20th September 2008, Liverpool
I had been invited by Michael Marmot to speak at the annual meeting of the Academia Europaea. Michael had organised a session on Health and Wealth so I was presenting our work on the contribution of health to economic growth in Europe. It was my first opportunity to hear Michael speaking since the publication of the Report of the Commission on Social Determinants of Health, which he chaired.
The report begins by documenting, in great detail, the scale of the problem we face. Life expectancy at birth ranges from 54 to 82 years, not in the world as a whole but within a single city, Glasgow. The Commission states very clearly that "social injustice is killing people on a grand scale" and sets out a vision for closing the health gap between rich and poor in a generation.
The Commission made three broad recommendations:
- Improve the conditions of daily life—the circumstances in which people are born, grow, live, work, and die Equity from the start; healthy places, healthy people; fair employment and decent work; social protection across the life course; universal health care;
- Tackle the inequitable distribution of power, money, and resources—the structural drivers of the above conditions of daily life—globally, nationally, and locally Health equity in all policies, systems, and programmes; fair financing; market responsibility; gender equity; political empowerment—inclusion and voice; good global governance;
- Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.
This is an ambitious but achievable agenda. The real question is whether the governments of the WHO’s member states will have the courage and determination to take it forward.