The Relation Of Socioeconomic Status To Health Inequities And Inequalities

People from different backgrounds and social communities living in different countries enjoy health at different levels. In Australia, the level of health enjoyed by its citizens is generally good, however, good health is sometimes not shared equally. There are noticeable differences in the health status of different population group in Australia. For example, differences in life expectancy, mortality rates, incidences of diseases (especially NCDs) and usage of health services. This difference is attributable to ‘Health Inequity’ and ‘Health Inequality’.

Health inequity is the significant difference in the health status between various population groups due to external conditions outside the control of the population. In this case, the unequal distribution of resources or social circumstances maybe unfair or unjust. For example, differences in education, occupation, fresh food, income, employment status, rurality, ethnicity and gender. These unequal distribution cause inequities in health. In United States, infant mortality rates is 13 times higher in Hispanic blacks than Hispanic whites. The differences in infant death rates among this racial group is as a result of preventable difference in health education and access to prenatal care. Whereas, health inequality refer to measurable differences in health of individual or group of people and the observed differences are not subjected to fairness or just. The fact that young people enjoy better health than aged population is not unjust or unfair but health inequality because health differences based on age cannot be avoided or considered unjust since younger people would become old someday and older people were once young too.

Health inequities and inequalities within rural and remote populations, develop from greater exposure to social determinants of health leading to wide disparities in infectious, non-infectious and injury (intentional and unintentional) disease burdens. For example, Indonesia is home to diverse ethnic groups at the same time, absolute inequality persists across all regions of Indonesia; residents living in urban cities like Java and Bali enjoy higher life expectancy, low infant and maternal mortality rate. In 2010, maternal mortality rate in Java and Bali is reported to be 210 deaths per 100,000 live births, on the other hand, in Papua, eastern and remote part of Indonesia, the maternal mortality rate is 573 per 100,000 live births.

Various evidences point to the connection between characteristics of a place of residence and health outcomes even after accounting for individual risk factors. For the past two decades, about 30% of the Australian population lives in rural and remote areas, including areas outside major cities. In comparison with those who live in urban cities, residents in remote areas are exposed to more risk factors. Certainly, they are likely to be smokers, overweight or obese, have lower levels of education, work in risky environments, poorer access to medical services and generally have lower socioeconomic status. For instance, Australians living in rural and remote areas tend to experience poorer health outcomes; lower life expectancy, maternal and infant mortality and higher rates of diseases including Non Communicable Diseases.

In spite of the increased burden of illness in rural and remote areas, there is lack of access to health professionals and services. But, access to health care means little without access to adequate food and safe working conditions. In rural China, there is experience of the burden of malnutrition among children. The risk factors of child nutrition are complex and can differ according to different status of malnutrition. In the case of overweight or obesity among children living in China major cities, the improved economic status drives their preference for eating energy-dense foods, is determined by contextual actors such as physical inactivity environments and urbanisation. On the other hand, under-nutrition among children in rural China, for example underweight and stunting, are often as a result of inadequate food or nutrient deficiency in relation to deprived economic conditions.

The effect of the combination of different levels of remoteness and socioeconomic status (SES) on health and mortality are complex and it is yet to be understood till date. There is a strong association between socioeconomic status and health disparities. For example, preterm birth and intrauterine growth restriction have been consequently associated with people with lower socioeconomic status in Canada. With the infant mortality rates significantly higher in lowest income neighborhoods like British Columbia. Though, the cause of this disparity is not consistent, other factors like race, ethnicity degree of rurality, rates of smoking during pregnancy and other community‐level factors contribute to this health outcome.

Cardiovascular mortality and morbidity represent a high economic and health burden that disproportionately affect the indigenous population in Australia. For those living outside of major cities that is remote and rural areas, there is extremely higher levels of socioeconomic disadvantage compared to their metropolitan counterparts, an attribute also associated with increased preventable mortality and higher rates of chronic disease.

It is no doubt education, health, life expectancy, literacy, per capita income and human development in general have improved in all countries during the last decades. Beyond the global improvements, however, distribution of health inequities among the rural and remote residents relatively to their better off counterparts points to worse health outcomes for example, infant mortality rate. In rural provinces of China, about 20–50% of women of reproductive age have access to basic emergency obstetric care, likewise in India, the infant mortality rate is 50% higher in rural areas than in urban cities, with almost two-thirds of all households using private medical services due to poor quality or absent public services.

A recent review for North African countries, namely Algeria, Egypt, Libya, Morocco and Tunisia established that even though they belong in the same group called ‘Arab World’ as affluent countries, like Saudi Arabia and United Arab Emirates, the health indicators still show disparity with respect to health care access in the rural-urban or regional areas. As an example, more than 30% of the rural population in the remote north east of Morocco travel at least 10 kilometres to reach the nearest hospital because the ratio of available physician is 6362 to 380 in the capital, Rabat.

Health inequities within and between countries, population groups, gender, race are politically, socially and economically unacceptable, unfair and that the promotion of health equity is essential for a better quality of life and well-being for all, which in turn can contribute to peace and security. Health is determined by social and economic factors, thus, people living in rural and remote communities, indigenous people, people from different race and sometimes men and women are exposed to inequalities that stems from the inequities of health.

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