{"id":63,"date":"2018-09-06T08:07:23","date_gmt":"2018-09-06T07:07:23","guid":{"rendered":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/?p=63"},"modified":"2018-11-14T11:23:57","modified_gmt":"2018-11-14T11:23:57","slug":"the-commission-on-social-determinants-of-health-ten-years-after","status":"publish","type":"post","link":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/2018\/09\/06\/the-commission-on-social-determinants-of-health-ten-years-after\/","title":{"rendered":"The Commission on Social Determinants of Health: Ten years after"},"content":{"rendered":"

Ten years ago, the World Health Organization\u2019s Commission on Social Determinants of Health released its final report<\/a>.\u00a0 The authors, led by Sir Michael Marmot<\/a>, began by stating that the \u2018unequal distribution of health-damaging experiences is not in any sense a \u2018natural\u2019 phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics\u2019. \u00a0The unsparing critique proceeded from there. \u00a0In a generally laudatory review, The Economist<\/em> wondered<\/a> whether the Commission was \u2018baying at the moon\u2019 when it attacked such \u2018global imbalances\u2019.<\/p>\n

However, the financial crisis that was spreading across the world even as the report was released made it clear that the Commission\u2019s analysis was spot-on. \u00a0Against that background Margaret Chan, then Director General of WHO, warned the United Nations General Assembly<\/a> in October, 2008 that \u2018[t]he policies governing the international systems that link us all so closely together \u2026. need to be put to the true test. What impact do they have on poverty, misery, and ill health \u2013 in other words, the progress of a civilized world? Do they contribute to greater fairness in the distribution of benefits? Or are they leaving this world more and more out of balance, especially in matters of health?\u2019\u00a0 As was often the case, Dr. Chan was far ahead of the organisation she led \u2013 and as we know, in the decade of counterproductive austerity<\/a> that followed, her advice was seldom heeded.<\/p>\n

Ten years on, where are we?\u00a0 In an article I have just published<\/a> in Critical Public Health<\/em> (if you don’t have access through your institution please e-mail me<\/a>), I argue that \u2013 as in many other areas of global health policy and politics \u2013 the glass can be considered either half empty or half full.\u00a0 Is the fate of the Commission’s report the tale of a sinking stone …<\/p>\n

\"\"<\/p>\n

… or of promise yet unrealised?<\/p>\n

On the one hand, the international community has now signed on to at least the rhetoric of the Sustainable Development Goals<\/a> \u2013 a legacy of the World Commission on Environment and Development, which reported not ten years ago, but 31.\u00a0 On the other hand, on most measures and in most contexts economic inequality is rising, and an expanding body of social science research suggests that the reductions in inequality that occurred in the twentieth century, in the context of two world wars that required mass mobilisation and a devastating depression, are an anomaly that is unlikely to be repeated.<\/p>\n

As I point out in the article, references to \u2018social determinants of health\u2019 in the scientific literature are increasing in number.\u00a0 A PubMed search turned up 75 references in 2008, rising steadily to 1042 in 2017.\u00a0 Research ventures like the LIFEPATH consortium<\/a> are expanding the already substantial evidence base for acting on social determinants of health.\u00a0 Whether the strength of that evidence matters is ultimately a political issue; getting health equity and the corollary need for redistributive economic and social policies onto mainstream political agendas remains a formidable challenge, but perhaps not an insurmountable one.<\/p>\n

The article was finalised before the remarkable primary victory of Democrat Ayanna Pressley<\/a> in Massachusetts\u2019 7th<\/sup> District.\u00a0 Here\u2019s what she had to say about health equity<\/a> in her \u2018equity agenda\u2019 (MBTA is the Massachusetts Bay Transport Authority):<\/p>\n

\u2018Today, when you board the MBTA\u2019s number 1 bus in Cambridge, it\u2019s less than three miles to Dudley Station in Roxbury, but by the time you\u2019ve made the 30-minute trip, the median household income in the neighborhoods around you have dropped by nearly $50,000 a year.<\/a>[2]<\/sup><\/a>\/<\/a>[3]<\/sup><\/a> As the bus rolls through Back Bay, the average person around you might expect to live until he or she is 92 years old, but when it arrives in Roxbury, the average life expectancy has fallen by as much as 30 years.<\/a>[4]<\/sup><\/a> \u00a0\u2026. These types of disparities exist across the 7th<\/sup> District, and they are not naturally occurring; they are the legacy of decades of policies that have hardened systemic racism, increased income inequality, and advantaged the affluent\u2019.<\/p>\n

If the \u2018social movement, based on evidence\u2019<\/a> that Sir Michael and colleagues envisioned after the Commission\u2019s report is to take shape \u2013 it hasn\u2019t, yet – this is the kind of language we need to hear, from political actors and public health professionals alike.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ten years ago, the World Health Organization\u2019s Commission on Social Determinants of Health released its final report.\u00a0 The authors, led by Sir Michael Marmot, began by stating that the \u2018unequal distribution of health-damaging experiences is not in any sense a … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1834,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[15,17,14,16],"class_list":["post-63","post","type-post","status-publish","format-standard","hentry","category-uncategorised","tag-health-equity","tag-sir-michael-marmot","tag-social-determinants-of-health","tag-social-movements"],"_links":{"self":[{"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/posts\/63","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/users\/1834"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/comments?post=63"}],"version-history":[{"count":5,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/posts\/63\/revisions"}],"predecessor-version":[{"id":81,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/posts\/63\/revisions\/81"}],"wp:attachment":[{"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/media?parent=63"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/categories?post=63"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/tags?post=63"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}