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Equity and health systems

The notion of what is fair differs between societies and people within those societies. So, how do we define equity in health systems?
A child sits crouched on the ground with hands clasped looking up at a woman holding an empty pot of food.
© UNICEF/UN056039/Holt

Equity is all about fairness. As we begin to look at the question of equity in health systems, it is important to remind ourselves that not all societies, and not all people within a society, share a common view of what is fair. Equity is subjective, as it can mean different things to different people and different communities. Moreover, health systems place different emphasis on the goal of equity. For some, it is a top priority, while for others, it is not. Each health care system must decide upon its own equity objective and how to put it into operation.

This extract from a paper by Professor Stephen Leeder at the University of Sydney highlights the different emphasis placed by countries and their health systems on equity. The quote is from an American talking to a group of people from other countries:

“The difference between us is that you guys believe in equity and we don’t. In the US, people are less interested in making sure everyone gets care than that those who can get it get great care. They accept not getting care now if they can see the opportunity to improve their position and succeed, so that, when they get the money, they will be able to buy great care the minute they want it. It is all about opportunity. People in the US want opportunity, not equity. That’s what they think is fair.” (Leeder, 2003, p.475)

While the quote obviously employs hyperbole, it is clear that how people in a community define fairness matters greatly for how health systems evolve and how they may be changed.

Equity is an ethical principle, and countries making a commitment to the achievement of universal health coverage (UHC) are, in effect, making a commitment to equity. An understanding of how equitable a health system is needs to underpin the pursuit of UHC. Financing is regarded as equitable if contributions are in line with the ability to pay, while health service use is equitable if benefits are distributed according to need for health care. You will hear more about these principles in the following step.

Keep these concepts in mind when we examine models of UHC schemes later this week – how are they measuring achievement towards their goals of equity?

Leeder, S. 2003, ‘Achieving equity in the Australian healthcare system’, Medical Journal of Australia, vol. 179, pp.475-478, viewed 24 June 2019, <>.
© Nossal Institute for Global Health at the University of Melbourne
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