But I will go beyond these determinants and say that the main concern for us all is inequity in health status between and within countries. There are still unacceptable differences between countries and between groups of persons in the countries. To the extent that these differences are socially unjust then I describe them as manifestations of inequity. The issue of equity in health is important for those who are concerned predominantly with health, but is also of concern in the context of social stability in our countries. I am asked often whether poverty is not the more important issue but my response is that both are significant, but our attention to the undeniable health problems of the poor should not blind us to the effect of inequality on health.
Economic inequality is related to poorer health.
In those countries with the widest income inequality we find poorer health indicators. It is now generally accepted that Latin America has seen a worsening of the distribution of income in recent years. The change in many countries has been contemporaneous with the growth of market friendly economic reforms and it is tempting to draw causal conclusions. The decade of the 60's and 70's had given hope that poverty might have been eradicated, but the growth records were obviously not maintained and the crisis of he 80's has been succeeded by growth which has perpetuated or accentuated the maldistribution of income. I now appreciate that equity goes beyond access to health care services, and we must address inequality or inequity in health outcomes themselves as well as equity in provision of other than care services.