Credit contraction offers opportunity to close gaps in health inequities

doi:10.1136/bmj.a2505

Published 12 November 2008, doi:10.1136/bmj.a2505
Cite this as: BMJ 2008;337:a2505

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Credit contraction offers opportunity to close gaps in health inequities

Deborah Cohen

¹ BMJ

The sudden global reduction in credit may lead to opportunitiesto rethink and improve global strategies to reduce health inequities,an international conference heard last week.

Michael Marmot, chairman of the World Health Organization’scommission on social determinants of health, said, "During thecrises [the first and second world wars] there was social solidarityand the thought that we have to do things differently. The creditcrisis is an opportunity to say are we going to do things differently."He was speaking at a conference entitled Closing the Gap ina Generation: Health Equity through Action on the Social Determinantsof Health.

Professor Marmot pointed to the fact that Western governmentshad recently found hundreds of billions of dollars to supportthe banks and that the commission’s report early thisyear had put the cost of upgrading the world’s slums at$100bn.

"For one ninth of the money we put into saving the banks, everyurban resident in the world could have clean running water,"he said, although the will to tackle health inequity was lacking.

Click on image to view video

Professor Sir Michael Marmot discusses the impact of the world's financial crisis on global health

Professor Marmot also called on international finance ministersto put equity at the top of their agenda when they next meet."If you deal with the various aspects of social organisationin a fair way you will be dealing with health in a fair way,"he said.

Despite concerns that the public would be unwilling to fundinternational development when there are financial difficultiesat home, Ivan Lewis, undersecretary for international development,pledged that the United Kingdom would fulfil its promise togive 0.7% of gross national income to international developmentby 2013. It was even more important to do this in the currenteconomic climate, he said.

Alan Johnson, health secretary, added that "at an internationallevel, we have to apply the same vigour and commitment to addressinginequality as our governments are currently applying to stabilisingthe world economy."

Click on image to view video

What will US president elect Barack Obama do for health inequity? Professor Sir Michael Marmot outlines his wish list

Despite the financial instability, Mr Johnson said that he wasdetermined to tackle health inequities. A UK survey by the NationalSocial Marketing Centre released last week indicates that hehas public support. According to the survey seven in 10 peoplewant the gap in incomes reduced, and more than 90% thought thatall children in the UK should have an equal chance of livinga long and healthy life and of becoming a high earner.

"The temptation in these difficult economic times is to seeaddressing the deeply complex social determinants of poor healthas a luxury we can’t afford, whereas, in fact, it is aproblem we can’t afford to neglect," said Mr Johnson.

"If we ignore these issues because of the current economic situation,when the downturn is over we’ll be left with even morepronounced social problems, as the inequalities that lead toexclusion and prevent people from being fit, active, and productivecitizens will have deepened further."

Mr Johnson announced that Professor Marmot is to lead a UK reviewon action required on health inequities and set new targetsfor the future. The last set of targets are unlikely to be met(BMJ 2008;336:1278-81, doi:10.1136/bmj.a169), and a recent governmentreview showed that health inequities for some groups had widened(BMJ 2008;336:1328, 10.1136/bmj.39609.351493.DB).

Cite this as: BMJ 2008;337:a2505

Watch Michael Marmot talk about the impact to health inequitiesof the global financial situation and the election of BarackObama on bmj.com.

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