Chapter 2: The Geography of Need
It would be reasonable to assume that the demand for health workers has some relation to need; hence this chapter examines the changing global and regional distribution of disease and ill-health burdens, the task of reducing these burdens and the role of SHWs. Although definition and measurement of needs and shortages are complex (Vujicic and Zurn 2006), and the competence and effectiveness of workers equally hard to assess, the need for health care is greatest in least developed countries and regions; most of these are tropical, with the greatest disease burdens. Disease burdens are also usually greater in rural areas. However, in a global example of the ‘inverse health care law’, national and regional needs are less well served than in developed countries. Why that should be so is considered here. The provision of health workers is only one of many factors influencing health status, and there are significant variations in the health status of countries with similar ratios of health workers to population. The relationship between poverty, material deprivation and poor health is now well established, alongside a range of social determinants including gender, ethnicity, education, functional literacy, social capital (trust), drug use, malnutrition and social inequality, some of which, and notably the last, have been enhanced through contemporary processes of economic globalisation (Nguyen and Peschard 2003; Loewenson 2004). While inequalities tend to be more significant, critical and visible in developing countries, increasing geographical inequalities in health have also characterised many Western countries since the 1980s (e.g. Pearce et...
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