Equity, Poverty and Health

1. Equity, Poverty and Health

2. "Poverty is not just about shortage of money. It is about rights and relationships; About how people are treated and how they regard themselves; About powerlessness, exclusion and loss of dignity. Yet the lack of an adequate income is at its heart." rights

3. The Right to Health • Preamble to the constitution of the WHO states: • “The enjoyment of the highest standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”

4. The Right to Health • The Declaration of Alma Ata, International Conference on Primary Health Care: • “The right to health is the most important social goal”

5. The Right to Health • The International Declaration of Human Rights • “Everyone has a right to a standard of living adequate for the health and well being of his family including food, clothing, housing and medical care”

6. Global disparities in life expectancy

7. Under-five mortality: gaps between and within countries

8. Inequity within countries • African American age adjusted death rates exceeded those for whites • By 77% in stroke • By 47% for heart disease • By 34% for cancer • By 655% for HIV infection

9. Equity as Equality of … • Use • Access • Outcome • Opportunity

10. Equity as Equality of Use There are many problems with this principle: • Not everybody responds to treatment in the same way • It ignores differences in individual preferences over health and health care

11. Equity as Equality of Access • Access to health care may have instrumental value to promoting better outcomes • but it may also be valued in its own rightas contributing towards procedural justice

12. Equality of health • It represents a consequentialist view in which the only concern is with the distribution of health • It has been criticised on the grounds that it is paternalistic and ignores individual choice and differences in preferences • Severe Inefficiency in Poor Prognosis Hard to Treat Cases • Ignores Personal Responsibilities about Health

13. Equity as Equality of Opportunity • Equality of opportunity of having a healthy life

14.    Life Span Life Span   Life Quality Life Quality Health Inequality Person or Population A Person or Population B Diseases Genes Family Life Style Nutrition Education Environment Money Health services

15. Allocation of Public Subsidies for Health in Indonesia, 1987

16. Appropriate Nutrition Access to Income Generating Opportunities Access to Capital, Technology, Market; Employment Appropriate Housing Income Generating Capabilities Health, Education, Skills Income Generating Prerequisites Wealth Welfare Appropriate Recreation Security for Income Generation Security from Disease, Disability, Accident Retirement Appropriate Education Power Access, Voice, And Vote Appropriate Health

17. Poor Nutrition Lack of Opportunity Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Illness, Illiteracy Lack of Skills Lack of Capability Lack of Income Generating Prerequisites Poverty Deprivation Poor Recreation Vulnerability Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Voicelessness, Votelessness Lack of Influence Powerlessness Poor Health Poverty can be defined in relation to deprivation either as a lack of means (ie: purchasing power) to avoid deprivation, or as an end in its own right (ie: deprivation itself).

18. Poor Nutrition Lack of Opportunity Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Lack of Capability Illness, Illiteracy Lack of Skills Poverty Deprivation Poor Recreation Vulnerability Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Powerlessness Voicelessness, Votelessness Lack of Influence Poor Health Poverty is both a consequence and a cause of ill health.

19. Diagnostic Diagnostic Diagnostic Allocation of Public Subsidies for Health in Indonesia, 1987 Targeting Poor Nutrition Unemployment; Lack of Access to Capitals, Technology, Market The cost of targetingis the economic value of all resources devoted to the targeting effort. The effectiveness of targetingis the proportion of the subsidy that reaches the intended beneficiaries. Based on Individual Assessment Based on Group Characteristics Self-targeting By Type of Service Universal Provision Public health subsidies is the sum of all resources, expressed in monetary terms, allocated by the government to the health sector. Type I error: To classify as “non-poor” someone who is truly poor Type II error: To classify as “poor” someone who is not poor Poor Housing Illness, Illiteracy Lack of Skills Poverty Poor Recreation Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Voicelessness, Votelessness Lack of Influence Poor Health Preventive Primary Prevention Therapeutic Secondary Prevention Tertiary Prevention Rehabilitative

20. Specific Pro-poor Policies Poor Nutrition Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Illness, Illiteracy Lack of Skills Poverty Poor Recreation Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Voicelessness, Votelessness Lack of Influence Poor Health Poverty Preventive Strategies Primary Prevention Preventive Secondary Prevention Therapeutic Poverty Eliminating Strategies Tertiary Prevention Rehabilitative Deprivation Reducing Strategies

21. Specific Pro-poor Policies Poor Nutrition Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Illness, Illiteracy Lack of Skills Poverty Poor Recreation Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Voicelessness, Votelessness Lack of Influence Poor Health Opportunity Strategies Poverty Preventive Strategies

22. Specific Pro-poor Policies Poor Nutrition Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Illness, Illiteracy Lack of Skills Poverty Poor Recreation Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Voicelessness, Votelessness Lack of Influence Poor Health Capability Strategies Poverty Preventive Strategies

23. Specific Pro-poor Policies Poor Nutrition Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Illness, Illiteracy Lack of Skills Poverty Poor Recreation Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Voicelessness, Votelessness Lack of Influence Poor Health Security Strategies Poverty Preventive Strategies

24. Specific Pro-poor Policies Poor Nutrition Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Illness, Illiteracy Lack of Skills Poverty Poor Recreation Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Voicelessness, Votelessness Lack of Influence Poor Health Empowerment Strategies Poverty Preventive Strategies

25. Specific Pro-poor Policies Poor Nutrition Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Illness, Illiteracy Lack of Skills Poverty Poor Recreation Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Voicelessness, Votelessness Lack of Influence Poor Health Cash Assistance Strategies Poverty Eliminating Strategies

26. Specific Pro-poor Policies Poor Nutrition Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Illness, Illiteracy Lack of Skills Poverty Poor Recreation Financial Shocks Due to Disease, Disability Accident, Retirement Poor Education Voicelessness, Votelessness Lack of Influence Poor Health Non-Cash Assistance Strategies Deprivation Reducing Strategies

27. Specific Pro-poor Policies Poor Nutrition Unemployment; Lack of Access to Capitals, Technology, Market Poor Housing Illness, Illiteracy Lack of Skills Poverty Poor Recreation 60 Financial Shocks Due to Disease, Disability Accident, Retirement 40 Frequency Poor Education 20 Voicelessness, Votelessness Lack of Influence Poor Health Poverty Line Growth Effect on Poverty Distribution Effect on Poverty Policies Against Poverty Pro-equity Policies In Ethiopia growth could have reduced the poverty headcount by some 31 per cent between 1981-95. Yet, because of changes in the distribution that contributed to a 37 percent increase in poverty, the final effect has been a net increase in poverty of 6 per cent. The case of Indonesia between 1996 and 1999 is the opposite. There, distributional changes compensated for the adverse effect of growth on poverty. Pro-poor Growth Policies Poverty is a dynamic not static concept. A poverty line can be absolute (e.g. less than $1 daily) or relative (e.g. less than 50% of average earnings).

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