In 1984, the 32 member states of the World Health Organization European Region took a remarkable step forward in agreeing unanimously on 38 targets for a common health policy for the Region. Not only was equity the subject of the first of these targets, but it was also seen as a fundamental theme running right through the policy as a whole. However, equity can mean different things to different people. This article looks at the concepts and principles of equity as understood in the context of the World Health Organization's Health for All policy. After considering the possible causes of the differences in health observed in populations—some of them inevitable and some unnecessary and unfair—the author discusses equity in relation to health care, concentrating on issues of access to care, utilization, and quality. Lastly, seven principles for action are outlined, stemming from these concepts, to be borne in mind when designing or implementing policies, so that greater equity in health and health care can be promoted.
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References
1.
World Health Organization. Targets for Health for All, European Health for All Series No. 1. WHO Regional Office for Europe, Copenhagen, 1985.
2.
World Health Organization. Review of EURO target 1 by EAHCR reviewers Eino Heikkinen and Judith Shuval. Unpublished document EUR/ICP/RPD 131. WHO Regional Office for Europe, Copenhagen, February 1989.
KohlerL.MartinJ. (eds.). Inequalities in Health and Health Care. WHO/Nordic School of Public Health, Gothenberg, 1985.
5.
IllsleyR.SvenssonP.-G. (eds.). The Health Burden of Social Inequities. WHO Regional Office for Europe, Copenhagen, 1986.
6.
The Black Report 1982. In Inequalities in Health, edited by TownsendP.DavidsonN.WhiteheadM., pp. 29–213. Penguin, London, 1988.
7.
WhiteheadM.The Health Divide. In Inequalities in Health, edited by TownsendP.DavidsonN.WhiteheadM., pp. 215–381. Penguin, London, 1988.
8.
Gunning-SchepersL. (eds.). Socio-economic Inequalities in Health: Questions on Trends and Explanations. Ministry of Welfare, Health and Cultural Affairs, The Hague, 1989.
9.
FoxJ. (ed.). Health Inequalities in European Countries. Gower, London, 1989.
10.
GiraldesM. (eds.). Socio-economic Factors in Health and Health Care: Literature Review. European Commission, 1992, in press.
11.
IllsleyR.Wnuk-LipinskiE. (eds.). Non-Market Economies and Inequality in Health. WHO Regional Office for Europe, Copenhagen, 1992, in press.
12.
BlackD. (eds.). Inequalities in Health: Report of a Research Working Group. Department of Health and Social Security, London, 1980.
13.
La santé en France. Rapport au Ministre des Affaires sociales et de la Solidarité nationale et au Secrétaire d'Etat chargé de la Santé. La Documentation Française, Paris, 1985.
14.
JozanP.An Ecological Approach in Revealing Socio-economic Differentials in Mortality: Some Preliminary Results of the Budapest Mortality Study. Hungarian Central Statistical Office, Budapest, 1984.
15.
INE. Movimento national de lapublación 1979 (National population trends 1979). Madrid, 1981.
16.
MezentsewaE.RimachevskayaN.Health of the USSR population in the 70s and 80s: An approach to the comprehensive analysis. In Non-Market Economies and Inequality in Health, edited by IllsleyR.Wnuk-LipinskiE., WHO Regional Office for Europe, Copenhagen, 1992, in press.
17.
SmithA.JacobsonB.The Nation's Health: A Strategy for the 1990's. King's Fund, London, 1988.
18.
KalimoE.Need, Use and Expenses of Health Services in Finland 1964–76. The Social Insurance Institution, Helsinki, 1983.
19.
PhillimoreP.Shortened Lives: Premature Death in North Tyneside. Bristol Papers in Applied Social Studies, No. 12. University of Bristol, Bristol, 1989.
20.
WestcottG.SvenssonP.-G.ZollnerH. (eds.). Health Policy Implications of Unemployment. WHO Regional Office for Europe, Copenhagen, 1985.
21.
RonaR.SwanA.AltaianD.Social factors and height of primary school children in England and Scotland. J. Epidemiol. Community Health32: 147–154, 1978.
22.
MaseideP.Norway. In The Health Burden of Social Inequities, edited by IllsleyR.SvenssonP.-G., WHO Regional Office for Europe, Copenhagen, 1986.
23.
CoxB.Health and Lifestyle Survey. Health Promotion Research Trust, Cambridge, 1987.
24.
BlaxterM.Health and Lifestyles. Tavistock, London, 1990.
25.
Le GrandJ.The Strategy of Equality: Redistribution and the Social Services. George Allen and Unwin, London, 1982.
26.
World Health Organization. Social Justice and Equity in Health. Unpublished report on a WHO meeting, Leeds, United Kingdom, July 1985. WHO Regional Office for Europe, Copenhagen, 1986.
27.
MooneyG.Equity in Health Care: Confronting the Confusion. Discussion Paper No. 11/82. Health Economics Research Unit, University of Aberdeen, Aberdeen, 1982.
28.
LeenanH.Equality and Equity in Health Care. Paper presented at WHO/Nuffield Centre for Health Service Studies meeting, Leeds, United Kingdom, July 22–26, 1985.
29.
RichieJ.JacobyA.BoneM.Access to Primary Health Care. OPCS/HMSO, London, 1981.
30.
ColledgeM.Migration and Health: Towards an Understanding of the Health Care Needs of Ethnic Minorities. WHO Regional Office for Europe, Copenhagen, 1986.
31.
HartJ. T.The inverse care law. Lancet1: 405–112, 1971.
32.
GiraldesM.The equity principle in the allocation of health care expenditure on primary health care services in Portugal: The human capital approach. Int. J. Health Plann. Manage.3: 167–183, 1988.
33.
BarnardK.RitsatakisA.SvenssonP.-G. (eds.). Equity and Intersectoral Action for Health. WHO/Nordic School of Public Health, Gothenberg, 1987.
34.
BlaxterM.Health services as a defence against the consequences of poverty in industrialised societies. Soc. Sci. Med.17: 1139–1148, 1983.
35.
OstrowskaA.The Elements of Health Culture of the Polish Society. OBOP, Warsaw, 1980.
36.
RuttenF.An economic approach to equality in health care. In De ongelijke verdeling van Gezondheid. WRR, V58, The Hague, 1987.
37.
CartwrightA.O'BrienM.Social class variations in health care. In The Sociology of the NHS, edited by StaceyM., Sociological Review Monograph 22. University of Keele, Keele, 1976.
38.
BlaxterM.Equity and consultation rates in general practice. Br. Med. J.288: 1963–1967, 1984.
39.
BlaxterM.Fifty years on—inequalities in health. In Proceedings of the British Society for Population Studies, edited by HobcraftJ.MurphyM., Oxford University Press, Oxford, 1987.
40.
StarrinB.SvenssonP.-G.WintersbergerH. (eds.). Unemployment, Poverty and the Quality of Working Life: Some European Experiences. WHO/European Centre for Social Welfare Training and Research, Berlin, 1989.
41.
GrahamH.Women and smoking in the UK: The implications for health promotion. Health Promotion3: 371–382, 1989.
42.
KickbuschI.Involvement in health: A social concept of health education [special supplement]. J. Health Educ. 24(4): 1–15, 1981.
43.
World Health Organization. Report of the Technical Discussions on the Role oflntersectional Co-operation in National Strategies for HFA, 39th World Health Assembly. A39/Technical Discussions/4. WHO, Geneva, 1986.
44.
World Health Organization. Intersectional Action for Health: The Role of Intersectional Cooperation in National Strategies for Health for All [Nonserial publication]. WHO, Geneva, 1986.
45.
TsourosA.Equity and the Healthy Cities project. Health Promotion4: 73–75, 1989.
46.
DraperR.Making equity policy. Health Promotion4: 91–95, 1989.
47.
World Health Organization. Priority Research for Health for All. European Health for All Series No. 3. WHO Regional Office for Europe, Copenhagen, 1988.
