who: "social injustice on a grand scale"

I'm sure you'll see this in many places, but here it is again.

The World Health Organization's Commission on Social Determinants of Health has issued its final report, called "Closing the gap in a generation: Health equity through action on the social determinants of health".

The report makes it clear why massive numbers of people are dying of completely preventable and treatable diseases, around the planet and in our own backyard. Two words: social injustice.

Although the report tells us what we already know, quantifying the problem and identifying potential solutions are necessary steps on the road to progress.
People are dying early not only because of health gaps between rich and poor countries but also because of a lack of housing and clean water in wealthy countries like Canada, policy makers said in a report to the World Health Organization on Thursday.

The 256-page report, titled "Closing the gap in a generation: health equity through action on the social determinants of health" shows how the conditions in which people live and work directly affects the quality of their health.

The "toxic combination of bad policies, economics, and politics is, in large measure, responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible," the report's authors wrote.

"Social injustice is killing people on a grand scale."

The report defines social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness.

In Canada, nearly 1.5 million people, mostly single mothers and children, lack decent family income, safe and affordable housing, suffer food insecurity and are vulnerable to violence, said the group's Canadian commissioner, Monique Bégin, professor at the School of Management at the University of Ottawa, and a former federal health minister.

Canadians may be proud that the United Nations voted the country "the best country in the world in which to live" for seven years in a row, but not everyone shares equally in that high quality of life, Bégin said.

"This report is a wake-up call for action towards truly living up to our reputation."

Food banks in Canadian cities, unacceptable housing, high suicide rates among young Inuit, and the uprooting of Kashechewan Cree community from the James Bay region in 2005 and 2008 because of unsafe water and flooding are examples of areas for improvements, Bégin said.

Health inequities are reflected in the differences in life expectancies between countries, and within countries, the report said.

A child born in Japan or Sweden can expect to live to 80 years, but less than 50 years in several African countries.

Within a rich country like the United Kingdom, the life expectancy at birth for men in the Calton neighbourhood of Glasgow is 54 years, 28 years less than that of men in Lenzie, a few kilometres away, the report said.

The commission's three recommendations to close the gap in a generation are:

1. Improve daily living conditions, such as nourishing mothers and expanding education to early child development.

2. Tackle the inequitable distribution of power, money and resources, for example between men and women.

3. Measure and understand the problem of health inequity and evaluate the impact of changes.

Canada, Brazil, Chile, Iran, Kenya, Mozambique, Sri Lanka, Sweden, and the U.K. have committed to improving social determinants of health equity, and are already developing policies across governments to tackle them, the commission said.

Examples in Canada include the Healthy Cities project that supports health promotion, Saskatoon's plan of action on poverty and the Calgary Committee to End Homelessness, Bégin said.

WHO news release, and the 2008 World Health Report, available for download.

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