Low Anne, Ithindi Taati, Low Allan
Directorate of Health Improvement, Derwentside Primary Care Trust, Shotley Bridge, England.
Int J Equity Health. 2003 Apr 28;2(1):5. doi: 10.1186/1475-9276-2-5.
Equality of health status is the health equity goal being pursued in developed countries and advocated by development agencies such as WHO and The Rockefeller Foundation for developing countries also. Other concepts of fair distribution of health such as equity of access to medical care may not be sufficient to equalise health outcomes but, nevertheless, they may be more practical and effective in advancing health equity in developing countries. METHODS: A framework for relating health equity goals to development strategies allowing progressive redistribution of primary health care resources towards the more deprived communities is formulated. The framework is applied to the development of primary health care in post-independence Namibia. RESULTS: In Namibia health equity has been advanced through the progressive application of health equity goals of equal distribution of primary care resources per head, equality of access for equal met need and equality of utilisation for equal need. For practical and efficiency reasons it is unlikely that health equity would have been advanced further or more effectively by attempting to implement the goal of equality of health status. CONCLUSION: The goal of equality of health status may not be appropriate in many developing country situations. A stepwise approach based on progressive redistribution of medical services and resources may be more appropriate. This conclusion challenges the views of health economists who emphasise the need to select a single health equality goal and of development agencies which stress that equality of health status is the most important dimension of health equity.
健康状况平等是发达国家所追求的健康公平目标，世界卫生组织和洛克菲勒基金会等发展机构也倡导发展中国家追求这一目标。其他健康公平分配的概念，如获得医疗服务的公平性，可能不足以使健康结果均等，但尽管如此，它们在促进发展中国家的健康公平方面可能更具实用性和有效性。方法：制定了一个将健康公平目标与发展战略相关联的框架，该框架允许将初级卫生保健资源逐步重新分配给更贫困的社区。该框架应用于独立后的纳米比亚初级卫生保健的发展。结果：在纳米比亚，通过逐步应用人均初级保健资源平等分配、同等满足需求时获得机会平等以及同等需求时利用平等的健康公平目标，健康公平得到了推进。出于实际和效率方面的原因，试图实现健康状况平等的目标不太可能进一步或更有效地推进健康公平。结论：在许多发展中国家的情况下，健康状况平等的目标可能并不合适。基于医疗服务和资源逐步重新分配的渐进式方法可能更合适。这一结论对强调需要选择单一健康平等目标的健康经济学家以及强调健康状况平等是健康公平最重要维度的发展机构的观点提出了挑战。
