Cross posted from: "[health-vn discussion group]" health-vn@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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Vern Weitzel
mailto:vern.weitzel@gmail.com