25 May 2001
The ICB in the general introduction of the document focuses on the definition of equity (in terms of the possibility for all to reach the highest attainable standard of health, and the access and quality of healthcare), the distinction between equity and equality, the resources for health (which are not only monetary, pharmacological and professional) and the relationship between the State and the market regarding healthcare.
The opinion outlines the picture on global health in relation to the increasing disparity in income (which penalizes life expectancy in developing countries) and the influx of other factors such as the political and social choices, education, the environment, the levels of justice and solidarity.
The ICB underlines the importance of practical measures capable of reducing “unjust inequalities” in healthcare by the implementation of equity policies which improve living and working conditions, promoting healthy lifestyles, involving the people and local government in decisions on health, assessing the health impacts of productive and environmental projects, spreading basic healthcare to the entire population, and above all, by considering human life not as a secondary variable in the economic system, but as an intrinsic value and as a condition for the expression of freedom.
The resources to meet the health needs of human beings are not unlimited; it is from this that the problem of equity in the allocation of resources originates. In fact, it may become necessary to make choices through a “rationing” of healthcare which would ultimately affect to a greater extent the weaker sections of the population such as the elderly and persons with low education.
Therefore, ethically, the most difficult problem is to find a convincing criterion able to guide the often painful and sometimes tragic choices which health workers face due to the scarcity of available resources.
In the final part of the document the ICB advises to bear in mind, in order to identify the guidelines to pursue, the principles for action already formulated on the subject of equity by the WHO in 1990 – and also included in the Declaration of Erice in 2001 on equity and the right to health – which recognise, in the fight against inequality in health, the need to redefine a new table of values to regulate relations between different areas of a now global world and which can act as an efficient counterbalance against world expansion of the sole economic logic of profit.