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Editorial The Health Equity Puzzle: No Easy Pieces
Easier said than done: much has been written about achieving improved health outcomes across the board, but the challenge remains in the doing. The context for this issue of MEDICC Review is globalized frustration, provoked by dismal progress towards the Millennium Development Goals (MDGs) revealed in the Human Development Report 2005, and the September Millennium Summit’s retreat from its responsibility to hasten the rescue of the world’s 1.2 billion poor. Speaking at the Summit on behalf of 132 developing nations in the Group of 77, Jamaican Prime Minister P.J. Patterson put it bluntly: “We have failed to meet the targets we set; poverty and infectious disease remain rampant…Too many are being left behind in the march towards the MDGs.”[1] Perhaps most compelling is the Report’s assertion that “for many of the MDGs the jury is now in, with the evidence that a ‘trickle down’ approach to reducing disparities and maintaining overall progress will not work.”[2] As this paradigm is shattered, so too is the assumption espoused for years by international lending and financial institutions that growth automatically drives poverty reduction, and a country’s wealth automatically brings health. They do not, and a growing body of evidence - Cuba’s included - reveals that it is the distribution of that wealth, social cohesion, and the equity with which society’s opportunities are offered that may have far more to do with health than simple GDP.[3] This is not to disregard the fundamental obstacle that poverty presents to good health. On the contrary. But it does mean that political will, translated into effective “pro-poor” health policies, can trump some key and otherwise deadly non-medical determinants of health. Indeed, poor countries like Cuba are faced with the dual challenge of designing economic policies to overcome their poverty, and health and social policies to defy it. (See Cuba’s approach in this month’s Spotlight MDGs and Health Equity in Cuba.) This is in fact the essence of the Cuban experience in the search for equitable health outcomes, a search that has been guided by the conviction that universal, community-oriented primary care must be at the heart of the health system, staffed by professionals whose preventive focus also grapples with social determinants.[4,5] The road to health equity already traveled by Cuba is perhaps best explored in the Latin American context, one of the most unequal regions in the world (Professional Literature: Human Development and Equity in Latin America and the Caribbean). But the road is also a long one, as our interview with Dr. Francisco Rojas Ochoa and The Right to Health Care and the Law reveal; and there is always more ground to cover (MR Feature: Changes to Cuban Health Care Aim to Extend Equity). We are especially pleased to publish, for the first time in English, A Monitoring System for Health Equity in Cuba, by Cándido López, PhD, and Abelardo Ramírez, MD, PhD, a summary of Dr. Ramírez’ doctoral thesis which he successfully defended shortly before his death in 2003. A visionary in the field of health equity, throughout his entire professional career Dr. Ramírez devoted his substantial intellect and energies to the pursuit of “health for all” in Cuba. A second article by Dr. Ramírez, Equity in Public Health: A Challenge for Disaster Managers, cuts to the quick of issues raised by the recent disasters on the US Gulf Coast and in places as far-flung as Guatemala and Pakistan. Cuba’s experience in disaster preparedness and management, and contribution to disaster relief efforts globally, is reflected in this month’s International Cooperation Report: Cuban Disaster Doctors in Guatemala, Pakistan and our Top Story, Hurricane Wilma: Living to Tell the Tale. Excerpts from the International Red Cross and Red Crescent Society’s publication, World Disasters Report 2005, shed further light on the theme. It is our hope that Cuba’s piece will be useful to those struggling to solve the puzzle of equitable health outcomes - which is of course, in essence, the puzzle of equitable human development itself. The Editors Notes & References: 1. Deen, T. “March Toward MDGs Leaving Millions Behind,” IPS, UN Headquarters, Sept. 16, 2005. |
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