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Social factors key to ill health

Social factors key to ill health

A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is one in 17 400; in Afghanistan, the odds are one in eight.

Biology does not explain any of this. Instead, the differences between - and within - countries result from the social environment where people are born, live, grow, work and age.

These "social determinants of health" have been the focus of a three-year investigation by an eminent group of policy makers, academics, former heads of state and former ministers of health.

"Health inequity really is a matter of life and death," said WHO Director-General Dr Margaret Chan. "But health systems will not naturally gravitate towards equity. Unprecedented leadership is needed that compels all actors, including those beyond the health sector, to examine their impact on health. Primary healthcare, which integrates health in all of government's policies, is the best framework for doing so."

Much of the work to redress health inequities lies beyond the health sector. According to the Commission's report: "Water-borne diseases are not caused by a lack of antibiotics but by dirty water, and by the political, social, and economic forces that fail to make clean water available to all; heart disease is caused not by a lack of coronary care units but by lives people lead, which are shaped by the environments in which they live; obesity is not caused by moral failure on the part of individuals but by the excess availability of high-fat and high-sugar foods." Consequently, the health sector – globally and nationally – needs to focus attention on addressing the root causes of inequities in health.

"We rely too much on medical interventions as a way of increasing life expectancy," explained Sir Michael, Commission chair. "A more effective way of increasing life expectancy and improving health would be for every government policy and programme to be assessed for its impact on health and health equity; to make health and health equity a marker for government performance."

Based on this compelling evidence, the Commission makes three overarching recommendations to tackle the "corrosive effects of inequality of life chances":

  • Improve daily living conditions, including the circumstances in which people are born, grow, live, work and age.
  • Tackle the inequitable distribution of power, money and resources – the structural drivers of those conditions – globally, nationally and locally.
  • Measure and understand the problem and assess the impact of action.

WHO

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