problem in global health: why health hazards seem to change form and migrate everywhere on the earth; thirdly, the article inquires why governments should care about serious health threats outside their borders, and explores the alternative rationales: direct health benefits, economic benefits, and improved national security; fourthly, the article describes how the international community focuses on a few high profile, heart-rending, issues while largely ignoring deeper, systemic problems in global health. By focusing on basic survival needs, the international community could dramatically improve prospects for the world's population; and finally, the article explores the value of international law itself, and proposes an innovative mechanism for global health reform a Framework Convention on Global Health.
• Monitoring Equity in Access to AIDS treatment programmes: A review of concepts, models, methods and indicators
  "Strong health systems are essential for equitable and sustainable HIV/AIDS – related programmes. Health systems need to be accessible and responsive to the specific needs of excluded groups, such as under-served rural and low-income communities. Against a background of wider inequities in health and health care, the expansion of HIV/AIDS treatment and care should tap any opportunities to strengthen equity in the provision of good quality health services. At the same time, we need to take care not to aggravate inequities by inappropriately withdrawing resources from other interventions or other parts of the system. As antiretroviral therapy (ART) is rolled out in the region, it is important to have a comprehensive framework to monitor and evaluate equity in access to HIV / AIDS treatment programmes and to gauge the strength of health systems. The World Health Organization (WHO) and the Regional Network for Equity in Health in east and southern Africa (EQUINET) through REACH Trust Malawi and Training and Research Support Centre (TARSC) developed this review. It provides a practical resource for programme managers, health planning departments, evaluation experts and civil society organizations working on health systems and HIV / AIDS programmes at sub-national, national and regional levels in east and southern Africa." [Commissioned by the World Health Organization (Department of Ethics, Equity, Trade and Human Rights - Social Determinants of Health) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through REACH Trust and Training and Research Support Centre (TARSC) – 2010]
• Natural and unnatural synergies: climate change policy and health equity
  "Climate change and health inequities represent two of the greatest challenges to human development in the 21st century. As the Copenhagen summit on climate change planned for December 2009 approaches, there are opportunities to use the political momentum of climate change to promote health equity. The broad-ranging policies required to address climate change have both positive and negative implications for health and health equity. Similarly, interventions to reduce health gaps will not necessarily help stabilize the climate. Poorly designed policies could easily undermine both climate and health equity goals, and reduce public support for their implementation. This paper reviews the potential tensions between climate stabilization and improving health equity and discusses how these might be resolved." [Bulletin of the World Health Organization, Volume 87, Number 10, October 2009, pp.733-804]
• Neighbourhoods of choice and connection: the evolution of American neighbourhood policy and what it means for the United Kingdom
  This paper puts forward the thesis that the provision of long-term improvement in areas of concentrated poverty requires both increased socioeconomic diversity - neighbourhoods of choice, and high quality and accessible education and training opportunities - neighbourhoods of connection. It draws on the American neighbourhood policy experience to comment on the policy choices in the U.K.
• Neighborhood Inequality, Relative Deprivation and Self-perceived Health Status (PDF)
  In this study published by Statistics Canada in 2004 the authors, Feng Hou and John Myles examines two theses concerning the relationship between individual health status and the socioeconomic composition of the neighbourhoods in which they live. The first thesis contends that unequal communities will not generate the social capital/ social cohesion necessary for healthy populations whether rich or poor. The second tests two opposing theories; one that in unequal communities poorer members suffer from the unequal competition which disadvantages them, and the other that they benefit from interaction with their more affluent neighbours.
• New Equity Agenda? Reflections on the 2006 World Development Report, the 2005 Human Development Report and the 2005 Report on the World Social Situation
  Inequality is a key issue in debates about achieving the MDGs. There are still important issues which need to be resolved before one can design sensible and effective policies for addressing inequality. These issues are highlighted by three main questions: which inequalities matter; what drives inequalities, and how can they be affected by policy; which specific policy instruments work best where? This Overseas Development Institute paper examines these questions in the light of the 2006 World Development Report, the 2005 Human Development Report and the 2005 Report on the World Social Situation.
• Our cities, our health, our future
  This KNUS (Knowledge Network on Urban Settings) report summarizes the findings concerning structural and intermediate social determinants of health that are of importance in the urban setting. The framework of the Commission on Social Determinants of Health (CSDH) guided the work. While unmasking the health inequities and inequalities in urban settings, it was decided at an early stage to make a strategic focus on slums and informal settlements where one billion people live in deplorable conditions. This number may double in coming decades unless appropriate policies for economic, social and health equity are developed and implemented. An example of the health inequalities in these circumstances is the strong gradient in infant and child mortality rates within Nairobi, Kenya, with rates in the slums more than three times higher than the city average and possibly ten or more times higher than in the richer parts of the city. Other data from Africa show that these mortality rates among the urban poor are, on average, almost as high as the rates among the rural poor, while among the richer urban groups the rates are the lowest.
• OUTSIDERS? The Changing Patterns of Exclusion in Latin America and the Caribbean
  "The 2008 edition of the Report on Economic and Social Progress deals with the changing patterns of social inclusion and exclusion, one of the most pressing concerns faced by policymakers in Latin America and the Caribbean. In fact, much of the lively debate on the economic and social policies needed to attain sustainable and equitable growth hinges on the issue of social inclusion. What this report shows is that attaining social inclusion demands not only redressing past injustices with resource transfers and affirmative action programs, but also, and more importantly, changing the way decisions are made, resources are allocated, and policies are implemented."
• Pandemic Influenza Planning in the United States from a Health Disparities Perspective
  "We explored how different socioeconomic and racial/ethnic groups in the United States might fare in an influenza pandemic on the basis of social factors that shape exposure, vulnerability to influenza virus, and timeliness and adequacy of treatment. We discuss policies that might differentially affect social groups' risk for illness or death. Our purpose is not to establish the precise magnitude of disparities likely to occur; rather, it is to call attention to avoidable disparities that can be expected in the absence of systematic attention to differential social risks in pandemic preparedness plans. Policy makers at the federal, state, and local levels should consider potential sources of socioeconomic and racial/ethnic disparities during a pandemic and formulate specific plans to minimize these disparities." [Author Abstract]
• Pathways of influence on equity in health
  Written by Barbara Starfield of Johns Hopkins School of Hygiene and Public Health, Baltimore, USA and published in Social Science & Medicine (64, 1355–1362, 2007) , "the article proposes pathways, with bidirectional arrows, pursuant to theories and analytical frameworks for social and societal influences on health".
• Petition on the Ratification of the Rights of Women in Africa, Pambazuka News site
  This petition, published by Pambazuka news site calls on the African Union Heads of State to fast track the ratification of the Protocol on the African Charter on Human and People's Rights on the rights of women in Africa.
• Population, poverty, and sustainable development: a review of the evidence
  There is a very large but scattered literature debating the economic implications of high fertility. This paper reviews the literature on three themes: (a) Does high fertility affect low-income countries’ prospects for economic growth and poverty reduction? (b) Does population growth exacerbate pressure on natural resources? and (c) Are family planning programs effective at lowering fertility, and should they be publicly funded? The literature shows broad consensus that while policy and institutional settings are key in shaping the prospects of economic growth and poverty reduction, the rate of population growth also matters. Recent studies find that low dependency ratios (as fertility declines) create an opportunity for increasing productivity, savings and investment in future growth. They find that lower fertility is associated with better child health and schooling, and better health and greater labor-force participation for women. They also indicate that rapid population growth can constrain economic growth, especially in low-income countries with poor policy environments. Population growth also exacerbates pressure on environmental common property resources. Studies highlight the deep challenges to aligning divergent interests for managing these resources. However, part of the pressure on these resources can be mitigated by reducing the rate of population growth. Although family planning programs are only one policy lever to help reduce fertility, studies find them effective. Such programs might help especially in the Sub-Saharan African region, where high fertility and institutional constraints on economic growth combine to slow rises in living standards. [author abstract] [The World Bank, June 2011]
• Population tobacco control interventions and their effects on social inequalities in smoking
  Reducing social inequalities in smoking and its health consequences is a public-health and political priority: the Department of Health has a specific target to reduce the prevalence of smoking in “manual groups” from 32% to 26% by 2015. Although the extent and causes of health inequalities have been extensively researched, we know remarkably little about the actual effects of measures to reduce such inequalities in general or about the differential impacts of tobacco control measures in particular. It is possible that a strategy which successfully reduces smoking in the population overall might widen inequalities if its benefits are concentrated among the better-off. The overall aims of this project were: To synthesise the best available evidence about the differential effects of population tobacco control interventions on groups with different sociodemographic characteristics; To assess which interventions are likely to be effective in reducing smoking related health inequalities and to identify reasons why other interventions may be ineffective, attempting to answer the questions: What works? What might work? For whom? In what contexts?; and To extend systematic review methods by integrating existing, related systematic reviews and the primary studies included in those reviews into a new systematic review, taking a broad view of the types of evidence which are available in seeking to answer a policy-relevant question, and To identify where evidence is lacking and to suggest areas where further primary or secondary research is required.
• Poverty & Environment Indicators: Report prepared for UNDP-UNEP under the Poverty and Environment Initiative
  The report is conceived as an introduction to the literature on human well-being and environment indicators at the same time that it proposes a new methodology for integrating health, education and standard of living dimensions with environmental variables. This report is divided into four parts: a) The first part introduces some well-known general indicators that relate human well-being dimensions to environmental conditions. Although not central to this report, an investigation of a sample of general indicators raises important practical issues in defining poverty & environment indicators. b) The second part explores what recent studies have said about poverty & environment links, with the purpose of learning about the existence of concrete associations that might inform policy-makers about similar situations that might be going on in their own countries. c) The third part presents basic definitions used to handle poverty & environment indicators, including criteria for choosing indicators and the use of scale scores to help making a decision. d) Finally, the report describes a new methodology for elaborating poverty & environment indicators that solves some technical limitations of previous methodologies.
• Poverty and exclusion among urban children
  This UNICEF Innocenti digest assesses the human rights situation of poor and marginalised children around the world. It considers the range of problems these children face and draws attention to the need for actions based on a knowledge of urban areas and potential urban advantages and examines the capacity of competent, accountable and transparent urban governance to promote the rights of children, enable communities and poor households to influence public policies and actions and ensure tangible progress in improving conditions in urban settlements.
• Principles of action to tackle social inequality in health
  A small document presenting Action principles to tackle social inequalities in health from a Norwegian interdisciplinary expert group of scientist within the field. Report in Norwegian and English (scroll down document to find the English version). [The Norwegian Directorate of Health, adopted on 24 November 2005]
• Priorities for Research to Take Forward the Health Equity Policy Agenda
  This report is the output of the Task Force on Health Systems Research Priorities for Equity in Health. It was prepared in close cooperation with the World Health Organisation (WHO) Health Equity Team to feed into the World Ministerial Summit on Health Research that took place on the 16th-20th of November 2004 in Mexico City.
• Progress for Children: A Child Survival Report Card Vol. 1 2004
  This report from UNICEF addresses the fourth Millennium Development Goal which aims for a two thirds reduction of under five mortality rates between 1990 and 2015. A number of factors contribute to persistent child mortality, these include the direct result of illness such as acute respiratory infection, diarrhoea, malaria, measles as well as others due to indirect causes such as conflict, marginalisation and HIV/AIDS. Malnutrition and the lack of safe water and sanitation contribute to more than half of these deaths.
• Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa
  This protocol calls for fundamental human rights for women including the elimination of discrimination against women; the rights to life, integrity and security of person, the elimination of harmful practices; equal rights in marriage; access to justice and equal protection before the law, right to participate in the political and decision making process, right to peace, protection of women in armed conflict, right to education and training, economic and social welfare rights, health and reproductive rights and the right to food security.
• Psychosocial resources and social health inequalities in France: Exploratory findings from a general population survey
  “We use a unique general population survey to assess the respective impact on self-assessed health status of subjective perceptions of social capital controlling for standard sociodemographic factors (occupation, income, education, age and gender). The survey is unique for two reasons: First, we use a variety of measures to describe self-perceived social capital (trust and civic engagement, social support, sense of control, and self-esteem). Second, we can link these measures of social capital to a wealth of descriptors of health status and behaviours. We find empirical support for the link between the subjective perception of social capital and health. Sense of control at work is the most important determinant of health status. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to social capital is not equally distributed in the population, these findings suggest that psychosocial factors can explain a substantial part of social inequalities in health in France.” (au)
• Qualitative Techniques for Health Equity Analysis: Technical Notes
  These Technical Notes published by the World Bank, outline, through worked examples, the issues that arise in the quantitative analysis of health equity. The first set of notes outline issues that arise in the measurement of key variables, such as health outcomes and living standards. The next set outline various generic tools that can be used to analyse a variety of questions. The final set outlines various applications of these and other techniques.
• Quality in and Equality of Access to Healthcare Services
  "This study reviews barriers of access to health care that persist in EU countries and presents an analysis of what policies countries have adopted to mitigate these barriers. It has a focus on the situation of migrants, older people with functional limitations, and people with mental disorders. What are the barriers to accessing high quality health care for people at risk of social exclusion? What are the interdependencies between poverty, social exclusion and problems of accessing health care? What policies have EU Member States put in place to improve access and quality of health care for vulnerable groups of the population? The study is based on eight country reports: Finland, Germany, Greece, the Netherlands, Poland, Romania, Spain, and the United Kingdom. This was complemented with findings from the literature and European comparisons… Ensuring equitable access to high-quality healthcare constitutes a key challenge for health systems throughout Europe. Despite differences in health system size, structure and financing, evidence suggests that across Europe particular sections of the population are disproportionately affected by barriers to accessing healthcare. Studies have also shown that difficulties in accessing healthcare are compounded by poverty and social exclusion, and that poverty and social exclusion compound difficulties in accessing healthcare." Executive Summary.
• Reaching the Poor Programme
  The Reaching the Poor Program (RPP) is an effort to begin finding better ways of ensuring that the benefits of health, nutrition, and population (HNP) programs flow to disadvantaged population groups. It has been undertaken by the World Bank, in cooperation with the Gates Foundation and the Dutch and Swedish Governments.
• Real Determinants of Health
  This report discusses the conditions that are most conducive to good health and their policy implications. It examines factors such as the degree of income equity, the level of government financing of health care, the relationship between public investment in health and economic growth and more generally between health and wealth.
• Reducing Health Disparities and Promoting Equity for Vulnerable Populations
  The health disparities outlined in this synthesis paper reflect the present-day health effects of decades of struggle as Aboriginal peoples - First Nations, Inuit and Métis in Canada --continue to work toward economic, political, social and health equity. While there are tremendous successes and powerful indicators of triumph in many sectors there are still far too many signs of the effects of inequity resulting in a disproportionate burden of ill health and social suffering on Aboriginal populations.
• Report on the World Situation 2005: The Inequality Predicament
  The 2005 edition of this biennial United Nations Report sounds alarm over persistent and deepening inequality worldwide, focusing on the chasm between the formal and informal economies, the widening gap between skilled and unskilled workers, the growing disparities in health, education and opportunities for social, economic and political participation.
• School feeding for improving the physical and psychosocial health of disadvantaged students (Review)
  Background: Early malnutrition and/or micronutrient deficiencies can adversely affect physical, mental, and social aspects of child health. School feeding programs are designed to improve attendance, achievement, growth, and other health outcomes. Objectives: The main objective was to determine the effectiveness of school feeding programs in improving physical and psychosocial health for disadvantaged school pupils . Search strategy: We searched a number of databases including CENTRAL (2006 Issue 2), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), PsycINFO (1980 to May 2006) and CINAHL (1982 to May 2006). Grey literature sources were also searched. Reference lists of included studies and key journals were handsearched and we also contacted selected experts in the field. Selection criteria: Data from randomized controlled trials (RCTs), non-randomised controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series studies (ITSs) were included. Feeding had to be done in school; the majority of participants had to be socio-economically disadvantaged. Data collection and analysis: Two reviewers assessed all searches and retrieved studies. Data extraction was done by one of four reviewers and reviewed by a second. Two reviewers independently rated quality. If sufficient data were available, they were synthesized using random effects meta-analysis, adjusting for clustering if needed. Analyses were performed separately for RCTs and CBAs and for higher and lower income countries. Main results: We included 18 studies. For weight, in the RCTs and CBAs from Lower Income Countries, experimental group children gained an average of 0.39 kg (95% C.I: 0.11 to 0.67) over an average of 19 months and 0.71 kg (95% C.I.: 0.48 to 0.95) over 11.3 months respectively. Results for weight were mixed in higher income countries. For height, results were mixed; height gain was greater for younger children. Attendance in lower income countries was higher in experimental groups than in controls; our results show an average increase of 4 to 6 days a year. Math gains were consistently higher for experimental groups in lower income countries; in CBAs, the Standardized Mean Difference was 0.66 (95% C.I. = 0.13 to 1.18). In short-term studies, small improvements in some cognitive tasks were found. Authors’ conclusions: School meals may have some small benefits for disadvantaged children. We recommend further well-designed studies on the effectiveness of school meals be undertaken, that results should be reported according to socio-economic status, and that researchers gather robust data on both processes and carefully chosen outcomes. [publication abstract] [The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 2009]
• Segregated spaces, risky places: the effects of racial segregation on health inequalities
  "This report is based upon two studies with distinct sets of data analyses. Both studies are designed to test whether geographic location – or “place” – plays a significant role in determining racial and ethnic health inequalities. The first study updates previously published findings, which document the relationship between residential segregation and racial disparities in infant mortality rates across U.S. cities. This study sought to determine whether a slight decline in residential segregation by race between 2000 and 2010 coincided with a corresponding reduction in racial health inequalities… The second study tested whether the correlation between segregation and health disparities varies more in accordance with the racial composition of neighborhoods or the concentration of neighborhood poverty. Data from the 2006 Medical Expenditure Panel Study (MEPS) along with zip code level data from the 2000 US Census were used to examine the relationships between segregation, concentrated poverty and racial and ethnic health inequalities. The study revealed that for certain health conditions, place does matter. When controlling for the variable of living in a high-poverty zip code, racial health disparities were diminished. In other words, living in a high poverty zip code is most likely to have negative effects on health status and outcomes. Place matters for minority communities not because they are predominantly black or Hispanic but rather due to higher rates of poverty… Racial and ethnic segregation has previously been documented as a predictor of health disparities. Segregated communities in the U.S. tend to be environments which produce poor health outcomes. The research literature documents that “places” which are racially segregated with high concentrations of blacks or Hispanics tend to be places with limited opportunities and failing infrastructure, resulting from a lack of investment in social and economic development. The result is a community that produces bad health outcomes. So, racial inequalities in health status and outcomes are predominantly the result of place. Race helps to determine place, and in turn, place influences health." [Joint Center for Political and Economic Studies (USA), September 2011]
• Selected Comparisons of Measures of Health Disparities: A Review Using Databases Relevant to Healthy People 2010 Cancer-Related Objectives
  "The purpose of this report is to empirically evaluate the performance and suitability of various measures of health disparity for the purpose of monitoring disparities in cancer-related health outcomes. The goal of these analyses was to examine the consistency of different measures of health disparity across a range of cancer-related outcomes. First, we concluded that all measures of health disparity implicitly or explicitly contain value judgments concerning the relative importance of capturing different aspects of health disparity. Two of the most important considerations concern: 1) How much weight to give to individuals?; and 2) How much to weight the health of individuals of different social groups? Should our measures of health disparity be more sensitive to health improvement among the socially disadvantaged than the advantaged?"
• Setting the stage for equity-sensitive monitoring of the maternal and child health Millennium Development Goals
  This study uses a population based survey to analyse several indicators and stratifiers to demonstrate that establishing a health equity baseline is necessary and feasible. The data reveal that inequities are complex and interactive; inference cannot be drawn about the nature and extent of inequalities in health outcomes from a single stratifier or indicator.
• Shared Destiny: Community Effects of Uninsurance
  This report prepared for the US Institute of Medicine finds that the adverse effects of uninsurance that accrue to uninsured individuals and families in a community, as well as the financial strain placed on the community’s health care system, have important spillover effects on community health care institutions and providers.
• 16 Days of activism against gender violence: November 25 - December 10
  16 Days of Activism Against Gender Violence is an international campaign originating from the first Women's Global Leadership Institute sponsored by the Center for Women's Global Leadership in 1991. The 16 Days Campaign has been used as an organising strategy by individuals and groups around the world to call for the elimination of all forms of violence against women.
• Social conditions, health equity, and human rights
  The fields of health equity and human rights have different languages, perspectives, and tools for action, yet they share several foundational concepts. This paper explores connections between human rights and health equity, focusing particularly on the implications of current knowledge of how social conditions may influence health and health inequalities, the metric by which health equity is assessed. The role of social conditions in health is explicitly addressed by both 1) the concept that health equity requires equity in social conditions, as well as in other modifiable determinants, of health; and 2) the right to a standard of living adequate for health. The indivisibility and interdependence of all human rights — civil and political as well as economic and social — together with the right to education, implicitly but unambiguously support the need to address the social (including political) determinants of health, thus contributing to the conceptual basis for health equity. The right to the highest attainable standard of health strengthens the concept and guides the measurement of health equity by implying that the reference group for equity comparisons should be one that has optimal conditions for health. The human rights principles of non-discrimination and equality also strengthen the conceptual foundation for health equity by identifying groups among whom inequalities in health status and health determinants (including social conditions) reflect a lack of health equity; and by construing discrimination to include not only intentional bias, but also actions with unintentionally discriminatory effects. In turn, health equity can make substantial contributions to human rights 1) insofar as research on health inequalities provides increasing understanding and empiric evidence of the importance of social conditions as determinants of health; and, more concretely, 2) by indicating how to operationalize the concept of the right to health for the purposes of measurement and accountability, which have been elusive. Human rights laws and principles and health equity concepts and technical approaches can be powerful tools for mutual strengthening, not only by contributing toward building awareness and consensus around shared values, but also by guiding analysis and strengthening measurement of both human rights and health equity. [author abstract] [Health and Human Rights: An International Journal, vol. 12, no. 2, 2010]
• Social Inequality
  This site describes a research project of the Russell Sage Foundation in New York to examine social inequality on a number of dimensions, including family well-being, educational opportunity, health care and coverage, legal services and criminal justice, political participation and representation, banking and credit, housing, pension provision, environmental quality, and even access to computers and the Internet. It includes links to the full text of working papers and descriptions of programme partners.
• Social Policy in the Post-crisis Context of Small Island Developing States: a synthesis
  "This paper provides a synthesis of the multifaceted impact of the global economic crisis on Small Island Developing States (SIDS), focusing on the Pacific and Caribbean regions. It shows that the social investment agenda, which has underpinned so much of the development progress of SIDS, has been particularly challenged by the global economic crisis and will require innovations and policy changes by SIDS in order to sustain and advance beyond current achievements. Global action will be required to enhance the available fiscal space for these actions. Additionally, in the SIDS, particular attention needs to be paid to the design and implementation of social policies that reduce vulnerability, improve resilience to exogenous shocks, and thus lower the human and productivity costs of exposure to repeated shocks. These include high unemployment and underemployment, rising crime and persistent inequalities across income groups and between rural and urban communities. The transitive effects of such exogenous shocks on the incomes, food security and access to basic public goods of poor and vulnerable households demonstrate the need for a new policy approach, one that is better placed than current approaches to increase SIDS’ resilience to future shocks. The synthesis, based largely on experiences of and lessons learned from five countries in the Pacific and five in the Caribbean, seeks to advocate a 'paradigm shift' in global and national-level approaches to the development challenges facing SIDS." [United Nations Development Programme (UNDP) - Working Paper No. 67, July, 2010]
• Socioeconomic Inequalities in Health in 22 European Countries
  "Background: Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. Methods: We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes. Results: In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern. Conclusions: We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care…".
• Socioeconomic inequality in malnutrition in developing countries
  This paper, written by Ellen Van de Poel, Ahmad Reza Hosseinpoor, Niko Speybroeck, Tom Van Ourti and Jeanette Vega, and published in the Bulletin of the World Health Organization (BLT) - Volume 86, Number 4, April 2008, 241-320, describes how "disparities in health outcomes between the poor and the rich are increasingly attracting attention from researchers and policy-makers, thereby fostering a substantial growth in the literature on health equity. 'Socioeconomic inequality' in malnutrition refers to the degree to which childhood malnutrition rates differ between more and less socially and economically advantaged groups. This is different from 'pure inequality', which takes into account all factors influencing childhood malnutrition… This paper contributes to the literature in several ways. First, it updates and enlarges the evidence base on average malnutrition and socioeconomic inequality in malnutrition using the most recent Demographic and Health Survey (DHS) data from 47 developing countries. The inclusion of such a large number of countries makes it possible to obtain insights into the regional clustering of poor–rich malnutrition disparities in the developing world and into the association between the average level of malnutrition and socioeconomic inequality. Given the focus on average rates of malnutrition in international development targets, it is of interest to establish how countries compare in terms of average rates of malnutrition and inequality in malnutrition. In addition to quantifying the degree of socioeconomic inequality using a single index, this paper also illustrates the different patterns found for the distribution of malnutrition across socioeconomic groups…".
• Socioeconomic Status and Obesity
  This study by Lindsay McLaren, and published in Epidemiologic Reviews (29: 29-48 (2007), reviewed a total of 333 published studies, representing 1,914 primarily cross-sectional associations. "The overall pattern of results, for both men and women, was of an increasing proportion of positive associations and a decreasing proportion of negative associations as one moved from countries with high levels of socioeconomic development to countries with medium and low levels of development. Findings varied by SES indicator; for example, negative associations (lower SES associated with larger body size) for women in highly developed countries were most common with education and occupation, while positive associations for women in medium- and low-development countries were most common with income and material possessions... The overall pattern of results, for both men and women, was of an increasing proportion of positive associations and a decreasing proportion of negative associations as one moved from countries with high levels of socioeconomic development to countries with medium and low levels of development. Findings varied by SES indicator; for example, negative associations (lower SES associated with larger body size) for women in highly developed countries were most common with education and occupation, while positive associations for women in medium- and low-development countries were most common with income and material possessions." [author abstract]
• State of the World’s Children 2007 – Women and Children: The Double Dividend for Gender Equality
  The State of the World’s Children 2007 reports on the lives of women around the world for a simple reason: Gender equality and the well-being of children go hand in hand. When women are empowered to live full and productive lives, children prosper. UNICEF’s experience also shows the opposite: When women are denied equal opportunity within a society, children suffer.
• Statistical methods in analysing health inequalities among the world citizens
  While many international and national institutions world over, such as, World Health Organisation (WHO), the World Bank and national/ state health institutions, strive to promote health, prevent and control disease, formulate policies, programmes and evaluate interventions, and mobilise resources, all of these with an ultimate aim to prolong life of the world citizens as well as increase access to health care, health inequalities between advantaged and disadvantaged populations continue to increase at unprecedented rates and with greater complexity. [author abstract] [Paper presented at the 18th World IMACS / MODSIM Congress, Cairns, Australia, 13-17 July 2009]
• Successful Social Protection Floor Experiences
  "This book presents 18 case studies on social protection floor policies from 15 countries of the global South. Access to health services, education, food, water, housing, sanitation and information as well as enjoyment of a basic level of income security are human rights enshrined in the Universal Declaration of Human Rights. Social protection is an important factor in enabling people to exercise these rights. The social protection floor approach combines all these social services and income transfer programmes in a coherent and consistent way, preventing people from falling into poverty and empowering those who are poor to escape the poverty trap and find decent jobs. In the absence of social protection, people are subjected to increased risks of sinking below the poverty line or remaining caught in poverty." [ILO/UNDP – February 2011]
• Tackling health inequalities: 2007 Status Report on the Programme for Action
  "…If evidence-based policy making were to be honoured in the observance rather than the breech what might it look like? A simple description might be: review the evidence and make recommendations; use these recommendations as a base to formulate policies; monitor their effects. By this description, action on inequalities in health in England conforms rather well to evidence-based policy making. The Independent Inquiry into Inequalities in Health (the Acheson Inquiry) reviewed the scientific evidence on health inequalities. It made 39 recommendations. Importantly, Acheson took a social model of health. Thirty-six of it’s (our) recommendations ranged across the whole spectrum of government policy that influences health inequalities. Only three were specifically aimed at the health service. It was then appropriate that a cross-cutting review on health inequalities was conducted by the Treasury with the participation of 18 government departments and agencies. The result was a national Programme for Action. Government Departments entered into 82 commitments aimed at tackling health inequalities. Targets on reduction of health inequalities, for infant mortality and life expectancy were set. A key part of the Programme for Action was to monitor health inequalities and a few key determinants and components. The overseeing of this monitoring task was assumed by the Scientific Reference Group on Health Inequalities. In our first Status Report, 2005, we suggested that time was too short to see any effect of policy changes. Now, two years later, that is still a major issue. It is simply too early to say if too little has been done or the right actions were not taken. Whatever actions were taken between 2003 and 2006 there would be little short-term impact on health inequalities. Nevertheless it is important to keep close watch on what has been happening both to important policy areas such as housing, child poverty and education, as well as to health inequalities." [Preface by Professor Sir Michael Marmot]
• Tackling Health Inequalities An All-Ireland Approach to Social Determinants
  Looks at: Concepts, Definitions and Theories; Health Inequalities in Ireland and Northern Ireland; and Key Social Determinants of Health: Poverty and Inequality; Social Exclusion and Discrimination (Gender; Ethnicity; Travellers; Asylum Seekers, refugees and low income migrant workers; Homelessness; Disability; Mental Health; Sexual Orientation); A Life Course Perspective (Pregnancy; Childhood; and Older Age); Public Policies and Services (Health services; Education; Housing and accommodation; Transport; The Built Environment (Work and Employment; and Community and Social Participation); Health Behaviours (Alcohol; Food; and Smoking); and Stress.
• Tackling Health Inequalities: ten years on
  A review of developments in tackling health inequalities in England over the last ten years. “This [May 2009] report reviews developments in health inequalities over the last 10 years across government - from the publication of the Acheson report on health inequalities in November 1998 to the announcement of the post-2010 strategic review of health inequalities in November 2008. It covers developments across government on the wider social determinants of health, and the role of the NHS. It provides an assessment of developments against the Acheson report, reviews a range of key data sets covering social, economic, health and environmental indicators, and considers lessons learned and challenges for the future.”
• The Chronic Poverty Report 2008-09
  "Over the last five years, in an era of unprecedented global wealth creation, the number of people living in chronic poverty has increased. Between 320 and 443 million people are now trapped in poverty that lasts for many years, often for their entire lifetime. Their children frequently inherit chronic poverty, if they survive infancy. Many chronically poor people die prematurely from easily preventable health problems. For the chronically poor, poverty is not simply about having a very low income: it is about multidimensional deprivation – hunger, undernutrition, illiteracy, unsafe drinking water, lack of access to basic health services, social discrimination, physical insecurity and political exclusion. Whichever way one frames the problem of chronic poverty – as human suffering, as vulnerability, as a basic needs failure, as the abrogation of human rights, as degraded citizenship – one thing is clear. Widespread chronic poverty occurs in a world that has the knowledge and resources to eradicate it. This report argues that tackling chronic poverty is the global priority for our generation. There are robust ethical grounds for arguing that chronically poor people merit the greatest international, national and personal attention and effort. Tackling chronic poverty is vital if our world is to achieve an acceptable level of justice and fairness…Priority goes to two policy areas – social protection (Chapter 3) and public services for the hard to reach (Chapter 5) – that can spearhead the assault on chronic poverty. Alongside these are anti-discrimination and gender empowerment (Chapter 5), building individual and collective assets (Chapters 3, 4 and 6) and strategic urbanisation and migration (Chapters 4 and 5). Working together, these policies reduce chronic poverty directly and create and maintain a just social compact that will underpin long-term efforts to eradicate chronic poverty (Chapter 6). Such social compacts ensure a distribution of public goods and services that contributes to justice and fairness."
• The Effectiveness of Interventions to Address Health Inequalities in the Early Years: A Review of Relevant Literature
  "The review has been prepared to summarise the relevant evidence base and advise policy colleagues of the known effectiveness of specific early years’ health interventions. The review covers the following areas: pregnancy at a young age; maternal and foetal health during pregnancy; maternal and child nutrition and physical and mental health; child development and early education; parenting in the early years; vulnerable groups and longer term impacts." The final chapter draws together key messages about the effectiveness of interventions that have been rigorously evaluated, areas where the evidence base is lacking, and methodological issues that need to be addressed by future research.
• The Evolution of Income-related Inequalities in Health Care Utilization in Switzerland over Time
  Robert E. Leu, Martin Schellhorn, “This study investigates equity in access to health care in Switzerland over time, using nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple quintile distributions and concentration indices are used to assess horizontal equity, i.e. the extent to which adults in equal need for medical care appear to have equal rates of medical care utilization”.
• The Growth Report: Strategies for Sustained Growth and Inclusive Development
  Published by The International Bank for Reconstruction and Development / The World Bank [on behalf of the Commission on Growth and Development, Conference Edition, May 21, 2008], this report examines, “What does it take to achieve sustained, poverty reducing growth? Twenty-one leading economic experts from government, business, and academia from around the world comprising the independent Commission on Growth and Development worked for two years to identify key characteristics of economies that have been able to achieve growth of more than 7 percent annually in more than 25 of the years since World War II and to explore how other developing countries might emulate them. The Commission's conclusions highlight the actions that are most likely to improve developing countries' growth prospects, with a goal of providing leaders in developing countries with a framework to help them design and implement successful growth strategies… According to the Commission, fast sustained growth is not a miracle; it is attainable for developing countries with the 'right mix of ingredients.’ Countries need leaders who are committed to achieving growth and who can take advantage of opportunities from the global economy. They also need to know about the levels of incentives and public investments that are necessary for private investment to take off and ensure the long-term diversification of the economy and its integration in the global economy… We chose to focus on growth because we think that it is a necessary condition for the achievement of a wide range of objectives that people and societies care about. One of them is obviously poverty reduction, but there are even deeper ones. Health, productive employment, the opportunity to be creative, all kinds of things that really matter to people seem to depend heavily on the availability of resources and income, so that they don’t spend most of their time desperately trying to keep their families alive." Michael Spence, Chair, Commission on Growth and Development…”.
• The hidden inequity in health care
  "Inequity is the presence of systematic and potentially remediable differences among population groups defined socially, economically, or geographically. It is not the same as inequality, which is a much broader term, generally used in the human rights field to describe differences among individuals, some of which are not remediable (at least with current knowledge). Some languages do not make a distinction between the two terms, which may lead to confusion and a need to clarify exact meaning in different contexts. Some people use the term ‘unfairness’ to define inequity, but unfairness is not measurable and therefore not a useful term for policy or evaluation. Inequity can be horizontal or vertical. Horizontal inequity indicates that people with the same needs do not have access to the same resources. Vertical inequity exists when people with greater needs are not provided with greater resources. In population surveys, similar use of services across population groups signifies inequity, because different population subgroups have different needs, some more than others. What is generally considered equity (equal use across population subgroups) is, in fact, inequity. Most industrialized countries have achieved both horizontal and vertical equity in the use of primary care services, meaning that people with greater health needs receive more primary care services. Although some countries have achieved horizontal equity in use of specialist services, very few have achieved vertical equity because socially-deprived populations have less access to specialist services than their needs require." [International Journal for Equity in Health, 2011, 10:15]
• The impact of user fees on access to health services in low- and middle-income countries
  Following an international push for financing reforms, many low- and middle-income countries introduced user fees to raise additional revenue for health systems. User fees are charges levied at the point of use and are supposed to help reduce ‘frivolous’ consumption of health services, increase quality of services available and, as a result, increase utilisation of services. Objectives: To assess the effectiveness of introducing, removing or changing user fees to improve access to care in low-and middle-income countries. Search strategy: We searched 25 international databases, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group’s Trials Register, CENTRAL, MEDLINE and EMBASE. We also searched the websites and online resources of international agencies, organisations and universities to ?nd relevant grey literature. We conducted the original searches between November 2005 and April 2006 and the updated search in CENTRAL (DVD-ROM 2011, Issue 1); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (January 25, 2011); MEDLINE, Ovid (1948 to January Week 2 2011); EMBASE, Ovid (1980 to 2011 Week 03) and EconLit, CSA Illumina (1969 - present) on the 26th of January 2011. Selection criteria: We included randomised controlled trials, interrupted time-series studies and controlled before-and-after studies that reported an objective measure of at least one of the following outcomes: healthcare utilisation, health expenditures, or health outcomes. Data collection and analysis: We re-analysed studies with longitudinal data. We computed price elasticities of demand for health services in controlled before-and-after studies as a standardised measure. Due to the diversity of contexts and outcome measures, we did not perform meta-analysis. Instead, we undertook a narrative summary of evidence. Main results: We included 16 studies out of the 243 identified. Most of the included studies showed methodological weaknesses that hamper the strength and reliability of their findings. When fees were introduced or increased, we found the use of health services decreased significantly in most studies. Two studies found increases in health service use when quality improvements were introduced at the same time as user fees. However, these studies have a high risk of bias. We found no evidence of effects on health outcomes or health expenditure. Authors' conclusions: The review suggests that reducing or removing user fees increases the utilisation of certain healthcare services. However, emerging evidence suggests that such a change may have unintended consequences on utilisation of preventive services and service quality. The review also found that introducing or increasing fees can have a negative impact on health services utilisation, although some evidence suggests that when implemented with quality improvements these interventions could be beneficial. Most of the included studies suffered from important methodological weaknesses. More rigorous research is needed to inform debates on the desirability and effects of user fees. [publication abstract] [Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD009094]
• The (Indispensable) Middle Class in Developing Countries; or, The Rich and the Rest, Not the Poor and the Rest
  Inclusive growth is widely embraced as the central economic goal for developing countries, but the concept is not well defined in the development economics literature. Since the early 1990s, the focus has been primarily on pro-poor growth, with the “poor” being people living on less than $1 day, or in some regions $2 day. The idea of pro-poor growth emerged in the early 1990s as a counterpoint to a concern with growth alone (measured in per-capita income) and is generally defined as growth which benefits the poor as much or more than the rest of the population. Examples include conditional cash transfers, which target the poor while minimizing the fiscal burden on the public sector, and donors’ emphasizing primary over higher education as an assured way to benefit the poor while investing in long-term growth through increases in human capital. Yet these pro-poor, inclusive policies are not necessarily without tradeoffs in fostering long-run growth. In this paper I argue that the concept of inclusive growth should go beyond the traditional emphasis on the poor (and the rest) and take into account changes in the size and economic command of the group conventionally defined as neither poor nor rich, i.e., the middle class. [author abstract] [Center for Global Development, Working Paper 207, March 2010]
• The Interaction between Democracy and Development
  This paper examines the relationship between democracy and development. It contends that development is not just a matter of economics and that, the dysfunction of political institutions has a negative impact on living conditions. It was the opinion of the author's that true democracy characterised by rule of law, respect for human rights and recognition of the intrinsic dignity of all human beings cannot be maintained unless people enjoy a minimum standard of living, which in turn requires a minimum level of development.
• The Poor Pay More — Poverty’s High Cost to Health
  "This report describes many of the ways in which being poor is bad for one’s health and points to policies that have the potential for restoring the prospect of good health to the lives of the poor. We present compelling evidence that poverty has an impact on not just the body politic but the body corporeal as well—that being poor leaves a broad footprint on the health of individuals. The health costs of poverty are high. Those among us who are poor tend to have more illness and die younger... Recognizing that the poor disproportionately bear the nation’s burden of ill-health is important, but how are we to break the link between poverty and poor health? The answer may lie in the growing recognition, among the public health and medical community, that good health is not merely a function of doctor visits and adequate health care coverage. Health is also powerfully affected by a range of other factors such as neighborhood safety, work hazards, housing quality, the availability of social and economic supports during times of need, and access to nutritious food, physical activity, quality education, and jobs that pay livable wages." [Spotlight on Poverty and Opportunity, Center for Social Epidemiology and Population Health - University of Michigan, USA, September 2009]
• The Relationship Between Health Care Need and Standardized Mortality Ratios in Ontario
  Needs based health care funding methods are increasingly being considered for the Canadian health care system. This paper applies the non-linear least squares method suggested by Bedard et al. (2000) to identify the empirical relationship between standardised mortality ratios (SMRs) and health care need in Ontario, Canada.
• The wider determinants of inequalities in health: A decomposition analysis
  Background: The common starting point of many studies scrutinizing the factors underlying health inequalities is that material, cultural-behavioural, and psycho-social factors affect the distribution of health systematically through income, education, occupation, wealth or similar indicators of socioeconomic structure. However, little is known regarding if and to what extent these factors can assert systematic influence on the distribution of health of a population independent of the effects channelled through income, education, or wealth. Methods: Using representative data from the German Socioeconomic Panel, we apply Fields’ regression based decomposition techniques to decompose variations in health into its sources. Controlling for income, education, occupation, and wealth, we assess the relative importance of the explanatory factors over and above their effect on the variation in health channelled through the commonly applied measures of socioeconomic status. Results: The analysis suggests that three main factors persistently contribute to variance in health: the capability score, cultural-behavioural variables and to a lower extent, the materialist approach. Of the three, the capability score illustrates the explanatory power of interaction and compound effects as it captures the individual’s socioeconomic, social, and psychological resources in relation to his/her exposure to life challenges. Conclusion: Models that take a reductionist perspective and do not allow for the possibility that health inequalities are generated by factors over and above their effect on the variation in health channelled through one of the socioeconomic measures are underspecified and may fail to capture the determinants of health inequalities. [author abstract] [International Journal for Equity in Health, 10: 30 - 26 July 2011]
• Tides of Change: Addressing Inequity and Chronic Disease in Atlantic Canada
  Published by Health Canada, the purpose of this discussion paper is to explore the relationships between inequity and chronic disease in Atlantic Canada in the context of the particular social and economic patterns that may influence health in this region.
• Toward Health Equity and Patient-Centeredness: Integrating Health Literacy, Disparities Reduction, and Quality Improvement: Workshop Summary
  "To receive the greatest value for health care, it is important to focus on issues of quality and disparity, and the ability of individuals to make appropriate decisions based on basic health knowledge and services. The Forum on the Science of Health Care Quality Improvement and Implementation, the Roundtable on Health Disparities, and the Roundtable on Health Literacy jointly convened the workshop "Toward Health Equity and Patient-Centeredness: Integrating Health Literacy, Disparities Reduction, and Quality Improvement" to address these concerns. During this workshop, speakers and participants explored how equity in care delivered and a focus on patients could be improved."
• Towards Reducing Health Inequities: A Health System Approach to Chronic Disease Prevention: A Discussion Paper
  "The increasing prevalence of chronic health conditions among British Columbians has been identified as a key threat to the sustainability of the health care system. Evidence shows ‘at-risk’ or ‘vulnerable’ groups have a higher rate of chronic disease due to their social and economic circumstances; however, the impacts of chronic diseases can be significantly reduced through chronic disease prevention and management efforts. While in the past, many chronic disease prevention strategies have focused on interventions aimed at modifying individual lifestyle and behavioural risk factors associated with increased risk of chronic disease (such as smoking, diet, and physical activity), there is growing evidence that such approaches will have limited success. Research shows that community- and systems-level approaches that target the social, economic, and environmental root causes of poor health can be more effective at preventing chronic disease and can greatly improve the overall health of the population. Although British Columbians in general rank among the healthiest in the world, health is not evenly distributed across British Columbia’s population. There are a significant number of British Columbians who have poorer health than others in the province, including: Children and families living in poverty; People with mental health and substance use issues; Aboriginal people; Immigrants; and Refugees." [Population & Public Health, Provincial Health Services Authority, Vancouver, Canada (2011)]
• United Nations Development Project: Human Development in Animation
  This flash animation presentation from the United Nations Development Programme highlights many of the issues presented in the 2003 World Development Report. Its themes include; the progress and reversals in health and income since 1960; the tragic setbacks in development during the 1990s and the large differences within countries, explored using data on Chinese provinces.
• Urban HEART: Urban Health Equity Assessment and Response Tool
  "The impact of the urban setting on health and, in particular, inequity in health has been widely documented. Evidence shows that while, on average, public services, including health and health service provision, in urban areas may be better than in rural areas, these averages often mask wide disparities between more and less disadvantaged populations. One key factor is the exclusion of the marginalized and vulnerable in public health planning and response systems. Urban health is influenced by a dynamic interaction between global, national and subnational policies; within that wider context, city governments and local communities can play an instrumental role in closing the gap between the better off and the worse off. Regardless of the evidence, only a few countries have examined their inter- or intra-city health inequities, and few do so regularly. Information that shows the gaps between cities or within the same city is a crucial requirement to trigger appropriate local actions to promote health equity. Evidence should be comprehensive enough to provide hints on key health determinants, and concise enough to facilitate policy- making and prioritization of interventions. In order to facilitate the process of proactively addressing health inequities, WHO collaborated with 17 cities from 10 countries in 2008–2009 to develop and pilot-test a tool called the Urban Health Equity Assessment and Response Tool (Urban HEART). Urban HEART guides local policymakers and communities through a standardized procedure of gathering relevant evidence and planning efficiently for appropriate actions to tackle health inequities. This collective effort towards a common goal has galvanized both city governments and communities to recognize and take action on health inequities. It is envisaged that cities in varied contexts can locally adapt and institutionalize Urban HEART, while maintaining its core concepts and principles." [World Health Organization, The WHO Centre for Health Development, Kobe, 2010]
• Using Social Transfers to Scale up Equitable Access to Education and Health Services - Background Paper
  "This paper focuses on the impact of one form of demand-side policy option – social transfers, particularly cash transfers and vouchers - on access to health and education services by the extreme poor. It also touches upon the broader contribution that social transfers make to human development outcomes."
• US National Healthcare Disparities Report 2005
  "The 2005 National Healthcare Disparities Report (NHDR) tracks disparities in both quality of and access to health care in the United States for both the general population and for congressionally designated priority populations. The report presents, in chart format, the latest available findings on quality of and access to health care in the general U.S. population and among priority populations. It focuses on four components of quality — effectiveness, patient safety, timeliness, and patient centeredness — and two components of access—facilitators and barriers to health care and health care utilization."
• Violence against women fuels spread of HIV/AIDS
  This Amnesty International Press Release outlines the implications of sexual violence against women, particularly in conflict situations for the spread of HIV/ AIDS.
• What does the empirical evidence tell us about the injustice of health inequalities?
  Whether or not health inequalities are unjust, as well as how to address them, depends on how they are caused. I review a range of health inequalities, between men and women, between aristocrats and commoners, between blacks and whites, and between rich and poor within and between countries. I tentatively identify pathways of causality in each case, and make judgments about whether or not each inequality is unjust. Health inequalities that come from medical innovation are among the most benign. I emphasize the importance of early life inequalities, and of trying to moderate the link between parental and child circumstances. I argue that racial inequalities in health in the US are unjust and add to injustices in other domains. The vast inequalities in health between rich and poor countries are arguably neither just nor unjust, nor are they easily addressable. I argue that there are grounds to be concerned about the rapid expansion in inequality at the very top of the income distribution in the US; this is not only an injustice in itself, but it poses a risk of spawning other injustices, in education, in health, and in governance. [author abstract] [Center for Health and Wellbeing, Princeton University, January 2011]
• What Evidence is there about the effects of health care reforms on gender equity, particularly in health
  This report by Dr Piroska Östlin of the Karolinska Institutet is a synthesis of systematic reviews, narrative reviews and individual articles on the effects on health care reforms on gender equity, focusing on the impact of health policies.
• What is the effectiveness of empowerment to improve health
  “….This report from the Health Evidence Network shows that empowering socially excluded populations is a viable strategy for improving health. While participatory processes make up the base of empowerment, strategies must also build community organizations and individuals capacity to participate in decision-making and advocacy…..”
• World Bank - World Development Report 2006 Protecting and assisting the internally displaced: the way forward
  The World Development Report for 2006 concludes that inequality of opportunity, both within and among nations, sustains extreme deprivation, results in wasted human potential and often weakens prospects for overall prosperity and economic growth.

Educational resources

• 17 October - World Day To Overcome Extreme Poverty
  This site is dedicated to October 17, The World Day to Overcome Extreme Poverty. Officially recognised in 1992, the day was born from the initiative of thousands of people who gathered at the Human Rights Plaza in Paris, France in 1987.
• Course Reader: Health Equity Research to Action
  This short course reader was designed by Lexi Bambas and Qamar Mahmood for the Global Equity Gauge Alliance at School of Public Health University of Western Cape South Africa, 2004.
• Disability World
  A bimonthly web-zine of international disability news and views
• ELDIS Gateway to Development Information
  Part of the Institute of Development Studies, Sussex, ELDIS is an internet-based information source filtering, structuring and presenting development information via the web and Email. Its library includes selected and abstracted online documents, and an organisational directory of development-related internet resources.
• Equity Oriented Tool Kit
  The Equity-Oriented Tool Kit for Health Technology Assessment is a needs-based health technology assessment model used to provide methods to match the identified health needs of a population, to the most appropriate interventions. The existing tool kit that focused on averages, has now been expanded to take into account issues of gender equity, social justice and community participation. The Tool Kit has been developed by the WHO Collaborating Centre for Health Technology Assessment.
• European Portal for Action on Health Equity
  This Portal is a tool to promote health equity amongst different socio-economic groups in the European Union. The Portal includes information on policies and interventions to promote health equity within and between the countries of Europe, via the socio-economic determinants of health.
• Factline: Tracking Health in Underserved Communities
  This website is sponsored by the National Library of Medicine and Meharry Medical College. It highlights health disparities in underserved communities including women, members of minority groups, the elderly and others. It presents significant findings from scholarly research in public health on the subject of health disparities and provides bibliographic references to the literature in which these findings are established.
• Health Inequalities Intervention Tool
  "This tool [presented by the London Health Observatory] provides information on the following: the current life expectancy in each local authority, and in the most deprived quintile of each local authority; the current gap in life expectancy between the most deprived quintile and the local authority as a whole for all areas, and between the local authority and England for spearhead areas; an analysis of the contribution of causes of death to the gap between the most deprived quintile of the local authority and a variety of comparators. The tool allows the user to investigate two scenarios: an intervention applied across the local authority and the same size of intervention applied only in the most deprived quintile. The tool thus supports action to reduce health inequalities within every local authority."
• Health Poverty Index
  The Health Poverty Index (HPI) is a collaboration between the Social Disadvantage Research Centre (SDRC), University of Oxford, and the South East Public Health Observatory (SEPHO) and the Department of Geography and Geosciences, University of St Andrews, which is sponsored by the U.K. Department of Health. The HPI tool will allow groups, differentiated by geography, social or economic position and cultural identity, to be contrasted in terms of their 'health poverty’. A group's 'health poverty' is a combination of both its present state of health and its future health potential or lack of it. The key justification for the selection of a particular set of groups is the expectation of an equal distribution of health and its determinants between the groups from the perspective of social justice.
• Public Health Observatory Handbook of Health Inequalities Measurement
  This handbook primarily focuses on the measurement and interpretation of health inequalities. Written by Roy Carr-Hill and Paul Chalmers-Dixon of York University, it provides a comprehensive collection of material for those concerned to document and understand health inequalities.
• Surveying the Landscape of Opportunity - What contributes to social and economic disparities among neighborhoods?
  This report examines the implications of the social dynamics of urban neighbourhoods, and the need for greater research in the area to enable policy makers to better understand fundamental problems and work to build stronger neighbourhoods.
• Where the Poor Are - An Atlas of Poverty
  Where the Poor Are: An Atlas of Poverty brings together a diverse collection of maps from different continents and countries, depicting small area estimates of vital development indicators at unprecedented levels of spatial detail. The atlas is a product of the CIESIN Global Poverty Mapping Project, begun in 2004, which was made possible by support from the Japan Policy and Human Resource Development Fund, in collaboration with The World Bank. The atlas of 21 full-page poverty maps reveals possible causal patterns and provides practical examples of how the data and tools have been used, and may be used, in applied decisions and poverty interventions.
• World Bank - PovertyNet
  PovertyNet provides an introduction to key issues as well as in-depth information on poverty measurement, monitoring, analysis, and on poverty reduction strategies for researchers and practitioners.
• The World Health Organization Ethics and Health
  An information aid to a broad range of bioethics issues, including health delivery, clinical care and biotechnology. Also included are links and information on bioethics related WHO activities.

Organisations and Networks

UN and multinational

• Commission on the Social Determinants of Health
  The Commission, created in March 2005, is the World Health Organization’s vehicle to draw the attention of governments, civil society, international organisations, and donors to pragmatic ways of creating better social conditions for health. Lack of income, inappropriate housing, unsafe workplaces, and lack of access to health systems are some of the social determinants of health leading to inequalities within and between countries.

Government

Non Government

• ActionAid
  "A leading development charity working directly with three million of the world's poorest people in Africa, Asia and Latin America, helping them in their fight against poverty"
• Center for Impact Research
  "A Chicago-based not-for-profit organization that works towards elimination of poverty through grass-roots research aimed at identifying innovative policy strategies better reflecting low-income persons' needs. CIR's projects all result in new poverty solutions crafted in collaboration with low-income persons, community-based organizations, and governmental agencies"
• Center for Policy Analysis on Trade and Health
  The Center for Policy Analysis on Trade and Health (CPATH) is a project of the Center for Policy Analysis, which is non-profit organisation. It is dedicated to protecting and expanding access to health care, water, and other vital human services. CPATH links health, health care, and global trade communities to create economically and socially just, democratically accountable, and environmentally sustainable solutions to the negative effects of economic globalisation.
• Institute for Research on Poverty (USA)
  A national, university-based centre for research into the causes and consequences of poverty and social inequality in the United States. It is non-profit and non-partisan. Located at the University of Wisconsin-Madison.
• Institute on Race and Poverty
  The Institute on Race & Poverty at the University of Minnesota Law School aims to share the latest and most relevant information on issues confronting communities facing the combined challenges of race and poverty.
• International Poverty and Health Network
  "A world-wide network of people and organisations from health, business, NGOs, government and society-in-general who exchange experiences and share information on the most effective approaches and solutions for health in poverty eradication policies, strategies and actions"
• MacArthur Research Network on the Socioeconomic Status and Health
  "The mission of the Network on Socioeconomic Status and Health is to enhance our understanding of the mechanisms by which socioeconomic factors affect the health of individuals and their communities"
• National Center for Children in Poverty (USA)
  "The aim of the NCCP is to Identify and promote strategies that reduce the number of young children living in poverty in the United States, and that improve the life chances of the millions of children under six who are growing up poor"
• National Coalition for the Homeless (USA)
  A national advocacy network of homeless persons, activists, service providers, and others committed to ending homelessness through public education, policy advocacy, grassroots organising, and technical assistance.
• NetAid
  "NetAid is making long-term effort to use the unique networking capabilities of the Internet to promote development and alleviate extreme poverty across the world. The NetAid Foundation serves as a global exchange point to link people to successful agents and agencies of change."
• People's Health Movement
  "The principle goal of the People's Health Movement is to promote Health for All through an equitable, participatory and inter-sectoral movement and ...to encourage government and other health agencies to ensure universal access to quality health care, education and social services according to people's needs and not people's ability to pay."
• RRojas Databank The political economy of development studies
  The purpose of this site is to publish electronic versions of books, papers, notes and statistical and analytical material related to economics and development studies and to facilitate easy access to major sources of academic information for development studies.
• World Alliance of Cities Against Poverty
  "A network, formed on the initiative of UNDP, which offers participants an opportunity to benefit from the experience of cities and the proximity of municipalities to the population to give a new impetus to the fight against poverty and thus contribute effectively to the "International Decade for the Eradication of Poverty" (1997-2006), proclaimed by the United Nations General Assembly in 1996"

Academic Institutions with particular focus in this area

• School of Public Health and Community Medicine, UNSW
• School of Public Health and Community Medicine, UNSW - Research

Key Conferences, conference and workshop reports

Conference reports

Journals, Newsletters, Forums

Bibliographies, Libraries

Public health bookshops

• Public Health bookshop