A panel of experts representing 53 countries has published a final report entitled “Review of Social Determinants and the Health Divide in the WHO European Region”. It finds a range of difference in life expectancy in countries of 17 years for men and 12 years for women, with the lowest life expectancies occurring the in the eastern part of the region. The new review was commissioned to help inform planning for Health 2020, a health policy framework.

Headed by Michael Marmot, director of the Institute of Health Equity in the UK, the review was intended to provide practical guidance on what interventions countries could use to act on the social determinants of health. It provides guidance or “best buy” priorities in 12 policy areas.

Public Health Emergency

A key concern for the authors of the report is the financial crisis that has occurred since 2008. “The financial crisis threatens a public health emergency, and inaction will lead to a worsening of social, economic, and health burdens,” according to WHO. For Marmot, “unemployment, particularly the high persistent levels of youth unemployment, is a public health time bomb waiting to explode…I would say to any government that cares about the health of its population: look at the impact of their policies on the lives people are able to lead and, more importantly, at the impact on inequality. Health inequality kills. It is socially unjust, unnecessary, and avoidable, and it offends against the human right to health.”

Excerpts

Other important observations from the report include the following:

“We now know that what makes societies flourish and sustainable also makes people healthy.”

“A central argument of this review is that social policies can by judged by their likely impact on health equity.”

Countries in the region should have two aims: “improving average health and reducing health inequities by striving to bring the health of less-advantaged people up to the level of the most advantaged. Improving the levels and equitable distribution of the social determinants should achieve both aims.”

“Central to this approach is empowerment—putting in place effective mechanisms that give those affected a real say in decisions that affect their lives and by recognizing their fundamental human rights, including the right to health.

“There is a vibrant debate on what is sometimes portrayed as a tension between action on social determinants and individual freedoms. This review calls for social action—but individual freedoms and responsibilities feature strongly in the approach taken…The wider influences of society on the social determinants of health are of fundamental importance in enabling people to achieve the capabilities that lead to good health. An individual’s resources and capabilities for health are influenced by social and economic arrangements, by collective resources provided by the communities of which they are part, and by welfare state institutions…

“A key action area is to develop new instruments and mechanisms—and strengthen those that exist—to empower people and ensure that the opinions and perspectives that are heard in decision making processes include a better reflection of equity arguments. Empowering people includes promoting civil society, enabling unions to be formed, and developing political and non-political organizations freely.”

The report is available for download at:

http://tinyurl.com/kfm6xu7

An executive summary is also available at:

http://tinyurl.com/l9769wg
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