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Health inequality refers to the differences in health status that occur among individuals or groups based on factors such as income level, race, and gender. In this article, we will explore the meaning of health inequality, the current situation, and the ways to address it.

The country you were born in, the race you were born into. Is it right for such conditions to determine a person’s lifespan?

In Sub-Saharan Africa, the mortality rate for children under five is 14 times higher than in developed countries. Most of these deaths are due to preventable diseases, largely because Sub-Saharan Africa lacks basic healthcare systems.

Developed countries are not exceptions either. In the United States, the maternal mortality rate for Black women is 2.5 times higher than that for white women. Everyone has the right to safe medical services during childbirth, but the reality for Black women is far from that.

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Q. What is Health Inequality?

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A. Health inequality refers to a situation where people do not receive equal access to the resources necessary for maintaining their health.

For example, some people can easily go to good hospitals, while others cannot because the hospitals are far away and expensive, so they avoid seeking care even when they are sick.

Because of these differences, some people get sick more often than others, and can even die from simple illnesses. This is what health inequality is all about.

The World Health Organization (WHO) defines health inequality as follows:

"Health inequalities are avoidable inequalities in health between groups of people within countries and between countries. These inequalities arise from inequalities within and between societies."

The International Society for Equity in Health defines health inequality as “the differences that exist between socially, economically, and geographically distinct population groups, manifested in one or more aspects of health, which are systematic and potentially improvable.”

Health is a fundamental human right.

Every person has the right to receive quality medical services without discrimination from the moment they are born, so ensuring this right goes beyond mere economic benefits; it is about preserving human dignity.

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Global Health Inequality Types and Current Status

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Health inequality manifests in various forms worldwide, primarily arising from economic, social, and environmental factors.

1. Economic Inequality

Economic inequality refers to differences in access to health services based on income levels.

∎ Low- and Middle-Income Countries

According to the World Health Organization (WHO), the gap in health service coverage between the wealthy and the poor in low- and middle-income countries has decreased from 40% to 20% over the past decade. While this represents significant improvement, there remains a substantial gap.

∎ Health Disparities by Income

The Centers for Disease Control and Prevention (CDC) has reported that the incidence of chronic diseases varies significantly by income level. Low-income individuals experience higher rates of chronic diseases such as obesity, diabetes, and cardiovascular disease compared to high-income individuals. For example, the rates of diabetes and cardiovascular disease in low-income populations are 2 to 3 times higher than those in high-income populations (CDC Blogs).

2. Social Inequality

Social inequality refers to differences in health status and access to healthcare services based on social factors such as race, gender, and education level.

∎ Race and Ethnicity

In the United States, the mortality rates from preventable and treatable causes are highest among Black individuals and American Indian/Alaska Native populations. Notably, the maternal mortality rate for Black women is 2.5 times higher than that for white women.

∎ Gender

According to a WHO report, women are more vulnerable to certain diseases compared to men and may face difficulties accessing maternal health services. For instance, in low- and middle-income countries, about 40% of women do not receive assistance from skilled healthcare personnel during childbirth.

3. Geographic Inequality

Geographic inequality refers to differences in health status and access to healthcare services based on residential location.

∎ Urban-Rural Disparities

Individuals living in rural areas have lower access to healthcare services compared to those in urban areas. According to WHO data, children in rural areas are over 50% more likely to miss vaccinations than children in urban areas.

∎ Regional Health Status Differences

According to the WHO’s health inequality monitoring, the under-five mortality rate in Sub-Saharan Africa is more than 14 times higher than that in developed countries.

4. Environmental Inequality

Environmental inequality refers to disparities arising from the impact of environmental factors, such as air and water quality, and living conditions on health.

∎ Environmental Pollution

Areas predominantly inhabited by low-income populations often face severe air and water pollution, which can harm health. According to WHO reports, approximately 91% of people worldwide live in areas where air pollution levels exceed WHO's recommended guidelines, resulting in about 7 million premature deaths each year.

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Health Inequality: What is the problem?

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Health inequality is a human rights issue. We are all beings of equal value, and everyone has the right to access the medical services they need.

Moreover, health inequality is a significant problem that has serious repercussions for society. When many people are sick, it places a heavy burden on the economy.

For instance, in the United States, the additional healthcare costs due to health inequality amount to about $23 billion annually, primarily arising from preventable diseases and the management of chronic conditions (National Academies).

Above all, health inequality exacerbates social inequality. Individuals in poor health are more likely to face disadvantages in education and employment opportunities, creating a vicious cycle that leads to income inequality.

As a result, the deeper the health inequality, the greater the social discontent, which can lead to social unrest and conflict.

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How can we reduce health inequality?

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Dr. Gino Strada, a recipient of the Sunhak Peace Prize, once said,

"Health is a fundamental human right, and it requires the social and political will to provide it."

The international community also regards this issue as a key focus for creating a better world. The World Health Organization (WHO) and the United Nations (UN) have made "Universal Health Coverage (UHC)," ensuring that everyone can access the healthcare services they need, the third goal of the Sustainable Development Goals (SDGs), and are actively working on various initiatives.

(Source: Cancer Council)

▪ Providing quality essential healthcare services:

  - Preventive services: Vaccinations, maternal health checkups, disease prevention campaigns, etc.

  - Treatment services: Emergency care, surgeries, cancer treatment, etc.

  - Rehabilitation services: Physical therapy, vocational rehabilitation, etc.

  - Health promotion: Nutrition counseling, exercise programs, mental health services, etc.

▪ Reducing the financial burden of healthcare:

  - Healthcare costs: Household healthcare expenditure ratios, protection against expensive medical services.

  - Insurance benefits: Coverage scope of health insurance, premium support, public healthcare assistance, etc.

▪ Ensuring healthcare for all:

  - Protection for vulnerable groups: Ensuring healthcare access for socially vulnerable groups such as low-income individuals, people with disabilities, and rural residents.

  - Regional balance: Balancing the quality and accessibility of healthcare services between urban and rural areas, or across different regions.

▪ Providing high-quality healthcare services:

  - Improving patient satisfaction: Surveys on patient experiences and satisfaction.

  - Enhancing service efficiency and effectiveness: Disease treatment rates, effectiveness of preventive services, medical error rates, etc.

Despite global efforts, health inequality remains widespread around the world.

Margaret Whitehead, a British epidemiologist, has defined health inequality as something that is "unfair, unjust, and should not exist, yet is also something that can be overcome."

The key point is that it is "overcomeable." When each citizen holds social and political will toward the right to health, we can create a better world. We must all pay greater attention so that the day comes when everyone around the world has equal access to healthcare services.

"Human rights mean that every living human being has equal dignity.

They cannot be divided into classes A, B, or C based on wealth disparity.

Because all living beings hold equal value."

—Sunhak Peace Prize Laureate Dr. Gino Strada—

Written by: Director Choi Yeon-jae