PHA-Exch> Narrowing World Health Disparities

[Claudio Schuftan]

From: Vern Weitzel <vern.weitzel at gmail.com>
crosposted from: "[health-vn discussion group]" health-vn at cairo.anu.edu.au


http://www.time.com/time/health/article/0,8599,1836907,00.html

Narrowing World Health Disparities

By LAURA BLUE  (excerpts)

The causes of these disparities are almost entirely social, according to a
new report from the World Health Organization (WHO) released today.


A "social gradient of health" exists even among the rich: the outlandishly
wealthy live healthier and longer than the rich, who live better than the
merely comfortable. In every country around the world, WHO's Commission on
the Social Determinants of Health found that the very best off had better
health than people a few rungs below them on the socioeconomic ladder. "Even
in Sweden" — a country with a strong history of social and economic equality
— "if you look over the last 10 years, life expectancy has improved across
the board. But it's improved more for people with high education than it has
for people with low education".

Education, of course, is a major social determinant of health. More highly
educated people tend to make more healthful lifestyle choices and, as they
also tend to be richer, have greater access to health care. The Commission's
"social determinants" cover a vast territory, encompassing virtually every
factor that can be changed in a person's life by applying reasonable
political and economic resources.

The Commission's new report highlights social factors that go well beyond
having enough money to buy a doctor's care or medication, and well beyond
having the know-how to use it. The world's poor tend to die prematurely and
log more life-years spent ill or suffering or depressed also because they
are more likely to live in dangerous neighborhoods, have limited access to
clean drinking water, be forced to endure long, sometimes arduous commutes
to work, labor in unsafe environments and have little representation in the
governance of their local society. Behavior and lifestyle are determined by
the circumstances in which people find themselves.

The Commission's ultimate finding, however, is that "it does not have to be
this way." The new report uncovers "the causes of the causes." It sets
out to pinpoint the social factors that make the more poorly likely to
suffer, and this "gradient," or the degree to which different groups are
unequal in health, is far steeper in the U.S. than in most other
industrialized countries. One reasonis  that the U.S. comprises a more
diverse population than other places, mixing a high proportion of recent
immigrants with long-time American dwellers, which makes it all the more
difficult to tackle social determinants early in life. The U.S. also invests
probably less in improving that social gradient. There are countries that
really invest in making sure that all children have quality education
regardless of the education of their parents. There are countries that
invest in making sure that everybody has access to a [minimum] level of
quality of [health] care.

The team of commissioners combed through health data from around the world,
and based on that evidence, drew up recommendations to narrow the
inequalities of circumstance and opportunity that affect health. The
suggestions are broad, only semi-concrete policies that are general enough
to be applied to almost every country in the world: increase prenatal care,
increase early education and provide free elementary and secondary school
for all children. The report suggests cleaning up slums, supplying clean
water for everyone, and giving people around the world health insurance and
unemployment insurance. And it recommends doing a better job overall of
measuring health disparities in the first place.

These demands are, in a word, steep. But the report authors do not feel they
are unreasonable. The report authors believe, biological problems like
infectious disease can also be brought under control through social policy.

The key may just be political will. The commissioners are convinced that
focusing on the social determinants of health will save both lives and cash
in the long run. We're wasting a lot of the money that we invest in health
and health care.

That's not to say that lab breakthroughs won't bring all kinds of new health
benefits in the decades to come. But we don't need to wait for those new
breakthroughs to make enormous differences.
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