Adopted by the 60th WMA General Assembly, New Delhi, India, October 2009
For over 150 years, the existence of health inequality has been acknowledged worldwide. The recently published Final Report of the WHO Commission on Social Determinants of Health has highlighted the critical importance of health equity to the health, economy and social cohesiveness of all countries. It is clear that while there are major differences between countries, especially between the developing and developed countries, there are also substantial disparities within countries with respect to various measures of socio-economic and cultural diversity. Disparities in health can be defined as either disparities in access to healthcare, disparities in quality of care received, or both. The differences manifest themselves in a wide variety of health measures, such as life expectancy, infant mortality, and childhood mortality. Particularly disturbing is evidence of the gradual and ongoing widening of specific disparities.
At the core of this issue is the healthcare provided by physicians. National medical associations should take an active role in combating social and health inequalities in order to allow their physician members the ability to provide equal, quality service to all.
The Role of the Health Care System:
While the major causes of health disparities lie in the socio-economic and cultural diversity of population groups, there is a very significant role for the health care system in their prevention and reduction. This role can be summarized as follows:
- To prevent the health effects of socio-economic and cultural inequality and inequity – especially by health promotion and disease prevention activities (Primary Prevention)
- To Identify, treat and reduce existing health inequality, e.g. early diagnosis of disease, quality management of chronic disease, rehabilitation (Secondary and Tertiary Prevention).
The members of the medical profession, faced with treating the results of this inequity, have a major responsibility and call on their national medical associations to:
- Recognize the importance of health inequality and the need to influence national policy and action for its prevention and reduction
- Identify the social and cultural risk factors to which patients and families are exposed and to plan clinical activities (diagnostic and treatment) to counter their consequences.
- Advocate for the abolishment of financial barriers to obtaining needed medical care.
- Advocate for equal access for all to health care services irrespective of geographic, social, age, gender, religious, ethnic and economic differences or sexual orientation.
- Require the inclusion of health inequality studies (including the scope, severity, causes, health, economic and social implications) as well as the provision of cultural competence tools, at all levels of academic medical training, including further training for those already in clinical practice.