Kumanan Rasanathan, Eugenio Villar Montesinos, Department of Ethics, Equity, Trade and Human Rights, World Health Organization, Geneva.
A concern for health equity is not new in global health. Equity was central to the World Health Organization (WHO) 1946 constitution, and to the work that culminated in the Declaration of Alma Ata in 1978. Despite this, the health agenda has mostly focused on securing progress on priority challenges. This has contributed to substantial advances in average life expectancy in most parts of the world. Yet the global health community has often seemed unable to counter the widening inequities brought by uneven progress.
The recently completed World Health Assembly has the potential to be a turning point in addressing health inequities. Two resolutions were passed, fundamentally grounded in a concern for equity and social justice – one on ‘primary health care, including health systems strengthening’ (available at http://apps.who.int/gb/ebwha/pdf_files/A62/A62_R12-en.pdf) , and another on ‘reducing health inequities through action on the social determinants of
health’ (available at http://apps.who.int/gb/ebwha/pdf_files/A62/A62_R14-en.pdf).
Around 50 countries spoke in strong support of the resolution on primary health care, and almost 40 countries intervened in support of acting on the social determinants. There was a constructive consensus in favour of both texts, with discussion centred on the strength and tone of the resolutions. Throughout the Assembly, multiple references were made to the importance of social justice and fairness in the plenary and across the agenda items.
The events that sparked these resolutions from WHO – the convening of the Commission on Social Determinants of Health in 2005 and the groundswell of support from countries for the renewal of primary health care, leading to the 2008 World Health Report – reflect an increasing understanding and intolerance for widening health inequities in the modern era. There is increasing support for the idea that health equity should be seen as a key development goal and as a measure of the progress of the global community.
Such consensual support would have been unthinkable until relatively recently and has strongly built on the explosion in knowledge of health inequities, both within and between countries, in the last twenty years.
The broad range of civil society and academia have made important contributions in terms of advocacy, the generation of knowledge and the demonstration of innovative strategies to address the social determinants. The Commission’s damning diagnosis – ‘social injustice is killing people on a grand scale’ – owes much to this work.
So what now? The twin resolutions call for a broad range of actions based on the values of Alma Ata from the international community, member states and the WHO secretariat. The Assembly’s understanding of both primary health care and addressing the social determinants of health emphasises the key role of multi-sectoral action, beyond the necessary but insufficient functioning of health systems, if health inequities are to be reduced. Achieving such action issues a difficult challenge to health leaders at global, national and local levels.
Anyone who believes in health equity should be encouraged by these developments. Of course, the resolutions by themselves will not achieve health for all. But they provide a powerful endorsement of the report of the Commission and of the need for renewal of primary health care. The challenge in implementing these resolutions, to contribute towards improved health equity, is one to which civil society can continue to make a vital and essential contribution.
First published in EQUINET Newsletter No 101, July 2009: Health Equity: to the Centre of the Global Health Agenda?
Equinet news is the electronic mailing list of the network for equity in health in east and southern Africa (EQUINET)
http://www.equinetafrica.org/
email: admin@equinetafrica.org
Filed under: social determinants of health
