Health Care Access

Health care can be neither universal nor equitable if it is less accessible to some sections of society than it is to others. Equitable access refers to access appropriate to peoples’ health needs, their personal situation, and their broader socioeconomic context. Equal access refers to access that is the same for everybody.

In the contexts of low-income countries, where resources are scarce, marginalized or vulnerable people may experience greater social exclusion and have their right to health undermined to a greater extent than in wealthier countries. Thus, Leslie London argues that “developing countries are faced with declining expenditures on health and social services, increased burdens posed by both communicable and non-communicable diseases and economic systems that are not orientated to fostering sustainable development for the poorest and most marginalized” (2007, p. 1). This directly challenges the UN call for Health for All with its implicit assumption of universal and equitable access to health care.

The Health for All concept asserts that attaining health for all as part of overall development starts with primary health care based on “acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford” (Declaration of Alma-Ata, 1978). Since that declaration, all countries have been urged to consider the Health for All concept when formulating policies and action plans. It was believed that, by interpreting Health for All in [Page 780]a national social, political, and developmental context, each country would be able to contribute to the global aim of health for all by the year 2000. Internationally global health is now focused on achieving the Millennium Development Goals (MDGs) by 2015. Early gains toward these goals have arguably been with those who have had easier access to health care; subsequent gains are only going to be achieved if they can address the challenges faced by a range of vulnerable groups. Equitable health care access is thus critical for achieving the MDGs.