Posted on Sep 08, 2008 by Sergio Ulloa
The World Health Organization (WHO) was recently presented with the results of a 3 year study by an advisory body named the Commission of Social Determinants of Health (CSDH). The commission was comprised of policy makers, academics, heads of state and health ministers from around the world including two former directors of the U.S. Center for Disease Control, a former president of Chile, an economics Nobel laureate and a former prime minister of Mozambique
. The study focused on what, outside of medical knowledge and technology, affects our health in the largest ways and what we can reasonably hope to do about it.
Health data from across the world was gathered and studied by the advisory body to afford us a more thorough knowledge of global health inequities, described by the WHO as "unfair, unjust and avoidable causes of ill health
". The study confirmed prior reports which highlighted inequities between countries but also showed that even within a country's own borders there is a gradient of health. Those living in abject poverty were more likely to live shorter, sicklier lives than poor segments of the population, while the poor were, in turn, worse off than those of average incomes and so on
The social determinants looked at by the commission covered almost every aspect about a person's situation which could be changed by altering political or economic resources. Topics
included education, the environment, availability of basic amenities, economic circumstances, and gender equality, as well as political and cultural factors.
The report is replete with factoids and statistics relating to the difference in life expectancy and mortality rates of diverse sectors of the population both between and within countries. For instance, not only will a girl born in Japan live on average, 42 years longer than a girl born in the country of Lesotho, Africa, but an indigenous Australian man will live, on average, 17 years shorter than their non-indigenous counterparts
. However, the commissioners stress that the wealth of a country is not a determining factor in the level of health inequity. Countries such as Cuba, Costa Rica, China, Sri Lanka and others have done a surprisingly good job of maintaining good levels of health in their populations despite their relatively low per-capita income. The U.S.
leads the charge in the other direction with a larger gap in health equity than many other wealthy nations. A former U.S. Surgeon General says this may be due to both to the high level of diversity in the American population and the fact that the U.S. does not invest much into improving the social gradient in terms of trying to ensure that the entire population has access to a basic level of healthcare
The general conclusions and broad recommendations that the commission drew from their data and research had precious little to do with improving medical care and technology. In fact, the advice was to not rely on medical advances as these would most likely further increase social health inequity
. Instead, we should focus on improving the day to day conditions
of where people are born, live, work and age. Clean drinking water needs to be provided and substantial investments need to be made in education, public transport, working environments and housing
. The panel of experts also says that the problem of inequitable distribution of wealth, power and resources needs to be tackled on every level; global, national and local
The commission strongly advises that further study and data gathering needs to be done on health inequity and its social determinants so we may further understand the problems and that any move forward needs to be fully examined and assessed to determine what impact it will have on social health inequity. Focus needs to be on managing health resources more efficiently, with the commissioners in fairly unanimous agreement that reallocating health investments to focus on social determinants will save money and peoples lives over time
. This of course means that policy makers and many workers both inside and outside of the health industry will need to be trained to asses these impacts.
The question is will this bring about a brave new world of healthcare? Will other countries reorient their healthcare systems to promote socially equitable healthcare, let's take the U.S. for instance. With staggering numbers of uninsured, underinsured
and people in medical debt
in the U.S., will the growing movement for a government-backed single-payer
system come to pass? Brazil, Canada, Chile, Iran, Kenya, Mozambique, Sri Lanka, Sweden, and the UK have already drawn inspiration from the WHO commission's findings, declaring that they are already developing policies which are committed to improving the social factors of health equity
. With a growing public concern in the U.S. over the cost of healthcare and many Americans being nigh uninsurable
under the current for-profit system, does America have the political wherewithal to enact such broad sweeping changes or will they continue to run with what they have? Maybe we'll get a sign of the future in November.