Is the HIC/LMIC country classification still relevant in today's health equity dialogue?
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School of Public Health, University College Cork, Ireland ASPHER Western Gateway Building, University College Cork Ireland
World Federation of Public Health Associations, Institute of Global Health, University of Geneva, Geneva, Switzerland
ASPHER, Kampala, Uganda
School of Economics, University College Cork ASPHER Aras na Laoi, University College Cork Ireland
Department of Public Health, Medical University of Gdansk ASPHER "Department of Public Health and Social Medicine, Medical University of Gdansk, Poland Dębinki 7, budynek nr 15, 80-211 Gdańsk" Poland
School of Public Health, University College Cork, Ireland ASPHER University College Cork Ireland
WFPHA WFPHA Geneva Switzerland
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1829
Background and Objectives:
The World Bank categorises economies into Low Income Countries, Lower Middle-Income Countries, Upper Middle-Income Countries and High-Income Countries (HICs), based on Gross National Income (GNI), with 136 (63%) countries in the Low- and Middle-Income Country (LMIC) categories. The ubiquitous use of LMIC suggests it represents something meaningful, however, we argue that its far-reaching impact lacks a people-centred focus required for health equity. The measurement requires change in today’s world where there are low-income settings (LISs) in HICs and vice-versa. Are health outcomes in LISs in HICs better or worse than those of HISs in LMICs? The use of these terminologies cannot be separated from decisions on resource allocation and their impact.

A rapid literature review was conducted from peer reviewed journals, published during the last 5 years. Search terms included public health; health equity; in combination with terms such as LIMC; HIC, deprived community; deprivation index. WHO data was used to examine the proportions of the population in LMICs and HICs exposed to catastrophic health expenditure.

We conclude from the literature that the human aspect should be a key thread to follow when assessing LISs. The evidence points toward the need to talk about specific groups; indigenous, migrants, travellers or those from deprived communities and their settings. This approach provides a better insight into health equity. The structure of national health systems also plays a role in determining the extent to which sections of the population are exposed to catastrophic health expenditure.

Considering the purely economic nature of the categories, we conclude that the current classification requires adaptation, specifically a shift towards a human-focused perspective rather than a geographical focus. In changing to a setting approach, we believe that health-related challenges and health equity will be better addressed.

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