Elizabeth Fee and Ana Rita Gonzalez
Health equity has long been an ideal, with roots in social medicine reaching back into the mid-nineteenth century when visionary public health leaders and social critics recognized that social and class inequalities led to inequities in health. The Constitution of the World Health Organization states that “the highest standards of health should be within reach of all, without distinction of race, religion, political belief, economic or social condition”. The Universal Declaration of Human Rights of the United Nations states that “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family” and that “Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status”. Various organizationsthe Rockefeller Foundation, the World Bank, and many nongovernmental organizations (NGOs) have frequently used the terms “health equity” and “inequity” in their statements of mission and purpose. In 1971, Julian Tudor Hart coined the Inverse Care Law: "The availability of good medical care tends to vary inversely with the need of the population served.” Other analysts have pointed out that medical care is only one of the requirements for good health, with income, education, nutrition, sanitation, and living and working conditions all being essential determinants of health. Margaret Whitehead has emphasized the difference between health differentials that are unavoidable, and those that are avoidable and preventable; the latter were health inequities and recognized as injustices. This essay traces the history of the idea of health equity and raises questions about the translation of the concept into practice.
