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Health as if everybody counted blog

Where the health equity action is, around the world

Posted by Ted Schrecker
Ted Schrecker
Ted Schrecker is a clinical scientist at the Élisabeth Bruyère Research Institut
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on Wednesday, 10 April 2013
in CHNET-Works!

Herewith a selection of promising efforts from around the world (sadly, none from Canada) to implement the health equity agenda.

The Social Determinants of Health Network (SDH-Net) is a four-year collaboration with the aim of building research capacity on social determinants of health in Mexico, Colombia, Brazil, South Africa, Tanzania and Kenya. It involves leading institutions in each of the six, in partnership with similar institutions in Germany, Spain, the United Kingdom and Switzerland.  The network is now in its second year of operation, and mapping reports on research capacity in each LMIC will soon be posted online.  Among other bodies of expertise, the project builds on earlier work by the World Health Organization on social determinants of health and public health programs.  SDH-Net is funded by the European Commission, the executive branch of the European Union, under the seventh Framework Research Programme.

Also funded by the European Union – are you seeing a pattern? – is the European Portal for Action on Health Inequalities.  In addition to links to a verity of external resources, the site offers access to a multilingual policy database that is searchable by EU country, implementation level, characteristics of policy or keyword. On an initial exploration of the database, and perhaps inevitably given the state of health equity intervention research, many of the entries link either to official statements of policy (which may or may not be reflected in actual practices) or to self-reports. Nevertheless, such platforms already serve a valuable purpose in encouraging creative imitation and thinking outside the box.

Still in the EU, a multi-university collaboration on Poverty and Social Exclusion funded by Britain’s Economic and Social Research Council has just released summary findings from report starkly titled The Impoverishment of the UK.  The report found, for instance, that about 5.5 million adults go without essential clothing, about 4 million children and adults are not properly fed by today’s standards, and more than one in four people skimped on their own food in the past year so others in their household could eat.  It should be kept in mind that these findings come from a country where academics are warning that pending benefit cuts may push 200,000 more children into poverty; where the income tax rate paid by the country’s highest earners has just been lowered; and where a wealth tax on houses worth more than £2 million remains controversial.  The survey does not consider direct effects on health, but underscores the fact that in the face of the recommendation by the Commission on Social Determinants of Health to “tackle the inequitable distribution of power, money, and resources,” some countries are moving in the opposite direction.

Finally, a new WHO report on Closing the Health Equity Gap, with a former official in Britain’s Cabinet Office (Ross Gribbin) as one of the two lead authors, draws on the reports of the various knowledge networks set up to support that Commission to identify concrete, and relatively short-term, implications for public policy.  The first main section identifies actions for health systems and health policy: moving toward universal coverage; expanding and redesigning public health programs; improving the measurement of health inequities; and making the case for intersectoral action.  The second main section focuses on cross-government actions in areas such as social protection, urban policy, trade, labour markets, and (commendably) policy and attitudes towards women.  Those who have been working on health equity issues professionally for some time will probably not find much that is new here, but that isn’t the point.  The point is rather to disseminate key messages about practical possibilities for acting on the moral imperative of reducing health inequity to audiences that may be unfamiliar with the concept, or else convinced of its importance but frustrated by the lack of ‘how do we get there from here’ information. 

Unfortunately, the current British trajectory – essentially, a large-scale social experiment on nonconsenting subjects in a jurisdiction that is a world leader in research on socioeconomic disparities and their health consequences – suggests that more information and better messaging may not be adequate to address the raw politics that perpetuate health inequity.

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kathie cram
kathie cram
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kathie cram Friday, 12 April 2013

I am happy to see someone acknowledge that the "rational" approach to change might not be enough. It strikes me that this model of change we are trapped in (a kind of modern day Matrix), is based on an unstated set of political assumptions that are steeped in liberal philosophy; that is change happens through gathering of facts, building awarness, making rational arguments and suggestions in acceptable language and building awareness. This model of change that we use in population health promotion has a political premise to it that remains hidden; it presents itself as if it is nuetral and apolitical. I think we are fooling ourselves. As right wing governments manage to get elected and force an agenda that favors big business and the wealthy, health disparities are going to get worse. We are doing our communities a disservice by not moblizing with them. I am sometimes disheartened by our distance from this hard work and by the lack of inclusion of First and Essential Voices in our work. When we dedicate time, money and investments in research, awareness and trying to convince business to come on board, the consequence is that these other voices get lost and we lose the opporunity to build those relationships. In my mind, it is those relationships and the scary work of strengthening community action that we are missing. Maybe we have to be prepared to take risks and get into trouble with the "powers that be" to really have the impact we long for.

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