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'Punchily written ... He leaves the reader with a sense of the gross injustice of a world where health outcomes are so unevenly distributed' Times Literary Supplement 'Splendid and necessary' Henry Marsh, author of Do No Harm, New Statesman There are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor. A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian's life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country's version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions – improved medical care, sanitation, and control of disease vectors; or behaviours – smoking, drinking – obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.
In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
The Government recognises that many lifestyle-driven health problems are at alarming levels: obesity; high rates of sexually transmitted infections; a relatively large population of drug users; rising levels of harm from alcohol; 80,000 deaths a year from smoking; poor mental health; health inequalities between rich and poor. This white paper outlines the Government's proposals to protect the population from serious health threats; help people live longer, healthier and more fulfilling lives; and improve the health of the poorest. It aims to empower individuals to make healthy choices and give communities and local government the freedom, responsibility and funding to innovate and develop ways of improving public health in their area. The paper responds to Sir Michael Marmot's strategic review of health inequalities in England post 2010 - "Fair society, healthy lives" (available at http://www.marmotreview.org/AssetLibrary/pdfs/Reports/FairSocietyHealthyLives.pdf) and adopts its life course framework for tackling the wider social determinants of health. A new dedicated public health service - Public Health England - will be created to ensure excellence, expertise and responsiveness, particularly on health protection where a national response is vital. The paper gives a timetable showing how the proposals will be implemented and an annex sets out a vision of the role of the Director of Public Health. The Department is also publishing a fuller story on the health of England in "Our health and wellbeing today" (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122238.pdf), detailing the challenges and opportunities, and in 2011 will issue documents on major public health issues.
The WHO European Region has seen remarkable health gains, though inequities persist both between and within countries. Much more is understood now about the extent and social causes of these inequities, particularly since the 2008 report of the Commission on Social Determinants of Health. This review of inequities in health across the 53 Member States of the Region was commissioned to support the development of the new European policy framework for health and well-being, Health 2020. It builds on the global evidence and recommends policies to reduce health inequities and the health divide across all countries, including those with low incomes. The report is presented in four parts. Part I provides the context and background to the review, and sets out the key principles underpinning the recommendations and the rationale for grouping them into four broad themes: life-course stages, wider society, the broader macro-level context, and governance, delivery and monitoring systems. Part II summarizes current evidence on the magnitude of the health divide among European Region countries, describing the inequities in health and their social determinants. Part III focuses on the four themes, making recommendations with supporting evidence. Part IV outlines the implementation issues, summarizes the framework for action, discusses reasons for failure, provides guidance on good practice and summarizes the review's conclusions and recommendations. The review is a wake-up call to political and professional leaders alike, an opportunity for them to facilitate the work of those dedicated to improving health outcomes and narrow the health gap between and within the countries of the Region.
This second edition of Social Injustice and Public Health is a comprehensive, up-to-date, evidence-based resource on the relationship of social injustice to many aspects of public health. With contributions from leading experts in public health, medicine, health, social sciences, and other fields, this integrated book documents the adverse effects of social injustice on health and makes recommendations on what needs to be done to reduce social injustice and thereby improve the public's health. Social Injustice and Public Health is divided into four parts: · The nature of social injustice and its impact on public health · How the health of specific population groups is affected by social injustice · How social injustice adversely affects medical care, infectious and chronic non-communicable disease, nutrition, mental health, violence, environmental and occupational health, oral health, and aspects of international health · What needs to be done, such as addressing social injustice in a human rights context, promoting social justice through public health policies and programs, strengthening communities, and promoting equitable and sustainable human development With 78 contributors who are experts in their respective subject areas, this textbook is ideal for students and practitioners in public health, medicine, nursing, and other health sciences. It is the definitive resource for anyone seeking to better understand the social determinants of health and how to address them to reduce social injustice and improve the public's health.
Which inequalities in longevity and health among individuals, groups, and nations are unfair? And what priority should health policy attach to narrowing them? These essays by philosophers, economists, epidemiologists, and physicians attempt to determine how health inequalities should be conceptualized, measured, ranked, and evaluated.
Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.
From one of the leading policy experts of our time, an urgent rethinking of how we can better support each other to thrive Whether we realize it or not, all of us participate in the social contract every day through mutual obligations among our family, community, place of work, and fellow citizens. Caring for others, paying taxes, and benefiting from public services define the social contract that supports and binds us together as a society. Today, however, our social contract has been broken by changing gender roles, technology, new models of work, aging, and the perils of climate change. Minouche Shafik takes us through stages of life we all experience—raising children, getting educated, falling ill, working, growing old—and shows how a reordering of our societies is possible. Drawing on evidence and examples from around the world, she shows how every country can provide citizens with the basics to have a decent life and be able to contribute to society. But we owe each other more than this. A more generous and inclusive society would also share more risks collectively and ask everyone to contribute for as long as they can so that everyone can fulfill their potential. What We Owe Each Other identifies the key elements of a better social contract that recognizes our interdependencies, supports and invests more in each other, and expects more of individuals in return. Powerful, hopeful, and thought-provoking, What We Owe Each Other provides practical solutions to current challenges and demonstrates how we can build a better society—together.