Health Equity: 02/01/11

Tuesday, February 1, 2011

[EQ] What does the empirical evidence tell us about the injustice of health inequalities?

What does the empirical evidence tell us about the injustice of health inequalities?

Angus Deaton, Center for Health and Wellbeing

Princeton University, January 2011

Available online PDF [26p.] at: http://bit.ly/fE0plY

“……Whether or not health inequalities are unjust, as well as how to address them, depends on how they are caused. I review a range of health inequalities, between

men and women, between aristocrats and commoners, between blacks and whites, and between rich and poor within and between countries. I tentatively identify

pathways of causality in each case, and make judgments about whether or not each inequality is unjust.

Health inequalities that come from medical innovation are among the most benign. I emphasize the importance of early life inequalities, and of trying to moderate the link between parental and child circumstances. I argue that racial inequalities in health in the US are unjust and add to injustices in other domains. The vast inequalities in health between rich and poor countries are arguably neither just nor unjust, nor are they easily addressable. I argue that there are grounds to be concerned about the rapid expansion in inequality at the very top of the income distribution in the US; this is not only an injustice in itself, but it poses a risk of spawning other injustices, in education, in health, and in governance…..”

“……….How we should think about inequalities in health depends, in part, on the facts about health inequalities, and on how we understand them. Causal interpretations

are required to design policy. Hausman (2009, 237) notes that “understanding the health gradient helps to guide benevolent interventions” and emphasizes the need to clarify causal paths.

Facts and correlations, without an understanding of causation, are neither sufficient to guide policy nor to make ethical judgments.

Without getting causation right, there is no guarantee that interventions will not be harmful. It is also possible that an inequality that might seem to be prima facie

unjust might actually be the consequence of a deeper mechanism that is in part benevolent, or that is unjust in a different way. I provide examples of good inequalities…………

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[EQ] Interim first report on social determinants of health and the health divide in the WHO European Region

Interim first report on social determinants of health and the health divide in the WHO European Region

European Social Determinants and Health Divide Review - Chair of the Review: Sir Michael Marmot

Report prepared by: Sir Michael Marmot and his team - September 2010

Executive summary – PDF [41p.] at: http://bit.ly/f84Ber

“…..Although health has improved for many people, there are major inequalities in health - within and between countries - across the WHO European Region. Evidence shows that these inequalities should be mostly avoidable and has significant human and economic costs.

The WHO Regional Office for Europe commissioned a regional review of the health divide and inequalities in health from July 2010 to 2012 in order to inform the new health policy for the Region. The first phase of the review is assessing levels of inequalities in health across the European Region and identifying the barriers to and opportunities for reducing these. ………..”

Content:

Key Messages

1. There are major health inequalities within and between countries in the WHO European Region. Evidence shows that these inequalities should be mostly avoidable by reasonable means. Action is needed because of the significant human and economic costs.

2. Unless urgent action is taken, these gaps between and within countries will increase. This action must be both systematic and sustained and is critical in responding to the global economic downturn, allocating resources and developing a new health policy for the Region.

3. The lower a person’s social position, the worse his or her health is. Everyone except those at the very top experiences some degree of inequality in health.

4. Inequality in health arises from inequalities in the social determinants of health: social policies and programmes, economic arrangements and the quality of governance. This, in turn, is responsible for inequalities in the lives people are able to lead: early years, education, working conditions and employment levels, levels and distribution of income, communities and public health and health systems.

5. Action is needed across all key government sectors to reduce health inequalities. Health ministries have a vital role to play both in ensuring the contribution of the health system and in advocating for health equity in the development plans, policies and actions of players in other sectors. The health system alone cannot reduce health inequalities.

6. Realizing the potential of health for all in the Region requires scaling up and systematizing action on the social determinants of health and reducing inequalities in health. This review will inform - in the area of social determinants of health - the new health policy for the Region by:

- outlining existing knowledge and evidence and proposing action at the regional, national and local levels;

- enhancing awareness and the capacity to deliver; and

- building on the commitment by WHO, its partners and Member States in the European Region to increase policy awareness and action

Introduction

A. The health divide in the WHO European Region

Life expectancy

Age structure

Geographical differences within countries

Health indicators

B. Social determinants of inequality in health

Social and economic variation

Health and social determinants

Inequality in health between individuals based on their personal circumstances

C. What can be done?

Systems for action

Economic forces

Country differences and specific contexts

Measurement and monitoring

D. What are the next steps for review?

Role of the task groups

Structure of the review of social determinants and the health divide in the European Region

Draft timeline

References