Content area
Full Text
The gross inequalities in health that we see within and between countries present a challenge to the world. That there should be a spread of life expectancy of 48 years among countries and 20 years or more within countries is not inevitable. A burgeoning volume of research identifies social factors at the root of much of these inequalities in health. Social determinants are relevant to communicable and non-communicable disease alike. Health status, therefore, should be of concern to policy makers in every sector, not solely those involved in health policy. As a response to this global challenge, WHO is launching a Commission on Social Determinants of Health, which will review the evidence, raise societal debate, and recommend policies with the goal of improving health of the world's most vulnerable people. A major thrust of the Commission is turning public-health knowledge into political action.
There are gross inequalities in health between countries. Life expectancy at birth, to take one measure, ranges from 34 years in Sierra Leone to 81.9 years in Japan.1 Within countries, too, there are large inequalities-a 20-year gap in life expectancy between the most and least advantaged populations in the USA, for example.2 One welcome response to these health inequalities is to put more effort into the control of major diseases that kill and to improve health systems.3,4
A second belated response is to deal with poverty. This issue is the thrust of the Millennium Development Goals.5,6 These goals challenge the world community to tackle poverty in the world's poorest countries. Included in these goals is reduction of child mortality, the health outcome most sensitive to the effects of absolute material deprivation.
To reduce inequalities in health across the world there is need for a third major thrust that is complementary to development of health systems and relief of poverty: to take action on the social determinants of health. Such action will include relief of poverty but it will have the broader aim of improving the circumstances in which people live and work. It will, therefore, address not only the major infectious diseases linked with poverty of material conditions but also non-communicable diseases-both physical and mental-and violent deaths that form the major burden of disease and death in every region of the...