Health Inequity And Territorial Disparity In Under-Five Mortality Between and Within Who-EMR Countries
Health equity was stressed in the Constitution of the World Health Organisation in 1946 and then regularly reaffirmed by different declarations and reports such as the Alma Declaration, the Rio Political Declaration on Social Determinants of Health, the Commission on Social Determinants of Health and a multitude of conferences on health prevention. However, despite the formal engagement of governments world-wide, health gaps between rich and poor, rural and urban, educated and non educated as well as territorial disparity remain a challenge for health decision makers in developing countries as well as in developed countries. In this paper, we concentrate on inequalities in under-five mortality rate in eleven WHO-Eastern Mediterranean countries.
We used disaggregated data provided by well known surveys like Demographic Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), Pan Arab Family Health Surveys (PAPFAM) and World Health Surveys (WHS) to compare under-five mortality rate between eleven WHO-EMR countries and within each country, using differences by income, education, milieu (rural-urban) and territorial residence.
In the 11 WHO-EMR countries considered, health inequity was found in under-five mortality rate between rich and poor, educated and non educated mothers, rural and urban children and according to territorial residence. Between countries, U5MR follows a clear gradient.
The comparison between the eleven countries showed a gradient in under-five mortality rate with a level between 10 and 20 in one country, between 20 and 50 in five countries and greater than 50 in five countries. The U5MR is highly inversely correlated with HDI. In each country, a more or less large ratio between the highest and the lowest level of under-five mortality rate was generated by income, education, rural-urban and territorial residence.
This study shows that huge gaps are seen in U5MR between and within the 11 WHO-EMR countries considered. The third goal of the Sustainable Development Goals is "to Ensure healthy lives and promote well-being for all at all ages", leaving no one behind. Consequently, health decision makers in WHO-EMR countries should consider seriously the persisting problem of health inequalities and face this challenge urgently and efficiently.
Key words - Health inequity, income, education, territorial disparity, Eastern Mediterranean