Health Inequalities in the Americas

In the past decade, most economies in Latin America and the Caribbean have undergone rapid growth, allowing approximately 70 million people to rise out of poverty. Sadly, this growth has not benefited everyone equally. In turn, it has resulted in major variations in health indicator data, both between and within countries in the Americas region.

About inequality:
The Gini coefficient is a measure of the inequality of a distribution, a Gini coefficient of 0 represents exact equality—that is, every person in the society has the same amount of income and a Gini coefficient of 1 represents total inequality—that is, one person has all the income and the rest of the society has none. The average Gini coefficient of Latin America is 0.52 although this average hides a deep variation between countries, for example Bolivia, Haiti and Jamaica have Gini coefficients around 0.60 and Uruguay close to 0.45; but taking a look in the Americas’ region the gap becomes bigger and bigger with two developed countries like US and Canada, that have Gini coefficients of 0.45 and 0.32 respectively.

On the 22nd of June, 2015, the World Health Organization (WHO) State of Inequality Report was presented to the Americas’ Region at the Pan American Health Organization (PAHO) Headquarters in Washington, DC, USA.

With the knowledge that the Latin American region faces the greatest socioeconomic and health inequalities in the world, national Health Ministers, department heads of the PAHO, non-governmental organizations (among these, the International Federation of Medical Students Associations’) and many others, were anxiously awaiting the release of this report.

The objective of this report was to showcase best practices in inequality reporting in low- and middle-income countries (LMICs) using high-quality data, robust analysis methods, and user-friendly reporting methodologies.

The publication focuses on inequalities pertaining to reproductive, maternal, newborn, and child health (RMNCH), and has been compiled using public data from 86 LMICs. Using 23 RMNCH indicators, inequality status and its evolution over the last few decades has been assessed.  All data has been disaggregated according to four dimensions of inequality: education, economic status, education, sex, and place of residence.

A simultaneously promising and disappointing message permeated the report. Within-country inequalities have narrowed, with improvements in the poor subgroups driving the national decreases in disparities. However, significant inequalities in the RMNCH indicators continue to be present worldwide. Women, infants, and children who are the most socioeconomically disadvantaged, least educated and living in rural regions are the most vulnerable to health inequalities.

Maternal health intervention indicators were found to be the most disparate across inequality dimensions. The percentage of births attended by skilled birth health personnel, for instance, was 80 percentage points higher in the richer subgroups compared to the poor subgroups. A similar trend was discerned in antenatal care coverage (at least 4 visits), wherein the poor and less educated experienced at least a 25 percentage point difference in coverage.

On a positive note, coverage gaps in immunization (specifically BCG, measles, polio, and DTP3) were noted to be very minimal to virtually non-existent across inequality dimensions. Additionally, the under-five mortality rate has significantly decreased in poorer subgroups within the last decade, indicative of narrowing inequalities in child mortality.

On the whole, in many nations reported improvements in health coverage have been driven by select subgroups, failing to capture the true status of all citizens. Health inequality monitoring is thereby integral to the promotion and attainment of health equity, and without a designated regard for and analysis of disadvantaged subgroups, nations risk blinding themselves to the true state of health coverage in the face of improving national averages.  As Dr. Carissa Etienne, Director of the Pan American Health Organization remarked on June 22nd, “We need to go beyond the averages. Because beyond the averages is human suffering of immense proportions.”

As we enter the post-2015 era, we must continue to strive for access to essential health interventions for all who need them, without financial hardship. And in the words of Dr. Etienne, it must be ensured that “we leave no one behind.”

The full report can be accessed at: http://apps.who.int/iris/bitstream/10665/164590/1/9789241564908_eng.pdf?ua=1&ua=1

Entry written by Claudia Frankfurter (IFMSA-CFMS) and Maria Jose Cisneros Caceres (IFMSA Regional Coordinator for the Americas)

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