Today, no self-respecting journal article, inaugural speech or blog post in the field of international cooperation—much less global health—can fail to make some mention of equity, whereas at the beginning of the second millennium the notion barely got a mention. It would appear that the development community as a whole has experienced an epiphany like that of Saul of Tarsus on the road to Damascus. The question is, why now?
Life expectancy at birth has always been and still is the most useful measure of equality in the enjoyment of health, and there is no doubt that the gap between countries has increased over the last two centuries, as beautifully illustrated by the sterling work of Hans Rosling: 200 years ago almost all the countries in the world were poor and life expectancy was short (under 40 years), but this situation changed radically following the industrial revolution. That process gave rise to an ever widening gap that has brought us to the present situation, in which people in Japan—the country with the longest life expectancy (83 years)—live on average nearly 77% longer than those in Sierra Leone—the country with the shortest (47 years).
So, is the fact that equity is currently the buzzword on everybody’s lips a reflection of a new reality that has just now become evident? Not really. As early as 1842, Edwin Chadwick showed that the average life expectancy in the UK varied from 15 to 57 years depending on social group: a 3.8-fold difference (almost 400%!). Therefore, while differences between countries were not so significant at that time, marked inequalities between different populations already existed.
It is difficult to comprehend why equity has become a kind of magic word for politicians, experts and activists, and many factors are probably involved. Nor is it easy to understand the many different facets of the problem and its implications for organisations who work in the field, such as the Barcelona Institute for Global Health. Health equity is the subject of a new document entitled El poder, el dinero, y los recursos: la equidad en salud en un mundo globalizado [in Spanish], written by the author of this blog post and published by ISGlobal. We encourage you to read it critically and we hope you will find it useful.
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