Can health equity become a reality?
The Lancet, Volume 372, Issue 9650 - 8 November 2008
Health Equity - A global movement to address the social determinants of health has been gathering pace. This week's issue of The Lancet contributes to this campaign by publishing evidence on actions that can reduce the startling health inequalities that persist within and between countries.
Baying at the moon: addressing the politics of global health
Only after devastating world wars has the call for global governance been as pervasive as it is today. 1945 saw the creation of a new system for international cooperation emerge in
The role of welfare state principles and generosity in social policy programmes for public health: an international comparative study
Prof Olle Lundberg PhD a , Monica Åberg Yngwe PhD a, Maria Kölegård Stjärne PhD a, Prof Jon Ivar Elstad PhD b, Tommy Ferrarini PhD c, Prof Olli Kangas PhD d, Prof Thor Norström PhD c, Prof Joakim Palme PhD c e, Prof Johan Fritzell PhD a e, for the NEWS Nordic Expert Group
Editors' note: Since social policies could have an important effect on social determinants of health, it is important to know whether the characteristics of the policies of different welfare states influence population health. Under the auspices of the NEWS project, researchers investigated to what extent variations in the principles and generosity of family and pension policies in 18 OECD (Organisation for Economic Co-operation and Development) countries were linked to infant mortality and old-age excess mortality during the post-war era. Policies typical of the Nordic model (which have a unique and generous type of welfare state) were associated with low infant mortality and reduced old-age excess mortality. Thus, social policies are crucial for how we can understand and tackle the social determinants of health.
Effects of fully-established Sure Start Local Programmes on 3-year-old children and their families living in
Prof Edward Melhuish PhD a , Prof Jay Belsky PhD a, Prof Alastair H Leyland PhD b, Prof Jacqueline Barnes PhD a, the National Evaluation of Sure Start Research Team
Editors' note: The Sure Start Local Programmes set up by the UK Government are ambitious in their aim to improve the health and wellbeing of young children living in disadvantaged neighbourhoods by trying to stop the transmission of inequalities in health, poverty, education, and social exclusion between generations. Given the substantial costs of the programmes, regular evaluation is essential. A randomised comparison is not possible, for ethical and social reasons. This quasi-experimental design provides valuable feedback and allows early assessment of whether the programmes are having any beneficial effect. The study found encouraging evidence of some benefit in children's social development and in parenting skills.
Best-practice interventions to reduce socioeconomic inequalities of coronary heart disease mortality in
Prof Mika Kivimäki PhD a , Martin J Shipley MSc a, Jane E Ferrie PhD a, Archana Singh-Manoux PhD a b, G David Batty PhD c, Tarani Chandola DSc a, Prof Michael G Marmot PhD a, Prof George Davey Smith DSc d
Editors' note: There is little disagreement about the existence of social inequalities in coronary heart disease but much debate about the best ways to reduce the inequality. Previous studies have assessed the contributions of various risk factors by comparing relative risk of disease between high and low socioeconomic groups before and after adjustment for these risk factors. However, that approach does not take into account the extent to which reduction in each risk factor is feasible. This paper, focusing on classic risk factors and modelling the potential of best-practice interventions to reduce socioeconomic inequalities in mortality from coronary heart disease, has a clear message: best-practice interventions and smoking cessation, if applied universally, would eliminate most of the difference in risk between high and low socioeconomic groups.
Effect of exposure to natural environment on health inequalities: an observational population study
Dr Richard Mitchell PhD a , Frank Popham PhD b
Editors' note: Whether access to green environments affects socioeconomic inequality in health within populations is unknown. A study comparing income-related health inequality in people living in areas of England with high and low amounts of green space shows that people exposed to the greenest environments are less likely to die (from all causes or from circulatory diseases) even when taking into account income. Thus, there are substantial differences in health inequality between populations who are exposed to the same welfare state, health service, and distribution of national income but who live in different types of physical environment. Environments that promote good health might be crucial to reduce health inequalities
Closing the gap in a generation: health equity through action on the social determinants of health
Prof Michael Marmot PhD a , Sharon Friel PhD a, Ruth Bell PhD a, Tanja AJ Houweling PhD a, Sebastian Taylor PhD a, on behalf of the Commission on Social Determinants of Health
The Commission on Social Determinants of Health, created to marshal the evidence on what can be done to promote health equity and to foster a global movement to achieve it, is a global collaboration of policy makers, researchers, and civil society, led by commissioners with a unique blend of political, academic, and advocacy experience. The focus of attention is on countries at all levels of income and development. The commission launched its final report on August 28, 2008. This paper summarises the key findings and recommendations; the full list is in the final report.
Globalisation and health: the need for a global vision
Ted Schrecker, Ronald Labonté, Roberto De Vogli
The reduction of health inequities is an ethical imperative, according to the WHO Commission on Social Determinants of Health (CSDH). Drawing on detailed multidisciplinary evidence assembled by the Globalization Knowledge Network that supported the CSDH, we define globalisation in mainly economic terms. We consider and reject the presumption that globalisation will yield health benefits as a result of its contribution to rapid economic growth and associated reductions in poverty. Expanding on this point, we describe four disequalising dynamics by which contemporary globalisation causes divergence: the global reorganisation of production and emergence of a global labour-market; the increasing importance of binding trade agreements and processes to resolve disputes; the rapidly increasing mobility of financial capital; and the persistence of debt crises in developing countries.
Global health equity and climate stabilisation: a common agenda
Sharon Friel, Michael Marmot, Anthony J McMichael, Tord Kjellstrom, Denny Vågerö
Although health has improved for many people, the extent of health inequities between and within countries is growing. Meanwhile, humankind is disrupting the global climate and other life-supporting environmental systems, thereby creating serious risks for health and wellbeing, especially in vulnerable populations but ultimately for everybody. Underlying determinants of health inequity and environmental change overlap substantially; they are signs of an economic system predicated on asymmetric growth and competition, shaped by market forces that mostly disregard health and environmental consequences rather than by values of fairness and support.
Addressing social determinants of health inequities: what can the state and civil society do?
Erik Blas, Lucy Gilson, Michael P Kelly, Ronald Labonté, Jostacio Lapitan, Carles Muntaner, Piroska Östlin, Jennie Popay, Ritu Sadana, Gita Sen, Ted Schrecker, Ziba Vaghri
In this Health Policy article, we selected and reviewed evidence synthesised by nine knowledge networks established by WHO to support the Commission on the Social Determinants of Health. We have indicated the part that national governments and civil society can play in reducing health inequity. Government action can take three forms: (1) as provider or guarantor of human rights and essential services; (2) as facilitator of policy frameworks that provide the basis for equitable health improvement; and (3) as gatherer and monitor of data about their populations in ways that generate health information about mortality and morbidity and data about health equity.
Recommendations for action on the social determinants of health: a Canadian perspective
Shanthi Johnson, Sylvia Abonyi, Bonnie Jeffery, Paul Hackett, Mary Hampton, Tom McIntosh, Diane Martz, Nazeem Muhajarine, Pammla Petrucka, Nazmi Sari
Health disparities are widely prevalent within and between countries, and Canada is no exception.1,2 Although historic efforts to address such disparities have not been successful and Canada's provincial and territorial health goals have been only partly achieved,3 we are now well positioned to understand and address health disparities at the global, national, and local levels. The global resurgence of interest in addressing health disparities in the 1990s and 2000s through various movements, such as the WHO Commission on the Social Determinants of Health and their final report with evidence-based recommendations,4,5 have provided momentum to countries around the world to re-engage in dialogue at the national and international levels for this vitally important issue.
Placing the individual within a social determinants approach to health inequity
Ian Forde, Rosalind Raine
The Final Report of the WHO Commission on Social Determinants of Health is a welcome challenge to governments. It sets out the core conditions that have to be met to give everyone a fair chance of leading a healthy and flourishing life.
The Commission distinguishes two contrasting approaches to public health—action through the individual and his or her choices versus action on social determinants. 1 It justifies its preference for action on social determinants by reasoning that “Contemporary public ...
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