Building of the global movement for health equity: from Santiago to Rio and beyond Michael Marmot, Jessica Allen, Ruth Bell, Peter Goldblatt
Health inequalities are present throughout the world, both within and between countries. The Commission on Social Determinants of Health drew attention to dramatic social gradients in health within most countries and made proposals for action. These inequalities are not inevitable. The purpose of this article is to report on activity that has taken place worldwide after the report by the Commission on Social Determinants of Health. First, we summarise the global situation. Second, we summarise an interim report of the emerging ﬁndings from an independent review of social determinants and the health divide, which was commissioned by the WHO European region. The world conference on social determinants of health will be held in Rio de Janeiro, Brazil, in October, 2011. This summit provides an opportunity to galvanise support, prioritise action, and respond to the call by the Commission on Social Determinants of Health for social justice as a route to a fair distribution of health.
Lancet 2012; 379: 181–88 Published Online October 19, 2011 DOI:10.1016/S01406736(11)61506-7 See Comment page 103 Department of Epidemiology and Public Health, University College London, London, UK (Prof M Marmot FRCP, J Allen PhD, R Bell PhD, Prof P Goldblatt PhD) Correspondence to: Dr Jessica Allen, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK email@example.com
“Social Injustice is killing on a grand scale” “A toxic combination...of poor social policies and programmes, unfair economic arrangements, and bad politics...is responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible.” Commission on Social Determinants of Health1
In Afghanistan, the lifetime risk of a maternal death is one in 11; in Europe, the lowest is one in 31 800.2 Some of the appalling premature loss of women’s lives could be mitigated by provision of skilled birth attendants. But much of it arises because of the nature of social and economic arrangements, both globally and locally. The evidence brought together by the Commission on Social Determinants of Health (CSDH) attributed health inequities to the circumstances in which people are born, grow, live, work, and age, in addition to the healthcare systems put in place to deal with illness. Wide inequities in the distribution of power, money, and resources account for these conditions of daily life.1 Inequities in health are noted in men and women, children and elderly people, and people of working and childbearing age. Health inequities are not conﬁned to poor health for people in poor countries and to good health for everyone else. The CSDH drew attention to dramatic social gradients in health recorded within most countries. Within London, England, there is as much as a 17-year diﬀerence in male life expectancy between Tottenham Green, a deprived area, and Queens Gate Ward, a wealthy one.3 In Glasgow, Scotland, the diﬀerence between the most deprived and least deprived areas is 28 years.4 Although the CSDH report recognised the importance of health-care-based solutions to health inequities within and between countries, it concluded that health inequities are manifestations of societal inequities. Gross social inequities deprive subgroups of the population of the opportunity to beneﬁt from economic and social development and damage social cohesion and integration with consequent social and www.thelancet.com Vol 379 January 14, 2012
health eﬀects. Reduction of these inequities is a matter of social justice and requires action at the societal level— globally, nationally, and locally. At the launch of the CSDH in 2005, the then Director General of WHO, J W Lee, referring to the need for action on social...
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