1. MODERATOR
 DR SUNIL KUMAR .D.
 ASSOCIATE PROFFESOR
 DEPT. OF COMMUNITY MEDICINE
 JSS MEDICAL COLLEGE
PRESENTED BY
 LOKESH DERANGULA
 1ST SEM MPH
 SCHOOL OF PUBLIC HEALTH
 JSS MEDICAL COLLEGE

2. Health equity found in the history of social medicine, since the mid-nineteenth century. Rudolf
Virchow, Friedrich Engels
recognized that social and class inequalities lead to inequities in health.
poses questions and leads to idea into practice.
(WHO, 1946)
“the highest standards of health should be within reach of all, without distinction of race, religion,
political belief, economic or social condition”
IN1948 UN, (UDHR) states that “everyone has the right to a standard of living adequate for the
health and well-being of himself and of his family control.”
IN1978 (WHO) Conference on Primary Health Care in Alma-Ata . The launch of “Health for All”
campaign (HFA), implicitly made health equity a priority for all countries.
IN 1991“The Concepts and Principles of Equity
and Health,” published Health Promotion International.
IN 2005 by the WHO
Equity in health was also a cornerstone of (MDGs) launched, to determine how countries
were advancing on HE in relation to the MDGs.
IN 2015 SDG/ Global Goals, to end poverty, protect the planet and ensure that all people enjoy
peace and prosperity by 2030.

3. overview
 Terminology
 Differences between equity/equality and examples
 Governance of health equity
 Advance health equity
 Health equity index
 Health equity monitoring
 Universal health coverage
 Difficulties facing to attain health equity
 Public health approach to achieve health equity
 Summary
 References

4. TERMINOLOGY
HEALTH : physical and mental health status and well-being,
EQUITY : Fair opportunity to everyone.
EQUALITY : the state of being equal, especially in status, rights, or opportunities
HEALTH EQUITY : Attain highest level of health for all people
as a process (valuing everyone equally reducing disparities in health and
its determinants) and
as an outcome (the elimination of social disparities in health and its determinants).
HEALTH DISPARITIES: differences in health outcomes and their determinants as social,
demographic, environmental, and geographic attributes.
HEALTH INEQUALITIES: differences in health status or in the distribution of health determinants
between different population groups.
HEALTH INEQUITIES: subset of health inequities that are modifiable, associated with social
disadvantage and considered ethically unfair.
SOCIAL DETERMINANTS OF HEALTH: conditions in the environments in which people are born, live
,learn ,work, play, worship, and age that effects a wide range of health

5. DIFFERENCES
Equality means giving everyone the same thing, whereas
Equity means giving people what they need to reach their best health.
Example: three people of different heights are trying to reach the fruit on the tree. In this case, the
fruit symbolizes good health. The different heights of the people represents the unequal distribution of
the social determinants of health in society.
If we treat these people equally, we would give everyone the same box to stand on, so only the tallest
person could reach the fruit.
If we treat them equitably, we would give them as many boxes as they need to reach the fruit.

6. GOVERNANCE OF HEALTH EQUITY
Governing for health equity through action on social determinants
Characteristics of smart governance:
 Collaboration
 Citizen engagement
 Through a mix of regulation and persuasion
 Through independent bodies and expert bodies
 Through adaptive policies, resilient structures and foresight
By these strategic approach to addressing health challenges, including
Reducing health inequalities as whole of government and as whole of society
approaches

7. PRINCIPLES TO ACHIEVING EQUITY IN HEALTH CARE
 Equity metrics
 Capacity building for health systems and health equity research
 Deliberative process of achieving equity in healthcare The challenge of how to
prioritize and implement pro-equity health policies
 Stakeholder responsibilities and accountabilities
 Investing in public health and primary care: cornerstones for equity in health

8. Actions to achieve HEALTH EQUITY

9. OUTCOMES FROM PRINCIPLES
 Good health flourishes across geographic, demographic, and social sectors
 Attaining the best health possible is valued by our entire society
 Individuals and families have the means and the opportunity to make choices that lead
to the healthiest lives possible
 Business, government, individuals, and organizations work together to build healthy
communities and lifestyles
 No one is excluded
 Everyone has access to affordable, quality health care because it is essential to maintain,
or reclaim, health
 Health care is efficient and equitable
 The economy is less burdened by excessive and unwarranted health care spending
 Keeping everyone as healthy as possible guides public and private decision-making

10. Mapping inequities in India

11. grand vision - quality healthcare to the common man.
• AB-NHPM benefit cover of Rs. 5 lakh per family per year.
• Cashless benefits from any public/private empanelled hospitals across the country.
• The beneficiaries can avail benefits in both public and empanelled private facilities.
• To control costs
• to co-operative federalism and flexibility to states.
• For giving policy directions and fostering coordination between Centre and States, it is
proposed to set up (AB-NHPMC) by Union Health and Family Welfare Minister.
• States would need to have State Health Agency (SHA) to implement the scheme.
• To ensure that the funds reach SHA on time, the transfer of funds from Central Government
through AB-NHPM to SHA
• In partnership with NITI Aayog, IT platform will be made operational which will entail a
paperless, cashless transaction.

12. Explaining the Key Steps to Advancing
Health Equity
1. Identify important disparities in health and social inequities in access to
the resources and opportunities needed to be healthy
2. Change and implement policies, laws, systems, environments,
and practices to reduce inequities in access to the opportunities and resources
needed to be healthy.
3. Evaluate and monitor efforts using short-, intermediate-,
and long-term measures.
4. Reassess strategies to plan next steps.

13. Advance Health Equity Practice
Inside strategies:
1. Focus on addressing the “causes of the causes of health inequities” – oppression
and power
2. Prioritize improving the social determinants of health through policy change
3. Build understanding of and capacity to address equity across the organization
4. Support leadership, innovation, and strategic risk-taking to advance equity
5. Change the narrative of what leads to health
6. Commit the organization and its resources to advance equity
7. Use data, research, and evaluation to make the case
8. Change internal practices such as hiring and contracting

14. Outside strategies:
Externally focused practices to advance health equity
1. Build partnerships with communities experiencing health inequities in ways that
intentionally share power and decision making and allow for meaningful
participation
2. Build alliances and networks with community partners to protect against risk and
build power
3. Build alliances with other public agencies
4. Engage strategically in social justice campaigns and movements
5. Change the administrative and regulatory scope of public health practice
6. Join broader public health movements to advance equity

15. HEALTH EQUITY INDEX
What is the Heath Equity Index?
 The Health Equity Index is a community-based assessment that can be used to
identify social, political, economic, and environmental conditions that are most
strongly correlated with specific health outcomes. The Health Equity Index is
implemented in conjunction with public health workforce development and
community engagement strategies as an overall approach to address health
inequities.
Why was the Health Equity Index Developed?
 Unlike approaches that describe differences in health status among certain
populations, the Health Equity Index was developed to focus on the root causes of
differences in health status.

16. How does the Health Equity Index Work?
The Health Equity Index is based on a seven social factors (determinants) that are
linked to health status:
• Civic Involvement/Political Access
• Community Safety and Security
• Economic Security
• Education
• Employment
• Environmental Quality
• Housing
What can the Health Equity Index Do?
•Illuminate conditions in neighborhoods and communities that are the root cause of
health.
•Encourage collaboration between public health personnel, community leaders,
municipal department heads, neighborhood residents, and community-based
to address health inequities.
•Provide an opportunity to focus policymakers’ efforts and investments in prevention,
improving conditions that promote good health rather than waiting for people to become
sick.

17. HEALTH EQUITY MONITORING
 “Identifying health inequalities and their drivers is essential for achieving health
equity”
WHO Thirteenth Global Programme of Work (GPW13)
 promotes the “strategic disaggregation of data through collection,
 The Health Equity Monitor database, a large database of disaggregated data,
which currently includes data for more than 30 reproductive, maternal, newborn
and child health indicators, disaggregated by six dimensions of inequality, from
over 360 international household health surveys conducted in 112 countries in
1991-2017.
 Interactive data visualizations, that present data from the Health Equity Monitor
database in an interactive way.
 The Health Equity Assessment Toolkit, a software application for assessing health
inequalities in countries.

18. UNIVERSAL HEALTH COVERAGE
UHC means that all people have access to the health services they need, when and where
they need them, without financial hardship. It includes the full range of essential health
services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
Currently, at least half of the people in the world do not receive the health services they
need. About 100 million people are pushed into extreme poverty each year because of out-
of-pocket spending on health. This must change.
UHC should be based on strong, people-centerd PHC. GHC are not only on preventing and
treating disease and illness, but also on helping to improve well-being and quality of life.
Service Delivery and Safety (SDS)
Health financing
Essential medicines and health products
Health system governance
Health workforce
Health statistics and information systems

19.  On 23 September 2019 a high-level meeting on UHC will be held at the UNGS Moving
Together to Build a Healthier World’, will bring together heads of state, political and health
leaders, policy-makers, and universal health coverage champions to advocate for health
for all.
UHC Key Asks :
 1. Ensure Political Leadership Beyond Health
 2. Leave No One Behind
 3. Regulate and Legislate
 4. Uphold Quality of Care
 5. Invest More, Invest Better
 6. Move Together

20. CHALLENGES
 The epidemiological transition.
 Low investment.
 Lack of accessing opportunities.
 Low quality of health services at primary care level.
 Financial crisis of the country.
 Less participation of innovation and implementation to find solutions of
health problems.
 Long way in achieving better health outcomes.
 India has one of the low density of health work force.
 Poor connection with remote areas.

21. Health Equity Network India
The network brings together individuals and institutions interested in advancing health
equity through research, advocacy and action.
The network was an outcome of the “Closing the gap:
Health equity research initiative in India” by the Achutha Menon Centre for Health
Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology,
Trivandrum. The health equity cluster is the national secretariat for the network.

22. PUBLIC HEALTH APPROACH
Access to high quality health care
Provide equal and social economic opportunities
Invest in and revitalize in low income neighborhoods

23. SUMMARY
Health equity existence since mid 19th century to SDG s and still follow up to 2030
Definitions of health equity and differentiation with equality with example
Governance key points social determinants and disparities to achieve health equity
Strategies of advance health equity
What why how about Health equity index
Health equity monitoring, database, HEFA
Universal health coverage towards wellbeing and quality of life and its key tasks
What are the challenges facing to achieve health equity
As a public health personnel How to approach towards health equity
By reducing health inequalities and disparities

24. REFERENCES
 Health Equity apha.org
 Cdc.gov/HealthEquity guide
 Sdoh.org Health Equity Alliance(Health Equity Index)
 WHO Universal Health
 https://www.india.gov.in/spotlight/ayushman-bharat-national-health-protection-
mission
 https://www.who.int/gho/health_equity/about/en/(health equity monitoring).