New Report: Social Determinants of Health

Posted by on October 27, 2008

WHO RELEASES NEW REPORT ON SOCIAL DETERMINANTS OF HEALTH:
Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health

A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17,400; in Afghanistan, the odds are 1 in 8. Biology does not explain any of this. Instead, the differences between – and within – countries result from the social environment where people are born, live, grow, work and age.

These “social determinants of health” have been the focus of a three-year investigation by an eminent group of policy makers, academics, former heads of state and former ministers of health. Together, they comprise the World Health Organization’s Commission on the Social Determinants of Health. “(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible,” the Commissioners write in Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. “Social injustice is killing people on a grand scale.”

“Health inequity really is a matter of life and death,” said Dr Chan today while welcoming the Report and congratulating the Commission. “But health systems will not naturally gravitate towards equity. Unprecedented leadership is needed that compels all actors, including those beyond the health sector, to examine their impact on health. Primary health care, which integrates health in all of government’s policies, is the best framework for doing so.”

Recommendations: Based on the compelling evidence, the Commission makes three overarching recommendations to tackle the “corrosive effects of inequality of life chances”:

* Improve daily living conditions, including the circumstances in which people are born, grow, live, work and age.
* Tackle the inequitable distribution of power, money and resources – the structural drivers of those conditions – globally, nationally and locally.
* Measure and understand the problem and assess the impact of action.

Recommendations for daily living: Improving daily living conditions begins at the start of life. The Commission recommends that countries set up an interagency mechanism to ensure effective collaboration and coherent policy between all sectors for early childhood development, and aim to provide early childhood services to all of their young citizens. Investing in early childhood development provides one of the best ways to reduce health inequities. Evidence shows that investment in the education of women pays for itself many times over.

Billions of people live without adequate shelter and clean water. The Commission’s report pays particular attention to the increasing numbers of people who live in urban slums, and the impact of urban governance on health. The Commission joins other voices in calling for a renewed effort to ensure water, sanitation and electricity for all, as well as better urban planning to address the epidemic of chronic disease.

The report also highlights how over 100 million people are impoverished due to paying for health care – a key contributor to health inequity. The Commission thus calls for health systems to be based on principles of equity, disease prevention and health promotion with universal coverage, based on primary health care.
Distribution of resources: Enacting the recommendations of the Commission to improve daily living conditions will also require tackling the inequitable distribution of resources. This requires far-reaching and systematic action.

The report foregrounds a range of recommendations aimed at ensuring fair financing, corporate social responsibility, gender equity and better governance. These include using health equity as an indicator of government performance and overall social development, the widespread use of health equity impact assessments, ensuring that rich countries honour their commitment to provide 0.7% of their GNP as aid, strengthening legislation to prohibit discrimination by gender and improving the capacity for all groups in society to participate in policy-making with space for civil society to work unencumbered to promote and protect political and social rights. At the global level, the Commission recommends that health equity should be a core development goal and that a social determinants of health framework should be used to monitor progress.

To read the full report, visit: http://www.who.int/social_determinants/final_report/en/