Health inequality

There also seems little doubt that the health sector remains massively under-resourced in many countries producing a substantial mismatch between broad expectations and actual performance. Globally, annual government expenditure on health varies from as little as $US20 per person to well over $US6, 000. Striking inequalities also exist throughout the world in access to health and health care and what people have to pay for care. For billions of people in low and middle income countries, more than 50 per cent of all health care expenditure must be met from personal resources.

Of approximately 136 million women expected to give birth this year in the world, 58 million will receive no medical care or assistance. Equally striking differences in life expectancy between the richest and the poorest countries continue to persist and the gap now exceeds 40 years. In Australia and New Zealand, life expectancy now exceeds 82 years. In parts of sub-Saharan Africa life expectancy remains below 45 years.

In an unequal world a return to primary health care principles would seem more relevant than ever before. Quite possibly, inequalities in health care are today much more marked than they were 30 years ago, and that is a major failing of world societies. We now live at a time of increasing polarisation of many societies where the well-off are generally healthier and have the best access to health care, while those at the other end of the socio-economic spectrum have much poorer health and are largely left to cope for themselves. Even in our own society we see evidence of this polarisation albeit on a more moderate scale.

In the final analysis, the WHO report argues that all societies must aim to diminish inequalities in health, eliminate all forms of health exclusion, develop health care systems that reflect people’s needs and expectations and become responsive to changing societal circumstances, to ultimately ensure that health care is available to all. The past 30 years suggests that we have made some progress in achieving these aims, but not nearly enough.