Health without wealth

According to the Health Inequality Data Repository (HIDR) of the WHO, the gap between rich-poor health service coverage among women, newborns and children in low- and middle-income countries – a category that includes Pakistan – has gone down by 50 per cent over the last decade. The data in the HIDR includes figures for over 2000 indicators broken down across 22 dimensions of inequality, making it among the most comprehensive health inequality datasets out there. However, the WHO highlights the fact that disaggregated data is still unavailable for many health indicators, particularly data that is disaggregated on the basis of wealth as opposed to gender or age. It is also worth noting that the HIDR’s conclusion combines data from many low- and middle-income countries so it is hard to tell how much progress our country specifically has made when it comes to tackling health inequality. Did Pakistan follow the trend or were we one of the few countries where progress was slower, there was no progress or there were setbacks?

Unsurprisingly, the HIDR data reveals that there are great inequities in terms of Covid-19 immunization rates. As recently as 2021, vaccination coverage for the most educated was about 15 per cent higher than for the least educated in over a third of the 90 countries for which there was data. Education levels are often a proxy for wealth, especially in Pakistan. If we also consider that a large chunk of the country remains unvaccinated and that most of the country is poor, it is likely that the rich-poor gap in Covid-19 vaccination rates in Pakistan is at least as high as 15 per cent, if not bigger. More unexpectedly, the HIDR data shows that obesity rates are actually higher among women than men in low-income countries like our own, when it is often the opposite in the wealthier countries. There could be many reasons as to why this is the case but it would be unwise to ignore women rights and the lack of access women have to public spaces and, in general, anywhere outside the home in countries like Pakistan. In many parts of the world, even today, women simply do not enjoy the freedom or the safety to lead a healthy lifestyle.

Assuming Pakistan generally followed the trend of other low- and middle-income countries, the HIDR data is indeed welcome news. It might even mean that efforts such as the mobile health clinics in poor, rural areas and rising rates of female education across income groups are finally paying off in terms of health outcomes. However, there is still much work to be done. The HIDR report points out that eliminating wealth-related inequality in under-five mortality in low- and middle-income countries could save up to 1.8 million lives annually. This means there is a clear need to expand programmes that offer preferably free or, at the very least, inexpensive healthcare to low-income groups while also spreading greater awareness of health issues among poor mothers through public initiatives. Furthermore, we must not forget that last year’s floods and the disastrous impact they had on healthcare, disproportionately affected the poor. Our healthcare network needs to become more robust and able to withstand major disruptions without a serious drop-off in care. If we look at how malaria cases have skyrocketed since the floods, it might be the case that the HIDR will paint an entirely different picture for countries like Pakistan in the coming years.