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Reducing health inequalities in developing countries 

Reducing health inequalities in developing countries
Chapter:
Reducing health inequalities in developing countries
Author(s):

Davidson R. Gwatkin

DOI:
10.1093/med/9780199218707.003.0094
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date: 19 June 2019

This chapter provides a review of current thinking about health inequalities in developing countries and how to reduce them. The chapter initially discusses the relationship between three related indicators that describe distributional aspects of health status: The health of the poor, health inequality and health inequity. A concern for the health of poor flows from a broader concern for disadvantaged population groups. The definition of poverty may concern ‘absolute poverty’, with poverty defined in terms of a given level of income or consumption which is equally relevant for people wherever they may be. The concept of ‘relative poverty’ is more country-specific and attempts to define the poverty line in terms of relevance for a specific society. An alternative approach is to focus more on reducing inequalities, both in general and with respect to health in particular. Such a focus has traditionally occupied a particularly important place in thinking about international health issues and it is rare for a prominent international health statement not to give significant weight to inequality reduction. Poverty and inequality are both primarily empirical concepts. Equity, by contrast, is a normative concept, closely associated with the concept of social justice. One of the most widely cited definitions of health inequity is that it ‘refers to differences in health which… are considered unfair and unjust’. At present, the greatest amount of attention in the overall economic development field is being paid to reducing absolute poverty, rather than to lessening relative poverty or decreasing inequality or inequity. This orientation is reflected most prominently in Millennium Development Goals (MDGs), a set of objectives that currently guide the strategy of most international and bilateral donor agencies. The second section of the chapter summarizes what is known about the dimensions and magnitude of health inequalities. The discussion focuses first on differences in life-expectancy and under-5 mortality between countries, and then describes variations in the distribution of health status and health service use within countries. The third section of the chapter presents a summary of current thought about how best to reduce inequalities and improve the health of the poor. This focuses on two, complementary issues. One is on reducing the social and economic inequalities that underlie the health inequalities described. The second is on reaching the poor more effectively with health and related services that are relevant to the principal health conditions from which they suffer. The chapter closes with a brief conclusion.

This is a review of current thinking about health inequalities in developing countries and how to reduce them. It is in three parts. The first is a discussion of the concept of health inequalities, and of the similarities and differences between other distributional concepts in current use. The second summarizes what is known about the dimensions and magnitude of health inequalities. The third presents a comparable summary of current thought about how best to reduce inequalities and improve the health of the poor. The review closes with a brief conclusion.

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