Author: Vincent Nyarko Kwabena, BSc student, Bachelor of Healthcare, Nursing, Novia UAS
Supervisor: Anita Wikberg, RN. RM. PhD, Senior Lecturer, Novia UAS

Abstract

The need to eliminate inequalities in health and healthcare has long been acknowledged globally. However, health equality remains a challenge to achieve worldwide, resulting in continued health inequality. Certain regions and disadvantaged population continue to experience suboptimal quality and access to healthcare. These populations continue to be disproportionately burdened by diseases and poor health outcomes, leading to high morbidity (Abdalla et al; 2021). This paper addresses three bases, first, the complexity of the root causes of health inequality, second, the differences and health needs in developed and developing countries; making it a challenge to attain equality of health and lastly, why policies focusing on addressing and attaining health equality has proven ineffective. These reasons suggest that addressing the health equality challenge requires multisectoral, multistakeholder and multifaceted approach, which addresses healthcare and social determinants of health, tailored to meet the health needs of different countries. This is because, equality in the health context needs equality in economic, social and political conditions generating health.

 Introduction

Health equality refers to the equal provision of health care to all people irrespective of the diverse levels of privilege or social advantage (Qidwai et al., 2017). According to Barsanti et al. (2017), pursuing health equality refers to the act of eradicating differences in health between groups, for example between the poor and the rich, which are considered unjust, avoidable, and unfair. In this sense, inequalities in health indicate systematic differences in health, which can be eliminated by proper policy intervention and deemed unjust and unfair. Three critical assets evaluate a health system that is equitable: equal health care access for people needing the health care; equal health care utilization for the people in equal health care need; and equitable health outcomes as measured in a country. This equality in health favors countries and populations with the most significant disease and poverty burden. It ensures that individuals have access to a minimum healthcare standard based on equal access for equal need concept (Qidwai et al., 2017). This paper discusses the challenges of attaining global equality in health.  

 Reasons to inequality in health 

Health equality is a challenge implying that health inequality continues to exist between population groups in all nations despite efforts to eradicate it and achieve equality. Many factors, such as diversity, affordability, access to the healthcare system, and social factors, influence health and outcomes. This creates a challenge to attain health equality thereby making equality in health an elusive and difficult task (Williams et al., 2016). The following are some of the reasons why attaining global health equality remains a challenge: 

First, health inequality's root causes are intricate interactions between social, environmental, personal, and economic factors. Marmot (2015), states that health inequalities result from a complex interaction of various factors that can be divided into five groups.  

The first one entails environmental, cultural, and socio-economic conditions present in the general society. These elements determine primary employment levels, social welfare programs, and salary scales.  

The second group concerns the working and living environment. This entails the position of individuals in society, with income, education, and occupation playing a crucial role. It also includes health care access, housing quality, and working conditions. Under this category, poverty denotes the most vital health inequality determinant. Income relies on employment access, which is often influenced by the level of education (Marmot, 2015).  

The third group however, moderates the second group factors. For instance, social exclusion and insecurity have a negative effect on the lives of many. This is because, when there are more despairing social statuses and much incomes differences, people do not conform to the norms of the society but act deviant which hampers the security and health of the society.  

The fourth group involves health behaviours at a personal level. These include a poor diet, smoking, and no physical activity, that all contribute to poor health. Even though individuals can modify these behaviours, they are also heavily influenced by the social environment and socio-economic position.  

Finally, the fifth group consists of non-modifiable factors within the individual level, such as heredity, age, and gender (Marmot, 2015). The majority of these factors influencing health inequality are beyond individual control. The most vulnerable are the most disadvantaged group to health inequality because their opportunities to enhance their social and physical environment are fewer. So, the complexity of these issues implies that tackling health inequalities needs actions at various levels. Consequently, interventions are needed at all levels, from national to local government, social groups, and local communities to families and individuals. The actions frequently need a multifaceted approach, which differ across the levels.  

Baciu et al. (2017) add that factors, which make health inequality complex, are interdependent, diverse, and evolving in nature. Therefore, it is essential to understand the underlying health inequality conditions and causes to inform equally effective and complex interventions to enhance health equality. Additionally, increasing evidence shows that focusing on investments, programs, and policies to address these conditions can enhance vulnerable populations’ health and minimize health disparities. These complex issues have no simple solution, or they are not of the nature that solution may be found solely through research. For that reason, issues that surround health inequalities need novel system-based approaches to governance (Baciu et al., 2017). Also, Orach and Garimoi (2019) affirm that addressing social determinants of health instead of healthcare alone will yield sustainable and more significant returns to existing efforts for enhancing global health equality. There is a need to empower nations, communities, and individuals. 

 The health inequality differs in developed and developing countries 

It is challenging to attain health equality globally because every country or region has specific health needs and disadvantaged populations, making it harder to apply policies to eradicate health inequality worldwide. In this case, providing access to healthcare for all people require political and economic will.  

According to Qidwai et al. (2017), evidence shows the inequality prevalence in healthcare and health within and between countries at differing development stages. In line with this, Qidwai et al. (2017) state that marginalized and poor society segments have more health care needs than their wealthy counterparts. However, health care access still follows the inverse law of care, and good quality healthcare availability appears to be inversely related to its need. Furthermore, Orach and Garimoi (2019) assert that health inequalities exist in all nations between the groups of the population. Nevertheless, the inequality caused in developed countries may differ from those in developing nations. For instance, research indicates that in developed nations like European countries and the US, healthcare services access is universal. Although health status inequalities have been demonstrated to relate to income and other socio-economic factors, this is a different case in developing nations. Enhanced health among the populations residing in urban areas has been found to be because of access to enhanced health care services and knowledge instead of higher incomes. 

Orach and Garimoi (2019) further add that data from the Organization for Economic Cooperation for Development (OECD) countries indicate that those who use health services more are the groups with lower income compared to the better off. Therefore, in these nations, health services underutilization is not the main factor in inequalities in the status of health between low and high-income groups since its universal and accessible to all. This is contrary to developing countries, where evidence from low-income nations suggests that health inequalities cause may reflect health care services' failure to reach the poor and deprived areas, which is an inequitable access to health care services.  

In this case, to overcome the challenges of attaining health equality globally, Barsanti et al. (2017) suggest that policies development to address health inequalities should be guided by region- and country-specific analyses, which determine what interventions provide the best possibility to narrow the nation- or region-specific health gaps between certain socio-economic groups. 

Policies focusing on addressing only health care have proven ineffective  

Most interventions aimed to tackle health inequalities are single-focused and majorly address the issue of access to health care, leaving the social determinants of health untouched (Maeda et al., 2014). Barsanti et al. (2017) add that, even though policies that targets health inequalities directly in the past decade have focused on the poorest population and those residing in harsh and poor conditions, health inequalities still vary from nation to nation. The content and context of such policies differ across these systems, which reflect different political ideologies and social, political, and historical legacies in every country.  

For instance, the universal health coverage (UHC) policy is one of the nations of the globe target set in 2015 when adopting sustainable development goals (SDGs). UHC implies that all communities and individuals get the health services they require without financial hardship (Maeda et al., 2014). Many countries have attained universal health, such as Turkey, Japan, Brazil, France, and Thailand. These countries have documented how UHC programs improve the welfare and health of their citizens while laying economic growth foundations. However, it is still a challenge to realize health equality globally because such policies address only one aspect of the root causes of health inequality (not all social determinants). Thus, they have not been successful in achieving health equality. 

Addressing social determinants of health can help make great impact towards attaining equality in health. World Health Organization affirms that addressing the social health determinants effectively and attaining health equality requires multisectoral and multistakeholder actions across society and government in different nations. This comprises strengthening capacity for governing better health across industries and implementation of multistakeholder systems, services, and policies. These policies, systems, and services need to engage service providers, citizens, the media, civil society, planners, politicians, and policymakers through a multifaceted approach. One of the primary focuses according to World Health Organization (2021) is to increase problem-solving skills and expertise, strengthen a practice informed by evidence, and support development and ongoing learning in adaptation and analysis of multisectoral methods to health equality. 

Williams et al. (2016) adds that the challenge of achieving health equality is deep-seated, and addressing it needs a systematic and sustained effort. This implies that action is needed at many levels, including global, national, regional, local community, and with families, friends, and other social groups who can take the initiative towards eradicating health inequality. It has become a challenge to achieve health equity globally because many interventions tailored to address health inequality are not adequate. 

 Conclusion 

Health equality remains a challenge implying that health inequality continues to exist between population groups in all nations despite efforts to eradicate it and achieve equality. Many diverse factors interact to bring complexity that makes efforts to attain health equality a challenge. The factors include diversity, affordability, access to the healthcare system, and social factors that influence health and outcomes. This creates a challenge that makes the health disparities elimination and attaining health equality an elusive and daunting task.  

The above discussion outlines reasons why health equality is a global challenge, including the root causes of health inequality being complex and challenging to address; the health inequality differs in developed and developing countries meaning the health needs of different countries makes it a challenge to attain health equality, and the policies focusing on addressing health care alone have proven ineffective. Addressing this health equality challenge requires a multisectoral, multistakeholder and multifaceted approach that addresses health care and social determinants of health tailored to meet the health needs of different countries. This is because it is clear that equality in the health context needs equality in economic, social, and political conditions generating health. Until addressing health equality taking a unique approach addressing, it will remain a global challenge.  

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