The
Lancet, Volume 372, Issue 9650 - 8 November 2008
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61663-3/fulltext
Health
Equity - A global movement to address the social determinants of health has been
gathering pace. This week's issue of The Lancet contributes to this campaign by
publishing evidence on actions that can reduce the startling health inequalities
that persist within and between countries.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61664-5/fulltext
Perspectives:
Baying
at the moon: addressing the politics of global
health
Ilona
Kickbusch
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61673-6/fulltext
Only after devastating world wars has the call for global governance been as
pervasive as it is today. 1945 saw the creation of a new system for
international cooperation emerge in
The
role of welfare state principles and generosity in social policy programmes for
public health: an international comparative
study
Prof
Olle Lundberg PhD a , Monica Åberg Yngwe PhD a, Maria Kölegård Stjärne PhD a,
Prof Jon Ivar Elstad PhD b, Tommy Ferrarini PhD c, Prof Olli Kangas PhD d, Prof
Thor Norström PhD c, Prof Joakim Palme PhD c e, Prof Johan Fritzell PhD a e, for
the NEWS Nordic Expert Group
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61686-4/fulltext
Editors' note: Since
social policies could have an important effect on social determinants of health,
it is important to know whether the characteristics of the policies of different
welfare states influence population health. Under the auspices of the NEWS
project, researchers investigated to what extent variations in the principles
and generosity of family and pension policies in 18 OECD (Organisation for
Economic Co-operation and Development) countries were linked to infant mortality
and old-age excess mortality during the post-war era. Policies typical of the
Nordic model (which have a unique and generous type of welfare state) were
associated with low infant mortality and reduced old-age excess mortality. Thus,
social policies are crucial for how we can understand and tackle the social
determinants of health.
Effects
of fully-established Sure Start Local Programmes on 3-year-old children and
their families living in
Prof Edward
Melhuish PhD a , Prof Jay Belsky PhD a, Prof Alastair H Leyland PhD b, Prof
Jacqueline Barnes PhD a, the National Evaluation of Sure Start Research
Team
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61687-6/fulltext
Editors' note: The
Sure Start Local Programmes set up by the UK Government are ambitious in their
aim to improve the health and wellbeing of young children living in
disadvantaged neighbourhoods by trying to stop the transmission of inequalities
in health, poverty, education, and social exclusion between generations. Given
the substantial costs of the programmes, regular evaluation is essential. A
randomised comparison is not possible, for ethical and social reasons. This
quasi-experimental design provides valuable feedback and allows early assessment
of whether the programmes are having any beneficial effect. The study found
encouraging evidence of some benefit in children's social development and in
parenting skills.
Best-practice
interventions to reduce socioeconomic inequalities of coronary heart disease
mortality in
Prof
Mika Kivimäki PhD a , Martin J Shipley MSc a, Jane E Ferrie PhD a, Archana
Singh-Manoux PhD a b, G David Batty PhD c, Tarani Chandola DSc a, Prof Michael G
Marmot PhD a, Prof George Davey Smith DSc d
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61688-8/fulltext
Editors'
note: There is little disagreement about the existence of social inequalities in
coronary heart disease but much debate about the best ways to reduce the
inequality. Previous studies have assessed the contributions of various risk
factors by comparing relative risk of disease between high and low socioeconomic
groups before and after adjustment for these risk factors. However, that
approach does not take into account the extent to which reduction in each risk
factor is feasible. This paper, focusing on classic risk factors and modelling
the potential of best-practice interventions to reduce socioeconomic
inequalities in mortality from coronary heart disease, has a clear message:
best-practice interventions and smoking cessation, if applied universally, would
eliminate most of the difference in risk between high and low socioeconomic
groups.
.
Effect
of exposure to natural environment on health inequalities: an observational
population study
Dr
Richard Mitchell PhD a , Frank Popham PhD b
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61689-X/fulltext
Editors'
note: Whether access to green environments affects socioeconomic inequality in
health within populations is unknown. A study comparing income-related health
inequality in people living in areas of England with high and low amounts of
green space shows that people exposed to the greenest environments are less
likely to die (from all causes or from circulatory diseases) even when taking
into account income. Thus, there are substantial differences in health
inequality between populations who are exposed to the same welfare state, health
service, and distribution of national income but who live in different types of
physical environment. Environments that promote good health might be crucial to
reduce health inequalities
Closing
the gap in a generation: health equity through action on the social determinants
of health
Prof
Michael Marmot PhD a , Sharon Friel PhD a, Ruth Bell PhD a, Tanja AJ Houweling
PhD a, Sebastian Taylor PhD a, on behalf of the Commission on Social
Determinants of Health
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61690-6/fulltext
The
Commission on Social Determinants of Health, created to marshal the evidence on
what can be done to promote health equity and to foster a global movement to
achieve it, is a global collaboration of policy makers, researchers, and civil
society, led by commissioners with a unique blend of political, academic, and
advocacy experience. The focus of attention is on countries at all levels of
income and development. The commission launched its final report on August 28,
2008. This paper summarises the key findings and recommendations; the full list
is in the final report.
Health
Policy
Globalisation
and health: the need for a global vision
Ted
Schrecker, Ronald Labonté, Roberto De Vogli
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61691-8/fulltext
The
reduction of health inequities is an ethical imperative, according to the WHO
Commission on Social Determinants of Health (CSDH). Drawing on detailed
multidisciplinary evidence assembled by the Globalization Knowledge Network that
supported the CSDH, we define globalisation in mainly economic terms. We
consider and reject the presumption that globalisation will yield health
benefits as a result of its contribution to rapid economic growth and associated
reductions in poverty. Expanding on this point, we describe four disequalising
dynamics by which contemporary globalisation causes divergence: the global
reorganisation of production and emergence of a global labour-market; the
increasing importance of binding trade agreements and processes to resolve
disputes; the rapidly increasing mobility of financial capital; and the
persistence of debt crises in developing countries.
Global
health equity and climate stabilisation: a common
agenda
Sharon
Friel, Michael Marmot, Anthony J McMichael, Tord Kjellstrom, Denny Vågerö
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61692-X/fulltext
Although
health has improved for many people, the extent of health inequities between and
within countries is growing. Meanwhile, humankind is disrupting the global
climate and other life-supporting environmental systems, thereby creating
serious risks for health and wellbeing, especially in vulnerable populations but
ultimately for everybody. Underlying determinants of health inequity and
environmental change overlap substantially; they are signs of an economic system
predicated on asymmetric growth and competition, shaped by market forces that
mostly disregard health and environmental consequences rather than by values of
fairness and support.
Addressing
social determinants of health inequities: what can the state and civil society
do?
Erik Blas,
Lucy Gilson, Michael P Kelly, Ronald Labonté, Jostacio Lapitan, Carles Muntaner,
Piroska Östlin, Jennie Popay, Ritu Sadana, Gita Sen, Ted Schrecker, Ziba Vaghri
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61693-1/fulltext
In this
Health Policy article, we selected and reviewed evidence synthesised by nine
knowledge networks established by WHO to support the Commission on the Social
Determinants of Health. We have indicated the part that national governments and
civil society can play in reducing health inequity. Government action can take
three forms: (1) as provider or guarantor of human rights and essential
services; (2) as facilitator of policy frameworks that provide the basis for
equitable health improvement; and (3) as gatherer and monitor of data about
their populations in ways that generate health information about mortality and
morbidity and data about health equity.
Viewpoint
Recommendations
for action on the social determinants of health: a Canadian
perspective
Shanthi
Johnson, Sylvia Abonyi, Bonnie Jeffery, Paul Hackett, Mary Hampton, Tom
McIntosh, Diane Martz, Nazeem Muhajarine, Pammla Petrucka, Nazmi Sari
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61694-3/fulltext
Health
disparities are widely prevalent within and between countries, and Canada is no
exception.1,2 Although historic efforts to address such disparities have not
been successful and Canada's provincial and territorial health goals have been
only partly achieved,3 we are now well positioned to understand and address
health disparities at the global, national, and local levels. The global
resurgence of interest in addressing health disparities in the 1990s and 2000s
through various movements, such as the WHO Commission on the Social Determinants
of Health and their final report with evidence-based recommendations,4,5 have
provided momentum to countries around the world to re-engage in dialogue at the
national and international levels for this vitally important issue.
Placing
the individual within a social determinants approach to health
inequity
Ian Forde,
Rosalind Raine
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61695-5/fulltext
The Final Report of the WHO Commission on Social Determinants of Health
is a welcome challenge to governments. It sets out the core conditions that have
to be met to give everyone a fair chance of leading a healthy and flourishing
life.
The
Commission distinguishes two contrasting approaches to public health—action
through the individual and his or her choices versus action on social
determinants. 1 It justifies its preference for action on social determinants by
reasoning that “Contemporary public ...
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