Tackling health inequitiesBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1526 (Published 03 September 2008) Cite this as: BMJ 2008;337:a1526
- George Davey Smith, professor of clinical epidemiology1,
- Nancy Krieger, professor2
- 1Department of Epidemiology and Public Health, Social Medicine, University of Bristol, Bristol BS8 2PR
- 2Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02115, USA
Finally, an official report on health inequity has been published that has the honesty and courage to say that “social injustice is killing people on a grand scale.”1 The report of the World Health Organization’s Commission on Social Determinants of Health synthesises evidence from a large and disparate range of sources, while recognising that what constitutes evidence is itself contested and not value free.2 It presents a wealth of data to show the unquestionable link between economic, social, and bodily wellbeing—within and across countries. In the case of life expectancy, these embodied facts of social inequity3 can span the equivalent of a lifetime: women born in Botswana can anticipate living an average of 43 years, half that of the 86 years for women in Japan; between the poorest and most affluent parts of Glasgow life expectancy in men ranges from 54 to 82 years.
Many official reports have documented social inequalities in health over the past 170 years, from Chadwick4 to Sachs.5 Yet, in contrast to these reports, which subtly (and not so subtly) emphasised the detrimental effects of poor health induced by poverty on economic performance,6 the commission firmly draws the arrow of causality from impoverished environments to ill health, something that is clear to most …