Health inequality among people between and within countries constitutes an urgent issue of social justice. It is clear that these health inequalities are the result of differences in the environment in which a person is born, grows, lives, works, ages, and dies. These are influenced by broader social, political, cultural, environmental, and economic factors. In recognition of these social determinants of health (SDH), the World Medical Association (WMA) adopted the Declaration of Oslo in 2011. In addition to highlighting the importance of acknowledging social determinants, the Declaration also suggests how the WMA can play a role in addressing them through disseminating medical skills and knowledge and gathering evidence on how physicians can address SDH.
Responding to increasing concern about persisting and widening inequalities, the 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 SDH and ways to overcome inequities. The Commission’s final report “Closing the Gap in a Generation” was launched in August 2008 with the following statistics included:
- The lifetime 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 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 $1USD per 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.
Addressing Social Determinants of Health
The report assesses the impact of SDH and makes recommendations to improve daily living conditions and 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 policymakers 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 and measure and understand the problem and assess the impact of action.
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 SDH. In addition, 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.
In 2014, the WMA hosted the H20 International Health Summit with the Australian Medical Association which highlighted the importance of SDH and urged the medical community to increase its efforts in this area. Currently the WMA is collaborating with WHO on an eBook that will help improve knowledge of SDH within the healthcare workforce.