Health inequality among people between and within countries is significant and constitutes an urgent issue of social justice. It is clear that these health inequalities are the result of differences in living conditions; the environment in which a person is born, grows, lives, works, ages, and dies.
Statistics illustrating health inequalities (WHO, Commission of the Social Determinants of Health 2008 Final Report):
- The life time risk of maternal death is 1 in 8 in Afghanistan and 1 in 17 400 in Sweden.
- In Manila’s slums, up to 39% of children aged between 5 and 9 are already infected with TB - twice the national average.
- In Glasgow, a boy born in an affluent suburb can expect to live 82 years while one born in a deprived suburb can expect to live 54 years. (WHO World Health Report 2006)
Responding to increasing concern about these persisting and widening inequalities, WHO established the Commission on Social Determinants of Health (CSDH) in 2005 to provide guidance to Member States and WHO’s programmes by gathering evidence on social determinants and ways to overcome inequities. The Commission's final report "Closing the Gap in a Generation" was launched in August 2008.
The report assesses the impact of social determinants of health and makes recommendations to improve daily living conditions and, ultimately, work toward a level of social equity necessary to empower all persons to claim their right to health. It insists on a multidisciplinary approach to achieving health equity. Improvements to the health sector alone are insufficient. Policies with the long term aim of improving health must touch all sectors of society. The report calls into action government, civil society, international organizations, and policy makers who shape the conditions under which people live.
The report includes three overarching recommendations:
- Improve daily living conditions
- Tackle the inequitable distribution of power, money, and resources
- Measure and understand the problem and assess the impact of action
Statistics illustrating the effect of social determinants on health (WHO, Commission of the Social Determinants of Health Final Report 2008):
- In Costa Rica, as a result of improvements made to primary care, the national infant mortality rate was reduced from 60 to 19 per 1000 live births between 1970 and 1985.
- In Asia, out-of-pocket healthcare payments pushed 2.7 % of the total population of 11 low to middle income countries below the very low poverty threshold of US$ 1/day.
- In Bolivia, the infant mortality of babies born to mothers with no education is 100 per 1000 live births while the infant mortality of babies born to mothers with at least secondary education is 40 per 1000.
Further to the publication of the report, the World Health Assembly adopted a resolution "Reducing health inequities through action on the social determinants of health"(May 2009). The Resolution calls on the international community, including United Nations agencies, intergovernmental bodies, civil society, and the private sector to take action in collaboration with WHO’s Member States and the WHO Secretariat to assess the impacts of policies and programmes on health inequities and address the social determinants of health
WHO has convened the World Conference on Social Determinants of Health (WCSDH), from 19-21 October 2011, in Rio de Janeiro, with the support of the Government of the Federative Republic of Brazil. In view of this event, WHO had launched a consultation on a draft technical paper which aims to inform the conference discussions and provide policy-makers with an overview of key strategies to implement action on SDH.
WHO Regional Offices commissioned case studies for the World Conference on Social Determinants of Health. These case studies present successful examples of policy action aiming to reduce health inequities, covering a wide range of issues, including conditional cash transfers, gender-based violence, tuberculosis programmes and maternal and child health.
WMA Current Policy & Action:
- On the occasion of the World Health Assembly 2009, the World Medical Association – on behalf of the World Health Professions Alliance (WHPA) - presented a statement. welcoming the report and supporting its holistic approach to social determinants of health, placing health equity at the core of the matter, in order to achieve the health related Millennium Development Goals (MDGs) and ultimately social justice worldwide. Regarding the health workforce, the WHPA regrets however that the report in general does not give more attention to health professionals as key players in addressing the social determinants of health and inequalities they face in their daily work
- Article in the World Medical Journal, February 2009
- WMA Statement on Inequalities in Health, Delhi, October 2009
- WMA Statement on Social Determinants of Health, Montevideo, October 2011
- WHO, Social Determinants of Health‘Reducing health inequities through action on the social determinants of health’ Sixty-second World Health Assembly, Resolution WHA62/R14