2514 week 3

Raphael Article

3. INCOME AND INCOME DISTRIBUTION

Health researchers have demonstrated a clear link between income and socio-economic status and health outcomes, such that longevity and state of health rise with position on the income scales. – Andrew Jackson and Govind Rao, 2016

Why Is It Important?

• Income is the most important social determinant of health.

• It shapes overall living conditions affecting physiological and psychological functioning.

• Income determines other social determinants of health:

  • Food security

  • Housing

  • Education

  • Early child development

• Health can be studied at two levels:

  • Individual or family actual income

  • Income distribution across the population

• More equal income distribution predicts better overall health.

• Canada funds public services (education, healthcare) but individuals must pay for many others (childcare, housing).

• Low income leads to material and social deprivation, affecting overall health and wellbeing.

• Individuals living in poverty face severe health risks.

• Men in the wealthiest 20% of neighborhoods live on average 5 years longer than those in the poorest 20%.

• Women in the wealthiest neighborhoods live 2 years longer than those in the poorest.

• Suicide rates and diseases are higher among low-income Canadians.

• Infant mortality is 46% higher in the poorest neighborhoods.

• Death rates in the lowest income group are significantly higher (67% for men, 52% for women).

• Canada has significant income inequality, surpassing the OECD average.

• From 1980 to 2015, the bottom 60% saw limited income growth while the top 20% flourished.

• Wealth inequality is increasing; the wealthiest have average net worth far above the poorest.

• Almost half of families would struggle if their paycheck was delayed.

• Policy implications:

  • Income inequality is a key health policy issue.

  • Raise minimum wage and boost social assistance for health benefits.

  • Reduce income/wealth inequalities via progressive taxation and universal programs.

  • Unionization can mitigate income and wealth inequalities.

WHO Report

The Commission calls for closing the health gap in a generation

• Social justice is a matter of life and death.

• Affects living conditions, chance of illness, and risk of premature death.

• Life expectancy varies dramatically across the world: 80+ years in some countries vs. <45 years in others.

• Health disparities are linked to social disadvantage and should not exist.

• Avoidable health inequalities arise from living, working, and aging circumstances.

• Living conditions shaped by political, social, and economic forces.

• Policies impact whether a child can reach their full potential.

• Health problems of rich and poor countries are increasingly converging.

• The quality of a society can be judged by its population’s health and health distribution.

• The Commission on Social Determinants of Health was established by WHO in 2005 to promote health equity.

• The Commission aims to foster a global movement for health equity through policy and program development.

• Calls for global action from governments, civil society, and WHO to improve the lives of citizens.

• Achieving health equity within a generation is both achievable and necessary.

A new global agenda for health equity

• Dramatic differences in life chances for children based on birth location.

  • In Japan/Sweden: life expectancy > 80 years.

  • In Brazil: life expectancy 72 years.

  • In India: life expectancy 63 years.

  • In several African countries: life expectancy < 50 years.

• Health disparities are seen worldwide, not just among the poorest.

  • Poor health and high premature mortality is prevalent among the poorest of the poor.

  • Social gradient: lower the socioeconomic position, worse the health.

• Health inequity: unjust differences in health that are avoidable.

  • Remediating these differences is a matter of social justice.

• For the Commission on Social Determinants of Health, reducing health inequities is an ethical imperative.

  • Social injustice is causing widespread harm.

The social determinants of health and health equity

• Commission: Global collaboration of policymakers, researchers, and civil society promoting health equity.

• Focus includes countries at all levels of income and development: global South and North.

• Health equity is a critical issue impacted by the global economic and political systems.

• Takes a holistic view of social determinants of health.

• Poor health of the poor and marked health inequities result from:

  • Unequal distribution of power, income, goods, and services (globally and nationally).

  • Unfair living conditions: access to health care, education, work, and community services.

• Not a natural phenomenon; arises from poor social policies, unfair economic arrangements, and politics.

• Structural determinants shape daily life, contributing significantly to health inequities.

• Urgent and sustained global, national, and local action needed to address these issues.

• Deep inequities in power distribution are pivotal to health equity.

• National and local governments have a significant role; civil society and local movements can prompt change.

• Climate change profoundly impacts health; must integrate the agendas of health equity and climate change.

• A balanced approach is necessary for social and economic development and addressing global health equity challenges.

A new approach to development

• Commission’s Work: Embodies a new approach to development.

• Health & Health Equity: Not always the aim of social policies, but a fundamental result.

• Economic Growth: Crucial for poor countries to improve lives.

• Social Policies: Necessary to ensure fair distribution of growth benefits for health equity.

• Health Sector Role: Traditionally seen as the focus for health concerns.

• Maldistribution of Healthcare: Failure to deliver to those who most need it is a social determinant of health.

• Burden of Illness: High premature mortality stems from conditions of birth, growth, living, working, and aging.

• Poor Living Conditions: Result from poor social policies, unfair economics, and bad politics.

• Action Required: Involvement of government, civil society, local communities, and international agencies.

• Policy Scope: Must encompass all key sectors, not just health.

• Minister of Health: Plays a critical role in promoting a social determinants of health approach and policy creation for health equity.

• WHO: Must lead on the global stage in advocating for health equity.

Closing the health gap in a generation

• Commission calls for closing the health gap in a generation.

• It is an aspiration, not a prediction.

• Dramatic improvements in health have occurred globally in the last 30 years.

• There is optimism: knowledge exists to make a huge difference in life chances.

• Must provide marked improvements in health equity.

• Realistic: action must start now.

• Solutions for gross inequities are outlined in the Report of this Commission.