Equity in Health

This statement was made after a meeting of Commonwealth Health Ministers (CHMM), which was held on 16 May 2010 in Geneva, Switzerland. The theme of the meeting was 'The Commonwealth and the Health MDGs by 2015'. The Meeting noted that only 5% of Commonwealth developing countries have met Millennium Development Goal (MDG) 4 targets or are on track to do so. At least 19 countries have high maternal mortality rates, and only 36% of developing Commonwealth countries have achieved or are on track to achieve the targets for births attended by skilled staff. The Meeting also noted the major challenges facing the world, and Commonwealth countries in particular, if the MDGs are to be met. Ministers were optimistic that many of the 2015 MDG targets could be met by Commonwealth countries. They, however, noted that this would require greater technical co-operation; attention to enabling environments, including legal frameworks, and where appropriate free healthcare to mothers and children; and an integration of preventative and curative services in the context of strengthening health systems through primary healthcare. Ministers called on the global community, especially the G8 and G20, to support maternal and newborn health programmes, and to meet MDGs 4 and 5. While acknowledging the tremendous achievements in access to anti-retroviral treatment, the Ministers noted that two thirds of those needing treatment did not receive it. Ministers pledged support for the greater alignment of non-communicable disease issues with the MDGs.

Since the Kyafukuma Rural Health Clinic (RHC) in northwestern Zambia closed its doors in 2000 after the old building collapsed, villagers have had to make do with a cramped inadequate clinic. Now, growing frustration over the lack of satisfactory medical care has led to a community-driven initiative that promises improved access to health care. After years of waiting for the reopening of the RHC, a joint project by the state-sponsored Zambia Social Investment Fund (Zamsif) and local people is expected to hasten completion of a new RHC, including the construction and rehabilitation of quarters for five staff members.

This study examined social determinants of tobacco use in the Democratic Republic of the Congo (DRC), including region, sex, ethnicity, education, literacy, wealth index and place of residence, to gain insights on tobacco use among sub-national groups. The project analysed data from the DRC 2013–2014 Demographics and Health Survey. Tobacco use was found to be highest among working poor people, those with less education and low literacy. Older age people and those living in larger cities were more likely to smoke , although the relationship between age and smoking was not linear. Wealth was strongly related to smoking as was being engaged in services, skilled and unskilled manual labour and the army. Being in a professional, technical or managerial position was highly protective against smoking. The authors observe that the data indicate that tobacco use in the DRC, as is common in low income countries, is heavily concentrated in working poor people with lower educational status. Higher educational status is consistently predictive of avoiding tobacco use. They argue that examining only national-level data to ascertain tobacco use levels and patterns may lead to mistaken conclusions and inefficient and ineffective allocation of resources for control of tobacco use.

In countries where health care is publicly provided and where equity considerations play an important role in policy decisions, it is often argued that an increase in co-payments is unacceptable as it will be particularly harmful to the less well-off in society. The present paper derives socially optimal co-payments in a simple model of health care where people differ in income and in severity of illness. Increased concern for equity may increase optimal co-payments for illnesses with homogeneous severity across the population. For illnesses where the severity varies strongly across the population, optimal co-payments go down as a response to increased concern for equity, provided income differences in the society are sufficiently small.