Equity and blindness: closing the evidence gap in support of universal eye health

BackgroundUniversal Health Coverage is a priority of the World Health Organization (WHO); this is echoed in the 2013 WHO eye health action plan which focuses on Universal Eye Health (UEH). Blindness is unequally distributed between and within countries, being more prevalent in poorer countries and, in all countries, among disadvantaged or marginalised population groups. Interventions exist to treat the most common conditions associated with blindness, including cataract. However, who receives these interventions is socially determined, with services being more available in rich countries than poor ones, and to those who are socially advantaged within populations.MethodsFour studies were undertaken; all analysed secondary data and focused on low and middle income countries. The first was a systematic review and meta-analysis of the association between gender and blindness, using population-based studies undertaken since 1980. The second explored inequalities in i) cataract blindness; and ii) blindness for women and men; between 21 geopolitical regions, and how these changed between 1990 and 2010. The third study utilised data from national surveys in Nigeria and Pakistan to examine inequality in cataract blindness and services in relation to gender, literacy status, marital status and place of residence. The final study examined inequality in vision status in Pakistan using hierarchical socioeconomic variables to calculate concentration indices as well as the slope and relative indices of inequality.Results and ConclusionThe studies revealed that prevalence of blindness remains higher in women compared to men, and the relative gender gap widened in some regions of the world between 1990 and 2010. Over this period a number of regions also became relatively worse-off compared to the best-off region. The disadvantaged subgroups experienced higher prevalence of cataract blindness, lower cataract surgical coverage (CSC) and worse surgical outcomes (CSO). The cumulative effects of multiple disadvantage were evident, with cataract blindness, CSC and CSO being consistently worst for groups who were disadvantaged across a number of social dimensions.More nuanced and layered analyses of inequality, including simultaneously reflecting multiple axes of disadvantage, are an essential part of the evidence required in the pursuit of universal eye health