Inequalities in non-communicable diseases and effective responses

Abstract

In most countries, people who have a low socioeconomic status and those who live in poor or marginalised communities have a higher risk of dying from non-communicable diseases (NCDs) than do more advantaged groups and communities. Smoking rates, blood pressure, and several other NCD risk factors are often higher in groups with low socioeconomic status than in those with high socioeconomic status; the social gradient also depends on the country's stage of economic development, cultural factors, and social and health policies. Social inequalities in risk factors account for more than half of inequalities in major NCDs, especially for cardiovascular diseases and lung cancer. People in low-income countries and those with low socioeconomic status also have worse access to health care for timely diagnosis and treatment of NCDs than do those in high-income countries or those with higher socioeconomic status. Reduction of NCDs in disadvantaged groups is necessary to achieve substantial decreases in the total NCD burden, making them mutually reinforcing priorities. Effective actions to reduce NCD inequalities include equitable early childhood development programmes and education; removal of barriers to secure employment in disadvantaged groups; comprehensive strategies for tobacco and alcohol control and for dietary salt reduction that target low socioeconomic status groups; universal, financially and physically accessible, high-quality primary care for delivery of preventive interventions and for early detection and treatment of NCDs; and universal insurance and other mechanisms to remove financial barriers to health care.

Evolução do excesso de peso e obesidade até a idade adulta, Pelotas, Rio Grande do Sul, Brasil, 1982-2012

“…Além disso, o maior incremento entre os grupos mais pobres pode levar ao aumento na desigualdade de ocorrência de tais doenças 31 . Portanto, é necessário que sejam adotadas políticas de combate à obesidade, abordando as múltiplas facetas associadas a sua ocorrência, tendo como prioridade os grupos de menor nível socioeconômico.…”

Diseases of the Rich? The Social Patterning of Hypertension in Six Low- and Middle-Income Countries

“…The question is whether developing countries will follow the same trend and at what point this will occur, but the limited available evidence does not provide a conclusive answer (Gwatkin, 2013;Subramanian et al, 2013;Di Cesare et al, 2013). Current knowledge about where "tipping points" are likely to occur in the social gradient of health remains limited (Suhrcke et al, 2006).…”

Tendencia en la sobrevida de pacientes hospitalizados por infarto agudo de miocardio según nivel socioeconómico: Chile, 2002-2012

“…El abordaje de las inequidades en salud demanda la implementación de políticas públicas a nivel poblacional y de estrategias dirigidas a los individuos de alto riesgo [21][22][23] . Con este objetivo se implementó progresivamente en Chile, durante la década pasada, un sistema de garantías universales (GES o AUGE) para patologías consideradas prioritarias; con ello se buscó asegurar el acceso y la oportunidad de atención médica a toda la población 24 .…”