By Evangeline T. Capuno
There are always two sides of a coin: right and left, correct and wrong, day and night, black and white, long and short, attractive and ugly, young and old, sweet and salty, rich and poor. The list goes on and on.
This brings us to the subject of disparity, defined as “a difference in level or treatment, especially one that is seen as unfair.”
Wayne Dyer once said: “One of the huge imbalances in life is the disparity between your daily existence, with its routines and habits, and the dream you have within yourself of some extraordinarily satisfying way of living.”
Yehuda Berg has this observation, “It is not our sexual preferences, the color of our skin, the language we speak, nor the religion we practice that creates friction, hatred and wars amongst in society. It is our words and the words of our leaders that can create that disparity.”
“Whenever we have an opportunity to engage with each other as human beings and to minimize the differences between us based on disparity in resources, then we should do it,” William T. Vollmann advised.
Disparity is synonymous with inequality. “There is so much wealth and so much misery at the same time, that it seems incredible that people can endure such class difference, and accept such a form of hunger, while on the other hand, the millionaires throw away millions on stupidities,” said Frida Kahlo, a Mexican artist writing about New York City in the 1930s.
Nelson Mandela, when he was the president of South Africa, in his State of the Nation Address in 1996, said: “We must work together to ensure the equitable distribution of wealth, opportunity, and power in our society.”
Just recently, the Geneva-based World Health Organization (WHO) released a report on access to morphine, a strong opiate that is found naturally in opium. It is mainly used as a pain medication, although it is also used recreationally or in making other illicit opioids.
The WHO report describes how the global distribution of morphine, as a vital pain medicine, is unequal and does not fulfil the medical need. The report, titled “Left behind in pain,” highlights the problems in access to this essential medicine and offers actions to improve safe access through balanced policy.
Despite morphine being an effective and relatively low-cost medicine for relieving strong pain, listed since 1977 in the first edition of the WHO Model List of Essential Medicines, the disparity in access across countries is stark. “There is a 5- to 63-fold difference in the estimated median consumption of morphine between high-income countries and lower income countries,” the WHO said in a statement.
Consumption pattern varies significantly across countries of similar wealth; it does not correspond to medical need, as indicated by the estimated number of days people are in pain, or suffer with severe shortness of breath for people with a terminal illness.
This data echoes that of the 2018 Lancet Commission which described the lack of access to pain relief medication as “one of the most heinous, hidden inequities in global health” with the richest 10% of countries possessing 90% of distributed morphine-equivalent opioids. “Leaving people in pain when effective medicines are available for pain management, especially in the context of end-of-life care, should be a cause of serious concern for policy-makers,” says Dr Yukiko Nakatani, WHO Assistant Director-General for Medicines and Health Products. “We must urgently advocate for safe and timely access to morphine for those in medical need through balanced policy, everywhere.”
There are several reasons why there is a disparity, according to the WHO report.
“Access to morphine for medical use is influenced by many interacting factors including enablers related to good governance, reliable/efficient procurement and supply processes, resource availability and capacity-building activities, along with barriers related to overly restrictive legislation and policies, inadequate service provision, and misinformed attitudes and perception,” the WHO pointed out.
Given different country contexts, enablers, barriers and priorities for action vary; a stakeholder survey presented in the report, with respondents from 105 WHO Member States, confirms this variation. For example, irregular supply of morphine and other strong opioids at health facilities due to limited financing were commonly noted as a barrier in low- and middle-income countries compared to high-income countries.
More than a third of respondents across all regions also noted barriers arising from legislative and regulatory factors while recognizing the importance of a legislative and regulatory framework in achieving safe access. “Unduly restrictive requirements could hamper patient access because they impede the flow of supply or make prescribing and dispensing difficult for health-care professionals,” the WHO said. “It is important to note that concerns about the potential harmful effects of opioids are valid, such as their potential to lead to opioid use disorder,” the WHO added.
