PHA-Exch> Can health equity become a reality?

Fri Nov 7 22:41:34 PST 2008

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crosspostedfrom: EQUIDAD at listserv.paho.org

 *Can health equity become a reality?*

*The Lancet, Volume 372, Issue 9650 - 8 November 2008 *

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61663-3/fulltext

Health Equity - A global movement to address the social determinants of
health has been gathering pace. This week's issue of The Lancet contributes
to this campaign by publishing evidence on actions that can reduce the
startling health inequalities that persist within and between countries.

*China** unveils plans for health-care reform*
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61664-5/fulltext

*Perspectives:

*

*Baying at the moon: addressing the politics of global health*

Ilona Kickbusch
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61673-6/fulltext
Only after devastating world wars has the call for global governance been as
pervasive as it is today. 1945 saw the creation of a new system for
international cooperation emerge in San Francisco under the leadership of
the USA. This month the International Monetary Fund, the G8, the G20, the
European Union, the UN, the World Economic Forum, and many regional fora are
all meeting to discuss new rules for global financial systems. At the World
Financial Summit, on Nov 15…

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*The role of welfare state principles and generosity in social policy
programmes for public health: an international comparative study*

Prof Olle Lundberg PhD a , Monica Åberg Yngwe PhD a, Maria Kölegård Stjärne
PhD a, Prof Jon Ivar Elstad PhD b, Tommy Ferrarini PhD c, Prof Olli Kangas
PhD d, Prof Thor Norström PhD c, Prof Joakim Palme PhD c e, Prof Johan
Fritzell PhD a e, for the NEWS Nordic Expert Group
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61686-4/fulltext

Editors' note: Since social policies could have an important effect on
social determinants of health, it is important to know whether the
characteristics of the policies of different welfare states influence
population health. Under the auspices of the NEWS project, researchers
investigated to what extent variations in the principles and generosity of
family and pension policies in 18 OECD (Organisation for Economic
Co-operation and Development) countries were linked to infant mortality and
old-age excess mortality during the post-war era. Policies typical of the
Nordic model (which have a unique and generous type of welfare state) were
associated with low infant mortality and reduced old-age excess mortality.
Thus, social policies are crucial for how we can understand and tackle the
social determinants of health.

*Effects of fully-established Sure Start Local Programmes on 3-year-old
children and their families living in England: a quasi-experimental
observational study*

Prof Edward Melhuish PhD a , Prof Jay Belsky PhD a, Prof Alastair H Leyland
PhD b, Prof Jacqueline Barnes PhD a, the National Evaluation of Sure Start
Research Team
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61687-6/fulltext

Editors' note: The Sure Start Local Programmes set up by the UK Government
are ambitious in their aim to improve the health and wellbeing of young
children living in disadvantaged neighbourhoods by trying to stop the
transmission of inequalities in health, poverty, education, and social
exclusion between generations. Given the substantial costs of the
programmes, regular evaluation is essential. A randomised comparison is not
possible, for ethical and social reasons. This quasi-experimental design
provides valuable feedback and allows early assessment of whether the
programmes are having any beneficial effect. The study found encouraging
evidence of some benefit in children's social development and in parenting
skills.

*Best-practice interventions to reduce socioeconomic inequalities of
coronary heart disease mortality in UK: a prospective occupational cohort
study*

Prof Mika Kivimäki PhD a , Martin J Shipley MSc a, Jane E Ferrie PhD a,
Archana Singh-Manoux PhD a b, G David Batty PhD c, Tarani Chandola DSc a,
Prof Michael G Marmot PhD a, Prof George Davey Smith DSc d
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61688-8/fulltext

Editors' note: There is little disagreement about the existence of social
inequalities in coronary heart disease but much debate about the best ways
to reduce the inequality. Previous studies have assessed the contributions
of various risk factors by comparing relative risk of disease between high
and low socioeconomic groups before and after adjustment for these risk
factors. However, that approach does not take into account the extent to
which reduction in each risk factor is feasible. This paper, focusing on
classic risk factors and modelling the potential of best-practice
interventions to reduce socioeconomic inequalities in mortality from
coronary heart disease, has a clear message: best-practice interventions and
smoking cessation, if applied universally, would eliminate most of the
difference in risk between high and low socioeconomic groups.

.

*Effect of exposure to natural environment on health inequalities: an
observational population study*

Dr Richard Mitchell PhD a , Frank Popham PhD b
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61689-X/fulltext

Editors' note: Whether access to green environments affects socioeconomic
inequality in health within populations is unknown. A study comparing
income-related health inequality in people living in areas of England with
high and low amounts of green space shows that people exposed to the
greenest environments are less likely to die (from all causes or from
circulatory diseases) even when taking into account income. Thus, there are
substantial differences in health inequality between populations who are
exposed to the same welfare state, health service, and distribution of
national income but who live in different types of physical environment.
Environments that promote good health might be crucial to reduce health
inequalities

*Closing the gap in a generation: health equity through action on the social
determinants of health*

Prof Michael Marmot PhD a , Sharon Friel PhD a, Ruth Bell PhD a, Tanja AJ
Houweling PhD a, Sebastian Taylor PhD a, on behalf of the Commission on
Social Determinants of Health
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61690-6/fulltext

The Commission on Social Determinants of Health, created to marshal the
evidence on what can be done to promote health equity and to foster a global
movement to achieve it, is a global collaboration of policy makers,
researchers, and civil society, led by commissioners with a unique blend of
political, academic, and advocacy experience. The focus of attention is on
countries at all levels of income and development. The commission launched
its final report on August 28, 2008. This paper summarises the key findings
and recommendations; the full list is in the final report.

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*Health Policy*

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*Globalisation and health: the need for a global vision*

* *

Ted Schrecker, Ronald Labonté, Roberto De Vogli
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61691-8/fulltext

The reduction of health inequities is an ethical imperative, according to
the WHO Commission on Social Determinants of Health (CSDH). Drawing on
detailed multidisciplinary evidence assembled by the Globalization Knowledge
Network that supported the CSDH, we define globalisation in mainly economic
terms. We consider and reject the presumption that globalisation will yield
health benefits as a result of its contribution to rapid economic growth and
associated reductions in poverty. Expanding on this point, we describe four
disequalising dynamics by which contemporary globalisation causes
divergence: the global reorganisation of production and emergence of a
global labour-market; the increasing importance of binding trade agreements
and processes to resolve disputes; the rapidly increasing mobility of
financial capital; and the persistence of debt crises in developing
countries.

*Global health equity and climate stabilisation: a common agenda*

Sharon Friel, Michael Marmot, Anthony J McMichael, Tord Kjellstrom, Denny
Vågerö

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61692-X/fulltext

Although health has improved for many people, the extent of health
inequities between and within countries is growing. Meanwhile, humankind is
disrupting the global climate and other life-supporting environmental
systems, thereby creating serious risks for health and wellbeing, especially
in vulnerable populations but ultimately for everybody. Underlying
determinants of health inequity and environmental change overlap
substantially; they are signs of an economic system predicated on asymmetric
growth and competition, shaped by market forces that mostly disregard health
and environmental consequences rather than by values of fairness and
support.

*Addressing social determinants of health inequities: what can the state and
civil society do?*

Erik Blas, Lucy Gilson, Michael P Kelly, Ronald Labonté, Jostacio Lapitan,
Carles Muntaner, Piroska Östlin, Jennie Popay, Ritu Sadana, Gita Sen, Ted
Schrecker, Ziba Vaghri

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61693-1/fulltext

In this Health Policy article, we selected and reviewed evidence synthesised
by nine knowledge networks established by WHO to support the Commission on
the Social Determinants of Health. We have indicated the part that national
governments and civil society can play in reducing health inequity.
Government action can take three forms: (1) as provider or guarantor of
human rights and essential services; (2) as facilitator of policy frameworks
that provide the basis for equitable health improvement; and (3) as gatherer
and monitor of data about their populations in ways that generate health
information about mortality and morbidity and data about health equity.

*Viewpoint*

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*Recommendations for action on the social determinants of health: a Canadian
perspective*

Shanthi Johnson, Sylvia Abonyi, Bonnie Jeffery, Paul Hackett, Mary Hampton,
Tom McIntosh, Diane Martz, Nazeem Muhajarine, Pammla Petrucka, Nazmi Sari

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61694-3/fulltext

Health disparities are widely prevalent within and between countries, and
Canada is no exception.1,2 Although historic efforts to address such
disparities have not been successful and Canada's provincial and territorial
health goals have been only partly achieved,3 we are now well positioned to
understand and address health disparities at the global, national, and local
levels. The global resurgence of interest in addressing health disparities
in the 1990s and 2000s through various movements, such as the WHO Commission
on the Social Determinants of Health and their final report with
evidence-based recommendations,4,5 have provided momentum to countries
around the world to re-engage in dialogue at the national and international
levels for this vitally important issue.

*Placing the individual within a social determinants approach to health
inequity*

Ian Forde, Rosalind Raine
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61695-5/fulltext

The Final Report of the WHO Commission on Social Determinants of Health is a
welcome challenge to governments. It sets out the core conditions that have
to be met to give everyone a fair chance of leading a healthy and
flourishing life.

The Commission distinguishes two contrasting approaches to public
health—action through the individual and his or her choices versus action on
social determinants. 1 It justifies its preference for action on social
determinants by reasoning that "Contemporary public ...
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