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access to healthcare among several low-and-middle-income countries in sub-Saharan Africa and
Southeast Asia, including Ethiopia, Rwanda, Equatorial Guinea, Myanmar and Cambodia. However, at
the same time, this progress was low or even halted in some countries, such as the USA and some Latin
American countries including Puerto Rico, Panama and Mexico (GBD 2016 Healthcare Access and
Quality Collaborators et al., 2018).
Globally, women are more vulnerable to suffer from health disparities. Women are not only prone to
be sicker as a result of widespread gender discrimination and women-specific biological
vulnerabilities, e.g. through childbearing (Rieker & Bird, 2005; Song & Bian, 2014); studies have also
shown that women have higher prevalence of hypertension, chronic pain, cancer, anxiety and
depression, and are more like to suffer from more days of disability compared to men (Perelman,
Fernandes, & Mateus, 2012). In countries where women are primarily responsible for fetching water,
they have higher risks of infections from faecal transmitted diseases such as ascariasis, diarrhoea,
trachoma, etc. (Caruso, Sevilimedu, Fung, Patkar, & Baker, 2015). Gender discrimination also expresses
itself in lesser access to healthcare for women, compared to men. For example, a study of 156,887 male
and female patients from hospital medical records dating from 2003 to 2009 in China showed that
men are hospitalized for longer and have higher expenditures (both self and public) for healthcare
compared to women – likely due to unequal power relations, lower levels of access to resources and
services, and riskier behaviour and environmental exposure than men in China (Song & Bian, 2014).
Apart from geographical and gender differences in health access and outcomes, health disparity is an
expression of social-demographic influence over direct and indirect access to healthcare. In spite of
the UN declaration in the late 40s, global health initiatives started focusing on access to healthcare only
in the late 70s. By endorsing the provision of primary health care (PHC) in 1978, the Alma Ata
declaration became the cornerstone of bottom-up health initiatives to address socio-demographic
barriers hindering access to health. PHC was specially designed to extend the coverage of essential
healthcare to the vulnerable and marginalized. In the early 90s, another movement called Health for
all (HFA) was endorsed to further PHC. The main objective of HFA was to ensure that everyone has
access to their required health services. Universal Health Coverage envisions access to quality
healthcare by all people, irrespective of their financial ability. At the beginning of this century, three of
the eight MillenniumDevelopment Goals (MDG) were directly related to health: reduce childmortality,
improve maternal health, and combat HIV/AIDS, malaria, and other diseases (WHO, 2018b).
The MDGs were very effective in reducing poverty, achieving equality in primary education between
boys and girls, and producing some targeted health-related successes. For example, the number of
people living in extreme poverty by the end of 2015 was 836 million, down from 1.9 billion in 1990.
Primary school enrolment increased from 83 per cent in 2000 to 91 per cent in 2015, including the
elimination of gender disparities across primary, secondary and tertiary education systems in
developing region. With relation to health, an impressive global decline in under-five mortality rate
was observed from 93.2 to 39.1 deaths per 1,000 live births between 1990 and 2017, the maternal
mortality ratio declined by about 45 per cent since 1990, new HIV infections dropped by 40 per cent
between 2000 and 2013, more than 6.3 million malaria deaths were prevented between 2000 and
2015, and an estimated 37 million lives were saved due to improvement in tuberculosis prevention,
diagnosis and treatment between 2000 and 2013 with 54 per cent of cases detected and a treatment
success rate of 86 per cent. below give graphical summaries of some health
indicators for which data is most frequently available. Nonetheless, considering health, the decrease
in maternal mortality ratio and under-five mortality rate was not effective in ensuring everyone’s
health-related wellbeing. Especially in the case of child mortality, most of the deaths are concentrated
in the poorest regions and during the first month of life. About 50 per cent of people in rural areas lack
improved sanitation facilities compared to urban (18 per cent) (UN, 2015).
Most of all, MDG has been a great success in demonstrating how a) targeted international effort and
coordinated partnership with stakeholders with a clear vision, b) stressing an universal and