Immorality of inaction on inequality

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j556 (Published 08 February 2017) Cite this as: BMJ 2017;356:j556

Say what you mean, mean what you say: inequality and inequity

Dear Editors

I suggest that there are better terms to describe what different rapid respondents (to this article) meant in spite of obvious cross talk using the same phrase "health inequality" when "health inequity" may be more apt.

This extract from "Global Health Europe" explains the situation well:

"Inequity and inequality: these terms are sometimes confused, but are not interchangeable, inequity refers to unfair, avoidable differences arising from poor governance, corruption or cultural exclusion while inequality simply refers to the uneven distribution of health or health resources as a result of genetic or other factors or the lack of resources. "


A good illustration of such differences in definition is found here:


Those covered by national health insurance schemes in various countries (NHS in UK, Medicare in Australia, etc) have access to health services more or less equally once they are in the system, regardless of gender, ethnicity, creed or religion. However the ability to benefit from these services is subject to individual autonomous decision making, socio-economic circumstances, social network; to ensure health equity, extra resources (including affirmative action) are needed to assist those perceived to be disadvantaged to make use of the same service provided by the health scheme. This may include travel assistance rebate or subsidy, income protection/supplementation and any other means-tested assistance schemes.

Obviously there will be health inequity, when those in higher income group can access private health services in addition to the national health scheme.

Obviously there is health inequality as well as inequity when comparing health services and outcome across the world. Much of the difference is due to uneven distribution of disposable wealth within the country as well as between nations. However, some of the apparent inequalities are also religious or societal.

Thus not all health inequalities can be solved by simply throwing large amounts of money at it, although money used at the right level can help a lot.

Competing interests: No competing interests

13 February 2017
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia