Narrowing health inequalities in Sri Lanka: issues and challenges.

For several decades Sri Lanka has shown better health outcomes compared to countries with similar income levels. These outcomes are mainly for infant and maternal mortality rates (IMR and MMR respectively) and life expectancy at birth. The country is often hailed as a model to achieve ‘good health at low cost’ [1, 2]. However, the apparently ‘good’ figures are average values that conceal wide variations in outcome between individuals or population groups. For example, the IMR in the lowest and highest wealth quintiles in Sri Lanka is 25 and 13 per 1000 live births [3]. These variations are known as health inequalities or health disparities and signify a comparison of health, especially among population or between social groups. They are observed between countries and within countries [4]. Within a country, the relatively poor (i.e. lower income or wealth) have worse health outcomes than their affluent counterparts. These worse outcomes are not confined to the poor and instead there is a gradient in health outcomes. In Sri Lanka the IMR falls step-wise from the lowest income quintile to the highest: 25; 21; 19; 14; and 13 (per 1000 live births) [3].