The connection between the economic status of a country and its ability to deliver robust public health services is an established fact. Also, the litmus test for the efficiency and effectiveness of any public health system is its performance in a crisis situation. Civil societies have come to expect basic protections at the time of these crises. Such emergencies also test a government’s true ability to act under pressure. In other words, “they define a state’s capacity to protect its population while exposing its vulnerabilities to political upheaval in the aftermath of poorly managed crises” (Gorin, 2002, p.56). Many of modern epidemics, including AIDS, polio, and malaria may in a few years’ time even out. But, for a developing nation, new challenges in the form of cancer, road accidents and cardiovascular disease will emerge. Further, although sufficient progress has been made in checking infant mortality rates in the Third World since the 1980s, cases of easily contagious epidemics like tuberculosis have not declined. This goes on to show that the biomedical model of health is inadequate in explaining inequalities in health. It also makes a case for exploring sociological explanations for health inequalities. The Cultural/Behavioural approach, for instance, offers insights into factors affecting healthcare. For example, differences have been noted in health status across various ethnic groups both here in the UK and also in the USA. But there are disagreements and weaknesses associated with this approach. For example, some scholars argue that
“the cultural and genetic factors are of greater importance…In much of the health related literature on ethnic minorities there is a strong tendency for explanations of variations in health status in different ethnic communities to be based on oversimplistic culturalistic explanations. These culturalist explanations ignore social and economic deprivation as being causally related to the development of certain illnesses. For instance rickets among Asian groups is held to relate to the ‘Asian diet’ and lack of sunlight. The fact that Asians live in inner city areas with limited access to park space and limited mobility on account of a real fear of racial discrimination is not taken into account.” (Dein, 2006, p.68)
The Structuralist/Materialist approach to studying health inequalities throws further light on the subject. Recent discussion in the field towards effective actions to tackle health inequalities has seen an increasingly explicit focus on addressing ‘unjust social structures’. Scholars and human rights advocates such as Whitehead, Braveman and Gruskin have attempted to clarify prevailing understandings of health and equity specifically for research and policy purposes. They argue that
“while structures of exploitation and discrimination prevail, the right to health is seriously circumscribed. From this perspective, health inequities are strongly associated ‘with unjust social structures; those structures (that) systematically put disadvantaged groups at generally increased risk of ill health and also compound the social and economic consequences of ill health’. This is significant because the right to health is a basic human right established and ratified by the Constitution of the WHO (1946) and international human rights treaties. Governments who are signatories to such treaties are therefore publicly committed to the implementation of the principles and practices of justice that will secure the right to health for all. Further, such a right is contingent on the equalisation of opportunities to be healthy.” (Schofield, 2007, p.105)
Further illustrating the Structuralist/Materialist constraints for equitable healthcare, the former chief of the World Health Organization, Dr. Gro Brundtland, agrees that there is a disconnection between wealth creation and wider access to public health in a world dominated by globalization. He observes: “Technologies are spreading, communication is worldwide, people know what is available, and yet the dramatic gaps and lack of access to healthcare become greater and greater. We must look upon the world as a shared responsibility so that we deal with the gaps and help those technologies become available for those who don’t have access. That’s the only way to keep globalization from becoming really unhealthy.” (Brundtland, 2001, p.28)