Let's look for a second at some of these points now, In greater detail and these slides should make very good sense to you. Because, however, unfortunate it is, we expect that health status, health out comes, health access, health coverage. Will vary by some of the factors that we've just talk about specially income, education and income and education. But I want to say before we look at this though that it's a very, very important when we think about health disparities to go beyond looking at the link between disparities in income. A fair number of people are concerned about how health disparities or who examined this, in the global health field tend to focus on disparities by income. These are very, very important but I think what we've just seen is that, if one were to stop there, one would miss a lot. And it’s really important to look at a range of factors associated with disparities. Some of which go substantially beyond income even though others might be quite closely tied, tied to income. So, let’s look first having said that at some of the relationships between health difference, health disparities and income. Now before you ask, let me explain that the people who work on health and global health some years ago. Created a variety of industries which allow them to divide populations up by what they call income quintile, and this is poorest 20% next 20%. Quintile means it's divided into 5, and so we're dividing the population into groups of 20% from the lowest 20% to the 20% of highest by income. There's actually more to this [LAUGH] than really just the income but that's the subject for other discussion. So I'm really just going to use the word income for now, so let's look how this plays out in two regions and here we're looking at birth attendance. Attendance at birth by skilled personnel. And here what we see is in these two, I think these were units of subregions of South Asia and Sub-Saharan Africa. What's the difference between attendance by a skilled personnel delivery by income quintile. Sadly, in some respects, but as we might expect, what we see is a very strong correlation between income and coverage. With average going up in a very linear way, as income goes when the poorest 20% to the richest 20% at the population. And clearly, a family with the minister of finance and ministry of health and talk to Rachel's the president of the country. She would say Madam President sadly, we continue to see at our own country important disparities by income group. But I want to assure you that under my leadership is the minister of health. We will do all that we can to compress this by helping to enable our poorest people to achieve the same nearly universal. Hopefully, universal coverage of birth by skilled birth attendants, because are better off people are ready do, let's look at another one. And here what we see just for the poorest 20% and the richest 20% for the same 2 regions, the percentage of underweight children 0 to 5 in these 2 regions over this period. And here, what we see is the blue is the richest 20%, the orange is the poorest 20%, and of course what we would expect is as incomes rise. We would expect children to be better nourished and we would expect to find lower rates of children being underweight and in fact that's what we find. What we see here is again a very strong correlation with the poorest 20% of the population in South Asia having rates of underweight among death 0 to 5 year old children. The trauma's three times higher than the better off communities and Sub-Saharan Africa they're more than two times higher. Let's look at another graphic on disparities, also by income and this is coverage of measles. And here, what we see again is we might expect, however unfortunate, there's a very strong correlation between income and coverage. Now I'm happy to tell you but thanks to important efforts by a number of countries, as well as important collected efforts through. For example, the global alliance for vaccines, the GAVI Alliance Vaccines and Immunization. If we were to look at this for 2013 and super impose it on this, there'd be very good story to tell. Immunization coverage rates have gone up and they have gone up even among these groups. There are still important gaps, but many countries and globally. We've made important progress in closing these gaps, exactly as we would want to see happen. Now we can also look at location as a factor linked to disparities. And here what we're going to do is look at the percentage of stunted children, 0 to 5, by location, for selected regions as well. And stunting has to do with children who are too short for their age, okay? Actually, they're much too short for their age, so I say and here, what we see is we would generally predict that urban children, even though there are urban slums there are lot of poor people in urban places. Everywhere, we would still expect that especially in low and middle income regions like these that urban children will be better nourished than rural children. And indeed, what we find is substantial differences between the two. And in one case in fact, probably in some respects reflecting indigenous populations as well in Latin America. We see that children living in rural areas have rates of standing that are more than twice as high as those living in urban locations. And we're going to see this is well for contraceptive problems and this again is another look at urban and rural. Here we have percentage of women 15 to 49 who are using contraception by location. And here, of course, we would again predict that in rural areas it would have lower use. Access might be less, coverage might be less, knowledge of the families about contraception might be lower as well. But again, your goal is policy makers would be to try to ensure that all family whether they're urban or rural at the same knowledge understanding and information. Needed to make it lighten choices voluntarily about the extent to which they wish to use contraception. And the world especially in Sub-Saharan Africa still has a substantial distance to go before these disparities can truly be considered to have been reduced, now. There are also important differences ethnically as we've discussed and this graphic looks at Maternal Mortality Ratios in two countries over a certain period of time for indigenous people. And it compares the maternal mortality ratio for indigenous people with the maternal mortality ratio for the country as a whole. We would predict that indigenous people for the reasons that we know well would actually have higher ratios of maternal mortality than the average population or non-indigenous people. And indeed, in both of these countries, Bolivia and Honduras, that's exactly what we see. And one of our goals, we hope will be to see that whether it's Bolivia, Honduras, or the country in which we live that such disparities along ethnic lines are reduced. Now, I want to say also that in addition to thinking about income, location, ethnicity, religion, occupation, etc. We need to think also about financial fairness which is not something that everybody does, and it's not a factor that everyone understands very well. But, we also want to take a look at the way in which the health system is financed and try to be sure that that itself is fair. There are countries in which we see that the better off people, let's say the best off 20% of the population. Actually gets 30% or 40% or 50% of all the health benefits from public expenditure on health. And by contrast, in some of those countries, what you also see is the bottom 20%, who in principle you might want to help more. Actually, receive less than 20% of the benefits from public expenditure on health. This is a complicated matter, but I want to remind you how important it is to think about financial fairness as well and look at the way in which the system is being financed. And then ask yourself the question, who pays and who benefits what's the extent to it's benefits flow compared to your share of the population. And if you're concerned, if you have a special concern for poor marginalized people, in principle, you might want to see a disproportion that your benefits flow their way. What you don't want to see is a disproportion that share benefits flow to the upper income groups. As I noted earlier, health disparities is a central issue in public health and in global health. And it's very important that in all countries, policy makers and people seek to reduce health disparities to the minimum. Thus, as we work on global health and study global health as I mentioned earlier in this session. It's really important I think, to keep on in equity lens and to use this equity lens to look at all that you're doing. I would encourage you to keep equity and inequality and disparity in mind at all times. I also would encourage you to be careful about how you use numbers and be careful about using averages. Because it's really important to be sure that we don't miss variations either within countries or across countries, within groups or across groups. We also want to look at how every piece of data we're dealing with in global health. Relates to health access, health coverage, health status as well as think about how it is the system is being financed and whether or not that itself is fair. Hopefully, you have a better sense than you did when we began this session of the importance of health equity of the factors that relate to health disparities. And the importance of insuring that as you think about health, public health and global health you always keep on an equity glance. In the next session, we're going to talk about the environment and health.