4 – Closing the Gap in Health

The health inequities that exist between the richest and the poorest populations

i.e. - poor ppl have higher levels of illness and premature mortality;
those in high income countries tend to have greater life expectancy and lower levels of illness

Because of the social determinants or circumstances in which people grow, live, work, and age, and the accessibility to healthcare allowing them to deal will illness
- Major factors that influence health outcomes

The poorest of the poor have the worst health. This is a global phenomenon between and within countries

1. Improve daily living conditions
2. Address inequalities in power, money, resources
3. Measure and understand the problem and assess the impact of action

- implement a universal social protection policy to protect all from insecure employment
- improve the circumstances in which children are born (equal childhood development and education between girls and boys to promote lifelong health)

5 main categories they highlight:
1. equity from the start
2. healthy places, healthy people
3. fair employment and healthy work
4. social protection throughout life
5. universal health care

Across the public and private sectors through effective health policy

Increase global health research through implementing effective measurement of health and the SDH
Evaluation of impact that policies have on health

1) Health - central to the notion of health is the work and home environment we find ourselves (work, home)

2) Essentials - in these places, it is essential that there is access to appropriate shelter, clean water, and sanitation
(shelter, clean water & sanitation)

3) Urbanization - increased rates of communicable diseases/violence/injuries in places with high urbanization or crowded living. Urbanization can cause the development of industry, which often leads to increases in pollution and climate change

1. Fair work and healthy employment
2. Social security throughout life
3. Healthy homes
4. Early childhood health and development
5. Universal health care

- profound effects on healthy equity
- when workers are in healthy conditions, they provide financial security, social status, self-esteem, protection from physical and psychosocial illness

Poor physical or psychosocial health and stress

This has been shown to increase risk of coronary heart disease by 50%

Can have profound negative effect on health
Induces poverty, material deprivation, and increased stress

Job security protects ppl from the financial and personal strains

Social security: any government system that provides monetary assistance to people with an inadequate or no income

WHO - a universal comprehensive social protection policy is needed on the basis that greater social security has been associated with better population health
- Implementing a universal social protection policy is critical for improving health in poor countries as most of the population work in the informal sector or domestically
○ Social security can greatly impact the status and health of a population
○ A negative association between the amount or social security provided and poverty rates
○ Poverty/low SES is one of the strongest SDH and can lead to poor excessive illness and premature death
Providing people with social support in times of need, such as periods of unemployment, may aid n increasing population health through reducing the level of poverty

- living conditions are important for early childhood development
- 200mil children are not achieving their full developmental potential due to poor living conditions in early life

The need to tackle inequalities in power, money, and resources

Given that inequities in daily living conditions is shaped by deeper social structures, including governmental policies and institutions, the report suggests the need to develop policies that promote equity

1) Appropriate local action across range of social determinants
2) Preventions and health promotions valued just as highly
3) Emphasis on the primary level of care with adequate referral to higher levels
4) An equitable system not relying on ability to pay

Needed to promote equitable health care systems that do not rely on a person's ability to pay

Aligning health policies across a number of government departments to promote health equity

Implies the inclusion of several factors, in addition to the health sector, when attempting to design public policies meant to address health outcomes

Health, trade, industry, education

- Can be large
- The market can bring health benefits through new technologies and goods and services
- Can also adversely affect SDH through economic inequalities, resource depletion, environmental pollution, unhealthy working conditions, and the circulation of dangerous goods

1) Social goods should be governed by the public sector


2) Enforce legislation that promotes gender equality

3) Promote political empowerment

- commercialization of education, health care, and other basic human and societal needs produces health inequity
- therefore it is advisable for these social goods to be governed by the social sector

- gender inequities appear to pervade in all societies, with women tending to have less power, resources, entitlements, and social value than men
- less income, less opportunities for education/employment
- empowerment of women and reducing gender inequities is essential to reducing health inequity

This can occur through many changes made to policy that effect the societal structure including:
- Legislation that enforces equity and equality
- Make discrimination on the basis of gender illegal
- Invest in formal and vocational education for girls
- Guarantee pay equity
- Increase investment in female sexual and reproductive health

The ability of individuals to contribute to and be included in political procedures

- autonomy
- provides an opportunity to voice their needs and interests
- allows them to change unfair graded distribution of resources

Inequity in who participates in political decision-making, with those who are most disadvantaged having the least amount of physical power

This leads to an unfair distribution of societal power and resources -> which contributes to health inequity

1) Top down - in which the state works to guarantee a complete set of rights for all citizens and fair distribution of resources across soceity

2) Bottom up/Grassroots - founded by self-organization of disadvantaged groups

To design effective, targeted interventions

Resources
- The GBD study - provides info on the magnitude of health problems
- MDG report - may be useful for identifying health problems that exist, offering solutions for how to address health problems

Obstacles and supports to health interventions, which can include health policy

- obstacles that could harm the feasibility of a policy or intervention
- examples: civil unrest, government policies or agendas, physical barriers (e.g. lack of infrastructure), cultural barriers (e.g. mistrust of western medicine)

- factors that can be leveraged to increase the feasibility/effectiveness of a policy or intervention
- examples: the willingness of a community to accept a policy or participate in an intervention; government programs that make additional resources available