Addressing the inequalities of health: A new and vital mandate

August 28, 2008

The lead Editorial in this week's Lancet is tied to the launch of of the final report by WHO's Commission on Social Determinants of Health, chaired by Michael Marmot from University College London, UK. The Lancet has been closely linked with the Commission's work from its very beginning. We offered strong support at its inception in March, 2005. We reviewed and commented on its interim statement, a version of which we published in September, 2007. And we are collaborating in a UK conference on the Commission's work scheduled for November 6-7, 2008. A theme issue of the journal devoted to action-oriented research and health policy in social determinants will be published on November 8.

The Commission's most refreshing conclusion is that hopelessness, impotence, and paralysis can be overcome by optimism, vigour, and muscular policy responses. It calls for a new global agenda for health improvement and health equity. It advocates an approach to health and human development in which equity is a fundamental objective of reform. Three principles of action are set out. First, to improve the conditions of daily life -- at home and at work, for women and men, in rural and urban settings, and for all ages. Second, to address the inequitable distribution of power and money, forces that shape the conditions of daily life. And third, to act -- based on knowledge, a professional workforce, alliances with civil society, and evaluation.

For inequalities in power, money, and resources, the Commission recommends a strong public sector-- "committed, capable, and adequately financed". A prerequisite for reducing inequities is better governance, nationally and globally holding all parties accountable. The Commission focuses especially on gender equity, political empowerment, and WHO's leadership role in making social determinants "a guiding principle" in all its work. Action will depend on reliable measurement and evaluation to assess the major causes of health inequities and to understand what works to address those predicaments.

The Editorial concludes: "After 3 years of gathering evidence, the Commission on Social Determinants of Health has performed an invaluable service in making the health case for a fairer society. It is a case that deserves the full support of health professionals and policymakers in all countries. At last equity is taking its rightful place at the centre of public debate about health. The Commission's report is a fitting tribute to Dr J W Lee, WHO's late Director-General who initially commissioned this brave project."
The Lancet Press Office T) +44 (0) 20 7424 4949 E)

Note to editors: The full report will can be downloaded from 1000H (UK time) on Thursday 28 August from

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