The most prominent disparities in health outcomes are between the Aboriginal and Torres Strait Islander population and the rest of Australia’s population; these are widely acknowledged as unacceptable. In 2008, the COAG agreed to set a target for closing the gap in life expectancy by 2031. This is a government and nongovernment effort, with the nongovernment component supported through the Australian Human Rights Commission.
Democratic progress in Brazil has enabled the development of national policies to ensure human rights and universal access for vulnerable groups. The National Human Rights Plan defends civil rights, protects social groups that have suffered historical inequities, and guarantees social rights in the context of economic inequalities.
The Public Health Agency of Canada includes health disparities reporting in its mandate, and the Canadian Institute for Health Information also reports on disparities in health care and health outcomes, with a focus on lower-income Canadians. No formal or periodic process exists to measure disparities; however, several P/T governments have departments and agencies devoted to addressing population health and health inequities.
There are still severe disparities in the accessibility and quality of health care, although China has made significant improvements in this regard in the past decade. Income-related disparities in health care access were especially serious before the reform of the health insurance system more than 10 years ago, as most people did not have any coverage at all. Health coverage through publicly financed insurance is now nearly universal, and there are safety nets for the poor (see above). As a result, income-related disparities have been reduced substantially. However, there is no oversight agency to monitor or report on health disparities and there are no targeted programs to reduce disparities for specific groups.
Equity is a value in the Danish health care system, as in other Nordic welfare systems. This is evident in the key principle of equal and easy access in the Danish health law and, more broadly, as an underlying argument for universal, tax-financed health systems that provide coverage to all citizens largely free of charge. Equity is also a key focus for regional and municipal organizers of health and social care services. Nevertheless, some social and geographical differences in health remain.
The Secretary of State, Public Health England, NHS England, and CCGs have a legal duty to “have regard” for the need to reduce health disparities, although the applicable legislation does not specify what actions need to be taken. NHS England publishes an annual report on the actions taken and progress being made in reducing disparities in access and outcomes, by gender, disability, age, socioeconomic status, and ethnicity.
Reducing disparities in regard to social determinants of health and access to care is a national priority. There is a 6.3-year gap in life expectancy between males in the highest social category and those in the lowest, and poorer self-reported health among those with state-sponsored insurance and no VHI.
Compared to percentages in other European countries, the share of population reporting an unmet need for medical care is very low (0.3%), ranging between 0.8 percent in the lowest income quintile and 0.1 percent in the highest income quintile in 2017.13 This suggests good access with few disparities.
Significant health, social, and income inequities exist across India, many of them a result of the country’s diversity, rapid economic growth, and historically limited wealth redistribution. There is evidence of high unmet need in access to public health services, especially among women in rural and tribal regions, who lack access to reproductive health services, neonatal care, and family planning services.
The Ministry of Health is leading a major national effort to reduce disparities, in cooperation with the NHI health plans and hospitals. Key initiatives include:
- Reducing financial barriers to care, particularly for those with low incomes and other vulnerable populations. Most prominently, mental health and dental care for children and the elderly have been added to the NHI benefit package.
- Enhancing the availability of services and professionals in remote regions by increasing the supply of beds and technologically advanced equipment in those regions.
- Addressing the unique needs of minorities through the adoption of cultural responsiveness requirements for all providers, the establishment of a national translation call center, and targeted interventions for the Bedouin and other high-risk groups.
- Implementing intersectoral efforts to address the social determinants of health and promote healthy lifestyles.
Italy has no national agency tasked with monitoring disparities; in most cases, the monitoring of inequalities is a responsibility of each region.
Interregional inequity is a long-standing concern to both regional and national policymakers. The less-affluent south trails the north in the number of beds and in the availability of advanced medical equipment, has proportionally fewer public versus private facilities, and has less-developed community care services. This gap in availability is increasing. Income-related disparities in self-reported health status are significant.
Reducing health disparities between population groups has been a goal of Japan’s national health promotion strategy since 2012. The strategy sets two objectives: the reduction of disparities in healthy life expectancies between prefectures and an increase in the number of local governments organizing activities to reduce health disparities.
Health disparities between regions are regularly reported by the national government; disparities between socioeconomic groups and in health care access have been occasionally measured and reported by researchers.
Every four years, variations in health accessibility are measured and published in the Dutch Health Care Performance Reports by the National Institute for Public Health and the Environment, focusing on socioeconomic differences such as ethnicity and education. Geographic or regional variation is not measured consistently.
Health disparities are a concern in New Zealand. Maori and Pacific Island people have shorter life expectancies than other New Zealanders (by seven and five years, respectively) and experience greater difficulty in gaining access to health services. Reducing disparities is a policy priority. Data describing disparities are routinely collected and publicly reported at both the national and the district level. A full range of data are collected and reported, including socioeconomic status, ethnicity, and proximity to services.
The Patient and User Rights Act ensures that all inhabitants have equal access to quality health care.
A national 2013–2017 strategy, Equality and Equity in Health Care – Good Health for All, targeted social determinants of health. The emphasis has now shifted to individual health-related behaviors, rather than social determinants of health.
In public hospitals, care is provided based on patients’ clinical condition, rather than on their subsidy status. When nonsubsidized drugs or treatments are deemed clinically required and cannot be replaced by subsidized alternatives, needy patients receive assistance (such as through MediFund) in accessing these drugs or treatments.
Sweden ranks in the top three among 11 high-income countries on measures related to health care equity. The Health and Medical Services Act emphasizes equal access to services according to need and a vision of equal health for all, and the level of unmet need is very low in Sweden. Disparities in access and health outcomes are measured primarily with regard to gender, income, and education by the National Board of Health and Welfare and the Public Health Agency.
The Swiss Federal Council’s national Health2020 strategy explicitly calls for improving health opportunities for the most vulnerable population groups, such as children, people with low incomes or poor educational backgrounds, the elderly, and immigrants. The aim is to facilitate easier access to necessary health care services.
More than 3 million economically disadvantaged Taiwanese (12.8% of the population) have full access to NHI services, owing to the NHIA’s various financial and access-assistance measures, including premium subsidies and copayment and coinsurance reductions or exemptions. The NHIA also makes interest-free loans and installment plans available to those who cannot pay their premiums on time because they are temporarily unemployed or between jobs. In recent years, the government has lowered the income threshold to allow more people to become eligible for these premium subsidies.
Several federal agencies are tasked with monitoring and reducing disparities. The Agency for Healthcare Research and Quality publishes an annual national report highlighting disparities in health care quality by race/ethnicity, age, and sex. According to the latest report, disparities related to income and race persist but grew smaller between 2000 and 2016. African Americans, American Indians, Alaska Natives, Native Hawaiians, and Pacific Islanders received worse care than whites according to about 40 percent of quality measures. Hispanics and Asian Americans received worse care per 35 percent and 28 percent of measures, respectively. Disparities for poor and uninsured populations are also persisting in major priority areas for quality.