Inequity and Inequality Are Bad for the Health of the Rich Too
Back at the start of this series, I concluded that the best definition of equity we have implies that, by itself, the difference in life expectancy between Luxemburg and Burundi is not an inequity, as we have no realistic means to make Burundi as rich as Luxemburg. However, this breaks down on the level of income distribution: Burundi's 10 percent richest households have access to a third of the total income in the country, but its 10 percent poorest have only access to 1.8 percent. This inequality in income distribution is clearly avoidable, and that it is unnecessary and unfair is evident. However, does this have any implications for global health?
It turns out it does. Luxembourg, with its high life expectancy, also has a more egalitarian income distribution: 22 percent of income for the richest 10 percent, and four percent of income for the poorest 10 percent respectively. This is no accident: there is ample evidence that bigger income inequalities imply a worse health status - not only for the poor, but even when taken as an average. Let me repeat this: distribute your income more evenly over the population, and your average health status will increase as if by magic.
Hence, inequalities have relevance for global health, and inequities even more so as they depend on what we do and do not. WHO's Commission on Social Determinants of Health gathered convincing evidence that this holds true for many other inequities as well, e.g. those related to social exclusion; these are part of the whole complex of ‘social determinants of health'.
Does this hold true on an international level too? Would an elimination (or compression) of inequalities (economic and otherwise) between countries lead to a better health status of the world population? The disappointing answer here is: we just don't know. We cannot compare between worlds with more and less equitable distribution of resources over countries, and time series are only of very limited use in view of the many other factors that impact on health status. However, there is no real reason why a relationship that is so pervasive and clear on the level of national populations, should not hold true on the level of the world's population as a whole.
Clearly, this means that global health professionals should do something about social and economical inequities; but what? More on that in next week's article.
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