Health equity: can we achieve it?

Today, there is a 38-year age gap between countries with the lowest and highest life expectancy rates. A child born in Sierra Leone can expect to live for 46 years while a child born in Japan may expect to live for 84 years. Most people in health care and health policy would agree that health equity is a desirable goal; but can it ever be achieved? Historically, there have been repeated efforts to define health equity with questions whether it means equity in the delivery of health services or equity in health status; the latter being a great deal becomes more difficult to measure and to attain. To guide actions at the policy and programmatic level, we first need to collect and analyze data on health equity. We used World Bank data to make cross-country comparisons of inequality using absolute and relative equity measurements (differences and ratios). We used aggregate indicators, such as infant mortality rate and life expectancy to illustrate trends in health and income, and regions of the world as equity stratifiers. We know that between and within countries, there is an inequitable distribution of power, money, and resources. We found that the measures of health we selected— infant mortality and life expectancy—, mirror these economic and political inequities. The evidence points to the existence of extensive (and widening) social inequities in health. This poses a public health challenge of the highest order.