Eqüidade em saúde: uma análise crítica de conceitos

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Abstract

A eqüidade em saúde tem sido estudada principalmente a partir de uma perspectiva epidemiológica e pouca atenção tem sido dada às questões conceituais. Em grande parte dos estudos revisados, a eqüidade tem sido utilizada como sinônimo de igualdade, e seu oposto, a iniqüidade, como sinônimo de desigualdade. As tentativas de melhor precisar seus significados têm sido, em boa parte, descritivas, com lacunas no que diz respeito à discussão das relações entre eqüidade em saúde, justiça e o processo de determinação social da saúde-doença. Neste ensaio, pretendemos analisar criticamente a série significante diversidade, diferença, desigualdade, iniqüidade, distinção no que concerne à produção da saúde-doença-cuidado em grupos sociais e suas possibilidades de articulação a uma teoria social da saúde. Nesse percurso, estaremos apoiados, por um lado, no conceito de Perelman de eqüidade e em alguns dos argumentos de Heller sobre a justiça e, por outro lado, na sociologia das práticas de Bourdieu, com o objetivo de melhor desenvolver esses conceitos, procurando discutir implicações para a formulação de políticas públicas no campo da saúde.

Translated abstract

Health inequalities have been studied mainly from an epidemiological perspective, with limited attention to conceptual issues. The terms "equity" and "equality" have often been used as synonyms, as have their opposites, "inequity" and "inequality". The few attempts to establish their meanings have been either purely descriptive or have failed to add to an understanding of the underlying dynamics in health-disease-related phenomena. The present essay explores the semantic series that includes difference, diversity, distinction, inequality, and inequity and its relationship to health phenomena in light of Perelman's concept of equity, Bourdieu's sociology, and some arguments in Heller's theory of justice, with the aim of contributing to the development of these concepts, while discussing their implications for policymaking in health.

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The concepts and principles of equity and health.

M. WHITEHEAD (1992)

In 1984, the 32 member states of the World Health Organization European Region took a remarkable step forward in agreeing unanimously on 38 targets for a common health policy for the Region. Not only was equity the subject of the first of these targets, but it was also seen as a fundamental theme running right through the policy as a whole. However, equity can mean different things to different people. This article looks at the concepts and principles of equity as understood in the context of the World Health Organization's Health for All policy. After considering the possible causes of the differences in health observed in populations--some of them inevitable and some unnecessary and unfair--the author discusses equity in relation to health care, concentrating on issues of access to care, utilization, and quality. Lastly, seven principles for action are outlined, stemming from these concepts, to be borne in mind when designing or implementing policies, so that greater equity in health and health care can be promoted.