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Colombian Journal of Anestesiology

Print version ISSN 0120-3347

Rev. colomb. anestesiol. vol.39 no.3 Bogotá July/Oct. 2011

https://doi.org/10.5554/rca.v39i3.247 

Editorial

 

International Society for Equity in Health

 

Daniel Maceira

Investigador Titular del Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina. Presidente de la International Society for Equity in Health (ISEqH). Correspondencia: Sánchez de Bustamante 27, Buenos Aires (1173), Ciudad Autónoma de Buenos Aires, Argentina. Correo electrónico: danielmaceira@cedes.org

Recibido: marzo 31 de 2011. Enviado para modificaciones: abril 4 de 2011. Aceptado: junio 21 de 2011.


Equity is inherent to all forms of political statements, ideas and actions and may become, in itself, a tenet as well as an objective, thus establishing itself as a societal value. For this reason, it is impossible to think about healthcare without including equity as a priority consideration.

Equity in health is an ethical value, inherently regulatory, based on the principle of fairness, and consistent with human rights tenets. However, it is important not to be blinded by the illusion that the issue of equity in health may be resolved within the discourse of universal ethics (1).

Societal needs have become structurally more complex and varied, requiring the articulation of positive differentiation mechanisms through which the diverse requirements of specific groups may be identified. Attaining equity must not be a simple statement of principles; it is necessary to create links among the various stakeholders and disciplines in order to effectively ensure enjoyment of the right to health (2). The 1990s witnessed a resurgence of a worldwide interest regarding socioeconomic determinants of health, as well as of new look into the sources that perpetuate inequalities in terms of health outcomes. The new evidence pointed to the need for a new world organization devoted to the science of equity in health (3).

Thus came about the creation of the International Society for Equity in Health, whose aim is to promote a comprehensive look into the equity of local, national and regional health systems, focusing on education, research, communication and policy-making. The Society also seeks to establish itself as a facilitator of informed action for understanding and addressing health inequalities.

Among the Society's main activities, the biannual conferences are designed to gather a large number of people to discuss and create consensus around specific topics associated with equity in health. They are also a special opportunity to expand the debate, to promote a future working agenda, and serve as springboards for new studies and policies (4).

The next meeting will take place in Cartagena de Indias, Colombia, on September 25, 26, 27 and 28, 2011. The theme of the VI International Conference is “Policy-making as process for building equity in health. This theme is supported by the fact that equity requires a multidisciplinary approach, as well as a link between research and policy. The aim is to identify clear experiences on how to reach equity in health and at the same time specify and qualify what equity actually means.

Several events and activities have been taking place against this backdrop throughout the Latin- American continent, including a meeting in Medellín during the XXIX Colombian Congress of Anesthesiology and Resuscitation where, as current President of ISEqH, I had an opportunity to participate with two lectures on the topic of the Health System in Latin America.

The first lecture on “Catastrophic financial spending in health” (5), was a discussion of the absence of coordination among the funding, insurance and provider arms of the health systems in the Latin-American region that results in the creation of unplanned cross subsidies within an extremely fragmented financial framework. The discussion was based on the premise that health systems may be analyzed from two perspectives: A horizontal perspective that refers to the presence of public, social security and private subsystems that develop and interact through different functions existing in the vertical chain of actions such as funding, insurance, management and service provision in the health sector (6).

Considering that the insurance function of the health system is scattered, the model's ability to provide timely services according to individual needs is necessarily curtailed. Consequently, the ability to ensure the right of access to health, identified by society in the form of service provision, depends not only on the existence of service providers, but also on their location and the coordination among them. Flaws are also derived from the modalities of insurance and management based on which the allocation of resources in planned and organized within the system.

The fragmentation of the insurance funds (social and private) is harmful for sustainability and also for the equity of the system as a whole, since it increases spending requirements. This then becomes a form of discrimination against the most vulnerable groups in society. This situation provides an opportunity to examine weaknesses and then establish financial and regulatory challenges for the public sector, with a view at devising the way to face the health needs of the population while articulating a strategy that may become part of the future political agenda.

Such a strategy must take into consideration knowledge creation as an integral part of a complex plan of action. Along these lines, the topic of the second lecture was “Public research into health in some nations of the Latin-American region” (7), motivated by the findings of the Commission for Health Research for Development (8). According to the Commission, there is an imbalance in the world between health needs and the resources allocated to health research: 10 % of the funds for research are allocated to 90 % of the health-related issues in developing countries (9). The Commission points to the significance of the study and proposes an improvement in resource allocation as a means to address this gap.

The regional study provides the input required to identify the priority lines of public research in health and their evolution in time, in comparison with the requirements of each of the countries considered. The study highlights a systematic increase in regional research efforts, although none of the countries analyzed escapes the need for new mechanisms designed to reduce the imbalance between health research investments and the needs of the population. Attempts at measuring financial flows and their connection with health priorities are still waiting to be undertaken throughout the region. This work tries to identify priority issues and measure relative gaps between research and needs, as well as patterns of coordination among funding agencies.

These presentations were enriched by the debate during the meeting, as well as by the quality of the panelists who participated in the Preparatory Workshop for the VI International Conference of the International Society for Equity in Health. The scope of the agenda for research and for health policies is far broader and includes many more issues than those discussed here as examples of the global and regional challenges that must be overcome in order to achieve a more equitable distribution of resources and interventions in the sector. However, the meeting again revealed the commitment of society, its policy-makers and researchers to make headway in the process of building a consensus that may help achieve more equitable, inclusive and fair health models.

REFERENCES

1. Braveman P, Gruskin S. Defining Equity in Health. J. Epidemiol. Community Health 2003;57;254-8.

2. Starfield B. The hidden inequity in health care. In: International Journal for Equity in Health. 2011;10:15.

3. Starfield B. Promoting equity in health trough research and inderstanding. Developing World Bioeth 2004;4:76-95.

4. Furler J, Harris E, Baum F, Dixon J, Lawless A, Maceira D, Nolen L, et al. An International Society and Journal for Equity in Health: 10 years on. In: International Journal for Equity in Health 2011,10:11.

5. Maceira D. Financiamiento, aseguramiento y prestación de servicios de salud en Argentina. En: Knaul FM, Wong R, Muiser J, Guerrero R and Arreola H, editors. Health Systems Analysis: Health Systems Financing, Financial Risk Protection Through Health Systems Development in Latin America and the Caribbean. Boston (MA): Ornelas Ed., Harvard University Press-IDRC-FUNSALUD. De próxima aparición 2011.

6. Maceira D. Dimensiones horizontal y vertical en el aseguramiento social en salud de América Latina y el Caribe. Iniciativas Latinoamericanas (HSPH, FPMD, PHR, PAHO, USAID). Edición especial 3. 2001.

7. Maceira D, Paraje G, Aramayo F, Duarte Masi S, Sánchez D. Financiamiento público de la investigación en salud en cinco países de América Latina. Revista Panamericana de Salud Pública 2010:27(6):442-51.

8. Commission on Health Research for Development. Health research, essential link to equity in development. (NY): Oxford University Press;1990.

9. Global Forum for Health Research (GFHR). The 10/90 report on health research 1999.10/90 Reports. Geneva (SW);1999.

1. Braveman P, Gruskin S. Defining Equity in Health. J. Epidemiol. Community Health 2003;57;254-8.         [ Links ]

2. Starfield B. The hidden inequity in health care. In: International Journal for Equity in Health. 2011;10:15.         [ Links ]

3. Starfield B. Promoting equity in health trough research and inderstanding. Developing World Bioeth 2004;4:76-95.         [ Links ]

4. Furler J, Harris E, Baum F, Dixon J, Lawless A, Maceira D, Nolen L, et al. An International Society and Journal for Equity in Health: 10 years on. In: International Journal for Equity in Health 2011,10:11.         [ Links ]

5. Maceira D. Financiamiento, aseguramiento y prestación de servicios de salud en Argentina. En: Knaul FM, Wong R, Muiser J, Guerrero R and Arreola H, editors. Health Systems Analysis: Health Systems Financing, Financial Risk Protection Through Health Systems Development in Latin America and the Caribbean. Boston (MA): Ornelas Ed., Harvard University Press-IDRC-FUNSALUD. De próxima aparición 2011.         [ Links ]

6. Maceira D. Dimensiones horizontal y vertical en el aseguramiento social en salud de América Latina y el Caribe. Iniciativas Latinoamericanas (HSPH, FPMD, PHR, PAHO, USAID). Edición especial 3. 2001.         [ Links ]

7. Maceira D, Paraje G, Aramayo F, Duarte Masi S, Sánchez D. Financiamiento público de la investigación en salud en cinco países de América Latina. Revista Panamericana de Salud Pública 2010:27(6):442-51.         [ Links ]

8. Commission on Health Research for Development. Health research, essential link to equity in development. (NY): Oxford University Press;1990.         [ Links ]

9. Global Forum for Health Research (GFHR). The 10/90 report on health research 1999.10/90 Reports. Geneva (SW);1999.         [ Links ]