Lecture 1 - Health equity as a policy problem

Question 1

What are the 4 philisophical theories that can govern equity decisions?

Answer 1

1. Libertarianism
2. Utilitarianism
3. Rawlsianism
4. Egalitarianism

Question 2

What is librertarianism?

Answer 2

Individual liberty is paramount. Individuals have the right to live their lives as they see fit, free from undue government interference.

Question 3

What is utilitarianism?

Answer 3

The best action is the one that maximizes overall utility for the greatest number of people.

Question 4

What is Rawlsianism?

Answer 4

Justice as fairness. A just society should be one that rational individuals would choose under a “veil of ignorance,” not knowing their own social or economic position. Benefits the least well-off

Question 5

What is egalitarianism?

Answer 5

Everyone should have equal access to health regardless of their background or circumstances.

Question 6

How does the WHO define health?

Answer 6

State of complete physical, social and mental well-being and not merely the absence of disease and infirmity”

Question 7

What is the optimist perspective on health and who supports it?

Answer 7

All countries can be healthy and wealthy

Hans Rosling - Swedish physician, academic and public speaker

Question 8

What is the support for the optimist perspective on health?

Answer 8

• Average life expectancy is increasing
• There has been a reduction in mortality across all age groups (infant mortality rate, maternal mortality rate, adult mortality)
• Reduction in mortality from infectious diseases (vector-borne diseases, smallpox eradicated)
• Reduction in mortality from NCDs

Question 9

What is the pessimist perspective on health and who supports it?

Answer 9

Equity gaps are becoming wider when it comes to differences in socio-economic status

Jason Hickel - anthropologist

Question 10

What is the support for the pessimistic perspective on health?

Answer 10

• ONS reported in 2022 that from 2011-2013 to 2018-2020, the difference in life expectancy for both males and females in England has increased. The gap in healthy life expectancy has also increased.
• ONS report in 2023 that the stillbirth rate and infant mortality rate were higher for Black African, Black Caribbean and Other Black ethnic groups in England
• Maternal mortality rates from 2009-2021 in England were higher in Black ethnic groups when compared to White, Asian, Chinese or mixed (National Perinatal Epidemiology Unit, 2023)
• COVID-19 mortality was higher in the black, Asian and minority ethnic groups in the UK (Bhatia, 2020)
• In some countries with as Sub-Saharan Africa, life expectancy is static or falling
• There is a threat of the appearance of new diseases (new viruses and zoonotic diseases) and the reappearance of some old diseases. Also antimicrobial resistance. This will lead to new health impacts.

Question 11

What is the double burden of health in LMICs?

Answer 11

• Unfinished agenda of infectious diseases, malnutrition and childbirth
• Emerging epidemics of NCDs and HIV/AIDS