It’s time to build a fairer, healthier world for everyone, everywhere. World Health Day 2021 Health equity and its determinants Health equity and its Health inequity and COVID-19 determinants Around the globe, COVID-19 has run along the seams of existing health inequities – the unfair This is the second World Health Day to and preventable differences in people’s health, fall during the COVID-19 pandemic – well-being, and access to quality health services. the world’s worst peacetime health crisis This is shown by the fact that COVID-19 cases and deaths in deprived areas are double those of in a century. It comes amidst gruelling more advantaged areas. and painful times for the world’s people who are dealing with the impacts of the Health inequity manifests itself in our pandemic, including those working in the communities: people worst affected by health sector. COVID-19 are those least able to withstand it – older people and others with pre-existing severe illness; socially disadvantaged people As of 1 April 2021, over 2.8 million people had with serious health conditions such as heart died from the COVID-19 virus, and more than disease and diabetes; people without Internet 130 million people had contracted it – many of access unable to receive the latest information whom now live with long-term health impacts. At to protect themselves; people unable to afford the same time, the wider health consequences out-of-pocket payments for treatment; and those of the pandemic have left untold millions bearing socially excluded, for example homeless people, the costs in terms of their emotional, social, or migrants, who may also experience obstacles and economic well-being. Loss of employment in receiving COVID-19 related government aid. and income has exacerbated food insecurity; They also include people who have suffered health services have been partially or completely unintended negative consequences of the disrupted across the world; and there have been measures introduced to contain COVID-19 adverse impacts on mental and physical health. (e.g. those exposed to domestic violence or The cost of COVID-19 is so high that it demands older-person or child abuse during lockdowns, we do things differently: that we commit to negative effects on education, employment and building a fairer and healthier world by taking mental health). health equity much more seriously than before Health inequity manifests itself globally, too: – and meet head-on the social and economic as of 1 April 2021, of the half a billion vaccines factors that cause health inequities. This is our administered, 86% have been in high-income call to action on World Health Day – and in the countries, while 0.1% have been in low-income year-long campaign that WHO is launching to countries. These countries watch and wait for mark the day. vaccine supplies and other COVID-19-related What is health equity? Health equity is the Health equity is achieved absence of unfair, when everyone can attain avoidable and their full potential for remediable differences health and well-being. in health status among groups of people. © Shutterstock treatments and technologies. This is unjust and cannot be accepted in a modern world with the resources to create health equity. What causes health inequities? Health and illness follow a social gradient – the lower a person’s socioeconomic position, the worse their chances for health. This downward slope is the product of the conditions in which people are born, grow, live, work, and age, and their access to power, resources and decision-making (the “social determinants of health”). These conditions include a person’s education; income; access to social protection (e.g. affordable child services, sickness pay, What do health inequities unemployment protection; and pensions); access to quality health services and good nutrition; look like? access to healthy housing and clean air; and to Between countries: A child born in Lesotho can financial and judicial services. expect to live to the age of 51 while a child born in Japan can expect to live to 84. Under-5 mortality The quality of these conditions is often made is more than eight times higher in Africa than in worse by discrimination, stereotyping, and Europe, and developing countries account for 99% prejudice, which most often affect women and of the world’s maternal deaths. girls, older people, people with disability, or are based on race, ethnicity or sexual identity. Within countries: Children from the poorest Such discrimination occurs not only between households are twice as likely to die before the individuals, but is often embedded within our age of 5 years than children from the richest institutions and systems, leading to whole households, while children in the poorest 20% populations being underrepresented in decision- of households are over four times more likely to making at all levels, receiving inferior services, experience severe mental health problems that and therefore experiencing poorer life chances. those in the highest 20%. And when climate change and conflict are added to the mix, billions of people face a cocktail Between neighbourhoods: In Glasgow, male of powerful, mutually reinforcing factors that life expectancy ranges from 66.2 years in less- prevent them ever enjoying healthy lives. advantaged parts of the city to 81.7 years in more advantaged areas. In London, when travelling east from Westminster on the city’s underground How do we make health system, each stop represents a drop of nearly a equity a reality? year in life expectancy. Health equity means putting in place policies and allocating resources so that the people with less resources and those who face exclusion and discrimination (on the grounds of race, sex, gender, age, disability, or income) see greater improvements in their health and living conditions faster than those who are better off. The role of the health sector The health sector has several important roles in fostering health equity. First, it must do all it can to ensure it promotes health equity by ensuring that everyone can © Jerry Redfern/LightRocket, Getty Images) receive high-quality health services when they Third, the health sector needs to work with need them, at an affordable cost (getting sick other sectors that can influence health equity must not lead to financial hardship). This is and reduce inequities in social services and known as “universal health coverage”, which all people’s living conditions, such as education, countries have committed to achieving by 2030. agriculture, environment, infrastructure, transport, But currently, about half of the world’s people finance, or social protection do not receive all the essential health services they need, and about 100 million people are Action: The health sector should: driven into poverty each year by the cost of • explain the importance of health equity health care. And it is not just cost and location and advocate effectively for action in other that affect some people more than others in sectors, while recognizing these sectors’ obtaining health care – other barriers include own interests and targets; discrimination that people face within health systems, and unequal levels of health literacy • work with other sectors to integrate the between population groups. delivery of social services and support, and jointly monitor policy impact on health Action: Prioritize the primary health care inequities; approach. This emphasizes health as a human right, community decision-making in the • be involved in the design and provision of care close to where people live, and implementation of intersectoral governance collaboration between sectors to promote and arrangements that are critical to lead, protect health. It is the most equitable way to facilitate and enable joint work between eliminate health barriers and achieve universal sectors; health coverage. • build the capacity of the health workforce and other sector workforces to foster cooperation and coordination. Second, the health sector needs to take the lead in monitoring health inequities through monitoring health outcomes and health service delivery – as well as working with other sectors to monitor people’s living conditions. Action: Disaggregate data by age, sex, education level, and income etc to identify who is affected by inequalities in health outcomes and health and social services. Five actions for World Health Day WHO calls on governments, international 3. Equitable services and infrastructure in all organizations and political leaders to work hand communities – both urban and rural. in hand with affected communities and individuals 4. Stronger primary health care for everyone, to address the root causes of inequities and to everywhere. implement solutions – within and beyond the health sector – to address them through: 5. Better data collection and reporting so countries know where the health inequalities 1. Equitable access to COVID-19 vaccines, tests are so they can address them better. and treatments within and between countries. 2. Post-COVID-19 recovery budgets and plans that protect and prioritize health and social sectors. Health is more than healthcare: how mental health, especially for older people, and other sectors can share the load impair children’s learning. Extreme indoor heat can lead to heat exhaustion, stroke, and heart Research shows that social and economic disease. Poor housing also exposes people to factors account for a substantial proportion of toxic materials, indoor air pollution low-quality health outcomes. For example, health-sector housing design and maintenance hazards, such investments accounted for only half the reduction as falls. in under-5 mortality between 1990 and 2010 in low- and middle-income countries (through COVID-19, housing, and health: COVID-19 has effective interventions such as immunization increased people’s exposure to the health risks of and other child health interventions, skilled birth poor housing through the global “stay at home” attendance and maternal and newborn services, response.