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Equity in the health of populations and individuals is a key goal of governments in Sri Lanka and elsewhere. Almost universally, the poor and socially-marginalised have worse health outcomes than the better-off. Reducing such inequalities is important not only because of the intrinsic benefits of reducing such inequality, but also because improving aggregate population health indicators, as required for the MDGs, cannot be done without improving the health of the poor and very poorest.
In comparative terms, Sri Lanka has historically done well in reducing inequalities in health outcomes, and this is most evident in the case of preventive, and maternal and child health. This experience is internationally important, because it provides important lessons of experience to other countries in reducing inequalities. Nevertheless, significant problems exist in Sri Lanka with respect to marginalised populations, such as IDPs and the estate population. In addition, it is likely that as the disease burden changes and is increasingly dominated by non-communicable disease, that new inequalities in NCD outcomes will also emerge. Systematically profiling such inequalities and identifying the underlying causes is a first step to begin to look for policy solutions.
Current research programme
Understanding what health inequalities exist, what drives them, and helping to develop solutions to reduce inequalities in health outcomes is a central concern in our research. A major part of our work during 2005-2007 has explored inequalities in maternal and child health health and nutrition outcomes in Sri Lanka, and other countries in Asia, using data sets such as the DHS. In the case of marginalsed populations, we have surveyed the health conditions of conflict-affected IDPs in the east and north of Sri Lanka. Looking forward, IHP is examining the technical and funding feasibility of examining inequalities in adult health outcomes in Sri Lanka, for example in NCD mortality, since this has been an under-researched area, but one with growing importance.
Where possible, we are keen to work with others both in Sri Lanka and also elsewhere in joint research on health inequalities, particularly when comparative research is needed. In recent years, collaboration has been driven by through our involvement in the regional Equitap partnership, and through work with the WHO Commission on Social Determinants of Health.
Our current research includes:
- A study examining inequalities in health and nutrition outcomes in Sri Lanka and four regional countries (Bangladesh, Indonesia, Maldives, Nepal), and decomposing the relative contribution of major determinants to the overall inequality, for informing the dialogue of the WHO Social Determinants Commission with regional policy-makers. more >>
- A scoping study to assess the feasibility of using available data sources to measure inequalities in adult mortality in Sri Lanka in relation to socioeconomic status (SES).
- Further analysis of the results of the IHP Survey of Conflict-affected IDPs in 2006 to profile disparities in health outcomes compared to the national population.