To Meet the Unmet: Preparing for health equity Challenges in WHO South-East Asia Region, 2024
Overview
Health inequities are unjust and avoidable systematic differences in the health status and access to health resources of different population groups. Health inequity manifests itself at all levels as differences across countries, within countries, between communities, and within population groups. Health inequities arise from social determinants of health, or social and environmental conditions in which people are born, grow, live, work and age; they do not occur randomly or by chance, and are largely beyond an individual’s control. These social determinants include a person’s education, income, access to social and health services, and good nutrition, access to healthy housing and environment factors.
A common phenomenon in all countries: the lower an individual’s socioeconomic position, the higher their risk of poor health. Because of its impact on population health and socioeconomic development, enhancing health equity, therefore, is an overarching goal of health system and universal health coverage (UHC).
The most worrying aspect of health inequity is the unmet health need, which is generally defined as people who need health services but do not use, or are unable to use, them for whatever reasons. Unmet need consists of two components; firstly, forgone care which occurs when someone who realizes the needs for services but is unable to access the services expressed; and secondly unexpressed (or un-realized) demand for health care. Unmet health care needs can result from various barriers, from both supply and demand sides of health care, and beyond the health system. Monitoring unmet need and understanding the reasons or forgone care are key components for monitoring and achievement of UHC.
Health inequities, expressed as discrepancies in health outcomes and access to health care, as well as unmet health needs, are a top agenda in the South-East Asia Region. Evidence shows that disadvantaged population groups are disproportionately vulnerable to poor health status, higher health risks and less access to health system resources. These groups include those having geographical hardships (island and rural); those with lower economic status, less education; women and children; the elderly; ethnic and gender-based minorities; migrants and refugees; and people living with diseases and health conditions. Twenty-five case studies in this document reflect a common direction from all Member States of the Region in tackling health inequities and addressing health needs of marginalized population groups. Besides strengthening of health system components and harnessing digital health, common success factors include a strong political commitment with a common understanding of the capacity of health systems, and coordination mechanisms across agencies and across levels.
To promote health equity and address the unmet need in the Region, five action areas are needed to tackle three groups of major challenges. These are (i) challenges in health system capacity; (ii) challenges in addressing social, economic and environmental determinants of health inequity; and (iii) challenges in monitoring and tracking progress. The five action areas are:
1. Strengthening system governance, partnership and accountability
2. Realizing UHC through people-centred health system strengthening
3. Ensuring actions beyond the health sector
4. Capitalizing innovations and technologies
5. Enhancing the capacity for monitoring and evaluation.
The WHO Regional Office for South-East Asia is always ready to support Member States in improving health equity through evidence-informed actions and strengthening system capacity, as well as augmenting health leadership beyond the health sector.
