Tuesday, 13 September 2011
Equity in Health: Progress or a Pipe Dream?
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At the end of August, Minister Aglukkaq announced funding for research on health equity in Canada http://www.cihr-irsc.gc.ca/e/44157.html . This is an extension of the Canadian institute of population and Public Health strategic plan http://www.cihr-irsc.gc.ca/e/40593.html which identified health equity of one of 4 research priorities. As noted in the previous posting, equity is a pre-requisite for health. While much literature links the determinants of health and equity, equity itself is not one of the determinants of health, it is the inequities that exists within the determinants that are the focus of reducing inequities. Hence, of the pre-requisites for health in the Ottawa Charter, equity is the one that has received the greatest attention.
Margaret Whitehead spoke of Health Equity in 1992 (Int J Health Services 22:429-445) in a foundation article. The WHO report chaired by Michael Marmot on Closing the Gap in health inequities through action on social determinants is a landmark international document worth a read WHO report on social determinants .
It was fitting that the first report of the Chief Public Health Officer of Canada, Dr. David Butler-Jones, was on addressing health inequalities 2008 Addressing Health inequalities report . Despite the intense political scrutiny that the position must endure, it is a publication that clearly lays out the disparities that exist within Canada. That the report was released without any announcements and quietly posted to the PHAC website speaks volumes to the political acceptability of the current government in addressing this agenda, so kudos for Minister Aglukkaq for now recognizing that this is a matter of health and not ideological stripes.
Not surprisingly, the report draws heavily on work by Russell Wilkens, a person whose contributions to research on health inequities spans several decades and perhaps one of the most underrated public health heroes in the field within Canada Stats Can report on neighbourhood inequities . Hidden in this technical report is much in the way of good news for Canada. First is that inequities have not been increasing as they have in some supposedly developed countries, second is that in some instances the gap has been reduced. Also hidden is the estimate that about 25% of disease burden can be directed attributed to excess caused by inequitable distribution of income alone.
If your fall schedule isn’t too busy, don’t miss the World Conference on social determinants of health in Rio de Janeiro in October where the “Rio Declaration on Social Determinants of Health” will be finalized.