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INTRODUCTION
1.1. Background
Health inequity
Ill-health is one of the major challenges for achieving human well-being, and there are stark disparities
in experiences of good health across the globe and between people within countries. In 2015, 22
countries in the world (all in Europe, Americas andWestern Pacific regions) had a life expectancy equal
or higher than 80 years whereas 22 countries – all in Sub-Sharan Africa - had a life expectancy lower
than 60 years. This is true despite 15 years of impressive progress which saw life expectancy increased
by about five years in the world, and 9 years in Africa.
Every day, 16,000 children die before reaching their fifth birthday. Just by being born in a family of the
poorest wealth quintile, the likelihood of dying by the age of 5 is twice as large as compared to children
of the richest quintile. African children have 14 times higher under-five mortality rates compared to
the rest of the world (WHO, 2017a). Developing countries carry the burden of 99 per cent of annual
maternal deaths (WHO, 2011); e.g. in Afghanistan and Somalia, over 1,000 mothers per 100,000 live
births die from pregnancy and child-birth related causes, compared to 21 in WHO’s European region.
In 2013, 98 per cent of births were attended by a skilled healthcare professional in Europe, compared
to 51 per cent and 68 per cent in Africa and South-East Asia, respectively (WHO, 2015b, pp. 90–91).
Within countries, although women have a higher life-expectancy than men, women are vulnerable to
suffer from disparities in access to health. Women are more prone to be sick due to socio-cultural
attributes and biological vulnerability, i.e. childbearing (Song and Bian 2014). In countries where
women are responsible for fetching water, they have higher risks of infections from faecal-oral
diseases such as ascariasis, diarrhoea, trachoma etc. (Caruso et al. 2015). Women also have less access
to healthcare compared to men. A study of 156,887 male and female patients from hospital medical
record from 2003 to 2009 in China showed that male have higher duration of hospitalization (p<0.05),
higher expenditure (both self and public) for healthcare (p<0.05) compared to women. The study
concluded that such differences occur due to unequal positions of women in life and power, access to
resources and services, risky behaviour and environmental exposure compared to men in China (Song
and Bian 2014).