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emphasis on the poor and their need. Finally, various policies and strategies (structural factors) will
be explored through the dimensions of access to see how they influence/facilitate access to healthcare
by the poor and their demand.
Figure 4: Proposed conceptual framework to assess to health by the poor
Source: elaborated by the authors.
2.3 Disparities in access to Health and Health Outcomes
Across the world, remarkable progress in various health indicators has been made since the last
century. Whereas at the beginning of the 20th century the average life expectancy at birth was about
30 years, it rose to 65 by the end of it, and today we live up to 72 years - about 2.5 times as long (WHO,
2018a). We have eradicated deadly disease like small pox, introduced public health marvels like
vaccines or oral rehydration therapy (ORT), made improvements in containing health threats like
Ebola or severe acute respiratory syndrome (SARS), reduced maternal mortality ratios (MMR), child
mortality rates (CMR), the global annual population growth rate has decreased from 2.059 in 1965 to
1.158 in 2015 – a reduction of about 1.8 times in 50 years (World Bank, 2018).
Yet there is considerable disparity related to access to healthcare. In 2015, a joint report published by
the Work Bank and the World Health Organization (WHO) stated that globally around 400 million
people lack access to essential healthcare. The impact of such access-related health disparity amounts
to about 6 per cent of people in low- and middle-income countries being pushed into extreme poverty
(World Bank & WHO, 2015). An international group of researchers has recently published their
analysis of health care access for 195 countries based on global burden of disease study 2016. Based
on their findings, the global healthcare access and quality score in 2016 was 54.4 (on a scale from 0-
100), a 12-point increase from 2000. This improvement is mainly based on the impressive increase in