Promoting health equity in conflict-affected fragile states

Promoting health equity in conflict-affected fragile states

This paper was commissioned by the Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health in response to their conclusion that a lack of data from conflict-affected fragile states made it difficult to delineate pragmatic ways of creating better social conditions for health for vulnerable populations.

The key questions we focused on were as follows:

  • What are the main factors that threaten health equity and health care equity in conflict and post-conflict fragile states? Which populations are most vulnerable to worsening inequity under these situations?
  • What strategies can reduce the impact of these factors? In particular what steps need to be taken to both build the foundation for future change and address immediate needs?
  • What are the roles of different actors at national, regional, and global level in developing and implementing these strategies?

Given the paucity of data to answer these questions, we adopted a broad based approach to data collection including a review of published and grey literature, as well as the use of key informants to provide an experiential perspective. We also conducted an analysis of some pre-existing data sets of health and social determinants of health indicators for fragile states and low income countries. Although the term equity is often used in a generic way in the fragile state and health literature, there has been no systematic attempt to link the fields of ‘health equity’ and ‘health development in fragile states’. As a result, we have had to build a framework for examining the complex interactions between health equity and the reconstruction of health systems. This framework facilitated an exploration of how conflict – via differential impacts on social stratification, exposures, vulnerabilities, and the consequences of disease – results in worsening health inequities. This paper is an initial exploration of a complex topic that clearly needs a great deal more research before definitive conclusions can be reached about how to intervene effectively to promote health equity in conflict-affected fragile states. However, we have identified a number of important issues related to the use of the equity concept in conflict-affected settings, including the key drivers of health inequity, as well as some useful strategies for addressing equity in both conflict and post-conflict settings.

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