Social determinants, inequality have negative impact on global health, WHO report says

Social inequalities such as inadequate education, a lack of human rights, poverty and poor housing negatively can impact global health conditions, according to a report released Thursday by the World Health Organization's Commission on the Social Determinants of Health, Toronto's Globe and Mail reports.

The report, titled "Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health," highlights existing health inequalities between countries that result from differing environmental factors. According to the report, the life expectancy of a girl born in Lesotho is 42 years less than that of a girl born in Japan (Picard, Globe and Mail, 8/28). The report also examines inequalities within countries and cities and found that the child mortality rate in slums in Nairobi, Kenya, is 2.5 times higher than in wealthier parts of the city (WHO release, 8/28).

Michael Marmot, chair of the commission and a professor at University College London, said that "[i]n countries at all income levels, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health" (Globe and Mail, 8/28). Marmot said that countries "rely too much on medical interventions as a way of increasing life expectancy," adding that health quality and equity should become an assessment measure and marker for government performance.

According to the report, the global health community should focus on addressing the root causes of health inequities in order to combat illness worldwide, increase life expectancy and close the health gap between countries within one generation (WHO release, 8/28). The commission called on governments to enact social policies that increase access to affordable housing, establish livable minimum wages and improve access to health care (Globe and Mail, 8/28). In addition, the report recommends improved governance; support for civil society; more equitable economic policies; and investment in child care and education, particularly for women and girls (The Economist, 8/28). On the global level, the report recommends that health equity be a core goal for development and calls for monitoring the social determinants of health (WHO release, 8/28).

Reaction

Ronald Labonte, Canada research chair in globalization and health equity and a medical professor at the University of Ottawa, said that there is "nothing terribly magical" about the commission's focus on social determinants but added that the report "provides compelling evidence that [the recommended approaches to improving health equity] work." Labonte recommended that discussion shift from what needs to be done to why countries are not acting. "A failure to act now is a moral failure," Labonte said (Globe and Mail, 8/28).

Ruth Levine of the Center for Global Development said the report is imperfect but added that with the commission's findings "we can see the pendulum swinging back" by renewing the focus on the links between inequality and poor health conditions. Adam Wagstaff, an economist at the World Bank, said he believes income "is causal" when determining health conditions despite the presence of inequalities. However, Wagstaff credited the commission for recognizing the role of economic growth in improving health inequities (The Economist, 8/28).

The report is available online (.pdf).

A Lancet editorial on the report's recommendations also is available online.