Social injustice is 'killing on a grand scale'
By Gursharan Randhawa Social inequity is worse for people’s health than a lack of medical facilities, but the situation can be remedied “within a generation”. That, in a nutshell, is the message from a three-year analysis of the quality of life around the world (pdf format), presented today by the Commission on Social Determinants of Health (CSDH), an advisory body to the World Health Organisation. The CSDH found that quality of life, health and life expectancy varied dramatically, depending on socioeconomic conditions. For example, a boy living in one suburb of Glasgow, UK, is expected to live 28 years less than a boy born in another just a few miles away. A baby born to an uneducated Bolivian mother is 25 times more likely to die than a baby born to a Bolivian mother with secondary level education. So what can be done to reduce health inequities around the world independently of science and medicine? We review what the commission found and recommended to “help people fulfil their biological potential”. The wealthier the country, the healthier the population, right? Not necessarily. Even if a country becomes wealthier, the population’s health may not improve unless the income is used and distributed wisely to promote equality in the various “social determinants of health” – education, employment, basic amenities and gender equality. Some countries and regions with low per-capita wealth, such as China, Cuba and the Indian state of Kerala have improved health regardless of a lack of money. How does the commission suggest we achieve global health equity? The key is to look beyond the temporary solutions provided by health-care and medicine. It is social injustice that leads to deeper health inequalities, the commission finds. Commission chair Michael Marmot has three key recommendations: 1. Provide care and support to all members of society, from newborn babies to the elderly, from education to employment to retirement. Invest in schooling, safe working environments, affordable housing, health-care and public transport. 2. Manage access to fatty foods, alcohol and tobacco, develop a well-financed public sector to fund projects, and promote gender equality and political empowerment. 3. Measure, research and understand problems, and train individuals to monitor and assess the impact of actions taken to improve health equity. Will there be policy changes as a result of the report? The commission was set up by the WHO to provide independent advice regarding health inequity. It is up to individual governments to decide what to do with the information – such as the finding that the more readily available alcohol and junk food are, the more likely people will consume them to the detriment of their health. But the commission says every government policy and initiative should be assessed for its impact on health. Did the commission put forward any radical ideas? An international tax on foreign exchange dealings was one possibility considered by the commission. Revenues would be fed back into a global development fund. In the meantime, Marmot hopes to spread the message that global health inequity should and can be overcome by implementing some key changes in the social,