Health Equity: 01/22/10

Friday, January 22, 2010

[EQ] Who owns health inequalities?

Who owns health inequalities?

Constance A Nathanson, Mailman School of Public Health, Columbia University, New York USA

The Lancet, Volume 375, Issue 9711, 23 January 2010

Website: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60119-5/fulltext

“…..Health inequalities are old news—very old news. John Graunt's analysis of the English Bills of Mortality, statistically documenting the fact of inequality in death, was published in the mid-17th century. Beginning early in the 19th century, death rates by occupation compiled by the Registrar General's Office in London left no doubt that those in the bottom ranks died at substantially higher rates than those at the top. At much the same time, French scholars concluded that the condition most closely associated with an early death was poverty, basing their findings on a series of remarkable studies published in the first public health journal, Annales d'hygiène publique.

The facts of inequality in disease and death were well known before the beginning of the 20th century. Their perennial rediscovery in the years since has little to do with lack of knowledge and much to do with heated (and value-laden) disagreement among scholars, bureaucrats, and politicians about why inequalities exist, what should be done about them, and who should do it…..”

“…..Are health “inequalities” a problem of the poor (and thus soluble by changing poor people's circumstances or behaviour) or are they an effect of rigid patterns of social stratification (requiring that resources be redistributed)? Are they “voluntary”—the result of bad choices (“booze and fags”)—or “involuntary”—the consequence of oppressive social structures? Should inequalities be framed as “disparities”—mere differences that may or may not be the result of human action—or as unacceptable “inequities”?

And finally, who “owns” health inequalities? Are they—as in the 19th century—a public health problem or are they a medical care problem? Are they a private problem or a public problem? These are not logical or empirical questions. They are political questions. How they are answered will depend on the policy preferences of those in power, or who aspire to power. I illustrate these points with the examples of the UK and the USA, countries at the extremes of public policy in this domain…..”

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[EQ] The Global Health System: Linking Knowledge with Action-Learning from Malaria

The Global Health System: Linking Knowledge with Action—Learning from Malaria

Gerald T. Keusch1*, Wen L. Kilama2, Suerie Moon3, Nicole A. Szlezák3, Catherine M. Michaud4

1 Department of International Health, Boston University School of Public Health, Boston, Massachusetts, United States of America,
2 African Malaria Network Trust, Dar es Salaam, Tanzania,
3 Sustainability Science Program, John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts, United States of America,
4 Harvard Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America
PLoS Med 7(1): e1000179. doi:10.1371/journal.pmed.1000179

Available online at:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000179

“…….Conducting basic research, translating it into the development of new health tools, and delivering products to patients in need of them are core functions of an effective global health system [1]. Yet performing these functions is a particular challenge for diseases that primarily affect the poor in low-income countries, partly because efforts to understand diseases and develop tools to combat them are often detached from efforts to deliver interventions.

For malaria, the global health system has evolved over the past century to integrate better the research, development, and delivery (R&D&D) of new products to treat and control the disease. This article traces that evolution and extracts lessons applicable to the many new challenges currently facing the global health system…..”

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[EQ] From Social Safety Net to Social Policy?

From Social Safety Net to Social Policy?

The role of conditional cash transfers in welfare state development in Latin America

Francesca Bastagli

Centre for Analysis of Social Exclusion (CASE), London School of Economics and Political Science

Working Paper number 60 December, 2009 -International Policy Centre for Inclusive Growth (IPC - IG)

Poverty Practice, Bureau for Development Policy, UNDP

Available online PDF [35p.] at: http://www.ipc-undp.org/pub/IPCWorkingPaper60.pdf

“…….During the 1990s, conditional cash transfers (CCTs) were adopted by countries across Latin America as central elements of their poverty reduction strategies. Alongside other developments in the area of social assistance, conditional cash transfers CCTs represent an opportunity for countries to develop an integrated and inclusive set of social policies.

At the same time, particular conditional cash transfers CCT features risk promoting the further residualisation and fragmentation of safety nets. Drawing on the experience of six countries in Latin America, [Colombia – Chile - Honduras – Nicaragua - Brazil – Mexico] - this paper identifies the variations and recent trends in conditional cash transfers CCT design and implementation.

Based on this review, it considers the contribution of conditional cash transfers CCTs to the potential transition from a largely absent or minimal safety net to a coordinated system of social policies…”

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