KAMPALA – Most times we are consumed by thoughts of which next magician’s shrine to burn down, which side of the hill does the storm’s lightning flash brighter, vibe on which musician hired a better model for their video, arguments on whose skin glows well after the beautician’s wielding at Kosmetikinstitut Aurora Innsbruck, or which Bayern FC Academy player will be on Vacation in Mombokolo at the fall of spring in August 2030 (at the expiration of the 17 Sustainable Development Goals): But we never get to the marrow of what affects us directly every passing Nano-second such us health – I mean our life.
Let us do due justice to this Rukiga-English phrase “Health nekwiita” to mean metaphorically “Health Inequity”. To the flipside of its coin is an ethical issue that resonates with human rights principles and is grounded in principles of distributive social justice called health equity: which, according to the Epidemiol Community Health 2003 in consideration of a mosaic of attempts, defines as the absence of systematic disparities in health between groups with different levels of underlying social advantage/ disadvantage.
This disadvantage / advantage is reflected through the mirrors of “failure” and “achievement” on those that have them but only through wishes and deep sleep dreams; These include wealth, power and prestige with relation to the absolute or relative deprivation of the same on the unfortunate bigger proportion of the collective. The uneven distribution of advantages and disadvantages dis-aligns community into different classes in access and utilization of health resources. Health inequity therefore re-punishes the disadvantaged and thus are unable to overcome the social disadvantages and rewards the advantaged which widens the social gap.
The big mistake that has been made for many years in finding solution in a society with health disparities is comparing the health of healthier people with the health of sicker ones. Damn it! How could one compare the greenness of boiled spinach to that of its fresh garden flowerings.
It is obvious that the health of the sicker and healthier is different. The world for long was failing on logic. May be we could start to compare the health of wealthier people with the health of poorer people or the health of people in powerful positions to the health of people in less or no powerful positions amongst other sensible comparisons. This is because assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These social determinants include: household living conditions, health care, health policies and programs that may include the receipt and utilization of services, distribution and allocation of health care services, budgetary prioritization of the health sector, the standard of services offered versus the standard demanded.
In fighting health inequity, we must act like the lion hunter who also burns the bush. Chasing health inequity out of the system should consider eliminating the structural leprosy that abets it. This is because inequity in health isn’t self-existent but breathes through the lungs of differences in social economic groups that are characterized by differences in income, economic assets, level of education. This differences are further distributed along gender, geography, ethnicity among others.
The route to progress can be travelled through a vehicle of better pay and even distribution of income, economic resources, equitable access to economic assets such as less interest on capital loans, access to education and information by all. This route could have more indicator passengers in addition to those mentioned. This journey to success should transport everyone irrespective of whether they male, female or non-conforming, which ethnic or racial group they belong to, where they are located or who their ancestors or parents knew or know amongst other differences.
To eliminate the systematic and persistent differences in the social determinants of health is to deal with the foundation of health inequity systematically and persistently.
The approach to eliminate health inequity may be one that will focus on improving the health standards of the less disadvantaged first.
This is because the highest possible health standard enjoyed by the more advantaged is the minimum standard everyone in a just and fair society must achieve at that time. Of course this standard must never be a measure of the how far the quality and quantity of health care must go. The yardstick of growth and development of health care services and interventions must look beyond the highest standard access by the more privileged of society at that particular time.
To concentrate on the improvement of health standards of the less advantaged is not a discriminatory approach but rather a selective concern to enable all people access the highest possible health care. This in the long run will reduce disparities in access and utilization of health care for healthier and long-living individuals and communities.
The writer, Kansiime Onesmus is a fellow at Global Health Corps