Health inequalities

Previous feature: Equity in health and health care in Malawi: analysis and trends

The Millennium Development Goals (MDGs) relating to poverty reduction and health improvement are closely related, reflecting the close relationships between ill-health, vulnerability and poverty. Many aspects of poverty have a negative impact on health and on access to effective health services. In turn, sickness and disability can affect the productivity of individuals, households and communities, making it more likely they will fall into poverty or be unable to escape poverty for long periods. This part of the resource guide presents information on these complex inter-relationships and appropriate policy responses.

How individuals, households and communities respond to risks and manage shocks holds direct implications for the poverty-health linkage. Resilience relates strongly to asset stocks and the livelihood approach can be helpful here. This traces the pathways through which ill-health reduces productivity and increases the burden on households, leaving them less able to withstand shocks.

Also important is the nature of the shock itself, (its duration, severity, and repetition), and who is affected (child, adult) and their role within the household (dependant, productive, reproductive, carer). Responding to vulnerability is critical in reducing the poverty-ill-health linkage. Focusing on curative care is important but so is more wide ranging support and livelihood promotion.

Many countries have formulated poverty reduction strategies (PRSs) to ensure that government, local stakeholders and development partners coordinate their efforts. Measures to improve health are an important aspect of a strategy to reduce poverty. Pro-poor health strategies give priority to common problems for which cost-effective interventions exist. Implementing these interventions can be difficult in certain locations, particularly where government administration and governance are weak. Examples of innovative efforts to overcome these problems are provided.

Reducing vulnerability is an important aspect of responding to poverty and ill-health. Some social groups experience greater levels of vulnerability, which reflect their specific needs (relating to age, gender, disability, ethnicity, location and so on) as well as their unequal access to health services. This resource guide provides information on disadvantaged groups and argues that equity is an important consideration in designing effective health strategies.