Health policy and planning
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Review
Existing health inequalities in India: informing preparedness planning for an influenza pandemic.
On 11 June 2009, the World Health Organization (WHO) declared that the world was in phase 6 of an influenza pandemic. In India, the first case of 2009 H1N1 influenza was reported on 16 May 2009 and by August 2010 (when the pandemic was declared over), 38730 cases of 2009 H1N1 had been confirmed of which there were 2024 deaths. Here, we propose a conceptual model of the sources of health disparities in an influenza pandemic in India. ⋯ We find that factors at multiple social levels could determine inequalities in the risk of exposure and susceptibility to influenza, as well as access to treatment once infected: (1) religion, caste and indigenous identity, as well as education and gender at the individual level; (2) wealth at the household level; and (3) the type of location, ratio of health care practitioners to population served, access to transportation and public spending on health care in the geographic area of residence. Such inequalities could lead to unequal levels of disease and death. Whereas causal factors can only be determined by testing the model when incidence and mortality data, collected in conjunction with socio-economic and geographic factors, become available, we put forth recommendations that policy makers can undertake to ensure that the pandemic preparedness plan includes a focus on social inequalities in India in order to prevent their exacerbation in a pandemic.
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BACKGROUND In many middle-income countries, there is limited data available to evaluate the effectiveness of non-communicable disease (NCD) programmes. Since 1970, three neighbouring middle-income countries-Argentina, Chile and Uruguay-have undergone health sector reforms and reorganized their NCD programmes. In this paper, we explore whether data on premature adult mortality can be used to gauge the effectiveness of these programmes. ⋯ CONCLUSION NCD interventions through health care have likely contributed to the reduction of premature NCD mortality in Chile and among women in Uruguay. In Argentina and among men in Uruguay, factors outside the health sector seem to have had a greater impact. This approach could be used in other countries to assess the effect of NCD interventions and raise key questions on programme effectiveness.