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Access to health References 1. McCoy D et al. Global Equity Gauge Alliance: reflections on early experiences. Journal of Health, Population and Nutrition, 2003, 21:273-87. 2. Marmot M. Social determinants of health inequalities. The Lancet, 2005, 365:1099-104. 3. Jong-wook L. Global health improvement and WHO: shaping the future. The Lancet, 2003; 362:2083-2088. 4. London L. Can human rights serve as a tool for equity? Equinet Discussion Paper 14. Co-published by the Regional Network for Equity in Health in Southern Africa (EQUINET) and the University of Cape Town School of Public Health and Family Medicine, December 2003, Harare. Available at URL http://www.equinetafrica.org/Resources/downloads/ EquinetDiscussionPaper14 5. London L. ‘Issues of equity are also issues of rights’: lessons from experiences in Southern Africa. BMC Public Health, 2007, 7:14. URL: http://www.biomedcentral.com/content/pdf/1471-2458-7-14.pdf 6. Mann J. Human rights and the new public health. Health and Human Rights 1995; 1: 229-33. 7. Mann J, Tarantola D. Responding to HIV/AIDS: a historical perspective. Health and Human Rights, 1998, 2: 5-8. 8. Gruskin S, Tarantola D. HIV/AIDS and Human Rights Revisited. Canadian HIV AIDS Policy and Law Review, 2001; 6:24-29. 9. Tarantola D et al. Jonathan Mann: founder of the health and human rights movement. American Journal of Public Health, 2006, Nov;96(11):1942-3. 10. De Cock KM, Mbori-Ngacha D, Marum E. Shadow on the Continent: Public Health and HIV/AIDS in Africa in the 21st Century. The Lancet, 2002, 360:67-72. 11. World Health Organization. Guidance on Provider-Initiated HIV Testing and Counselling in Health Facilities, 2007. Geneva, World Health Organization. 12. Jacobson PD, Soliman S. Co-opting the health and human rights movement. Journal of Law, Medicine and Ethics, 2002; 30:705-715. 13. O’Keefe E, Scott-Samuel A. Human rights and wrongs: could health impact assessment help? Journal of Law, Medicine and Ethics, 2002, 30:734-8. 14. Dasgupta P. An inquiry into well-being and destitution. Oxford: Oxford University Press, 1995. 15. Allison MC. Balancing responsibility for sanitation. Social Science & Medicine, 2002, 55: 1539–1551. 16. London L. Human Rights and Public Health: Dichotomies or Synergies in Developing Countries? Examining the Case of HIV in South Africa. Journal of Law, Medicine and Ethics, 2002, 30: 677-691. 17. McIntyre D, Gilson L. Putting equity in health back onto the social policy agenda: experience from South Africa. Social Science and Medicine, 2002, 54:1637-56. 18. Mooney G, Jan S, Wiseman V. Staking a claim for claims: a case study of resource allocation in Australian Aboriginal health care. Social Science and Medicine, 2002, 54:1657-1667. 19. Newdick C, Derrett S. Access, equity and the role of rights in health care. Health Care Analysis, 2006, Sep;14(3):157-68. 20. Cornwall A, Nyamu-Musembi C. Why rights, why now? Reflections on the rise of rights in international development discourse. Institute of Develpment Studies Bulletin 2005, 36:9-18. 21. Sen A. Development as Freedom, 2000. Anchor Books: New York. 22. Diderichsen F, Evans T, Whitehead M. The social basis of disparities in health. In Challenging inequalities in health. From ethics to action (1st edition), 2001, 13-23. Edited by Evans T et al. New York: Oxford University Press. 23. Braveman P, Gruskin S. Poverty, equity, human rights and health. Bulletin of the World Health Organization, 2003, 81:539-45. 24. Rifkin SB. A Framework Linking Community Empowerment and Health Equity: It is a Matter of CHOICE. Journal of Health, Population and Nutrition, 2003, 21:168-180. 25. Chowdhury Z, Rowson M. The People’s Health Assembly. Revitalising the promise of “Health for All.” British Medical Journal 2000, 321:1361-1362. 26. EQUINET Steering Committee: Equity in Health in Southern Africa Turning Values into Practice. EQUINET Policy Series # 7, 2000, Harare. 27. Beaglehole R, Bonita R. Reinvigorating public health. The Lancet, 2000, 356:787-788. 28. MacFarlane S, Racelis M, Muli-Musiime F. Public health in developing countries. The Lancet, 2000, 356: 841-846. 29. Scott-Samuel A, O’Keefe E. Health impact assessment, human rights and global public policy: a critical appraisal. Bulletin of the World Health Organization, 2007; 85:212-217. 30. Chen L et al. Human resources for health: overcoming the crisis. The Lancet, 2004, 364:1984–90. 31. M Joffe M, Mindell J. Impact Assessment. A framework for the evidence base to support health. Journal of Epidemiology and Community Health, 2002, 56;132-138. 32. World Health Organization Bulletin has called for papers on exactly this theme, seeking evidence for the application of ethical frameworks for public health decision-making. 33. People’s Health Movement. The global ‘Right to Health and Health Care Campaign’. URL: http://www.phmovement.org/en/campaigns/righttohealth. Accessed 6 August 2007. 34. United Nations, Economic and Social Council, UN Sub-Commission on Prevention of Discrimination and Protection of Minorities, Siracusa Principles on the Limitation and Derogation of Provisions in the International Covenant on Civil and Political Rights, Annex, UN Doc E/CN.4/1984/4 (1984). 35. International Federation of Red Cross and Red Crescent Societies (IFRCRCS) and the Francois-Xavier Bagnoud Centre for Health and Human Rights (FXBCHHR). The Public Health – Human Rights Dialogue. In (Editors) Mann JM et al. Health and Human Rights. A Reader, 1999, 46-53. New York, Routledge. 36. Gostin L, Mann JM. Towards the development of a Human Rights Impact Assessment for the formulation and evaluation of Public Health Policies. In (Editors) Mann JM et al. Health and Human Rights. A Reader, 1999, 54-71. New York, Routledge. 37. Rubenstein LS, London L, Baldwin-Ragaven L and the Dual Loyalty Working Group. Dual Loyalty and Human Rights in health professional practice. Proposed guidelines and institutional mechanisms, 2002). A project of the International Dual Loyalty Working Group. Physicians for Human Rights and University of Cape Town. Boston, 2002. Available at URL: http://physiciansforhumanrights.org/library/report-dualloyalty- 2006.html. 38. South African Human Rights Commission (SAHRC). Investigation into the right of access to health care. The right to have access to health care services – call for submissions. 9 February 2007 URL: http://www.sahrc.org.za/sahrc_cms/publish/article_244.shtml, accessed 7 August 2007. 39. Ignatieff M. The rights revolution, 2000. Anansi, Toronto. 058 ✜ Global Forum Update on Research for Health Volume 4
Access to health Inequality, marginalization and poor health Article by Lenore Manderson Variations in health status and outcomes occur in high-, middle- and low-income countries. Economic, political, social and other inequalities between individuals, communities and nations all have profound effects on vulnerability and risk of infection, disease and injury, on access to medical and other care, on treatment, management and outcomes, and on information and interventions designed to maximize well-being. Similarly, such inequalities have profound impact on social health, resulting in individual vulnerability to social exclusion, lack of participation in the social, cultural, religious, economic and other aspects of community life, and differential access to the benefits that derive from these various activities. The factors that influence health status and health outcomes occur at social, structural, institutional and systems levels in all societies. Gender, differences in ability, race, ethnicity, class and caste are all fields of marginalization, discrimination and personal and structural violence. These differences that result in inequality – gender, ability, age, class or caste, race, ethnicity, sexuality, geography, etc. – co-exist and are inter-related, contributing to poverty in much of the world. Poor people moreover are more likely than others to experience inequality within these social hierarchies, and the co-presence or intersection of various factors that result in inequality compounds the experience and impact of poor health and resultant poverty. These fields of vulnerability are reinforced through structural violence, leading to differences in rates and patterns of infection and illness. For example, people from poor and marginalized communities typically work in industries and occupations and reside in areas that have high risk of illness and injury, they are more likely to be directly exposed to pathogens, to have substandard medical services and poor quality of care, and to lack access to social support mechanisms. Social inclusion, participation in decision-making, social security, equality, human rights and social justice are key, underlying determinants of health that influence (and are influenced by) education, income and employment The individual personal, social and economic factors that contribute to inequality, and associated poor health and poverty, result in social exclusion, discrimination and marginalization. Social marginality, discrimination and exclusion affect health negatively in numerous ways, as illustrated by current research on social dimensions of health and illness. Social inclusion, participation in decisionmaking, social security, equality, human rights and social justice are key, underlying determinants of health that influence (and are influenced by) education, income and employment. Unjust social conditions therefore deprive people of the opportunity to be healthy and often lead to negative health outcomes. In turn, inequitable conditions often limit access to health and medical services, discouraging people who are marginalized or disempowered from presenting to clinics and influencing the quality of care they receive when they do attend. A woman from a minority caste, living in an isolated rural area with physical impairments from polio, is far more likely to be poor, to have poor access to health services, and to receive poor quality of care, than an urban dweller without impairment and from a higher status caste. People with highly stigmatized health conditions (mental illness, leprosy and still, in many cases, HIV), are similarly often denied quality health care. The direct and indirect costs of seeking medical attention, and the humiliation, embarrassment and disappointment experienced when health workers are rude and the necessary equipment, medication or advice are not forthcoming, discourage their continued presentation. Marginalization affects the health of populations in very different environments. In urban and other densely settled areas, individuals living in poverty, in poor housing, in areas of high population density such as slums or informal (squatter) settlements, or in other unsafe or inadequate living conditions, are disproportionately affected by communicable diseases. Similarly, migrants, nomadic and seminomadic pastoralists and others living in very isolated areas are vulnerable to parasitic and other infectious diseases and may be excluded from health care services run by settled populations. In these circumstances, other environmental conditions, such as poor wet and dry waste management and lack of potable water, also favour vector breeding to promote the spread of infectious diseases. These diseases create social Global Forum Update on Research for Health Volume 4 ✜ 059
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Page 7 and 8: Introduction Research contributions
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Page 11 and 12: Introduction making), takes account
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Page 67 and 68: Innovation 076 Towards the developm
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Research resources ✜ Health resea
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Research resources A new landscape
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Decision-making Delivering evidence
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Decision-making Policy-makers Compl
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Decision-making References 1. Haine
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Decision-making reviews in this fie
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Decision-making Inequities in healt
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Decision-making Deaths Crude death
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Decision-making Several strategies
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To achieve better health, particula
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