Purpose: With rising global interest among health researchers and policymakers in reducing health inequalities within countries, it is worthwhile to ask: who cares about health inequalities? Is it possible that reported concern regarding inequality is related to country-level geographic location and wealth?
Methods: We analyzed data from 201,950 individuals in 63 countries who participated in the World Health Survey, to study the distribution and determinants of how individuals rank the goals of their health care system. The survey asked respondents ages 18-70 to rank order the following health system goals: improving overall health; minimizing health inequalities; improving responsiveness of the health care system; minimizing inequalities in responsiveness; and fairness of financial contribution to the health system.
Results: We found that, globally, individuals most frequently prioritized overall health (46%) and responsiveness of the health care system (20%), ahead of reducing inequalities in health (14%), inequalities in health care responsiveness (11%) and fairness in financial contributions (10%). However, we found considerable heterogeneity in the response patterns, with the most frequent pattern (Health>Inequality>Responsiveness>Responsiveness Inequality>Fairness) only observed in 7.9% of the population (95% confidence interval [CI]=7.7%,8.0%). Conditional on individual age, gender, marital status, self-rated health, education, and income, the probability of giving highest priority to inequalities was higher among individuals in European countries (18.0%, 95% CI=13.0%, 22.8%) than in countries of the Western Pacific (8.5%, 95%CI=5.5%, 11.5%) or Southeast Asia (11.8, 95%CI=9.1%,14.5%). Individuals in wealthier countries were also more likely to prioritize inequality, as a 1-standard deviation increase in gross domestic product per capita increased the probability of prioritizing health inequalities 2.2 percentage points (95%CI=1.0,3.4), from 11.7% to 13.9%.
Conclusion: These findings suggest that concern for health inequality may be a “luxury” of residents of higher-income countries with comparatively effective health systems.
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