
“ALL ANIMALS ARE EQUAL, BUT SOME ANIMALS ARE MORE EQUAL THAN OTHERS”: EQUITY AS A FUNDAMENTAL DIMENSION OF HEALTH
Abstract
Inequity in health remains one of the most pressing challenges in global public health, marked by unjust and avoidable differences in access to healthcare, quality of services, and health outcomes across populations. While inequality refers to differences in health status or distribution of resources, inequity emphasizes the ethical and social injustices that underpin these disparities, often arising from systemic factors such as socioeconomic status, race, gender, and geographic location (WHO, 2018; Marmot, 2020). The distinction between inequity and inequality is pivotal for addressing health disparities, as it frames these differences as a matter of fairness and rights rather than merely outcomes.
Keywords
References
Alderwick, H., Hutchings, A., Briggs, A., & Mays, N. (2021). The Impacts of Collaboration Between Local Health Care and Non-Health Care Organizations. BMC Public Health, 21, 753.
Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. The Lancet, 389(10077), 1453-1463.
Bailey, Z.D. and Williams, D.R., (2023). Racial/ethnic health disparities. In Neurobiology of Brain Disorders (pp. 1009-1023). Academic Press.
Bedford, J., Farrar, J., Ihekweazu, C., Kang, G., Koopmans, M., & Nkengasong, J. (2020). A new twenty-first century science for effective epidemic response. Nature, 575(7781), 130-136.
Binagwaho, A., & Kubwimana, K. (2023). Rwanda’s Community- and Trust-Based Approach to Maternal and Child Health. Stanford Social Innovation Review. Retrieved from https://ssir.org/articles/entry/using_a_community_based_approach_to_improve_maternal_and_child_health, [Accessed: 01 November 2024]
Binagwaho, A., & Scott, K. W. (2023). Rwanda’s Community Health Worker Program: A Path to Equity. Global Health Action, 16(1), 123-134.
Braveman, P., (2023). The social determinants of health and health disparities. Oxford University Press.
Burton, D.C., Kelly, A., Cardo, D., Daskalakis, D., Huang, D.T., Penman-Aguilar, A., Raghunathan, P.L., Zhu, B.P. and Bunnell, R., (2024). Principles of health equity science for public health action. Public Health Reports, 139(3), pp.277-283.
Carson, B., Dunbar, T., Chenhall, R.D. and Bailie, R. eds., (2020). Social determinants of Indigenous health. Routledge.
Centre for American Progress. (2023). Discrimination and Barriers to Well-Being: The State of the LGBTQI+ Community in 2022. Available at: https://www.americanprogress.org/article/discrimination-and-barriers-to-well-being-the-state-of-the-lgbtqi-community-in-2022/, [Accessed: 01 November 2024]
Centres for Disease Control and Prevention. (2024). Reaching At-Risk Populations in an Emergency. Available at: https://emergency.cdc.gov/workbook/index.asp, [Accessed: 01 November 2024]
Chen, J., Hao, S. and Wu, Y., (2022). Housing and health in vulnerable social groups: an overview and bibliometric analysis. Reviews on Environmental Health, 37(2), pp.267-279.
Commonwealth Care Alliance. (2022). The Mental Health Crisis: The Impact On Our Most Vulnerable Populations. Available at: https://www.commonwealthcarealliance.org/about-us/newsroom-publications/the-mental-health-crisis-the-impact-on-our-most-vulnerable-populations/, [Accessed: 01 November 2024]
Cruickshank, C., Wade, C., & Bajwa, J. (2024). How AI Could Help Reduce Inequities in Health Care. Harvard Business Review. Available at: https://hbr.org/2024/08/how-ai-could-help-reduce-inequities-in-health-care
CSIS. (2022). Never More Necessary: Overcoming Humanitarian Access Challenges. Available at: https://www.csis.org/analysis/never-more-necessary-overcoming-humanitarian-access-challenges, [Accessed: 01 November 2024]
de las Fuentes, C. (2024). Poverty, discrimination, cultural norms influence community well-being. Monitor on Psychology, 55(3). Available at: https://www.apa.org/monitor/2024/04/structural-competence-community-well-being, [Accessed: 01 November 2024]
De Schutter, O., Frazer, H., Guio, A.C. and Marlier, E., (2023). How poverty is perpetuated across generations. In The Escape from Poverty (pp. 18-60). Policy Press.
Elhaddad, M. and Hamam, S., (2024) AI-Driven Clinical Decision Support Systems: An Ongoing Pursuit of Potential. Cureus. 2024 Apr 6;16(4):e57728. DOI: 10.7759/cureus.57728.
Evans, D. B., Hsu, J., & Boerma, T. (2022). Universal health coverage and equity in health systems. Global Health Action, 15(1), 2007918.
Evans, M. K., Rosenbaum, L., Malina, D., Morrissey, S., & Rubin, E. J. (2021). Diagnosing and treating systemic racism. New England Journal of Medicine, 383(3), 274-280.
Forde, I., Rasanathan, K., & Krech, R. (2021). The role of the social determinants of health in achieving universal health coverage. Global Health Action, 14(1), 1996943.
Franco, C.M., Lima, J.G. and Giovanella, L., (2021). Primary healthcare in rural areas: access, organization, and health workforce in an integrative literature review. Cadernos de Saúde Pública, 37, p.e00310520.
Gostin, L.O. and Friedman, E.A., (2019). Imagining global health with justice: transformative ideas for health and well-being while leaving no one behind. Geo. LJ, 108, p.1535.
Institute for Health Metrics and Evaluation (IHME) (2024). Global Burden of Disease 2021: Findings from the GBD 2021 Study. Seattle, WA: IHME, 2024.
Jayasinghe, S., Faghy, M.A. and Hills, A.P., (2022). Social justice equity in healthy living medicine-An international perspective. Progress in Cardiovascular Diseases, 71, pp.64-68.
Jensen, N., Kelly, A.H. and Avendano, M., (2022). Health equity and health system strengthening–time for a WHO re-think. Global Public Health, 17(3), pp.377-390.
Khatri, R. B., Endalamaw, A., Erku, D., Wolka, E., Nigatu, F., Zewdie, A., & Assefa, Y. (2024). Enablers and barriers of community health programs for improved equity and universal coverage of primary health care services: A scoping review. BMC Primary Care, 25(385).
Kluge, H. H. P., Jakab, Z., Bartovic, J., D’Anna, V., & Severoni, S. (2020). Refugee and migrant health in the COVID-19 response. The Lancet, 395(10232), 1237-1239.
Labonté, R. and Ruckert, A., (2019). Health equity in a globalizing era: past challenges, future prospects. Oxford University Press.
Macinko, J., & Harris, M. J. (2015). Brazil’s Family Health Strategy—Delivering Community-Based Primary Care in a Universal Health System. New England Journal of Medicine, 372(23), 2177-2181.
Marmot, M., (2015). The health gap: the challenge of an unequal world. The Lancet, 386(10011), pp.2442-2444.
Marmot, M., Allen, J., Goldblatt, P., Herd, E., & Morrison, J. (2020). Build back fairer: The COVID-19 Marmot review. London: Institute of Health Equity.
Ministry of Health and Family Welfare. (2024). Janani Suraksha Yojana. National Health Mission. Available at: https://www.nhm.gov.in/index1.php?lang=1&level=3&sublinkid=841&lid=309, [Accessed: 01 November 2024]
National Academies of Sciences, Medicine Division, Board on Population Health, Public Health Practice, Committee on Informing the Selection of Leading Health Indicators for Healthy People and 2030, (2020). Leading health indicators 2030: advancing health, equity, and well-being.
Örüklü, C. and Çakmak, S., (2021). Women's health within the framework of sustainable development goals: Sürdürülebilir kalkınma hedefleri çerçevesinde kadın sağlığı. Journal of Human Sciences, 18(3), pp.364-373.
Parenteau, A.M., Boyer, C.J., Campos, L.J., Carranza, A.F., Deer, L.K., Hartman, D.T., Bidwell, J.T. and Hostinar, C.E., (2023). A review of mental health disparities during COVID-19: Evidence, mechanisms, and policy recommendations for promoting societal resilience. Development and Psychopathology, 35(4), pp.1821-1842.
Priest, N. and Williams, D.R., (2021). Structural racism: a call to action for health and health disparities research. Ethnicity & disease, 31(Suppl 1), p.285.
Ray, K., (2023). Black health: The social, political, and cultural determinants of black people's health. Oxford University Press.
Rural Health Information Hub. (2024). Implementation Challenges for Health Equity Programs and Initiatives. Available at: https://www.ruralhealthinfo.org/toolkits/health-equity/4/implementation-challenges, [Accessed: 01 November 2024]
Souza, J.P., Day, L.T., Rezende-Gomes, A.C., Zhang, J., Mori, R., Baguiya, A., Jayaratne, K., Osoti, A., Vogel, J.P., Campbell, O. and Mugerwa, K.Y., (2024). A global analysis of the determinants of maternal health and transitions in maternal mortality. The Lancet Global Health, 12(2), pp.e306-e316.
Stanley, L.R., Swaim, R.C., Kaholokula, J.K.A., Kelly, K.J., Belcourt, A. and Allen, J., (2020). The imperative for research to promote health equity in indigenous communities. Prevention Science, 21, pp.13-21.
Strasser, R., Kam, S. M., & Regalado, S. M. (2016). Rural health care access and policy in developing countries. Annual Review of Public Health, 37, 395-412.
Tai, D. B. G., Shah, A., Doubeni, C. A., Sia, I. G., & Wieland, M. L. (2021). The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clinical Infectious Diseases, 72(4), 703-706.
UNICEF. (2023). Every Child Alive: The Urgent Need to End Newborn Deaths. Available at: https://data.unicef.org/resources/every-child-alive-urgent-need-end-newborn-deaths/, [Accessed: 03 November 2024]
UNICEF. (2023). Trends in maternal mortality 2000 to 2020. United Nations Children’s Fund. Available at: https://data.unicef.org/resources/trends-in-maternal-mortality-2000-to-2020/, [Accessed: 01 November 2024]
United Nations Population Fund (UNFPA). (2023). Maternal Health Statistics 2023. Available at: https://www.unfpa.org/maternal-health, [Accessed: 03 November 2024]
United Nations. (2023). Sustainable Development Goals Report 2023. Available at: https://sdgs.un.org/goals, [Accessed: 03 November 2024]
Viswanath, K., McCloud, R.F. and Bekalu, M.A., (2021). Communication, health, and equity: Structural influences. In The Routledge handbook of health communication (pp. 426-440). Routledge.
White, J., Sepúlveda, M.J., Patterson, C.J., National Academies of Sciences, Engineering, and Medicine and Committee on Population, (2020). Public Policy and Structural Stigma. In Understanding the Well-Being of LGBTQI+ Populations. National Academies Press (US).
World Bank. (2023). Life Expectancy Data. Available at: https://data.worldbank.org/indicator/SP.DYN.LE00.IN, [Accessed: 03 November 2024]
World Economic Forum. (2021). The 5 Inequalities in Health Digital Tech Can Address. Available at: https://www.weforum.org/stories/2021/09/how-digital-technologies-can-address-5-sources-of-health-inequity/, [Accessed: 01 November 2024]
World Health Organisation, (2015) Strategies toward ending preventable maternal mortality (EPMM), Available at: https://iris.who.int/bitstream/handle/10665/153544/9789241508483_eng.pdf, [Accessed: 03 November 2024]
World Health Organization, (2018) Health inequities and their causes, Available at: https://www. who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes#:~:text=Health%20inequities%20are%20differences%20in%20health%20status%20or,people%20are%20born%2C%20grow%2C%20live%2C%20work%20and%20age, [Accessed: 01 November 2024]
World Health Organization, (2021a). COVID-19 and the social determinants of health and health equity: evidence brief.
World Health Organisation, (2021b) Maternal mortality, Available at: https://www.who.int/europe/news-room/fact-sheets/item/maternal-mortality, [Accessed: 03 November 2024]
World Health Organization, (2021c). Universal health coverage (UHC): Moving together to build a healthier world. Geneva: WHO.
World Health Organization, (2022). Achieving health equity in COVID-19 vaccine rollout: A global challenge. Geneva: WHO.
World Health Organization, (2023a). Working together for equity and healthier populations: Sustainable multisectoral collaboration based on health in all policies approaches. World Health Organization.
World Health Organization (WHO). (2023b). World health statistics 2023: Monitoring health for the SDGs. Geneva: WHO. Available at: https://www.who.int/publications/i/item/9789240074323, [Accessed: 01 November 2024]
World Health Organization, (2023c). Global report on health equity: Progress and prospects. Geneva: WHO.
World Health Organization. (2023d). Universal Health Coverage. Available at: https://www.who.int/health-topics/universal-health-coverage, [Accessed: 04 November 2024]
World Health Organization. (2023e). Health in All Policies: Framework for Country Action. Available at: https://www.who.int/publications/i/item/9789240067530, [Accessed: 05 November 2024]
World Health Organization, (2024a). Life expectancy at birth (years). Global Health Observatory Data Repository. Available at: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/life-expectancy-at-birth-(years), [Accessed: 02 November 2024]
World Health Organization (2024b). Health equity. Available at: https://www.who.int/health-topics/health-equity, [Accessed: 03 November 2024]
Wouters, O. J., Shadlen, K. C., Salcher-Konrad, M., Pollard, A. J., Larson, H. J., Teerawattananon, Y., & Jit, M. (2021). Challenges in ensuring global access to COVID-19 vaccines: Production, affordability, allocation, and deployment. The Lancet, 397(10278), 1023-1034.
Xafis, V., (2020). ‘What is Inconvenient for You is Lifesaving for Me’: How Health Inequities are playing out during the COVID-19 Pandemic. Asian Bioethics Review, 12(2), pp.223-234.
Article Statistics
Downloads
Copyright License
Copyright (c) 2024 Dr. Kennedy Oberhiri Obohwemu

This work is licensed under a Creative Commons Attribution 4.0 International License.