Thomsen Sarah, Hoa Dinh Thi Phuong, Målqvist Mats, Sanneving Linda, Saxena Deepak, Tana Susilowati, Yuan Beibei, Byass Peter
Division of Global Health, Department of Public Health, Karolinska Institutet, Solna, Sweden.
Reprod Health Matters. 2011 Nov;19(38):176-82. doi: 10.1016/S0968-8080(11)38586-2.
Maternal and child mortality rates, the targets for two of the eight Millennium Development Goals, remain unacceptably high in many countries. Some countries have made significant advances in reducing deaths in pregnancy, childbirth, and childhood at the national level. However, on a sub-national basis most countries show wide disparities in health indices which are not necessarily reflected in national figures. This is a sign of inequitable access to and provision of health services. Yet there has been little attention to health equity in relation to the Millennium Development Goals. Instead, countries have focused on achieving national targets. This has led to an emphasis on utilitarian, as opposed to universalist, approaches to public health, which we discuss here. We recommend a policy of "proportionate universalism". In this approach, universal health care and a universal social policy are the ultimate goal, but in the interim actions are carried out with intensities proportionate to disadvantage. We also briefly describe an initiative that aims to promote evidence-based policy and interventions that will reduce inequity in access to maternal and child health care in China, India, Indonesia and Viet Nam.
孕产妇和儿童死亡率是八项千年发展目标中两项的指标，在许多国家仍高得令人无法接受。一些国家在国家层面降低妊娠、分娩和儿童期死亡方面取得了显著进展。然而，在国家以下层面，大多数国家的健康指数存在很大差异，而这些差异不一定反映在国家数据中。这表明在获得和提供卫生服务方面存在不公平现象。然而，与千年发展目标相关的卫生公平问题很少受到关注。相反，各国专注于实现国家目标。这导致强调功利主义而非普遍主义的公共卫生方法，我们在此对此进行讨论。我们建议采取“相称普遍主义”政策。在这种方法中，全民医疗保健和普遍社会政策是最终目标，但在此期间，行动的力度与不利程度相称。我们还简要介绍了一项倡议，该倡议旨在推动基于证据的政策和干预措施，以减少中国、印度、印度尼西亚和越南在获得孕产妇和儿童保健服务方面的不公平现象。
