Health equity and health system strengthening – Time for a WHO re-think

Abstract

The pursuit of health equity is foundational to the global health enterprise. But while moral concerns over health inequities can galvanise political commitment, how such concerns can or should translate into practice remains less clear. This paper reviews evolving ways that equity goals have featured in key World Health Organization (WHO)-related policy documents, before discussing the heuristic value and empirical traction that the concept of equity can bring to the health system strengthening (HSS) agenda. We argue that while health equity is often presented as the overarching goal of HSS, in practice this is typically circumscribed to the provision of healthcare services. Although health care equity is important, we suggest that this narrow focus risks losing sight of the structural political, social and economic drivers of health and health inequities, as well as the broader contexts of care and complex socio-political mechanisms through which health systems are strengthened. Drawing on new lines of empirical inquiry, we propose that broadening the equity lens for HSS ­offers exciting opportunities to put health systems at the heart of a more ambitious equity agenda in global health.

Exploring effort–reward imbalance and professional quality of life among health workers in Cape Town, South Africa: a mixed-methods study

“…More so, our study takes forward proposals to widen the ‘equity lens’ applied to health system strengthening efforts [ 72 ]. That exposure to stressful and unhealthy working conditions is a key driver of health inequities has been a central insight from work on the social determinants of health [ 73 , 74 ].…”

Penerapan Terapi Thought Stopping untuk Menurunkan Kecemasan pada Klien Hipertensi

“…World Health Organization menegaskan bahwa kesehatan ialah suatu keadaan yang sejahtera baik secara fisik, mental dan sosial dan bukan sekadar ketiadaan penyakit atau keterbatasan fisik (Jensen et al, 2022;Sartika et al, 2022). Sehingga perubahan kondisi kesehatan dapat menyebabkan timbulnya kecemasan karena terjadinya perubahan status kesehatan yaitu adanya masalah pada kesehatan fisik yang dapat mempengaruhi kesehatan mental.…”

Defining Success: Establishing Clarity of Purpose and a Measurement Framework to Advance Health Equity

“…In 1978, the World Health Organization (WHO) Alma Ata Declaration asserted that “health is a fundamental human right” and called for all governments, international organizations, and the world community to alleviate health disparities. 5 , 6 In 1991, WHO identified health inequalities as “one of the greatest challenges to public health.” It also suggested that enabling people to adopt healthier lifestyles acknowledges that some groups in society face greater limitations than others and recommended that “sensitive policy making” be used to enable people to live healthier lives. 2 Despite such recommendations, approaches to achieving health equity have been predominately indirect, focused on monitoring demographic differences in health outcomes and weighted toward increased access to health care.…”

“…For example, adopting a focus on the “absence of disparities” may lead to undue focus on increasing health care equity among populations rather than focusing on the necessary tenets of social justice. 6 The recommended definition of health equity should include our nation's historic social context, embrace current social complexities, and factor in those circumstances and contextual issues that define vulnerable populations. For this reason, we recommend the universal adoption of the Healthy People 2030 definition of health equity: “the attainment of the highest level of health for all people.” This recognizes that achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.…”

“…However, the study also clearly suggests that consistency in terminology is needed. For example, adopting a focus on the “absence of disparities” may lead to undue focus on increasing health care equity among populations rather than focusing on the necessary tenets of social justice 6. The recommended definition of health equity should include our nation's historic social context, embrace current social complexities, and factor in those circumstances and contextual issues that define vulnerable populations.…”