Health inequality

The recently released WHO World Health Report 2008, Now More Than Ever calls for a return to the values, principles and approaches of Primary Health Care. Globalisation, the report argues, has transformed the world and placed many countries and their health systems under particular stress with the result that many health systems are not delivering the goods and failing to provide even the most basic of health care.

Thirty years ago, the Alma-Ata Conference advanced the world Primary Care Movement, a set of broad principles designed to tackle the health inequalities in all countries, to place people at the centre of health, to stress social justice, and to place emphasis on the right to better health for all.

The sad reality is that in many ways these values have not been realised, and while access to health care for all is espoused by many world political leaders, success in actually delivering it has been profoundly disappointing and decidedly uneven.

There seems little doubt that moving towards health for all, produces challenges in an ever-changing globalised world: and while it is true that generally people are healthier and living longer lives today than 30 years ago; that many essential drugs have become commonplace; that there have been major advances in sanitation and water supply; and that the resources for health have never been better; the fact remains that inequality still reigns supreme and that there are still many health peaks to be climbed.

Certainly there have been many successes. If children still died at the rate they did 30 years ago, there would be about 16 million child deaths in the world today. In fact there are only about 9.5 million. This represents the equivalent of about 18,000 children’s lives saved every day.

So despite some important victories why has the global community failed to deliver on the promises made 30 years ago? A number of reasons seem to stand out.

First, global progress in health has been deeply unequal with some countries progressing in leaps and bounds while others have actually gone backwards. In the latter case, Zimbabwe comes to mind.

Second, many countries failed to anticipate and satisfactorily manage the impact of broad demographic and social change, particularly things like falling fertility, rapid population ageing, increasing population movements and urbanisation, and such trends have significantly changed the nature of health problems and impacted on health in a variety of unexpected ways.

Increasing population movement has, for example, transformed the health scene and raised the issue of infections, both old and new, to a new pedestal, while the burden of increasing chronic and degenerative disease concomitant on population ageing and “Westernisation” is fast taking central stage.

At the same time childhood infections, while declining in significance, still feature significantly in many developing countries.

All this has placed extraordinary strain on health systems and health care delivery. In addition, a complex web of other factors is also at work. This includes climate change, challenges to energy, water and food security, and social, economic and political tensions.

Health systems, particularly in the developing world, are not immune from such factors and are particularly sensitive to political and economic crises. The current health crisis in Zimbabwe is a good example as is the HIV-AIDS crisis and the way it was managed in the Republic of South Africa.