A health policy paper is being published by Professor Sir Michael Marmot from the University College London, UK and his team Dr. Jessica Allen, Dr Ruth Bell, and Professor Peter Goldblatt, ahead of the major conference due to take place between the 19th -21st of October, in Rio de Janeiro, Brazil. The conference has invited all World Health Organization member states to commit to solid policies in order to improve social determinants of health. The paper by Prof. Marmot and his team outlines the issues and challenges, highlighting the WHO European Region and its new policy Health 2020.

Between and within all countries inequalities in terms of health and other factors exist irrespective of income. In some cases these inequalities prove to be substantial. Different conditions in the daily life within a population are based on wide inequalities in the distribution of power, resources and money. Those suffering from inequities in health are men and women, the elderly, working people and those of childbearing age.

The new report by Prof. Marmot, refers to his WHO report from its Commission on Social Determinants of Health (CSDH) in 2008. Since 2008, various countries have made progress:

  • Costa Rica is trying a whole government method in order to improve health inequity
  • Brazil has established its own CSDH
  • Australia has worked together with the WHO Pacific region to make its own plans.
  • Considerable progress has been made in India with initiatives, such as the extension of the right to education and the rural employment guarantee scheme.
  • The government in the UK has issued a public health white paper, which puts the reduction of health inequalities at the core of its health plan. Which also includes goals, such as minimum income for healthy living, improvements in education and life long learning.
  • In Norway, polices have been set up in order to address the social gradient in health.
  • And Slovenia and Denmark have developed national plans based on the social determinants of health.

Ten health ministers from countries in southeastern Europe, signed the Banja Luka pledge on October 14 2011, this pledge commits to health in all policies and sheds light on tackling health determinants.

Led by director Zsuzsanna Jakab and Professor Marmot, The WHO European region has established a European analysis of the health divide and social determinants. The conclusions and suggestions of the review are due to be published in 2012. Temporary discoveries from the review are published in this Health Policy report. According to the authors both health equity and health improvement are crucial and no trade off between them is needed. They explain:

“In all regions, the global financial crisis has added urgency to consideration of dramatic financial inequities, within and between countries, which preceded it. As standards of living decreased in many countries, and government revenues are tightened, we would argue that it is even more urgent than the distributional effects of all policies are taken into account in policy decision making.”

The interim European discoveries revealed that between the 53 diverse countries in the WHO European Region there was enormous differences in life expectancy. They found that:

  • In all countries in the region women live longer than men.
  • The life expectancy of a Kazakhstan women is just less than 73 years in comparison with women in France whose life expectancy is 85 years.
  • Men in Iceland have a life expectant of 81 years, while men in Russia have a life expectancy of 61 years, one year less than men in India.
  • In the 12 countries that joined the European Union after May, 2004, female life expectancy was 4 years lower after joining the EU and 7 years lower for men, compared to countries that were part of the EU prior to May, 2004.

It is believed that inequity in eastern and central Europe is the result of societal transformations in the former Commonwealth of Independent States. Across Europe maternal mortality rates vary significantly from 70 per 100,000 live births in Kyrgyzstan to below 5 per 100,000 in countries like Iceland and Norway. In an investigation that involved 16 European Countries, it was discovered that inequality in mortality based on educational levels were higher in central and eastern countries in Europe and lowest in Sweden, Italy and Spain. The researchers state that disability, morbidity as well as mental illness are crucial problems that cause loss of healthy life in Europe and across the world. The observed advantages women have regarding life expectancy are reduced considerably when these non-fatal measures of ill health become the focal point.

In a discussion regarding the need for a European review, the researchers explain that is essential that the vast health divide between countries and growing health inequity within countries in some cases, are addressed. In addition they say that new evidence is needed, and an increased interest in local action on social determinants of health. Finally, action in this area contributes to the production of other social benefits, such as lower crime rates, improved education, wellbeing, improved social integration and more sustainable communities.

The researchers conclude:

“The Rio summit offers the opportunity to ensure that failure to implement a widely supported agenda does not happen again Social cohesion, an educated population, good employment and working conditions, and policies that foster processes of social inclusion will be good for health and good for society as a whole.”

In a joint comment, Ms Jakab and Professor Marmot outline the goals of the WHO European Region Health 2020 policy: to achieve better and more equitable health for the people of Europe through greater awareness, improved governance, and working collaboratively across the region with common strategic goals. Explain: “To accelerate knowledge sharing, innovation and enhanced citizen participation in health is important to achieve better, more equitable health.”

They conclude:

“As representatives of the global community gather in Rio de Janeiro, Brazil, in October, 2011, for the World Conference on Social Determinants of Health, there will be the opportunity to take important steps to make the CSDH’s call for a global movement on health equity a reality. We hope that the European review and the momentum created by Health 2020 in the European region will be an important contributor to that global movement.”

Written by Grace Rattue