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Vicente Navarro, MD, PhD, DrPH

Correspondence: Requests for reprints should be sent to Vicente Navarro, MD, PhD, DrPH, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205 (e-mail: vnavarro{at}jhsph.edu).

I agree with Hyder's normative statement that equity should indeed be considered desirable in health policy. As Coyne and Hilsenrath indicate, however, such a goal is not universally accepted, as evidenced by the growing health inequalities between and within countries. But Coyne and Hilsenrath are just plain wrong when they justify (at least in part) the existence of those inequalities while indicating that equity is difficult to achieve in heterogeneous societies. Actually, during the 1950s, 1960s, and 1970s, China, which has more ethnic diversity and a larger population than India, had lesser regional and class health differentials and better health indicators than India, even though its GNP per capita was lower.¹

Hyder is right when he calls for evaluating health systems' performance by looking at their impact on health outcomes, but he is wrong in believing that mortality is a good outcome measure of the effectiveness of health care. At least in the developed countries, where most morbidity is chronic, medical care does more caring than curing, and thus its impact on curing and on reducing mortality is small. The overall level of mortality in a country depends on many other interventions besides health care interventions.

Reference

1. Navarro V. Has socialism failed? Int J Health Sev.1992;22:583–601.

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