WORLDS CONTEMPORARY HEALTH ISSUES

Worlds Contemporary Health Issues

Worlds Contemporary Health Issues

Introduction

The issue of equity as it relates to the allocation of resources across groups or individuals is very clearly one in which economists have much to contribute. The vast body of literature devoted to this topic not only in the health economics field but also in the economics literature more generally is testament to this. There are, however, many ways in which equity as a principle can be presented. This reflects the fact that equity is about values (Olsen, 1997). Choosing between various possible equity principles therefore necessarily involves value judgement.

Whatever theory is chosen and whatever measures of equity adopted, it is important to note, within the Australian health policy context, the vast differences in health between indigenous and non-indigenous Australians. For instance, Aboriginal and Torres Strait Islander people have an average life expectancy of 15-20 years less than that of Australians in general and infant mortality rates around 3-4 times greater than the general population. In some communities, diabetes rates are 15-20% in comparison to 2-3% in the general Australian population (Abraham, d'Espaignet, & Stevenson, 1995). Such levels of disadvantage are also present in other social indicators. Perhaps, most striking is the evidence that the differences in health status between indigenous and non-indigenous populations are greater in Australia than in the US, Canada or New Zealand ( Kunitz, 1994).

Very clearly, given the significant disparities in health and health-related disadvantage between Aboriginal and non-Aboriginal Australians, the application of some notion of equity has a role to play in the formulation of policy with respect to Aboriginal health. This imperative can be read into virtually any policy statement relating to how health policy should deal with the concerns of the Aboriginal and Torres Strait Islander populations and, at least implicitly and increasingly explicitly, we can add 'vis-a-vis those of the non-Aboriginal and Torres Strait Islander population'. The problem then is to decide what is to be meant by equity in this context. Addressing this question is the aim of this paper. In the section, “Equity and the 'claims' approach”, some of the ways in which the issue of equity has been approached in the literature will be reviewed. In particular, the focus will be on the underlying values embodied in alternative versions of equity. Reference will be made in the section 'Basic needs approach' to the 'claims' approach which can be used to tease out some of the values embedded in notions of equity. The section, 'The bases for a claims approach to equity in Aboriginal and Torres Strait Islander health', contains an appraisal of one commonly cited approach to meeting the needs of the most disadvantaged groups in society, the basic needs approach. Specific reference is made to the values underlying this approach. This is followed in the next section, 'Where to go from here?', by an analysis of the claims approach as it relates to Aboriginal and Torres Strait Islander health. Finally, the section, 'Conclusion', provides a brief description of ...