Social inequalities and their impact on children's health: a current and global perspective

Abstract Objective: To describe the consequences of social inequalities on children's health as a global and persistent problem, demonstrating its historical and structural roots in different societies. Data sources: Relevant articles in the PubMed/MEDLINE database, in addition to those found in a manual search and in the bibliographic references of selected studies and consultation to the websites of international organizations to obtain relevant data and documents. Data synthesis: To understand how inequities affect health, it is necessary to know the unequal distribution of their social determinants among population groups. In the case of children, the parental pathway of determinants is central. The non-equitable way in which many families or social groups live, determined by social and economic inequalities, produces unequal health outcomes, particularly for children. This is observed between and within countries. Children from the most vulnerable population groups consistently have worse health conditions. Interventions aimed at children's health must go beyond care and act in an integrated manner on poverty and on social and economic inequalities, aiming to end systematic and unfair differences. Conclusions: Despite the considerable advances observed in children's health in recent decades at a global level, the inequalities measured by different indicators show that they persist. This scenario deserves attention from researchers and decision-makers, especially in the context of the global health crisis caused by the COVID-19 pandemic, which has further intensified the situation of vulnerability and social inequalities in health around the world.

Inequities and inequalities in health and some Public Health Proposals that may improve inequities and inequalities in accessing Primary Healthcare Services in Papua New Guinea

@#Inequity and inequality in accessing primary healthcare services can be created by systemic and structural barriers in a health system. A recent review of Papua New Guinea’s (PNG) health system revealed that there are inequities and inequalities in primary healthcare service access. This disparity is magnified in the rural and remote regions of the country. One of the main reasons for this has been the chronic shortage in government funding. This paper presents an overview of inequities and inequalities in health and suggests some public health approaches that may improve primary healthcare service access in PNG

Bases teórico-conceptuales para el análisis de inequidades sociales en salud: una discusión / Theoretical Implications for the Analysis of Social Health Inequalities: A Discussion

RESUMEN Las Inequidades Sociales en Salud (ISS) continúan representando un gran reto para la salud pública en los diferentes países del mundo. Por su parte, el estudio, análisis y generación de conocimiento en esta materia ha sido reconocida como prioritaria para la Organización Mundial de la Salud desde 1991. La investigación de las ISS debe basarse en fundamentos teóricos y conceptuales sólidos, pues son estos las que guiarán las decisiones metodológicas en términos de diseño de investigaciones, formulación de intervenciones y políticas públicas en salud. En Latinoamérica, los estudios realizados se han basado primordialmente en experiencias que se han llevado a cabo en países industrializados. Esto ha fomentado que el análisis de las ISS reproduzca posturas teóricas y metodologías, sin necesariamente presentar una perspectiva crítica de los posibles estratificadores sociales que aproximan de la mejor forma los determinantes sociales de la salud en los contextos particulares. Por esta razón, se expone que las aproximaciones teórico-metodológicas deben ajustarse a los contextos específicos de los países; que la estratificación social de la salud debe ser evaluada de forma prioritaria; que los determinantes de la salud individuales y estructurales deben ser considerados dentro de las mediciones; y que la justificación teórica de las decisiones metodológicas realizadas en los estudios y las medidas seleccionadas deben ser explícitas y responder a hipótesis concretas. Esto con el fin de proveer un análisis crítico y herramientas útiles tanto para la investigación como para la toma de decisiones en salud. Este estudio inicia con una síntesis de los principales antecedentes históricos que han permitido la evolución del concepto de ISS. Seguidamente, se presentan los principales conceptos subyacentes relativos a la definición de ISS (determinantes sociales, equidad, justicia, estratificación y gradiente social en salud) y cómo estos deben guiar las decisiones prácticas y metodológicas. Finalmente, se concluye con algunas recomendaciones para la generación de esta evidencia científica para Latinoamérica.

ABSTRACT Social health inequalities (or inequities) continue to represent a great challenge for public health research worldwide. Since 1991, the World Health Organization established that the study and analysis of health inequalities represented a priority for all countries. To better guide methodological and practical implications of health inequalities, research on this topic should present a solid theoretical model, able to impact future public health policies. Previous studies of health inequalities in Latin America are often inspired from abroad experiences, encouraging the reproduction of mainly European theoretical positions and methodologies. However, especially when it comes to this topic, it is known the important role of the social context and culture, playing an important role in promoting differences in health outcomes. From this perspective, to operationalize the different social determinants in health, a critical perspective and thoughtful analysis of the context is mandatory. In order to provide a critical analysis and useful tools for both research and health decision making, we recommend that the theoretical and methodological approaches used in social health inequalities research must be well adapted to the specific contexts; that health social stratification must be assessed as a priority; that individual and the wider health determinants must be well characterized; and that the theoretical justification of the methodological decisions made in the studies and the selected measures must be explicit and should answer specific hypotheses. This research provides a brief historical background, to share the basis for the conceptual evolution of social health inequalities; the main underlying concepts related to the definition of health inequalities (social determinants, equity, justice, stratification and social gradient in health); and some recommendations for the future perspectives of health inequalities research in Latin America.

Justicia global: sus implicaciones para el manejo de las inequidades en salud / Global justice: implications for managing health inequities

El debate sobre la justicia global, es decir, sobre la transformación de las relaciones económicas y políticas entre las sociedades más ricas y las más pobres es de vital importancia para la salud pública por dos motivos. Primero, porque se encuentra bien documentado un aumento de las desigualdades en salud como efecto del proceso de globalización económica; y segundo, porque para el manejo de estas desigualdades en salud se han hecho visibles especialmente dos enfoques que tienen total relación con el campo de trabajo de la salud pública: el enfoque de determinantes sociales de la salud de la oms y el enfoque de la determinación social de la salud de la medicina social latinoamericana. En tal sentido, el propósito de este artículo es analizar las perspectivas de justicia global que asume cada uno de estos enfoques y las propuestas para el manejo de las inequidades en salud que en cada caso se generan. Se concluye de dicho análisis que en los textos de la Comisión de Determinantes de la Salud de la oms no se cuestiona ni se demanda un cambio en las relaciones económicas y políticas globales, mientras que, por el contrario, para la medicina social latinoamericana el propósito de avanzar en la eliminación de las desigualdades globales pasa obligatoriamente por un cuestionamiento tico y una re-estructuración de las relaciones de poder a escala global.

The discussion on global justice, namely, on the transformation of economic and political relations among the richest societies and the poorest becomes vital for public health today due to two reasons. First, because its well documented an increase in health inequities as an effect of economic globalization process; and second, because to manage these health inequalities, have become visible especially two approaches that have full regard with the public health field of work: social determinants of health approach of the WHO, and Latin American Social Medicine approach. In this sense, the purpose of this article is to analyze the prospects for global justice that assumes each of these approaches, and proposals for management of health inequities that are generated in each case. We concluded, that texts of the Committee on Health Determinants of WHO don´t question nor demand a change in the global economic and political relationships, while in contrast, Latin American Social Medicine considers that to advance in global inequalities elimination involves ethical questions and to restructure power relationship globally.

Desigualdades sociais em saúde e práticas corporais: um exercício singular de análise / Social inequalities in health and corporal practices: a singular analysis exercise

Ao reconhecer a relevância dos estudos sobre as desigualdades sociais em saúde, o presente trabalho propõe uma análise que articula essa temática à questão das práticas corporais e sua institucionalização no campo público. Inicia resgatando as perspectivas ético-políticas legitimadoras do ideário da Atenção Primária à saúde e da Promoção da saúde e alguns elementos pontuais do vasto debate teórico sobre as desigualdades e iniquidades sociais em saúde. A partir desses pressupostos problematiza o modo como as práticas corporais têm sido "posicionadas" no universo da Atenção Primária no Brasil, uma vez que sua implementação vem ocorrendo de forma medicalizadora e fragmentada. Para tanto, debruça-se sobre o exame contextual de duas iniciativas públicas existentes no Espírito Santo (ES) que fomentam práticas corporais/atividades físicas. O empreendimento analítico foi subsidiado pelo cotejamento de informações relativas às condições de vida em alguns bairros da cidade de Vitória e às características de tais programas. Finaliza apontando algumas reflexões, com base no quadro empírico-conceitual produzido.