Applying an equity lens to child health and mortality: more of the same is not enough
Applying an equity lens to child health and mortality: more of the same is not enough
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DOI：
10.1016/s0140-6736(15)01024-7
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发表时间：
2003-07-19
期刊：
影响因子：
168.9
通讯作者：
Habicht, JP
中科院分区：
文献类型：
--
作者：
Victora, CG;Wagstaff, A;Habicht, JP
富国和穷国之间儿童死亡率的差距之大令人无法接受，在某些地区还在扩大，在大多数国家内，富国和穷国儿童之间的差距也在扩大。贫穷儿童比富裕儿童更有可能面临健康风险，由于营养不良和贫穷社区常见的其他危害，他们对疾病的抵抗力较弱。这些不平等现象因获得预防和治疗干预措施的机会减少而加剧。即使是公共卫生补贴也常常使富人比穷人受益更多。关于如何帮助贫困人口的经验和证据正在增加，尽管主要是通过小规模的个案研究。成功的办法包括改善贫困社区获得保健干预措施的地理机会、补贴保健和保健投入以及社会营销。针对穷人的保健干预措施和确保普遍覆盖是改善公平的有希望的办法，但两者都有局限性，需要在国家一级和以下各级规划儿童生存和有效提供服务。迫切需要定期监测不平等现象，并将由此产生的信息用于教育、宣传和加强公众和决策者的问责制，但这还不够。在设计儿童生存干预措施和交付战略时，必须将公平作为优先事项，必须建立确保国家和国际各级问责制的机制。
Gaps in child mortality between rich and poor countries are unacceptably wide and in some areas are becoming wider, as are the gaps between wealthy and poor children within most countries. Poor children are more likely than their better-off peers to be exposed to health risks, and they have less resistance to disease because of undernutrition and other hazards typical in poor communities. These inequities are compounded by reduced access to preventive and curative interventions. Even public subsidies for health frequently benefit rich people more than poor people. Experience and evidence about how to reach poor populations are growing, albeit largely through small-scale case studies. Successful approaches include those that improve geographic access to health interventions in poor communities, subsidised health care and health inputs, and social marketing. Targeting of health Interventions to poor people and ensuring universal coverage are promising approaches for improvement of equity, but both have limitations that necessitate planning for child survival and effective delivery at national level and below. Regular monitoring of inequities and use of the resulting information for education, advocacy, and increased accountability among the general public and decision makers is urgently needed, but will not be sufficient. Equity must be a priority in the design of child survival interventions and delivery strategies, and mechanisms to ensure accountability at national and international levels must be developed.