FOUR COUNTRIES COMPARISON 1

Audrey Vo

HSC 420 Global Health

Tuesday/Thursday 12:30-1:45 PM

Four Countries Comparison

March 29, 2020

FOUR COUNTRIES COMPARISON 2

Introduction

The World Health Organization defines health equity as the absence of unfair and

preventable differences in health between subgroups of a population (WHO, n.d.a). Currently,

the health status of every country differs greatly. Health status can be seen closely associated

with income-level. In order to compare health statuses of Ethiopia, the Philippines, Thailand, and

the Republic of Korea, also known as South Korea, the examination of disparities and factors is

necessary. Health indicators prompt for appropriate changes and include life expectancy, infant

mortality rate, maternal mortality rate, literacy rate, and immunization rates of DPT and Measles.

Health equity is a goal for those all over the world so understanding differences in education,

culture, and public policy and how it contributes to health disparities is important.

Analysis of health indicator

Health Ethiopia Philippines Thailand Korea, Rep.

Indicators

Life Expectancy 67.5 70 75.6 82.6

Infant Mortality 49.60 21.4 9.20 3.00

Rate

Maternal 401 121 37 11

Mortality Rate deaths/100,000 deaths/100,000 deaths/100,000 deaths/100,000
live births live births live births live births

Literacy Rate 51.8% (2017) 98.2% (2015) 92.9% (2015) 97.9% (2013)
(age 15 and over
can read and
write)

Immunization 72% and 61% 65% and 67% 97% and 96% 98% and 98%
Rate of DPT and
Measles
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Health indicators provide a glimpse at the health statuses of nations and how they fare

compared to each other. As mentioned above, the income-level of a nation is highly indicative of

their overall health as wealth provides the country with the necessary education, resources, and

health care. One of the health indicators is life expectancy, which is the average period an

individual is expected to live. The data for life expectancy corresponds with income-level.

Ethiopia, the low-income country, and the Philippines, the lower-middle income country, have

the lowest life expectancy at 67.5 and 70 years, respectively, compared to Thailand, the

middle-income country, and South Korea, the high-income country, have higher life expectancy

at 75.6 and 82.6 years, respectively (Central Intelligence Agency [CIA], n.d.). One of the most

revealing and important indicators of the overall health is infant mortality rate, which the Centers

for Disease Control and Prevention defines as the number of infants aged a year and younger for

every 1,000 live births (2019). This rate provides information on both maternal and infant health

as well as presence of medical services.

Analysis of factors contributing to the health challenges of the countries

Income-level itself is an indicator of the health status and challenges a country may face.

On the lower end of the income-level, countries may experience unmet material conditions and

lack of social participation. A set of material conditions includes clean water, good sanitation,

adequate nutrition, and adequate housing, which are all important for good health (Marmot,

2002). This set of material conditions has a threshold where after the threshold is met, any

increase in income will not translate strongly to material conditions. However, below the

threshold, the lower the income, the worse the health. This means that once clean water is

established, no matter how high the income, the cleanliness of water does not get safer (Marmot,
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2002). The next challenge is lack of social participation. For those from higher-income countries,

even when a set of material conditions is obtained, differences in health can still occur due to

differences in opportunities for social participation. Social participation can lead to a sense of

fulfillment and satisfaction in the individual’s life as well as a sense of control (Marmot, 2002).

Social participation has no threshold so if individuals who are relatively poor were to have high

social participation, they could obtain good health. This could account for the differences and

inequities of every nations’ health.

Ethiopia is the second most populated nation in Africa and has one of the fastest growing

economies, however, they are the poorest with a per capita income of $790 (The World Bank,

2019). They rank 92nd out of 95 on the United Nations Development Program’s Human Poverty

Index, with 45% of their population living below the poverty line, 75% lack clean water, and

80% lack the proper sanitation (WHO, n.d.b). Ethiopia has a history of droughts, epidemics,

displacements, and armed conflicts but their main concerns are maternal mortality, malaria,

tuberculosis, and HIV/AIDS. Ethiopia’s maternal mortality rate and infant mortality rate are the

highest among all 4 countries at 401 deaths per 100,000 live births and 49.60, respectively (CIA,

n.d.). These rates are associated with lack of sanitation, malnutrition, poor housing,

overcrowding, and lack of antenatal care (Marmot, 2002). Their health sector is severely

under-funded, leading to a limited number of health institutions and medical supplies and

sanitation. This makes access to health-care services difficult.

In terms of the health indicators, we see that the Philippines, a lower-middle income level

country, fare slightly better. Their maternal mortality rate and infant mortality rate is less than

half that of Ethiopia. This could be attributed to increased health insurance coverage, which
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covers 92% of the population, improved maternal and child health services, increased birth

delivery at health facilities, and increased attendance of professional service providers at time of

birth (WHO, 2018). The Philippines also saw improvements for communicable diseases in

preventative, diagnostic, and treatment services along with efforts to reduce illnesses and deaths

due to communicable diseases (WHO, 2018). However, despite these improvements, there are

still health inequities in the Philippines that occur due to social, economic, and geographic

barriers. Many people still lack the knowledge and information to make informed decisions

regarding their health. The topography of the Philippines leads to disadvantages especially for

those who live in remote and isolated areas, as well as areas with high poverty. They have more

difficulty accessing health care, which include antenatal care and are more likely to be at risk for

malnutrition (Dayrit et al., 2018). It was found that those with high economic status and level of

education were positively associated with antenatal care.

In comparison to Ethiopia and the Philippines, the health indicators display a healthier

population for the middle-income country Thailand. Their overall health status can be attributed

to their universal health coverage, which provides its citizens the right to essential health services

at any age and any health condition (Sumriddetchkajorn et al., 2019). Since its implementation in

2002, universal health coverage has increased life expectancy, declined the infant mortality rate,

and reduced out-of-pocket spending. Despite the success of the policy, the funding and revenue

for the program remains a struggle as their policy has 4 schemes that range based on income and

occupation. One of the schemes requires its citizens to pay higher premiums so that those from

the other schemes do not have to pay the premiums, but this is politically difficult so Thailand

must continue financing universal health coverage from public money. However, this solution
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provides little flexibility of the policy to meet rising demands. Thailand also faces poor

enforcements of road and vehicle safety laws, air pollution, and extreme weather. The poor

enforcement of laws led to Thailand’s secondary position for highest death rate due to road

accidents and air pollution caused over 48,000 deaths in 2013 (Sumriddetchkajorn et al., 2019).

Although Thailand has made remarkable progress, these problems present challenges to the

country in achieving health equity for all.

In contrast to the three previous countries, South Korea, a high-income level nation, has

an exceptionally high health status. Their economic development and universal health coverage

led to rapid improvements in health outcomes. After the introduction of universal health care,

two changes occured, the first was a change into a single insurer system and the second was the

separation of prescription and dispensary of medicine. Before the separation of medical

prescription and dispensing, Korean pharmacists were allowed to sell biomedical drugs without a

doctor’s prescription and medical professionals practiced without any accountability as the

government did not try to intervene. This led to the public’s exposure to excessive and

sometimes harmful health services as data revealed overuse of antibiotics, excessive use of

magnetic resonance imaging, and high cesarean delivery rates (Lee, 2003). Separating medical

prescription and dispensing has helped curb the staggering health data. Despite these

improvements to the health care system and the universal health coverage, South Korea still

faces health problems. The health care system has high out-of-pocket payments and co-payments

that remain a key issue to the population. Locations of medical facilities also contributes to the

health inequity as many facilities and resources are located in urban areas in order to maximize

their medical profit. Those in rural areas will have a more difficult time seeking health care. Due
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to their high life expectancy, South Korea faces a health financial deficit from the increase in

medical expenditure for chronic diseases by the elderly population, which is growing faster than

any other country (Song, 2009). Not enough of the elderly are getting the care they need for the

price they can afford.

Analysis of the potential global responses to address the health disparities and country

efforts to address their health challenges

Education is associated with health. If there are inequalities in education, one can expect

to see health disparities. The CDC states individuals with high education are less likely to

experience a number of health risks compared to individuals with less education (2018). Some of

these risks include obesity, substance abuse, and intentional and unintentional injuries.

Individuals with higher levels of education often experience a longer life and an increased

chance of gaining basic knowledge and services that they need to make informed health

decisions (CDC, 2018).

When analyzing Ethiopia and the Philippines, it is evident that they have low overall

health statuses. One way to improve this is to provide education for the country. Providing

education would benefit the whole population as well as subgroups of that population. For

instance, if women who are pregnant have some sort of education, they are more likely to receive

antenatal care from a skilled provider. According to a survey in 2013, 91% of women with an

elementary school education, 97% of women with a high school education, and 98% of women

with a college education sought antenatal care as opposed to 62% of women with no education

(Dayrit et al., 2018). Antenatal care can help reduce the high infant mortality rate and maternal

mortality rate of both Ethiopia and the Philippines as proper care and healthy lifestyles are
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promoted for both the child and mother. With education, the population can increase their

literacy rate and be armed with the knowledge and resources to make appropriate health

decisions.

Between all the countries and nations around the world lies many differing cultures. They

may have similarities but they each have their own unique customs and beliefs and that is why

being culturally competent is important. When proposing medical care to someone with a

different culture, it must be understood that the individual may oppose it due to contradictions to

their culture so medical care and advice must be tailored to suit each culture. In Ethiopia, it was

found that women were less likely to seek maternal health services due to their cultural and

traditional beliefs. They don’t talk about their pregnancy to anyone because they do not know

whether there may be a miscarriage (Kea et al., 2018). They also fear that they will not be able to

bury their placenta, an important practice, if they deliver their child at a medical facility.

Seeing the success in Thailand’s and South Korea’s universal health coverage, similar

policies should be implemented and adapted to Ethiopia and the Philippines. Although the

Philippines has increased their health care coverage, it does exclude some subgroups in their

population so expanding coverage to all would be beneficial as Thailand and South Korea saw a

decrease in their infant mortality rate and maternal mortality rate after implementing their health

system. A way to raise revenue for this health system is by implementing new taxes that are

earmarked for health spending, which includes taxing unhealthy products such as tobacco and

alcohol (Sumriddetchkajorn et al., 2019).

Self reflection
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Prior to this assignment, I didn’t understand the depth of the health disparities between

each country. I recall that at a younger age, I associated being poor with a bad health status and

being rich with a good health status. This assignment helped me understand that this is true to an

extent. Income-level and health status is associated but it also depends on many factors, factors

that I didn’t take into consideration before. I now understand that your health also depends on

your culture and the public policy of the country you live in. I am fortunate enough to grow up in

a country where I have access to adequate care, however, not everyone is that lucky. This

assignment has given me the skills to properly research and compare the health care systems of

differing countries but understand that what works for one country may not work for the other.

This was the case with South Korea where they implemented a new single insurer system that

would work best with their population.

Although a comparison between 4 countries was made that did not include the United

States, I couldn’t help but compare our health statuses and the reasons for any differences. For

example, would the United States have a better health care system if we switched to South

Korea’s single insurer system or if we provided universal health coverage? I know Obamacare

was a step towards this but not to the extent of South Korea and Thailand.

Conclusion

Health equity is a goal that is sought by countries of all income levels. However, due to

differences in cultural, social, and political factors, health disparities exist. Examination of these

disparities were done between Ethiopia, the Philippines, Thailand, and South Korea by looking at

five health indicators. In order to make appropriate actions, health disparities were evaluated
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through the lenses of education, cultural and ethnic studies, and public policy which led to a

deeper understanding of the different factors that affect overall health status.
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References

Center for Disease Control and Prevention. (2018). ​Health disparities.

https://www.cdc.gov/healthyyouth/disparities/index.htm

Center for Disease Control and Prevention. (2019). ​Infant mortality.

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

Central Intelligence Agency. (n.d.). ​The world factbook.

https://www.cia.gov/library/publications/the-world-factbook/

Dayrit, M. M., Lagrada, L. P., Picazo, O. F., & Pons, M. C. (2018). The Philippines health

system review. ​Asia Pacific Observatory on Health Systems and Policies, 8​(2).

https://apps.searo.who.int/PDS_DOCS/B5438.pdf

Kea, A. Z., Tulloch, O., Datiko, D. G., Theobald, S., & Kok, M. C. (2018). Exploring barriers to

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https://doi-org.csulb.idm.oclc.org/10.1186/s12884-018-1721-5

Lee, J. C. (2003). Health care reform in South Korea: Success of failure?. ​Am J Public Health,

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Sumriddetchkajorn, K., Shimazaki, K., Ono, T., Kusaba, T., Sato, K., & Kobayashi, N. (2019).

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