Inequality and inequity in eye health

According to the 2010 Global Burden of Disease (GBD) study, the global prevalence of blindness (age-standardised) has declined from 0.60% in 1990 to 0.47% in 2010.1 This seems to indicate that an increasing number of people have access to good eye health services. However, this improvement is not equally distributed within and across nations. The GBD study also showed that 60% of blindness worldwide is among women, underlining that gender equity in eye health has not yet been achieved. There are several other studies which show how inequitable access to eye health services is worldwide. A recent assessment of avoidable blindness and visual impairment in seven Latin American countries concluded that the prevalence of blindness and moderate visual impairment was concentrated among the most socially disadvantaged, and that cataract surgical coverage and cataract surgery optimal outcome were concentrated among the wealthiest.2 The same study showed that unoperated cataract remained the most common cause of blindness in Argentina, despite the high national cataract surgical rate (CSR) of 5,935 cataract operations per million population per year. A 2010 study in Gujarat, India concluded that, despite an even higher reported CSR of 10,000, cataract remained the predominant cause of blindness and visual impairment and blindness remained a significant problem among the elderly.3 A systematic review of barriers to cataract surgery in Africa4 (which involved reviewing 86 articles, including 12 RAAB, 10 quantitative and 5 qualitative studies) showed variability in the study outcomes. In the RAAB studies, barriers related to awareness and access were more commonly reported. Other studies reported cost as the most common barrier. Some qualitative studies tended to report community and family dynamics as barriers to cataract surgery. Overall, the systematic review found that the CSR was lower in females in 88.2% of the studies. These major barriers point to underlying factors of unequal access: illiteracy and low educational levels, poverty and economic hardship, no physical access (distance), and the socio-cultural situation. While, increasingly, data on eye health provision are collected separately by Everyone matters