Social factors, rather than biology, are the root causes of health inequalities, according to a World Health Organization (WHO) report published today (28 August 2008).
The report says that a child born in a particular Glasgow suburb has a life expectancy 28 years shorter than someone living only 13km away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is one in 17,400; in Afghanistan, the odds are one in eight.
These "social determinants of health" have been the focus of a three-year investigation by policymakers, academics, former heads of state and former health ministers who make up the WHO's Commission on the Social Determinants of Health.
"Health inequity really is a matter of life and death," said WHO Director-General Dr Margaret Chan. "But health systems will not naturally gravitate towards equity. Unprecedented leadership is needed that compels all actors – including those beyond the health sector – to examine their impact on health.
"Primary healthcare, which integrates health in all of government's policies, is the best framework for doing so."
According to the Commission's report: "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."
Consequently, the report suggests, the health sector (globally and nationally) needs to focus attention on addressing the root causes of inequities in health.
"We rely too much on medical interventions as a way of increasing life expectancy," explained Sir Michael Marmot, chair of the commission.
"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; to make health and health equity a marker for government performance."
Your comments: (Terms and conditions apply)
"Yes, yes, yes. But economic factors are key factors. Somebody has to be the cleaner – are we saying they should forgo having children because daily fruits, vegetables and lean meats are expensive? Why not offer fruit and veg tokens to certain groups? Similarly milk tokens. A way of kick-starting farmers" – Georgia Orunmuyi, London