According to the WHO World Health Report, the narrowest boundaries of definition of health system stems from the control of curative activities under the aegis of a country’s Ministry of Health. This excludes inter-sectoral activities directly affecting healthcare such as water and health sanitation. More broadly would be to define health systems as all activities directly contributing to healthcare. This latter definition has been endorsed by the WHO and the SRPG (Scientific Peer Review Group) and aims at making governments focus on activities that improve health. (WHO World Health Report, 2004)
From this definition it is then easy to determine the main objectives of an effective health system and these include improving the health of the population, responding to people’s expectations and providing financial protection. These objectives are achieved through the achievement of intermediate goals which include assuring equity and universal access to healthcare, assuring quality of care and fairness in contribution to cost of healthcare (Murray and Evans, 2002). Perhaps assuring equity and universal care to health care seems to be the most potent tool in achieving the objectives of an effective healthcare system in view of the challenges posed by accessing health care by the vulnerable poor and less privileged especially in the developing economies of the world.
Factors Affecting Demand and Supply of Health Care
The factors affecting the demand and supply of health care in any country mirrors the efficiency of the healthcare system of that country. Developing countries burdened by preventable diseases and lack of access to basic healthcare have been found to actually underutilize health care facilities available (O’ Donnell, 2002). Some of the reasons adduced for this include lack of knowledge about the illnesses and the potential benefits of treatment, long distance to health facilities, attitudinal beliefs and norms that give preference to often ineffective traditional therapies over modern treatment.
The brain drain syndrome which reflects the migration of skilled health workers from less developed countries to Europe and America also compounds the problem of supply of health care apart from the parlous government spending on health in these countries.
However demand and supply of healthcare in developed countries are mainly affected by the ageing population and an increase in tertiary health care spending as efforts are made to provide better quality of healthcare to the citizens (Resende, 2008). This has increased the percentage GDP spending on healthcare as the focus is now on towards a public health care plan enables taxpaying citizens of these countries to access healthcare provided and sponsored by the government (Resende, 2008)
Government Health Care Spending as a Percentage of Gross Domestic Product (GDP)
Source: ‘’Who’s Going Broke?’’ National Bureau of Economic Research, Working Paper No 11833, December 2005, p. 29.
Inequities in Health Care
Whitehead, 1992 defined inequities in healthcare as ‘‘differences in health that are unnecessary, avoidable, unfair and unjust.’’ (Gruskin and Braveman, 2002). Inadvertently, inequity in health further widens the gap between groups with different levels of social, racial, ethnic or religious status albeit in the determination of their health.
If there are recognisable deficits in accessing quality healthcare based on these factors, it then negates the United Nations Charter on Health as first enunciated in the World Health Organisation Constitution of 1946 and reiterated in the 1978 Alma Mater declaration on Primary Health Care and the 1998 World Health Declaration. Moreover, of the eight United Nation’s Millennium Development Goals (MDG’s), goals 4, 5, and 6 are directly related to healthcare while target 17 of the 8th goal harps on pharmaceutical companies providing access to affordable drugs in developing countries (Reidel, 2000).
Health inequities not only exist amongst nations but also exist within countries itself; Sierra-Leone has a life expectancy at birth of about 34 years while it is about 91 years in Japan.(World Health Report, 2004) Likewise there exists a gap of about 20years in life expectancy between the privileged and non-privileged communities in the United States of America. Social determinants of inequity in healthcare such as poverty and unequal access to healthcare needs to be tackled and made the focus of health policy decision makers in order to improve global health.
Principles for Achieving Equity in Health Care
The World health Organisation (WHO) in 2005 set up the Commission on Social Determinants of Health (CDSH) to tackle inequities in health care. The final recommendations were released in August 2008 and were hinged on the following three decisions;
(i) Improve Daily Conditions This recommendation is premised on the fact that about 200million children globally do not achieve their full potential and prescribes mechanisms for early child development. It also calls for an enhancement in living conditions with fair employment opportunities. Social protection throughout life especially in old age and in disability is also canvassed for in this recommendation while bearing in mind that access to universal basic healthcare especially primary health care with an emphasis on disease prevention and control is necessary for promoting equity in healthcare. These recommendations aim to tackle inequity in healthcare at the inception by providing access to affordable and decent housing, fair employment and decent work opportunities and increasing access to utilisation of basic and primary healthcare.
(ii) Tackle the Inequitable Distribution of Power, Money and Resources. The realisation that inequity in the conditions of daily living and consequently health is shaped by social structures and processes gave rise to this recommendation by the WHO Commission. This recommendation aims to tackle the unfair distribution of and access to power, wealth and other necessary social resources. It also calls for health equity to become a marker of government performance and strengthening of public sector leadership in provision of essential health related goods and services. Increases in global aid to 0.7% of Gross Domestic Product (GDP) as well as promotion of gender equity through enforced legislation are some of the policies advocated for. Most importantly it urges the United Nations to adopt health equity as a core global development goal and use social determinants of health framework to monitor progress.
(iii) Measure and understand the problem and assess the impact of action. Effective basic data monitoring to assess the impact of policies, systems and programmes put in place to combat health inequity is being canvassed for in this recommendation. This can be achieved through the central role of the governments of different countries as well the participation and collaboration of multilateral agencies, civil societies, research institutions and private bodies. The desired effect of ensuring health equity by these different bodies would be by using a common global framework of indicators to achieve improvements in health equity as well as ensuring that increases in aid and debt relief support coherent social determinants of health policy making and action among recipient governments. The WHO being the mandated leader in global health is also being strengthened though this recommendation to support goal setting on health equity among the UN member states with monitoring of its progress through a global health equity surveillance system.
Health inequity can most be tackled effectively by a government that is responsive and sensitive to the health needs of her citizens. The recent Health Reform Bills via the Patient Protection and Affordable Care Act of 2010 advocated by the Obama regime in the United States generated a lot of furore with diametrically opposing views among the proponents and antagonists of the reforms. This was however finally laid to rest through the adoption of its legality by the Supreme Court landmark ruling of the 28th of June, 2012.
Obama sought to make access to healthcare available to about 50million Americans especially the vulnerable poor and aged without any form of healthcare insurance despite the acclaimed sophistication of the American health care system. The bill also seeks to strengthen and increase the Medicare and Medicaid reimbursement by the central government for elderly and disabled Americans and the vulnerable poor respectively. Most countries in the European Union (EU) practice a public method of financing health care through a mixture of taxation and compulsory social insurance thus mitigating out of pocket payments and trying to make healthcare accessible to all. This is contrary to what obtains comparably in Africa where health financing is mainly through inadequate budget allocations mitigated by out of pocket payments for health services with the consequence of widening inequity in access as majority are unable to pay for healthcare. Therefore there is a need for policies tailored to the needs of individual countries in tackling this so that we can have a healthier world where accessing basic healthcare poses minimal challenges.
This article was originally submitted for publication by Dr. Gbeminiyi Onabanjo in ‘A Global Village,’ Imperial College, London’s Official Journal for International Affairs, July 2012.