Addressing the inequities in health: a new and vital mandate

[Guest guest]

Addressing the inequities in health: a new and vital mandate

 

The Lancet 2008; 372:689

DOI:10.1016/S0140-6736(08)61282-9

Editorial

 

This week saw the launch of the final report by WHO's Commission on Social

Determinants of Health, chaired by Marmot from University College

London, UK.

 

The report creates a solid foundation for urgently integrating social

determinants thinking into programmes for health-system reform—a priority that

is now recognised as an important prerequisite for achieving the Millennium

Development Goals.

 

The Commission talks unashamedly about social justice, a phrase that is used

more by politicians than health professionals. But the inequities and

inequalities in health that exist today must surely prick the concern and

conscience of every physician. The problem for most doctors is likely to be the

twin feelings of hopelessness and impotence at the sheer scale of the difficulty

they face. Those feelings often translate into paralysis.

The Commission's most refreshing conclusion is that hopelessness, impotence, and

paralysis can be overcome by optimism, vigour, and muscular policy responses.

Why? Because the evidence already shows that much can be achieved to reduce

inequity and inequality.

An example of what can be done to diminish inequalities is provided in this

week's LANCET issue by Tim Doran and colleagues.

 

The Commission calls for a new global agenda for health improvement and health

equity. It advocates an approach to health and human development in which equity

is a fundamental objective of reform.

Equity matters in its own right, but it also has strong instrumental

value—fuelling economic growth in low-income countries, for example. But

health equity cannot be delivered by the health sector alone. The response must

be across all of government and society.

This broader responsibility extends not only to national governments. It affects

WHO too.

 

Three principles of action are set out. First, to improve the conditions of

daily life at home and at work, for women and men, in rural and urban settings,

and for all ages. Second, to address the inequitable distribution of power and

money, forces that shape the conditions of daily life. And third, to act ”based

on knowledge, a professional workforce, alliances with civil society, and

evaluation.

 

From these principles flow recommendations in domains not only where the

evidence is strongest but also where the gains will be greatest.

For daily living conditions, this means focusing on adolescent girls and

children, the circumstances of childbirth, child development and education, and

social protection.

 

For inequalities in power, money, and resources, the Commission recommends a

strong public sector—“committed, capable, and adequately financedâ€. A

pre-requisite for reducing inequities is better governance, nationally and

globally holding all parties accountable. The Commission focuses especially on

gender equity, political empowerment, and WHO's leadership role in making social

determinants “a guiding principle†in all its work.

 

Action will depend on reliable measurement and evaluation to assess the major

causes of health inequities and to understand what works to address those

predicaments. The Commission encourages WHO to support the creation of national

and global equity surveillance systems.

Although much has been accomplished in the past 10 years, there remain major

challenges to registering births and deaths globally.

Finally, policymakers and practitioners must be properly trained in the science

of social determinants to translate research into practice.

 

After 3 years of gathering evidence, the Commission on Social Determinants of

Health has performed an invaluable service in making the health case for a

fairer society. It is a case that deserves the full support of health

professionals and policymakers in all countries. At last equity is taking its

rightful place at the centre of public debate about health. The Commission's

report is a fitting tribute to Dr J W Lee, WHO's late Director-General who

initially commissioned this brave project.

___________________

A copy of the commission report is available on the following url 

http://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf

AHF INDIA CARES ADVOCACY AND DISCUSSION FORUM

NEW DELHI

We request our forum members to share their views and experiences with regard to

this report so that inputs can be collated and sent as a response to the LANCET

for publication. We shall acknowledge individual contributions and appreciate

your prompt response.

The Lancet has an interest to declare the launch of the final report by WHO's

Commission on Social Determinants of Health, chaired by Marmot from

University College London, UK. A theme issue of the journal devoted to

action-oriented research and health policy in social determinants will be

published on Nov 8.

 

Dr. Mahesh Ganesan

Advocacy Coordinator,

AIDS Healthcare Foundation,

S-7, Panchsheel Park,

New Delhi 110 017

Tel: +91 11 41745541/42

Fax: +91 11 41745543

Cell: +91 9911331998

mahesh.ganesan@...

www.aidshealth.org