Disparity – WMA – The World Medical Association

Adopted by the 60^th WMA General Assembly, New Delhi, India, October 2009
and rescinded and archived by the 71^st WMA General Assembly (online), Cordoba, Spain, October 2020

PREAMBLE

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).

RECOMMENDATIONS

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.

Adopted by the 50^th World Medical Assembly, Ottawa, Canada, October 1998
and amended by the 60^thWMA General Assembly, New Delhi, India, October 2009 and
rescinded and archived by the 70^th WMA General Assembly, Tbilisi, October 2019

INTRODUCTION

Each country should have a health system with enough resources to attend to the needs of its population. However today, many countries across the world are suffering wide inequities and inequalities in health care and this is causing problems of access to health services for the poorer segments of society [the weak or underprivileged]. The situation is especially serious in low-income countries.

The international community has attempted to improve the situation. The 20/20 initiative of 1995, the 1996 Initiative for Heavily Indebted Poor Countries (HIPC), and Objectives for Millennium 2000 Development (MDGs) are all initiatives aimed at reducing poverty and dealing with poor health, inequities and inequalities between the sexes, education, insufficient access to drinking water and environmental contamination.

The objectives are formed as an agreement with acknowledgement of the contributions which developed countries can make, in the shape of trade relations, development assistance, reduction of the burden of debt, improving access to essential medication and the transfer of technology. Three of the eight objectives are directly related to health, which has a considerable influence on various other objectives that interact to support each of the others within a structural framework, these are designed to increase human development globally. The eight Millennium Development Objectives (MDO) foresee a development vision based on health and education, thus affirming that development does not only refer (allude) to economic growth.

Various reports from the World Health Organization have underlined the opportunities and skills [or techniques] which are currently involved in bringing about significant improvements in health, as well as helping to reduce poverty and encourage growth. Additionally, the reports highlight the fact that it is of fundamental importance to reduce limitations on human resources, in order to increase the achievements of the public health system, a situation which requires urgent attention. These limitations are related to work, training and payment conditions, and play a substantial role in determining capacity for sustained growth of access to health services.

RECOMMENDATIONS

The World Medical Association urges National Medical Associations to:

1. Advocate that their governments should adhere to and promote the proposals to increase investment in the health sector; and to adhere to and promote initiatives to reduce the debt burden for the poorest countries on the planet.

2. Advocate [defend] the inclusion of public health factors in all fields of policy provision, since health is mostly determined by factors that are external to the area of healthcare, for example, housing and education. [Health is not only medicine, it also depends on living standards].

3. Encourage and support countries in the planning and implementation of investment plans, which invest in health for the poor; guarantee that more resources be used for health in general, with greater efficiency and impact; and reduce limitations for the most effective use of the additional investments.

4. Maintain vigilance to ensure that the investment plans focus maximum attention on generating capacity, that they promote leadership skills and promote incentives to retain and place qualified personnel, whilst it is taken into consideration that the limitations in relation to the previous matter currently constitute the greatest obstacle for progress.

5. Urge international financial institutions and other important donors to: i) Adopt the necessary measures to help the countries that have already organised mechanisms to prepare their investment plans, and provide assistance to those countries that have begun to take the necessary steps, with the support and participation of the international community; ii) Help countries to obtain funds to develop and implement their investment plans; iii) Continue providing technical assistance to the countries for their plans.

6. Exchange information in order to coordinate efforts to change policies in these areas.