Reducing health inequities in a generation: a dream or reality?

Shankar Prinja a & Rajesh Kumar b
a. London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England.
b. School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Bulletin of the World Health Organization 2009;87:84-84. doi: 10.2471/BLT.08.062695
Volume 87, Number 2, February 2009

Available online at: http://www.who.int/bulletin/volumes/87/2/08-062695/en/index.html

“…..Inequalities in health are an indicator of distributional differences in the health status of populations. Low-income countries, which contribute 56% of global disease burden, account for only 2% of global expenditure on health.1 The WHO Commission on Social Determinants of Health has called for “closing the gap” – resolving health inequities between different groups – in the course of a generation. It aims to achieve this by improving conditions of daily living; tackling inequitable distribution of power, money and resources; and measuring and ascertaining the impact of interventions.2 However, there are several challenges to realizing this dream.

Health is generally not high on the political agenda. Policy and planning are heavily influenced by a few elite groups who are least affected by health inequalities. Powerful interest groups, such as the pharmaceutical industry, influence health policies in most countries. The revenue of the top 10 global pharmaceutical companies is more than the gross national income of the 57 lowest-income countries.3 Progressing towards the recommendations of the Commission would mean rejection of the biomedical model of disease causation and re-emphasizing the concepts of social medicine. None of this is in the interest of the power groups. Hence, the very step of agenda setting in the course of policy-making is laden with problems. It is difficult to convince politicians and bureaucrats about the long-term benefits of social interventions when they are focused on biomedical interventions that impact their status in the short term….” [au]