Equity in health and equity in health care have been ill-served in recent years.
While for many health care systems equity is stated to be an important goal, in
several of these equity in policy terms has been paid little more than lip-service.
While it is also the case that there has been an increasing research interest in the
social determinants of health, the extent to which the recognition of the impact of
these on health has led to action at a policy level has been limited. Poverty and
inequality are now well recognized in the academic literature, especially in social
epidemiology but in public health more generally, as contributing to population ill
health. National and global policy makers, however, have been all too little
concerned to address poverty and inequality and, inevitably, even less concerned
to do so for reasons purely of improving health.
Health economists have contributed considerably to debates about the construct
of equity in health care, be this seen in terms of health, access or use and
whether horizontal or vertical equity. Beyond considerable success in the 1970s
and 1980s in assisting methodologically to improving equity in health care
through needs-based, RAWP-type resource allocation formulae (DHSS 1976),
policy on equity in health care has been a field where health economists have
made relatively little impact.