Inequality is an area I’m very interested in but I’m always frustrated by headlines like this: “Social injustice is killing people on a grand scale”
To me this seems to state the obvious.
In this case, the headline belongs to a news article about a report released yesterday by the World Health Organization’s Commission on Social Determinants of Health called “Closing the gap in a generation: Health equity through action on the social determinants of health.”
According to the press release, the report “shows how the conditions in which people live and work directly affects the quality of their health.”
The report runs over 250 pages long and essentially reminds us that social determinants (housing, nutrition, physical activity, the environment) are more important to health than biomedical ones (medical care, drugs, hospitals, technological interventions). The Commission’s three recommendations to reduce health equity are to 1) improve daily living conditions; 2) tackle the inequitable distribution of power, money and resources, especially between the genders; and 3) measure, understand, and evaluate the problem of health inequity.
I have no doubt a lot of time and effort was involved in the Commission’s work, and I do hope it succeeds in raising awareness about social injustice. But I feel like this message about the social determinants of health has been out there a long time with little action or progress.
I dusted off my copy of the Lalonde Report, a Canadian governmental report that is considered by many to be the first acknowledgment by a major industrialised nation that health is determined by more than just biological factors. It was produced in 1974.
The Lalonde report was seminal, and led to other important international documents like the WHO’s Declaration of Alma-Ata. This for the first time internationally asserted the importance of primary health care, but is also credited with advancing the notion of health as a human right.
Alma-Ata also declared the inequity between the developed and the developing world to be unacceptable, stated that economic and social development was necessary for health, and that in turn health contributes to economic and social development and world peace. Alma-Ata was released in 1978.
Given the conclusions of yesterday’s report, it’s fascinating to look back over these declarations and see how prescient they were. The Lalonde report, for example, begins with these words: “Good health is the bedrock on which social progress is built. A nation of healthy people can do those things that make life worthwhile, and as the level of health increases so does the potential for happiness.”
It goes on to state “The health care system, however, is only one of many ways of maintaining and improving health….For these environmental and behavioural threats to health [environmental pollution, city living, habits of indolence, the abuse of alcohol, tobacco and drugs, and eating patterns which put the pleasing of the senses above the needs of the human body], the organized health care system can do little more than serve as a catchment net for the victims.”
Thirty four years later we have a new report, with seemingly no new messages. Regrettably I think we can assume no new progress on social justice.