While Americans ponder the dilemma of the disparities in health care delivery assured by a system which rations care based on the ability to pay for or otherwise acquire health care insurance, a study from the World Health Organization ("Primary health care: Now more than ever ") reminds us that vast disparities between health care outcomes are hardly a U.S. problem alone.
It is a gulf that can be measured across a global divide, but with one similarity—it is always the wealthier folk, whether measured as an individual or as a society, who have access to quality care, while the world's poorest—and typically as a result the poorest in health—who have the least access to quality care or even the most basic health care. The stark outcomes of such inequity can hardly be a surprise.
According to the report, a citizen of a wealthy nation can live up to 40 years longer than someone in a poor country, and of the 136 million women who will give birth this year, about 58 million (43 percent) will receive no medical assistance during childbirth or the postpartum period.
WHO Director-General Margaret Chan reminds us residents of the affluent world that the health-care gap is more than just a moral problem. It has real-world implications.
"A world that is greatly out of balance in matters of health is neither stable nor secure," she said in a statement from Almaty, Kazakhstan, where the report was released.
There is a wide gulf between per capita health care expenses in wealthier nations ($6,000 or more) and in the poorest, which succumb to a low of just $20. But there are lessons for rich nations like the U.S. which emerge from that astonishing disparity: High spending does not translate into better health outcomes in quality of life or longevity, suggesting that if the world's resources were more equitably distributed on health care, all nations could still anticipate improvements in health care performance.
"When countries at the same level of economic development are compared,those where health care is organized around the tenets of primary health care produce a higher level of health for the same investment," according to the report.
Here are five global shortcomings on health care identified by WHO:
Inverse care. People with the most means – whose needs for health care are often less – consume the most care, whereas those with the least means and greatest health problems consume the least. Public spending on health services most often benefits the rich more than the poor11 in high- and low income countries alike.
Impoverishing care. Wherever people lack social protection and payment for care is largely out-of-pocket at the point of service, they can be confronted with catastrophic expenses. Over 100 million people annually fall into poverty because they have to pay for health care.
Fragmented and fragmenting care. The excessive specialization of health-care providers and the narrow focus of many disease control programs discourage a holistic approach to the individuals and the families they deal with and do not appreciate the need for continuity in care. Health services for poor and marginalized groups are often highly fragmented and severely under-resourced16, while development aid often adds to the fragmentation.
Unsafe care. Poor system design that is unable to ensure safety and hygiene standards leads to high rates of hospital-acquired infections, along with medication errors and other avoidable adverse effects that are an underestimated cause of death and ill-health.
Misdirected care. Resource allocation clusters around curative services at great cost, neglecting the potential of primary prevention and health promotion to prevent up to 70 percent of the disease burden. At the same time, the health sector lacks the expertise to mitigate the adverse effects on health from other sectors and make the most of what these other sectors can contribute to health.
