Equity, Health and Human Development

CRICS V
La Habana, Cuba
Meeting of PAHO/WHO
April 24-27

Juan Antonio Casas
Director
Division of Health and Human Development
PAHO
Outline
• Concepts of Equity and Health
• Determinants of Health Inequities
• Dimensions of Health Inequity in LAC
• Health Equity and IT in Knowledge Societies
• Ethics, IT and Health Equity

¿Qué es la Equidad?
Del lat.aequitas, atis<aequus=igual

1. Ecuanimidad, trato justo
2. Tendencia a dejarse llevar por los dictados de la conciencia o del deber mas que por el rigor de la justicia o de la ley
3. Accion de llevar a cabo un reparto justo y proporcional a las necesidades de los individuos que intervienen en el
4. Justicia natural
Sin. Justicia, imparcialidad
Ant. Parcialidad.

What is Equity?
Justice according to natural law or right;
specifically: freedom from bias or favoritism.
-Webster's New Collegiate Dictionary
or
The state, ideal, or quality of being just,
impartial and fair.
-American Heritage Dictionary

Social Equity
• Increases:
- Growth with poverty reduction
- Internal savings
- Human capital
- Technological development
- Social capital
- Governability/governance
Social Inequities
• In income
• In control of resources and goods
• In access to credit
• In access to services
• In functional capability (A. Sen)
- Health, education, nutrition
Inequality and Poverty in LAC
• Poverty levels are four times that of other regions with similar GDP.
• Income concentration is increasing
• Poverty rates have not improved, in some cases worsened, since 1980
• Urbanization of poverty
• Growth of informal sector of the economy
• 98% of connectivity limited to 20% highest income group
Increasing income concentration in
Latin America
Definition of Health Inequities Applied to Health Conditions
(Whitehead)
• Disparities in health that are unnecessary, avoidable and unfair

- Risk behavior in which free choice is limited
- Exposure to unhealthy living and working conditions
- Inadequate access to health services and other basic services
- Social mobility due to illness (natural selection)
- Not linked to natural biological variances, freely chosen behaviors, nor to transient advantages of a certain group

Criterios para Identificar las Inequidades en Salud
Las disparidades deben ser:

• Innecesarias
- Científica-técnica,
- financiera y
- moralmente.

• Involuntarias

• Con Agente Responsable
- culpable O
- con capacidad de intervención
Macrodeterminant factors of health disparities in Latin America
• Social Class
- due to income, education, occupation
• Gender
• Ethnicity
• Rurality
• Migration

Cumulative mortality 1-4 years of age, per birth weight and family income, Southern Brazil, 1982-1987

Strategic Areas for Technical Cooperation on Equity and Health
• Measurement
- Tools for program management and monitoring equity targets
• Increasing health system responsiveness
- Improving adequacy for poor and vulnerable
• Focusing on broader determinants of health and intersectoral actions
• Better advocacy for health equity
- Mobilizing civil society and other development partners
• Identification and dissemination of best practices
• Reducing the social and digital divide in health information

Health inequities and the new IT technologies
- Impact on general health determinants: changes in economic, social, cultural and political relations (globalization)

- Redefinition of the concept of community: creation of virtual communities (social capital)

- Strengthening participation of poor in decision making process ("empowerment")

The changing digital divide...
- The world produces two exabytes of information a year, i.e.
o A Billion Billion bytes or
o the equivalent of 20 billion copies of a magazine

- 1 of every 8 persons in Latin America will have regular access to the Internet by 2003, compared to 1 in six in the OECD countries

- There are more internet hosts in Finland than in all of Latin America

Essential Elements of the Knowledge Society
• Human capital - literacy, technologically skilled workforce, R&D capacity
• Information infrastructure - connectivity, hardware, software
• Policy/regulatory frameworks, institutions, incentives for national innovation and open business environment
• Financing - for improvement of public services, connecting the poor, growing private enterprises

Capacity Building by
• Empowerment
- addressing economic, social, political and institutional inequalities which prevent the poor and disadvantaged groups from having access to and influence over policies and interventions which in turn influence their lives
Capacity Building by
• Security
- addressing the risk and vulnerability which poor nations will increasingly face in the global economy, and which the poor in poor nations have always faced and which traps them into poverty
Capacity Building by
• Opportunity
- putting in place the conditions for investment and sustainable economic expansion in which the poor participate fully, and which will not degrade the environment or increase risk and vulnerability.
The Knowledge Society: How Can It Relate to Increased Equity?
• Poor and vulnerable people empowered through greater connectivity, knowledge-sharing, transparency: closing the digital divide
• Increased generation, sharing, and local adaptation of knowledge - engine of sustainable development
• Higher-quality public services
• Vibrant economy rapidly expanding incomes and employment, reducing poverty
• New opportunities for developing countries to be globally competitive
We can address BOTH the Challenges of:
l Reducing health inequities

l Narrowing the digital divide….

By preparing citizens and health information infrastructure for the Knowledge Society

Towards an Ethical Framework for an Information based Global Society
"Just as poor countries are removing the shackles of a colonialism which thrived on the exploitation of their agriculture and raw materials, so they are threatened by a new colonialism, based on control of technology deployment and global communications.."
(Glastonbury, LaMendola, The Integrity of Intelligence:a Bill of Rights for the Information Age, 1992)
Information and Human Rights
• The Millenium Assembly of 2000 established the universal access to information and communication services as a basic human right

• Global initiative to provide access to the Internet through community access points for all the world population by 2004

• Chile, Costa Rica, Argentina, Brazil e-government initiatives

Strategy for Ethical IT Development
• Change IT concept from set of products and services to paradigm of social development
• Assess potential contribution to social goals and historical/cultural and ethical factors
• Potential impact on democratic principles and individual freedom
• Scrutiny regarding impact on inequities and forms of discrimination

"Today's discussions of knowledge societies emphasize the need to harness ICTs for development by enabling their use for empowering the poor and for scientific and technical capacity building that is consistent with development goals. The new technologies can be implemented to support democratic decision-making, more effective governance and lifelong learning"

Knowledge Societies: Information Technology for Sustainable Development UNCSTD, 1998

• Descentralized network of health TSI sources operated by community of producers, intermediaries and consumers of TSI in the Americas

Average Years of Education for 25 Year-olds
by Income Level in Latin America
NIH Strategic Plan to Eliminate Health Disparities (2000)
Public Information and Community Outreach
• Develop Research-based Information Resources
• Communicate research-based information to increase public awareness
• Transfer knowledge to health care providers
• Hispanic Communications Initiative
• Internet-based Information Resources
• Prevention research clearinghouses
• Use of Web-based Information
• Science for the lay public
• Community population and environmental health information
• Public Input/policy on Genetic Research
• Behavioral and social sciences and communications