Equity in Health

The conditions in which people live and work - the social determinants of health - help enhance or erode their health. At the direction of Health Assembly in 2005, the Commission on Social Determinants of Health has been examining these factors. The chair of the commission, Professor Sir Michael Marmot briefed delegates on the key recommendations of the commission's work. He said the commission's final report will pose recommendations under three action areas: the conditions of daily life; the structural drivers of those conditions; and the monitoring and training needed to measure progress. Concrete examples of implementing a social determinants approach to health were given from Brazil, Finland, India and Sri Lanka, as well as the International Organization of Migration. A common theme throughout the briefing was the need for more participation and representation from all stakeholder groups in these debates.

Three-quarters of the 68 countries most in need of improving mother and child mortality rates have made little, if any, progress in meeting internationally set goals over the past three years, according to a series of new reports. The Countdown to 2015 for Maternal, Newborn and Child Survival, an international group that monitors these goals, still holds hope that progress can be made quickly in these underachieving nations, according to reports in a special edition of The Lancet. The medical journal looks at the group's efforts in 68 "priority" or "countdown" countries, where 97 percent of the maternal and child under-5 deaths occur worldwide. The group has set goals to reduce child mortality rate by two-thirds and maternal deaths by three-quarters by 2015.

It is increasingly recognised that different axes of social power relations, such as gender and class, are interrelated, not as additive but as intersecting processes. This paper has reviewed existing research on the intersections between gender and class, and their impacts on health status and access to health care. The review suggests that intersecting stratification processes can significantly alter the impacts of any one dimension of inequality taken by itself. Studies confirm that socio-economic status measures cannot fully account for gender inequalities in health. A number of studies show that both gender and class affect the way in which risk factors are translated into health outcomes, but their intersections can be complex. Other studies indicate that responses to unaffordable health care often vary by the gender and class location of sick individuals and their households. They strongly suggest that economic class should not be analysed by itself, and that apparent class differences can be misinterpreted without gender analysis. Insufficient attention to intersectionality in much of the health literature has significant human costs, because those affected most negatively tend to be those who are poorest and most oppressed by gender and other forms of social inequality. The programme and policy costs are also likely to be high in terms of poorly functioning programmes, and ineffective poverty alleviation and social and health policies.

Climate-sensitive impacts on human health are occurring today, attacking the pillars of public health and providing a glimpse of the challenges public health will have to confront on a large scale, WHO Director-General Dr Margaret Chan warned during World Health Day. She said although climate change is a global phenomenon, its consequences will not be evenly distributed. Climate change can affect problems that are already huge, largely concentrated in the developing world, and difficult to control.