 Databank of social inequality cases
“Inequalities” or “Social inequity in Health” and “Social Equity in Health”
Social inequalities (inequities) in health refer to health disparities within and between countries. Inequities that are judged to be unfair, unjust, avoidable, and unnecessary (meaning: are neither inevitable nor irremediable and that systematically burden populations rendered vulnerable by underlying social structures and political, economic and legal institutions. As such, social inequalities (or inequities) in health are not synonymous with “health inequalities,” as this latter term can be interpreted to refer to any difference and not specifically to unjust disparities. For example, recently proposed measures of “health inequalities” deliberately quantify distributions of health in populations without reference to either social groups and/or social inequalities in health.*1
Reviewing some cases, whose characteristics may reappear in other contexts
Read the following cases, preferably in the order suggested and write down your ideas in your SDH Reflection Notebook, in answer to the following questions:
 Are these situations similar or different in your country, region or location?
What can you tell us about your country, region or location as to what is done to fight social inequities?
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Maternal Mortality Inequities in Urban Areas
It is well known that socioeconomically disadvantaged groups, even in developed countries, have a shorter life expectancy and are more prone to suffer from diseases than the rich. In the city of Sao Paulo (Brazil), maternal mortality rates were close to 40/100,000 in 2003. In the urban suburbs of the same city, the maternal mortality ratio reached 65/100,000, and was even worse among black womenl 200/100.000. *2
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Life Expectancy Inequities in Different Countries
At the global level, differences as to the extent to which people can lead healthy lives are simply radical. Health levels are crucial in measuring such differences. A woman in Botswana has a life expectancy of 34 years, while a woman living in Japan is expected to live 86 years. The rest of the world falls somewhere in between, with differences within each country according to socioeconomic strata. |
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Inequities in the Evolution of Health Gains
Let us take three children: a sub-Saharan African, a south-Asian and a European. In 1970, the life expectancy of the first two was less than 50 years. The European child, depending on his/her country average, had the same life expectancy in 1901. In the last century, life expectancy for the European child increased by about 30 years, whereas between 1970 and 2000 life expectancy for the south Asian child improved by 13 years, and only 4 months for the sub-Saharan African child. |
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Inequities in Adolescent Reproductive Health
At the end of the 90s, in the industrial area of the metropolitan region of Sao Paulo (specifically, in the city of Santo André), female adolescents showed a fertility rate three times higher than adolescents of the same age in socially inclusive areas.*3 |
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Inequities in Education-related Health Outcomes
In El Salvador, for example, if a mother has no schooling, her babies are 10% more likely to die in their first year of life (100 every 1000 cases). Instead, if a mother has completed her secondary education, infant death rate is reduced to one fourth. |
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Poverty, Migration, Gender, Labor and Social Protection Conditions, Culture
“Maria Alvarez, an 18 year-old woman living in a rural town, moved to the capital city in search of better opportunities for herself and her three-year old daughter.
Maria can only read and write. She dropped out of school to work out in the fields and raise her daughter after her partner left her. The rural establishment where she worked closed when a competitive free trade zone was created in the area, and Maria decided to migrate to the city, since she could not get another job in the free trade area due to her poor schooling.
Upon arriving in the city, some relatives of hers who lived in a suburban slum got her a job as a maid, and she was offered a basic salary and no social security benefits.
One month later, her little daughter contracted hepatitis and Maria had to take her to the emergency ward of a public hospital. In addition to hepatitis, she was diagnosed malnutrition. Although this was a public hospital offering free medical services, she was informed that she would have to pay for the laboratory tests and some medicines that were not included in the “basic coverage” list.
Maria’s bosses told her she could not continue working for them for fear of contagion and the risk posed to all family members, particularly their son. With the money earned in that month, she could only afford the costs of one-week hospitalization costs.
Ten days after being admitted to the hospital, her little daughter died of fulminant hepatitis complicated by a malnutrition history. Maria currently works as a waitress and sometimes as a prostitute.”
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Differential Quality of Health Care Services
Maria, a 42-year old woman from the city of Masaya, went to the nearest health care service looking for medical assistance for her 6-month son. Her son’s symptoms included vomiting, 39.7ºC fever and diarrhea lasting for 24 hours.
Maria arrived with her baby at 7.30 a.m., asking for assistance. She was given number 68 for the general medicine ward. After a half-hour wait, the child’s temperature was taken, and mother and child were guided to the URO unit, where a file was prepared, taking 15 minutes more.
The boy continued with vomiting and diarrhea and his fever was getting worse. At that moment, the boy had a convulsion and was taken to the nearest hospital. Eventually, they arrived at the hospital’s emergency ward, and a new administrative process was initiated for admission purposes, but the child died while he was being prepared for intravenous therapy. |
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Ethnicity, Origin, Access to Health Care, Gender, Culture, Poverty, Vulnerability
Amerindians were the first human beings in southern Central America. It is said that indigenous peoples who kept their ancestors’ habits had good health and high life expectancy rates. At present, changes resulting from globalization have triggered a demographic, epidemiological and cultural transition with negative impact on health conditions.
Today, Amerindians are an ethnic minority and the worst marginalized community despite their long tradition of resistance to domination. Their civilian rights are still very limited in the fields of education, effective political participation and access to health services.
They are mainly engaged in agricultural activities. Women’s access to health services depends on geographical location and language barriers. Some peoples still speak their own language (Bribri and Cabecar). Unlike men, many women are not bilingual.
Medical care during pregnancy, labor and delivery in the case of indigenous women living in Bratsi, in the south-east of Costa Rica near the border with Panamá, is highly deficient. This is a place inhabited by many Amerindian ethnical groups speaking Chibcha. The canton of Talamanca has the lowest human development index (HDI) in the country.
According to their geographical location, districts are classified into: those located before crossing rivers (no bridges are available), those located on the other side of the rivers (the Talamanca valley) and those located on top of the mountains. The last two groups have scattered populations, where huts may be more than one kilometer apart.
Infant death risk at Salamanca doubles the national risk, while child malnutrition in the third year of life (24-35 months) is attributed to poverty and insufficient coverage of nutrition needs by local programs. |
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*1 -Krieger, N (2002) Glosario de Epidemiología Social, Rev Panam Salud Publica vol.11 no.5-6 Washington May/June 2002
http://www.paho.org/english/
sha/be_v23n1-glossary.htm Part 1
http://www.paho.org/english/sha/be_v23n2-glossary.htm
Part 2
Acceso en septiembre 2008.
*2 -Secretaría Municipal de Salud de Sao Paulo, Brasil. Datos de 2004.
*3- Duarte et alli Gravidez na adolescência e exclusão social: análise de disparidades intra-urbanas. Rev Panam Salud Publica. 2006; 19(4): 236-243
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