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2. Health screening, development, and equity.

Author

Braveman P and Tarimo E

Subjects
Decision Making, Organizational, Ethics, Health Services Needs and Demand, Mass Screening standards, Developing Countries, Health Care Rationing, Mass Screening economics
Abstract

Given the worldwide epidemiologic transition and the lure of technology aggressively promoted by those profiting from it, policy-makers in developing as well as industrialized countries now frequently face decisions on the introduction of screening into routine health services. Concerns regarding development and equity raise issues that may not arise within the scientific, technical, or individually-focused ethical frameworks used in prior work on screening policy. Screening can divert attention from primary prevention of a society's most important threats to health, especially when primary prevention faces political challenges and screening costs are viewed in isolation from the overall strategy required to make it useful. For secondary prevention of diseases with easily recognizable symptoms, public education promoting timely self-referral to accessible medical services is preferable to "screening" unselected populations. In any country, but perhaps especially in developing countries, screening may waste scarce resources: it could also lead to widened inequities.

Published
1996

3. Strengthening health information systems to address health equity challenges

Author

Nolen, L. B., Braveman, P., Dachs, J. N. W., Iris Delgado, Gakidou, E., Moser, K., Rolfe, L., Vega, J., and Zarowsky, C.

Subjects
Public Health Informatics, Socioeconomic Factors, Social Justice, Humans, Policy Making, Developing Countries, Health Services Accessibility, Research Article, Information Systems
Abstract

Special studies and isolated initiatives over the past several decades in low-, middle- and high-income countries have consistently shown inequalities in health among socioeconomic groups and by gender, race or ethnicity, geographical area and other measures associated with social advantage. Significant health inequalities linked to social (dis)advantage rather than to inherent biological differences are generally considered unfair or inequitable. Such health inequities are the main object of health development efforts, including global targets such as the Millennium Development Goals, which require monitoring to evaluate progress. However, most national health information systems (HIS) lack key information needed to assess and address health inequities, namely, reliable, longitudinal and representative data linking measures of health with measures of social status or advantage at the individual or small-area level. Without empirical documentation and monitoring of such inequities, as well as country-level capacity to use this information for effective planning and monitoring of progress in response to interventions, movement towards equity is unlikely to occur. This paper reviews core information requirements and potential databases and proposes short-term and longer term strategies for strengthening the capabilities of HIS for the analysis of health equity and discusses HIS-related entry points for supporting a culture of equity-oriented decision-making and policy development.

4. Methodological concerns and recommendations on policy consequences of the World Health Report 2000.

Author

Almeida, Celia, Braveman, Paula, Gold, Marthe R, Szwarcwald, Celia L, Ribeiro, Jose Mendes, Miglionico, Americo, Millar, John S, Porto, Silvia, do Rosario Costa, Nilson, Rubio, Vincente Ortun, Segall, Malcolm, Starfield, Barbara, Travessos, Claudia, Uga, Alicia, Valente, Joaquim, Viacava, Francisco, Almeida, C, Braveman, P, Gold, M R, and Szwarcwald, C L

Subjects
*HEALTH, *EVALUATION of medical care, *HEALTH surveys, *WORLD health, *FORECASTING, *HEALTH planning, *HEALTH services accessibility, *INFANT mortality, *HEALTH policy, *PRIMARY health care, *SOCIOECONOMIC factors, DEVELOPING countries
Abstract

Suggests changes to the flawed approach of the World Health Report 2000. Concern about data availability, as well as the methods for determining health-system responsiveness, health distribution and inequalities; Flaws in the definition of fair financing; Methodological limitations and controversies; Use of relevant publications; Controversies about the measure of health status; Concerns about the multi-component indices used; Policy context of measurement issues; Conclusion.

Published
2001
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