Space and Global Health/Equity in Health Care/Contributing Factors Health Inequity

Contributing Factors to Health Inequity
The Inequities in health are contributed by a variety of reasons, firstly the economic inequality, the divide between the rich and poor, it affects spheres of health including the accessibility to health care services and also the affordability of healthcare services. These can be viewed form the lens of Social Determinants of Health.

Gender
Gender difference is another factor that affects the equity in healthcare, the persistent patriarchal norms have often limited the economic and social independence of women and issues like wage gap, pink collar jobs, gender-based harassment at work has again given rise to a scenario were the affordability to healthcare is restricted, not only that the lack of bodily integrity has led to issue of accessibility to healthcare. The familial norms of the caregiver have again contributed to a condition where the women neglect their own health. In 2020, seventy-seven per cent of new HIV infections among adolescents aged 10-19 years occurred among girls, worldwide. In 2019, maternal health conditions – such as hemorrhage, sepsis or obstructed labor – were the second leading cause of death among girls aged 15-19. Around one in three girls aged 15-19 today have undergone female genital mutilation in the 30 countries where it is concentrated.

Sexual Orientation
The LGBTQIA+ and the transgender community face hurdles in accessing health services due to stigmatization and unjust behavior from the society. This not only affects the physical but also mental health and well-being.

Geographical
The Geographical divide mainly with respect to Urban- Rural divide or the disparity between states in India has also contributed to worsening health inequity, while the urban area that houses only 31% of the population is served by 70% doctors, the 69% rural population is served by the rest 31% doctors. Spatial inequities is one of the major features of economic growth and inequalities. It is widened since 1990s and not only among rural and urban communities but also within villages and within urban sectors. Economic liberalization causes cuts in subsidies for agricultural inputs (fertilizers and pesticides) as well as low interest credits, pushing the farmers to depend on merchant moneylender in higher interest rate. Moreover, trade liberalization subjected farmers to compete with imported agricultural product. Thus, those working in agriculture faced double squeezed and many seek work and income opportunities in rural non-agricultural sectors. On the other hand, urban growth concentrated in export led, skill intensive, overseas demand dependent sectors which increases pockets of abject urban poverty in different parts of nations. Maximum non-agricultural employment is informal. These includes a substantial group of circular migrants who seek employment in urban informal sectors and returned their villages when there is no work.

Caste and Race
There are many social factors that affect equity of health, in India the Scheduled Caste and the Adivasi population is worse off than the other communities in all facets of health including maternal and child health. The caste barrier restricts accessibility, affordability and acceptability. Instances of medical professionals refusing to treat a lower caste person is not unheard of in India. This creates mistrust and hesitancy amongst such populations. The other inequity factor is the Race. The Blacks and Hispanics in the USA are much worse in the health indicators as compared to the Caucasian population. The social status and connection of the communities thus have a role to play in these situations. Those who were historically positioned lowest in the caste hierarchy have for centuries, experienced social and economic marginalization, while the indigenous group are distinguished by their relative isolation from mainstream society. Though the educational and economic status among these groups has improved in past decades, but the gap between them and rest of the population has increased. Three prominent mechanisms stand out as being the underlying driver of caste inequity- Identity/discrimination/ internalization of oppression and differential opportunities and unequal access to resources and power based on a particular caste.

Education
Education is a major factor that affects equity, a better educational level correlated to better knowledge of good health practices and access to health care facilities. Due to lack of appropriate awareness and health education, many health conditions get often neglected only to be noticed when it is late. Non communicable diseases are a growing concern which with continuous neglect and increased out of pocket expenditure adds up to the financial burden. The LMICs (Low Middle Income countries) are facing a two edged sword with non-communicable diseases on one side and infectious diseases on another.

Age
Age is yet another factor, old age may severely restrict a person's accessibility to health services on top of all the disabilities associated with old age. Many of the health policies are not formulated keeping the geriatric population in mind.

Digital Literacy
In the modern era the E-literacy is a big factor that affects health inequity, in a modern world that is connected by Internet a lack of knowledge of the IT related services and lack of a good internet connection in certain areas put a part of a population at a disadvantage, eg: The scenario in which ordinary people with no e literacy found it hard to register in the Co-Win portal for COVID 19 vaccines. Globally too this divide with respect to health inequity can be clearly seen between the developed and the developing nations, the COVID-19 pandemic being an eye opener of it.