Cities for global health

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Abstract

In the first of a new series of articles on the role of cities in health, Majid Ezzati and colleagues call for greater action to reduce health inequalities within cities

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Most cited references 26

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The majority of people now live in urban areas and will do so for the foreseeable future. As a force in the demographic and health transition, urbanization is associated with falling birth and death rates and with the shift in burden of illness from acute childhood infections to chronic, noncommunicable diseases of adults. Urban inhabitants enjoy better health on average than their rural counterparts, but the benefits are usually greater for the rich than for the poor, thus magnifying the differences between them. Subject to better evidence, I suggest that the main obstacles to improving urban health are not technical or even financial, but rather are related to governance and the organization of civil society.

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Equity of access to health care services: theory and evidence from the UK.

M. Goddard, P. Smith (2001)

The pursuit of equity of access to health care is a central objective of many health care systems. This paper first sets out a general theoretical framework within which equity of access can be examined. It then applies the framework by examining the extent to which research evidence has been able to detect systematic inequities of access in UK, where equity of access has been a central focus in the National Health Service since its inception in 1948. Inequity between socio-economic groups is used as an illustrative example, and the extent of inequity of access experienced is explored in each of five service areas: general practitioner consultations; acute hospital care; mental health services; preventative medicine and health promotion; and long-term health care. The paper concludes that there appear to be important inequities in access to some types of health care in the UK, but that the evidence is often methodologically inadequate, making it difficult to draw firm conclusions. In particular, it is difficult to establish the causes of inequities which in turn limits the scope for recommending appropriate policy to reduce inequities of access. The theoretical framework and the lessons learned from the UK are of direct relevance to researchers from other countries seeking to examine equity of access in a wide variety of institutional settings.

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Inequity and inequality in the use of health care in England: an empirical investigation.

Stephen Morris, Matthew Sutton, Hugh Gravelle (2005)

Achieving equity in healthcare, in the form of equal use for equal need, is an objective of many healthcare systems. The evaluation of equity requires value judgements as well as analysis of data. Previous studies are limited in the range of health and supply variables considered but show a pro-poor distribution of general practitioner consultations and inpatient services and a pro-rich distribution of outpatient visits. We investigate inequality and inequity in the use of general practitioner consultations, outpatient visits, day cases and inpatient stays in England with a unique linked data set that combines rich information on the health of individuals and their socio-economic circumstances with information on local supply factors. The data are for the period 1998-2000, just prior to the introduction of a set of National Health Service (NHS) reforms with potential equity implications. We find inequalities in utilisation with respect to income, ethnicity, employment status and education. Low-income individuals and ethnic minorities have lower use of secondary care despite having higher use of primary care. Ward level supply factors affect utilisation and are important for investigating health care inequality. Our results show some evidence of inequity prior to the reforms and provide a baseline against which the effects of the new NHS can be assessed.

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Author and article information

Contributors

Majid Ezzati: Role: professor of global environmental health

Christopher J Webster: Role: dean and chair professor of urban planning and development economics

Yvonne G Doyle: Role: director for London

Sabina Rashid: Role: dean and professor

George Owusu: Role: professor and director

Gabriel M Leung: Role: dean and chair professor of public health medicine

Journal

Journal ID (nlm-ta): BMJ

Journal ID (iso-abbrev): BMJ

Journal ID (publisher-id): BMJ-UK

Journal ID (hwp): bmj

Title: The BMJ

Publisher: BMJ Publishing Group Ltd.

ISSN (Print): 0959-8138

ISSN (Electronic): 1756-1833

Publication date Collection: 2018

Publication date (Electronic): 3 October 2018

Volume: 363

Electronic Location Identifier: k3794

Affiliations

[1 ]School of Public Health, MRC-PHE Centre for Environment and Health, WHO Collaborating Centre on Non-Communicable Disease Surveillance and Epidemiology, Imperial College London,

[2 ]Faculty of Architecture, The University of Hong Kong, Hong Kong, China

[3 ]Public Health England, London, UK

[4 ]James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh

[5 ]Centre for Urban Management Studies, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Accra, Ghana

[6 ]LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China

Author notes

Correspondence to: M Ezzati majid.ezzati@ 123456imperial.ac.uk

Article

Publisher ID: ezzm044191

DOI: 10.1136/bmj.k3794

PMC ID: 6170897

PubMed ID: 30282765

SO-VID: fb590e8b-7ebc-4ce7-8bff-469fe994a8f8

License:

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.

Cities for global health

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Most cited references 26

Health and urban living.

Equity of access to health care services: theory and evidence from the UK.

Inequity and inequality in the use of health care in England: an empirical investigation.

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