WHO report discloses extent of global health inequality

By Barry Mason
25 September 2008

In August the World Health Organisation (WHO) published a report, “Closing the gap in a generation: Health equity through action on the social determinants of health.” The report reveals the appalling levels of health inequality that exist and how this situation leads to stunted lives and premature death.

A WHO press release explained that “a majority of people in the world do not enjoy the good health that is biologically possible... Social injustice is killing people on a grand scale.”

Dr. Margaret Chan, WHO director-general, stated, “Health inequity really is a matter of life and death... health systems will not naturally gravitate towards equity. Unprecedented leadership is needed that compels all actors, including those beyond the health sector, to examine their impact on health.”

The report drawn up by a WHO commission was the result of three years of work by researchers from universities, government bodies and non-governmental organisations from throughout the world. The chair of the commission, Sir Michael Marmot, speaking on BBC radio, explained, “The key message of our report is that the circumstances in which people are born, grow, live, work and age are the fundamental drivers of health and health inequity.”

Illustrating the wide gap, the report notes, “A girl born today can expect to live for more than 80 years if she is born in some countries—but less than 45 years if she is born in others.”

The inequities do not occur just between countries, but within countries. The report notes that health inequalities in a particular country “are closely linked with degrees of social disadvantage.”

The Independent explained that “a boy born in relatively deprived Carlton areas of Glasgow was likely to live on average 28 years fewer than one born a few miles away in Lenzie, a village by the Glasgow-Edinburgh railway line.”

The commission spells out, “This unequal distribution of health damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements and bad politics.”

The impact of inequality begins in childhood. The report estimates at “least 200 million children globally are not achieving their full development potential.”

In 2007, for the first time in human history, a majority of people live their lives in an urban environment. Nearly one billion of the world’s population now lives in a slum. Large numbers of people are living without quality housing and shelter, potable water and access to sanitation, severely impacting their health.

The report warns that climate change can only make urban living conditions worse. The study states, “The current model of urbanization poses significant environmental challenges, particularly climate change—the impact of which is greater in low-income countries... The disruption and depletion of the climate system and the tasks of reducing global health inequalities go hand in hand.”

The commission notes that universal welfare and health provision is necessary to reduce health inequalities, stating, “Generous universal social protection systems are associated with better population health; including lower excess mortality among the old and lower mortality levels among socially disadvantaged groups... The Commission considers health care a common good, not a market commodity.”

They also note how current trade agreements reduce the ability of “underdeveloped” countries to be able to fund health and welfare provision. “Economic agreements between rich and poor countries that require tariff reduction can reduce available domestic revenue in low-income countries.”

Women are particularly affected by health inequality: “Women earn less than men ... girls and women lag behind in education and employment opportunities. Maternal morbidity remains high in many countries.”

The report concludes by posing the question: “Is closing the health gap in a generation feasible?” It answers: “If we continue as we are, there is no chance at all. If there is a genuine desire to change, if there is a vision to create a better and fairer world where people’s life chances and their health will no longer be blighted by the accident of where they happen to be born, the colour of their skin, or the lack of opportunities afforded to their parents, then the answer is: we could go along way towards it... This is a long-term agenda... At the centre of this action should be the empowerment of people, communities and countries that currently do not have their fair share.”

All of this is pie in the sky without addressing the fact that the various inequalities cited are rooted in the capitalist system of private ownership and production for profit, in a global economic and social system dominated by huge transnational corporations and major imperialist powers.

All indicators show that current capitalist development has been accompanied by an increasing inequality in countries throughout the world. In many Western European countries, the period following the Second World War saw the introduction of health and welfare provision that went some way to lessen health inequalities. That process is now in reverse, with social gains won by workers being rapidly eroded.

Another recent report issued by the United Nations, Millennium Development Goals (MDG) Gap Task Force, shows the goals will not be achieved by the deadline of 2015. The MDGs were drawn up at the beginning of the millennium and pledges made by the G7 leading industrial countries to fund development in the least developed countries. The goals included reducing by half the numbers without access to clean water and sanitation.

The reports states, however, that instead of going forward, “The weakening of the world economy and the steep rises in food and energy prices threaten to reverse some of the progress made in the various dimensions of human development.”