WHO says inequities around the world are killing people on a "grand scale"

Sep 1 2008

According to a report by the World Health Organization (WHO) inequities around the world are responsible for killing people on a "grand scale".

The WHO's Commission on the Social Determinants of Health has revealed some stark and shocking facts such as:-

• Life expectancy for Indigenous Australian males is shorter by 17 years than all other Australian males.
• A child born in one suburb of Glasgow, Scotland can expect to live 28 years more than one only 13 kilometres away.
• A girl in Lesotho is likely to live 42 years less than another in Japan.
• Poor Indonesian mothers die 3 to 4 times more often than the rich Indonesian mothers.
• In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17 400 while in Afghanistan, the odds are 1 in 8.

The WHO says these stark differences between and within countries are the result of the social environment into which people are born, live, grow, work and age and these "social determinants of health" have been the focus of a three-year investigation by the Commission on the Social Determinants of Health.

The report says a toxic combination of bad policies, economics and politics is largely responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible and social injustice is killing people on a grand scale.

The WHO says health inequity is a matter of life and death, but health systems do not naturally gravitate towards equity and all leaders need to examine their impact on health and primary health care is the best framework for doing so.

The Commission’s recommendations for creating the conditions for people to be empowered, to have freedom to lead flourishing lives says that a lack of empowerment is most obvious in the plight of women in many parts of the world.

The Commission says health inequities are unfair, unjust and are avoidable causes of ill health and there is evidence that demonstrates the poor are worse off than those less deprived, but the less deprived are in turn worse than those with average incomes, and so on.

According to the WHO this slope linking income and health is the social gradient, and is seen everywhere and not just in developing countries; the phenomenon is universal and wealth is not necessarily a determinant and increasing national wealth alone does not necessarily increase national health and without equitable distribution of benefits, national growth can even exacerbate inequities.

The enormous increase in global wealth, technology and living standards in recent years, still leaves the key question of how it is used for fair distribution of services and institution-building especially in low-income countries.

The report says wealth alone does not determine the health of a nation's population as some low-income countries such as Cuba, Costa Rica, China, the state of Kerala in India and Sri Lanka have achieved levels of good health despite relatively low national incomes.

But, the Commission points out, when wealth is used wisely as in some Nordic countries with policies that encourage equality of benefits and services, full employment, gender equity and low levels of social exclusion, an outstanding example of what needs to be done everywhere is presented.

The report says much of the work to redress health inequities lies beyond the health sector: -

• 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 - and the health sector globally and nationally needs to focus attention on addressing the root causes of inequities in health.

The report says too much reliance is placed on medical interventions as a way of increasing life expectancy when 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.

The report makes the following recommendations:-

• Daily living conditions, including the circumstances in which people are born, grow, live, work and age must be improved.
• The inequitable distribution of power, money and resources must be addressed, globally, nationally and locally and the scale of the problem must be measured and understood and the impact of action assessed.
• When it comes to daily living the report recommends that improvements to conditions should begin at the start of life with interagency collaboration and coherent policy between all sectors for early childhood development, which aim to provide early childhood services to all young citizens as an investment in early childhood development provides one of the best ways to reduce health inequities.
• Evidence shows that investment in the education of women pays for itself many times over.

The Commission calls for a renewed effort to cope with the billions living without adequate shelter and clean water in urban slums in order to ensure they have water, sanitation and electricity and highlights how over 100 million people are impoverished due to paying for health care, a key contributor to health inequity.

The report calls for health systems to be based on principles of equity, disease prevention and health promotion with universal coverage, based on primary health care.

The report offers a range of recommendations aimed at ensuring fair financing, corporate social responsibility, gender equity and better governance.