Health Equity, Role of Different Stakeholders and Challenges

What is Health Equity?

• Definition: Everyone has an equal opportunity to achieve optimal health, regardless of background. Goes beyond access to healthcare, addressing social determinants of health like poverty, education, and environment
• Example: A child in rural poverty lacks access to clean water, food, and immunizations, increasing risk of chronic health problems.

Challenges to Health Equity

Global Challenges

• Deeply rooted social injustices and global health issues create roadblocks.
• Diverse populations in multicultural countries like India need equitable healthcare access.
• Specific challenges include:
  • Pandemics disproportionately affect marginalised groups, widening the health equity gap (e.g., COVID-19).
  • Climate change disproportionately impacts low-income and vulnerable populations.
  • Conflicts destroy infrastructure, displace communities, and limit access to vital medical services.

India Specific Challenges

• A large and diverse population faces significant disparities in healthcare access and outcomes.
• Rural India lags behind urban areas in healthcare access despite improvements in the past 20 years.
  • According to the 2011 Census, urban slums make up over 17% of India’s metropolitan areas, and exhibit serious health disparities.
• Urban slums with overcrowding, poor sanitation, and limited clean water access exacerbate health risks.
  • Example: Infectious diseases like tuberculosis are 1.5 times more common in slums (source: Indian Council of Medical Research).
• Deep caste and gender disparities exist:
  • Scheduled Castes/Tribes have higher child mortality and lower immunisation rates (source: NFHS-5).
  • Anaemia is almost double as common among women in the lowest wealth quintile (source: NFHS-5).
• Non-communicable diseases (NCDs) cause over 60% of deaths in India.
  • The economic impact of NCDs is projected to exceed $6 trillion by 2030 (source: Public Health Foundation of India).
• Doctor shortage is critical, with only 8 doctors per 1,000 people (below WHO’s recommended ratio).
  • The shortage is worse in rural areas, with over 75% of healthcare professionals concentrated in cities (27% of the population).

The Road to Health Equity

• Requires a multi-sectoral approach beyond just healthcare access
• Collaboration is needed between governments, civil society, healthcare providers, and communities
• Examples of initiatives in India:
  • Ayushman Bharat: Free health coverage for the bottom 40% economically
  • National Health Mission (NHM): Expanding access, strengthening infrastructure, providing services to vulnerable populations
  • Focus on health literacy through education
  • Collaboration between public/private sectors and NGOs to improve access, workforce development, and infrastructure

The Role of Different Stakeholders

• Public and private health sectors can collaborate to:
  • Provide services to underserved communities
  • Focus on preventive education
  • Develop workforce
  • Improve infrastructure
• NGOs and civil society can:
  • Conduct direct community outreach
  • Address local health concerns
  • Partner with international/government organisations for culturally sensitive health initiatives.
• International organisations (WHO, Global Fund, Gavi) can:
  • Support health initiatives in resource-limited settings
  • Promote information and resource sharing to improve healthcare systems.
• Private sector and philanthropies can leverage innovation and technological advancements (digital health) to:
  • Enhance accessibility and affordability
  • Increase reach and effectiveness of healthcare delivery.
• Research institutions and academia can offer crucial insights into:
  • Health inequalities
  • Intervention effectiveness
  • Evidence-based practices and policies
• The Importance of Local Organisations:
  • Organisations with a strong local presence are crucial for health equity.
  • They understand community needs and can ensure program relevance and effectiveness.
  • Successful collaborations require:
    • Open communication
    • Mutual respect
    • Shared goals
    • Emphasis on community empowerment, knowledge sharing, and capacity building
    • Adaptability to evolving health concerns and community demands.

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