Elsevier

Public Health

Volume 149, August 2017, Pages 149-158
Public Health

Original Research
A paradigm shift for socioeconomic justice and health: from focusing on inequalities to aiming at sustainable equity

https://doi.org/10.1016/j.puhe.2017.04.015Get rights and content
Under a Creative Commons license
open access

Highlights

  • Northern countries are not sustainable, nor replicable models to be attained by all 7.2 billion global inhabitants.

  • Model countries require 3 characteristics: healthy population; economic feasibility to be replicated; and sustainability.

  • The global burden of health inequity has remained unchanged since the 1970's, at ∼17 million excess deaths every year.

  • 2012: estimated economic gap for health equity = $2.5 trillion (3.5% of world's GDP); total foreign aid was <5% of the gap.

  • Sustainable health equity is a novel benchmarking tool, which positions health equity as a compass for social justice.

Abstract

Objectives

To measure the ‘best possible health for all’, incorporating sustainability, and to establish the magnitude of global health inequity.

Study design

Observational, retrospective.

Methods

We identified countries with three criteria: (1) a healthy population—life expectancy above world average; (2) living conditions feasible to replicate worldwide—per-capita gross domestic product (GDP-pc) below the world average; and (3) sustainability—per-capita carbon dioxide emissions lower than the planetary pollution boundary. Using these healthy, feasible, and sustainable (HFS) countries as the gold standard, we estimated the burden of global health inequity (BGHiE) in terms of excess deaths, analyzing time-trends (1950–2012) by age, sex, and geographic location. Finally, we defined a global income ‘equity zone’ and quantified the economic gap needed to achieve global sustainable health equity.

Results

A total of 14 countries worldwide met the HFS criteria. Since 1970, there has been a BGHiE of ∼17 million avoidable deaths per year (∼40% of all deaths), with 36 life-years-lost per excess death. Young children and women bore a higher BGHiE, and, in recent years, the highest proportion of avoidable deaths occurred in Africa, India, and the Russian Federation. By 2012, the most efficient HFS countries had a GDP-pc/year of USD$2,165, which we proposed as the lower equity zone threshold. The estimated USD$2.58 trillion economic gap represents 3.6% of the world's GDP—twenty times larger than current total global foreign aid.

Conclusions

Sustainable health equity metrics provide a benchmark tool to guide efforts toward transforming overall living conditions, as a means to achieve the ‘best possible health for all.’

Keywords

Health equity
Benchmarking
International cooperation
Life expectancy
Sustainability
Gross domestic product

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