15-16 JUNE 2016 / Tour & Taxis / Brussels

Right to health: What about the equity?

<p>In 2000, the United Nations Millennium Declaration promoted equality as an essential value to international relations in the 21th century. However, despite efforts towards its accompanying Millennium Development Goals, inequities seem to have increased at national and international levels. It is a political, social, economic and environmental issue; it is about fairness and justice.</p> <p>How equity can be better included in the future development framework is at the core of the current debate on the post-2015 agenda. This session aims at deepening ideas on this question, taking stock of the experiences of Belgian, EU and southern actors. How does development cooperation tackle inequities? Which tools are used? How should the development cooperation approach be changed?</p> <p>The focus of the session will be on the right to health and healthcare in low-income countries.</p>
Lab 4
Session type: 
Tuesday, November 26, 2013 -
09:30 to 10:45
Key Points: 
  • Better equity in health can help the expansion of universal health coverage as a right.
  • This is not just an issue for the health services, but requires an ‘all-government’ approach.
  • The approach post-2015 must be inclusive, multisectoral, cross-governmental, integrated and comprehensive.
  • Efforts should focus on the poorest – the lowest 20 % of the population.

Equity in healthcare is about ensuring equal treatment of individuals or of groups. Participants set out to get a better understanding of the key issues underlying inequities in healthcare and to map out possible post-2015 strategies.

A key issue in this debate is the expansion of universal health coverage (UHC), which should be endorsed by national governments as an obligation and a right. UHC in developing countries is problematic as they only have a limited resource base for taxation.

Emma Iriarte, Executive Secretary of Salud Mesoamerica 2015, pointed out that many governments do have the possibility to sustain investment in healthcare through their existing pubic budgets. A country like Guatemala, she noted, had a health budget of US$ 2 billion dollars in 2012, enough to cover the minimum level of care if used fairly.

She said that in Mesoamerica the poorest have been left behind. While the national averages appear normal, the situation is bad for those at the lowest income level. For example, 80 % of children in Panama are anaemic. Only 30% have the full vaccination needed for their age. Only 3 % of women are using contraception. It is important to target the poorest 20 % of the population and identify which are the best interventions for them.

A further bottleneck in implementing UHC is the shortage of the qualified health workers needed to underpin a universal system. This gap is currently estimated at 7 million health workers and is increasing. In addition, ageing populations with growing care needs is increasing the demand for trained carers.

The expansion of the number of local community health workers is a partial solution, however, it is important to avoid having a dual system with trained doctors for the rich and informal community health workers for the poor.

Remco van de Pas, Head of Human Resources for Health Project at the Wemos Foundation, pointed out that inequity in health is not only an issue for less developed countries. Inequalities are also growing in Europe. In Greece, for example, social protection is being eroded by the collapse of the economy. It is necessary to put the European house in order, he said.

Bart Criel, Associate Professor and Head of the Health Financing Unit at the Institute of Tropical Medicine in Belgium, also pointed to the health inequities that exist in Belgium despite its excellent social protection and health system. People in the weakest socioeconomic groups have shorter lives and spend fewer years in good health.

One of the cornerstones of Belgium’s sustainable development policy and vision is Health For All. To make this work effectively it is important to designate a contact person at all levels of government to increase capacity building, raise awareness and improve involvement regarding health inequities.

There is a need for development cooperation to move beyond aid towards a governmental obligation to provide universal healthcare. There should super-national regulation concerning healthcare rights that can define a minimum level or base.

To strengthen equity in health, governments must change their approach and not just focus on the health sector. A pan-governmental or ‘all-government’ approach is needed to promote health equity. Each country should have a mechanism at government level to implement an all-society approach.


There is no simple single solution. What is needed is an multisectoral, integrated approach with an all-government focus on healthcare needs.

  • Health

    Poverty generates ill health, and poor health, in turn, increases vulnerability and poverty. The growing burden of non-communicable diseases increasingly also affects the poor. However, reducing the burden of infectious diseases remains essential and a prerequisite to reduce malnutrition. Controlling diseases is also a key element for economic growth. Therefore, the EU is strongly committed to increasing equitable access to quality health services in developing countries, whilst ensuring social protection against the financial risks of disease, strengthening social inclusion and boosting global health.

    In line with its Communication on ‘The EU Role in Global Health’, the EU pursues a rights-based approach to health and provides support to developing countries to develop their health policies. Support is also given to strengthen health systems and ensure that health is appropriately considered in other policies, in order to reduce inequalities in health and in access to healthcare, to improve the quality of care, to provide more comprehensive services and to protect against the financial risks of excessive health costs – also ensuring that women’s health concerns are appropriately considered.

    While the EU is a major supporter of global health initiatives – such as the Global Fund to fight HIV/AIDS, malaria and tuberculosis, and the GAVI Alliance for Immunisations – and of the specialised UN organisations – such as the World Health Organization – the main focus of the EU’s assistance in the health sector is to provide support directly to partner countries and support countries’ own efforts to achieve universal health coverage.

    In the Communication ‘An Agenda for Change’ on EU development policy, the EU confirms its commitment to health by announcing that at least 20 % of its 2014-20 aid budget will be allocated for human development and social inclusion, including health. Furthermore, the 2013 Communication on the post-2015 global development goals sets out the EU’s intention to provide a balanced approach to poverty eradication and sustainable development, ensuring basic living standards, including health, for all.