Gwatkin Davidson R, Bhuiya Abbas, Victora Cesar G
Lancet. 2004;364(9441):1273-80. doi: 10.1016/S0140-6736(04)17145-6.
Health systems are consistently inequitable, providing more and higher quality services to the well-off, who need them less, than to the poor, who are unable to obtain them. In the absence of a concerted effort to ensure that health systems reach disadvantaged groups more effectively, such inequities are likely to continue. Yet this situation need not be accepted as inevitable, for there are many promising measures that might be pursued: establishment of goals for improved coverage in the poor, rather than in entire populations, and use of those goals to direct planning toward the needs of the disadvantaged; use of one or more of the several techniques that seem to have been effective in at least some of the settings where they have been tried; and empowerment of poor clients to have a more central role in health system design and operation.
卫生系统一直存在不公平现象，为富裕人群提供了更多、质量更高的服务，而富裕人群对这些服务的需求较低，相比之下，贫困人群却无法获得这些服务。如果不做出协调一致的努力来确保卫生系统更有效地覆盖弱势群体，这种不公平现象可能会持续下去。然而，这种情况并非不可避免，因为有许多可行的措施可以采取：为改善贫困人口而非全体人口的覆盖范围设定目标，并利用这些目标指导规划以满足弱势群体的需求；采用在至少一些已试行的环境中似乎有效的几种技术中的一种或多种；赋予贫困客户权力，使其在卫生系统的设计和运营中发挥更核心的作用。
