Last week, a ‘landmark study’ was released that found social injustice to be a more significant factor in global health than access to medical care. Commissioned by the World Health Organization, a panel of 19 experts (including Amartya Sen!) formed the Commission on Social Determinants of Health and sought to find the “cause behind the cause” of global disease and health crises.
“Social injustice is killing people on a grand scale,” the introduction reads.
“In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health. It does not have to be this way and it is not right that it should be like this.”
To underscore the gaps, a number of stark statistics are featured, including the fact that a girl born today in the African country of Lesotho can expect to live 42 fewer years than one born in Japan.
The 256-page report, entitled Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health, also challenges current economic dogma, stating that global trade and an aversion to public spending on social programs is not improving the lot of most people in the world, but making things worse.
“Economic growth is without question important, particularly for poor countries, as it gives the opportunity to provide resources to invest in improvement of the lives of their population. But growth by itself, without appropriate social policies to ensure reasonable fairness in the way its benefits are distributed, brings little benefit to health equity,” the report says.
The report discussed how, even within small countries, life expectancies can vary greatly. Their recommendations to overcome social injustice focus on three overall areas:
- Improve daily living conditions
- Tackle the inequitable distribution of power, money, and resources
- Measure and understand the problem and assess the impact of action
Call me skeptical, but I have a feeling #2 is going to be difficult unless we see a global rise in socialism that finally does away with capitalist hegemony once and for all:
One of the commissioners was Canadian professor Monique Bégin of the University of Ottawa. She pointed out that social inequalities and the abandonment of social programs by more conservative administrations over the past decades has had an affect on Canadians’ health, as well:
“Canada likes to brag that for seven years in a row the United Nations voted us ‘the best country in the world in which to live.’ Do all Canadians share equally in that great quality of life? No, they don’t. The truth is that our country is so wealthy that it manages to mask the reality of food banks in our cities, of unacceptable housing, of young Inuit adults’ very high suicide rates.”
Prof. Bégin said she hopes the report will be a “wake-up call for action towards truly living up to our reputation.”
Similar “health gradients” are found in Australia as well. According to a WHO press release on the report:
- Life expectancy for Indigenous Australian males is shorter by 17 years than all other Australian males.
- Maternal mortality is 3–4 times higher among the poor compared to the rich in Indonesia. The difference in adult mortality between least and most deprived neighbourhoods in the UK is more than 2.5 times.
- Child mortality in the slums of Nairobi is 2.5 times higher than in other parts of the city. A baby born to a Bolivian mother with no education has 10% chance of dying, while one born to a woman with at least secondary education has a 0.4% chance.
- In the United States, 886 202 deaths would have been averted between 1991 and 2000 if mortality rates between white and African Americans were equalized. (This contrasts to 176 633 lives saved in the US by medical advances in the same period.)
- In Uganda the death rate of children under 5 years in the richest fifth of households is 106 per 1000 live births but in the poorest fifth of households in Uganda it is even worse – 192 deaths per 1000 live births – that is nearly a fifth of all babies born alive to the poorest households destined to die before they reach their fifth birthday. Set this against an average death rate for under fives in high income countries of 7 deaths per 1000.
And clearly biology doesn’t explain these differences.
Based on these findings, several countries have already committed to taking on board the three overarching recommendations. Brazil, Canada, Chile, Iran, Kenya, Mozambique, Sri Lanka, Sweden, and the UK have become ‘country partners’ on the basis of their commitment to make progress on the social determinants of health equity and are already developing policies across governments to tackle them. The WHO is now going to be calling upon Member States to take this report to their health agencies and develop policies to address social injustice as a primary determinant of health problems.
But as the report suggests, there is a vested interest in the status quo and until distribution of wealth and resources is addressed, it is unlikely we will see the health/life expectancy/education/everything gap close.
So who’s up for a revolution?
author on September 1st, 2008 | File Under Canada, Commentary, Health, Politics | No Comments - |