One cornerstone of justice and equality is equal capability to achieve health (Sen 2002). Those whose lives are cut short by unequal economic and social conditions are subject to a brutal inequality. For this reason, measures of survival, such as life expectancy, have justly become key indicators of social progress. We examine five aspects of health inequality: 1) inequalities of life and death between countries, 2) causes of death 3) disease prevalence, 4) health care spending. 5) inequalities within countries Inequalities of life and death between countries A child born in Swaziland is nearly 30 times more likely to die before the age of five than a child born in Sweden. (There are 119 deaths per thousand births in Swaziland compared to four in Sweden.) A child in Cambodia is 17 times more likely to die in its first five years than a child in Canada. These are differences between average child mortality rates in those countries. Inequalities within countries (described below) mean that the difference between the mortality of poor children in Swaziland and of rich children in the US is considerably larger. Inequalities of life expectancy, infant mortality and under five mortality are examined in Life and death -- inequalities between countries.
Causes of death Worldwide, one death in three is from a communicable disease (see figure), yet almost all these deaths occur in the Third World. The relative infrequency of death due to communicable disease in the industrialized world shows what world health equality could achieve. We examine these contrasts in Causes of death. Disease prevalence In the section Disease and Immunization, we examine national rates of disease incidence. Maps and graphics show the global pattern of incidence, and levels of immunization, for selected communicable diseases, generally for the last four decades. These pages show the decline of communicable diseases and the spread of immunization in many countries of the world (The figure below shows the global reduction in the prevalence of measles associated with the spread of immunization). Contrasts of health care spending and achievement Some countries achieve high life expectancy while spending little on health care. Others spend heavily while achieving relatively low life expectancy. In the graph below, the most striking comparison is between the US and Cuba. Cuba achieves virtually identical life expectancy to the US while spending less than $200 per person on health care, compared to $4,400 per person in the US.
In the section on Health care spending we look at some of the factors explaining these contrasts, and the "inverse care law" - the rich receive care while the poor have most of the illness and death and do not receive care. Wide inequalities also exist within countries National health data usually overlooks inequality within countries. Governments rarely collect systematic data on the differences between mortality rates and life expectancies of rich and poor. The graph below shows the Under Five Mortality of the children of the poor and of the rich for 44 countries for which data is available. We examine other examples in Within country inequalities.
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