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Core Concepts and Definitions

In this video, Oluwaseun Akinyemi reviews some core concepts and definitions of health equity and social justice (Step 5.4)
OLUWASEUN AKINYEMI: Now we go to core concepts and definitions. I’d just like you to consider each of these four scenarios. Scenario 1, 2, 3, and 4. Take a moment to reflect what each of these scenario mean in terms of equity, equality, disparity, and access to health.
I’d like you to consider each of these scenarios. Scenario 1, 2, 3, and 4. As you can see in scenario 1, all the three individuals have the same platform. In scenario 2, some have platforms, some do not. And in scenario 3, some have exaggerated platforms. Whereas in scenario 4, you may see that there are no barriers and the coast seems to be clear for [? all. ?] So what will you call each of these scenarios? What can you see in terms of access to health care, in terms of equity, equality, disparity? Take a moment to reflect on this.
As you might have considered, the first scenario all the three individuals have the same platform. So that’s a scenario that illustrates equality. Equality in terms of access to resources. Whereas in scenario 2, we see that at the end, all of them could see what is going on behind the fence. But they do not have the same access to the resources, so this describes equity, fairness, justice. In scenario 3, you can see that some have more than necessary. Whereas 1 and 2 could not see what is behind the fence. [? But ?] one person was just OK. So this is what we see in reality.
Some people will have more than they need, but some do not have anything, whereas some have just enough. But in scenario 4, it illustrates liberation, whereas the wall is taken away. Everyone has access. Everyone has unhindered, unfettered access. And these are some of the terms that we’ll be considering in the next few slides. So I said earlier in the previous slide, equality means that there are no differences in status, in rights, or opportunities. It means that everyone are the same. They have equal access to resources. Whereas disparity, in disparity there is systemic difference among the different groups in the population. So some example of disparity may include prostate problems among men. We know that women will not have prostrate problems.
[? But ?] when we’re talking about inequities, it may be differences in [INAUDIBLE] [? status ?] among girls and boys. In some societies they feed boys more than girls. So boys have greater access to health care. They kind of value boys more than girls. And the likelihood of receiving timely treatment for a heart attack among different ethnic groups can also be another case of inequity. Different levels of immunization coverage between different neighborhoods in a city or among different groups of people. So these are issues of inequity that illustrates some of the things we have said earlier. Equity is the absence of differences that are unnecessary, avoidable, unfair, unjust.
So equity talks about fairness, justice, and it has to do with achieving health equity for otherwise marginalized, disempowered, or under-served population. Poor people are often key target groups when it comes to health, the issue of health equity, but each specific context has unique concentration, and income is that the only issue we consider in equity. Now, let’s talk about the principles of social justice. Justice is defined as the process of assuring that individuals fulfill their societal roles and receive their due from society. Social justice is bounded by law and human rights in an understanding of the problem and solutions within the confines of the law and human rights. There are many views about what social justice is and what it means.
We utilize some of the guiding principles in determining what we understand by social justice. It’s often measured by distribution of health, opportunities, and social privileges. There is evolving emphasis on breaking down barriers to social mobility, including safety nets and economic justice. Now, there are two terminologies I’d like you to look at, sufficientarianism as well as systematic disadvantage. How can we apply these principles to social justice? I’d like you to take a moment to reflect on these. The idea of sufficientarianism is a theory of distributive justice. Rather than being concerned with inequalities as such [? or ?] we [? making ?] [?
situation ?] of the least well as good as possible, sufficientarianism justice aims at making sure that each of us has enough of what is good. Whereas systematic disadvantage is when systemic factors itself gives someone an advantage over others. This systematically disadvantage is a condition where someone or something gains an advantage over others because they are doing things in a specific way. So now the question is, why does equity matter? Lack of equity puts certain population at risk with respect to their health. And we have established that in the previous slide. Equity is also a moral principle. Health is central to well-being and important in overcoming other social disadvantages.
And we know that there cannot be social justice without equity, as equity is the vehicle of social justice. So population health can be assessed by degree of protection against ill health. And one very other important reason why equity [? matters ?] is because we cannot achieve sustainable development goals and the goal of universal health coverage without equity, without covering the poor and other disadvantaged population. And as you see in this diagram on your right, public health with social justice leads to health equity and is very important in our quest to assure access to everyone and to achieve the goal that we have mapped out for ourselves in the sustainable development goals.
The key message on this slide is that to achieve health equity, programs must be designed with the target population in mind. There must be regular evaluation of program effect, as well as enabling policy and infrastructure. So there should be organizational structures and functions that support health equity programs designed with target population in mind. There should be structures for measurement for monitoring and evaluation, and there should be [? enabling ?] policy, and all this will lead to health equity. Now, I’d like you to reflect on how health programs influence health equity. How do you think health programs may influence the issue about fairness or promote justice especially with regards to access to health and health care?
Take a moment to reflect on this.
So these are a few examples of how health programs may influence equity programs, may work to achieve fair distribution of resources, identify appropriate strategies and policies to address the needs of disadvantaged populations. It may also establish goals and objectives by mainstreaming indicators of social determinants of health into health outcomes. Programs can also promote accountability for achieving health equity outcomes as a benchmark for [? all ?] [? the ?] program’s performance. Health programs need to take into consideration a fair distribution of resources, identify appropriate strategies, processes, program, and policies to address specific health needs based on social justice and rights of disadvantaged social groups.
We may also establish goals and objectives in programs by mainstreaming indicators of social determinants of health, such as short, medium, and long term health outcomes. We may also work with policymakers, program managers, and implementers to promote accountability for achieving health equity outcomes as a benchmark for program performance. The major takeaway message from this slide is that the global public education initiative [? and ?] smallpox eradication program, including novel examples where health outcomes and impact was achieved across all social groups. In part, this is because as educational programs, they had to find ways to reach the ideas, to reach [? populations ?] [? that rare ?] [INAUDIBLE]..
As we continue to move through this module, we will be looking at what lessons we have learned to translate these examples and strategies to other health interventions for achieving health equity. Talking about other ways that health programs can influence health equity. This might be by perpetuating inequality or by widening gaps between the well-off and less well-off population, by improving access to the program and other resources for certain groups only. Health programs intend to equally distribute resources among the community. However, sometimes they end up [? with ?] [? the ?] inequities and widening the gap [? for ?] [? the ?] [? wherein ?] programs [?
offered ?] are designed to be more accessible to or better understood by the more well-off populations, and disadvantaged populations remain helpless, unable to overcome social determinants.

Oluwaseun Akinyemi, MD, MPH, FWACP, FRSPH, PhD
College of Medicine, University of Ibadan & University College Hospital, Nigeria

The lecture and readings What is Health Equity? And What Difference Does a Definition Make? and chapter 10 of Health Equity in All Policies, Systems, and Programs, outline the importance of promoting health equity and how it is shaped by global health programs.

In a few sentences, describe one example you have seen in your work or studies and post it in the discussion. It may be an example of inequitable access or an improvement of equitable access.

Then read the posts of other learners while considering the concepts presented in the lecture. Choose one post and respond with one possible way to improve equitable access even further.

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Planning and Managing Global Health Programmes: Promoting Quality, Accountability and Equity

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