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The persistence of global and domestic health inequities

Preventable and treatable injuries and diseases are on the decline, but still condemning many millions in avoidable death and illness in sub-Saharan Africa, the Indian subcontinent, and other impoverished areas of the world. By one measure, health inequities are at the root of nearly 20 million deaths. Life expectancy in sub-Saharan Africa is 58 years, a generation below that in high-income countries (79 years). Billions of people still lack access to fundamental human needs. In 2010, 870 million people were suffering from chronic hunger, and in 2012, 750 million people lacked access to clean water, and 2.5 billion people did not have access to proper sanitation facilities. The vast majority of these people living in developing countries.

A woman in sub-Saharan Africa is nearly 100 times more likely to die in pregnancy or childbirth during the course of her lifetime than a woman in a developed country, while a child born in Africa is 16 times more likely to die before she reaches age five than a child born in a high-income country.

These inequalities are replicated within countries, both high- and low-income. Those who are poor, who are disabled, who belong to indigenous populations, or other socially disadvantaged populations, are far less likely to be able to access quality health care and have their fundamental survival needs met, and consequently, their lives shorter. In the United States, American Indians on the Pine Ridge Reservation in South Dakota have a life expectancy in the upper 40s. A child in India is three times as likely to die before age five if her family is in the bottom wealth quintile compared to a child whose family is in the top wealth quintile.

It need not be this way. Many countries are seeing dramatic improvements in their populations’ health — but many others are not. Health equity is improving within some countries, but not others. In short, it is unconscionable that such inequities persist. It is intolerable that we know how to save millions of lives every year, but do not. It is severely unjust that still today, one’s very survival is so fundamentally determined by the place of one’s birth and one’s economic assets. And it is all the worse because saving these lives is eminently affordable, and well within the economic capacity of nations, in partnership with the global community.