Global inequity death toll: Targeting global health equity and estimating the burden of inequity

Introduction: Researchers and policymakers have called for standardized definitions and measures of health inequity that recognize health inequities as health differences associated with other dimensions of social power. Income is a key dimension of power, and is systematically associated with health outcome disparities at individual and group levels. Health indicators of high-income countries can be considered a proxy measure for the highest attainable standard of health. The burden of global health inequity can be defined as the gap between the present state of the world's health and the ideal state in which all countries would enjoy the best standard of health. Methods: Using UN country estimates of mortality rates since 1990, the Global Inequity Death Toll (GIDT) was constructed as a measure of global health inequity between multi-country income groups. The GIDT is the difference between the current number of annual deaths and potential number of deaths if average mortality rates of the high-income group were applied to all countries. Results/conclusions: The analysis shows that one in three deaths globally – close to twenty million in 2008 – are due to global health inequity. This burden has not improved in absolute or relative terms since 1990. These findings demonstrate the need for reform in the global health framework, with a greater focus on equity. The GIDT is a measure of inequity easily understood by civil society and politicians, and can be an important advocacy tool. This analysis will be standardized by age with Global Burden of Disease data.