Health Care Inequalities in World Cities

Mortality amenable to health care is a summary measure of the extent to which access to disease prevention, primary care, as well as specialty services, contribute to the reduction of premature mortality. Hospital discharges for so-called “avoidable hospitalizations” reflect the extent to which there are access barriers to timely and effective primary care services and disease management services. These indicators capture important dimension of inequalities in access to timely and effective disease prevention, primary care and/or specialty services, but they have never been used together, in a systematic way, to measure health system inequities. I use these indicators as a tool for assessing the health care systems in New York, London, Hong Kong and Paris. This approach provides a useful comparative analysis for understanding health care and health inequalities among and within these world cities and provokes important questions about how these cities can learn from one another, particularly with respect to the descriptive information on the experience of city's programs and policies on inter-sectoral action to improve population health.