Why tackling inequality in the current financial situation remains important

Two different views and researches on the importance of cohesion and reducing inequalities. A study conducted by NCoC in partnership with other organisations, explores the relationship between civic engagement and economic resilience. It finds that the density and type of nonprofit organizations in a community, as well as its social cohesion, are important predictors of that community’s ability to withstand unemployment in a recession. The study identifies two main types of civic health that seem to matter most. One is the role of nonprofit organizations. The number of nonprofits per capita and the degree to which they directly engage local residents are both related to the unemployment rate. The other factor is social cohesion: interacting with friends and neighbors. Each type of civic engagement is separately valuable for preventing unemployment increases.

Nobel Prize winner and previous World Bank chief economist, Prof. Joseph Stiglitz was interviewed by the  German weekly The Spiegel on the raising inequality in the United States:  "the American dream has become a myth. The life chances of a young US citizen are more dependent on the income and education of his parents than in any other advanced industrial country for which there is data. The belief in the American dream is reinforced by anecdotes, by dramatic examples of individuals who have made it from the bottom to the top -- but what matters most are an individual's life chances. The belief in the American dream is not supported by the data." In June, Stilglitz published a book on the same topic "The price of inequality: how today's divided society endangers our future". Stiglitz focus on the financial and econonimical aspects leading to inequality, but he uses several health examples in his book. 

The Prosperity of Cities is closely linked to a notion of development which include equity and environmental sustainability

Development actors need to explore a more inclusive notion of prosperity and development, finds new UN-Habitat report The State of the World’s Cities 2012/2013: The Prosperity of Cities.

According to the report, there is a need for a shift in attention around the world in favour of a MORE ROBUST NOTION OF DEVELOPMENT – one that looks beyond the narrow domain of economic growth that has dominated ill-balanced policy agendas over the last decades, and includes other vital dimensions such as quality of life, adequate infrastructures, equity and environmental sustainability.

“In this Report, UN-Habitat advocates for a new type of city – the city of the 21st century – that is a „good‟, people centred city,” said Dr Joan Clos, United Nations Under-Secretary-General and Executive Director of UN-Habitat.

“The cities of the future should be ones that are capable of integrating the tangible and more intangible aspects of prosperity, in the process shedding off the inefficient, unsustainable forms and functionalities of the city of the previous century or so and becoming the engine rooms of growth and development.”

The CITY OF THE 21ST CENTURY:

·         Reduces disaster risks and vulnerabilities for the poor and build resilience to adverse forces of nature.

·         Creates harmony between the five dimensions of prosperity and enhances the prospects for a better future.

·         Stimulates local job creation, promotes social diversity, maintains a sustainable environment and recognizes the importance of public spaces.

·         Comes with a change of pace, profile and urban functions and provides the social, political and economic conditions of prosperity.

The UNISDR report "Making Cities Resilient 2012 -- My city is getting ready! A global snapshot of how local governments reduce disaster risk" complements UN-HABITAT’s findings. Margareta Wahlström, Head, UNISDR, said that several elements used by UN-HABITAT to assess city prosperity, such as equity and good governance, also bolster disaster resilience. "The findings from our own studies on cities show that low socio-economic development need not necessarily limit all resilience-building activities, especially when the central government and multilateral agencies work together to ensure the right people come together to take action," said Wahlström said

Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda

Really interesting paper and as it's open access I've highlighted the thing bit that caught my eye rather than the summary points (abstract).

Some of it seems really hard to me! The whole paper is worth a read.

Characteristics of Third Wave Health Research Strategies and Methodologies

1. Go beyond the behavioral and other individual determinants of illness.
2. Examine the intersections among different social hierarchies, such as class and gender, and their cumulative impacts on health status and health inequities.
3. Examine the levels, pathways, and power connections across the “upstream” determinants or root causes of health inequities—that were central to the CSDH's conceptual framework—and the more traditionally investigated determinants of health inequities, such as risk factors or access to care.
4. Treat patterns of health inequity as a social reality in their own terms, requiring social (economic, sociological, political, and cultural) explanation that adds on to the aggregation and interpretation of individual biomedical processes and outcomes.
5. Consider the dynamic (rather than static) nature of equity in different country contexts, introducing a temporal dimension when investigating social structures, public policies, and impacts over the life course.
6. Describe the social institutions and processes that influence the generation and allocation of resources related to health and its social determinants.
7. Focus on how the global context affects choices about resource allocation at national and sub-national levels.
8. Build on active collaboration among researchers and other knowledge producers from different disciplines.
9. Recognize that certain kinds of evidence, such as results from randomized controlled trials, cannot be generated with respect to many interventions that address social determinants of health; therefore, a need exists to embrace diverse methodologies—fit for purpose—including a wide range of study designs, generating qualitative and quantitative data, that provide critical insight on the questions being examined.
10. Involve affected populations, which is often essential to appropriate research designs and their execution.

Source:

Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda.

Östlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L, et al. (2011)

PLoS Med 8(11): e1001115. doi:10.1371/journal.pmed.1001115

Click here to go to the full article.

Hat tip: David McDaid, Health Equity Email Network, UK

Social Determinants and the Health Divide in the WHO European Region

Interesting conceptual model linking policies and practices to social determinants of health (Pages 13 and 11).

My take home paragraph is (Pages 21-22):

"A human rights–based approach to health equity is needed Oldring & Jerbi (66) discussed human rights and health.

Today there is growing recognition of the links between health and a wide range of human rights, as well as a growing appreciation of the right to the highest attainable standard of health itself. There is broad agreement that health policies, programmes and practices can have a direct bearing on the enjoyment of human rights, while a lack of respect for human rights can have  serious health consequences. Protecting human rights is recognized as key to protecting public health.

The right to health means that governments must generate conditions in which everyone can be as healthy as possible. A human rights–based approach to health gives importance not only to goals and outcomes but also to the processes in trying to achieve these goals and outcomes. Health policy-making should be guided by human rights standards and aim at developing the capacity of those in positions of responsibility – for policy-making and delivery – to meet their obligations and empower rights-holders (the public) to effectively claim their rights.

Eliminating all forms of discrimination is at the core of a human rights–based approach, with a particular focus on gender equity in all policies. Human rights standards and principles, such as participation, equality, non-discrimination, transparency and accountability, should be integrated into all stages of policy-making and implementation.

The human rights principles and efforts to improve  health equity should be mutually reinforcing. The right to health complements the health equity concept by aiming for everyone to enjoy his or her full health potential. Moreover, the human rights principles of nondiscrimination and equality strengthen the conceptual foundation of health equity for the groups in society for whom inequities in health are related to wider vulnerability. "

Click here to download the 2nd Interim Report - Interim second report on social determinants of 
health and the health divide in the WHO European Region, WHO, 2011.


Click here to download the 1st Interim Report - Interim first report on social determinants of health and the health divide in the Regional Office for Europe WHO European Region

Rio Political Declaration on Social Determinants of Health

The bits that really resonated with me are:

We reaffirm that health inequities within and between countries are politically, socially and economically unacceptable, as well as unfair and largely avoidable, and that the promotion of health equity is essential to sustainable development and to a better quality of life and well-being for all, which in turn can contribute to peace and security.

We reiterate our determination to take action on social determinants of health as collectively agreed ... three overarching recommendations of the Commission on Social Determinants of Health:

• to improve daily living conditions;
• to tackle the inequitable distribution of power, money and resources; and
• to measure and understand the problem and assess the impact of action.

We are convinced that action on these determinants, both for vulnerable groups and the entire population, is essential to create inclusive, equitable, economically productive and healthy societies. Positioning human health and well-being as one of the key features of what constitutes a successful, inclusive and fair society in the 21st century is consistent with our commitment to human rights at national and international levels.

Click here to go to the WHO conference website and download the Declaration.

WHO Interactive Atlases on Health Equity in Europe

Click here to go to the WHO website.

One of the goals of the project is to improve availability of and access to evidence on inequalities in health system performance, including quality of care and the structural determinants of such inequalities across countries and regions in Europe.

To meet this goal, publicly available socioeconomic and health-related indicators from EUROSTAT databases have been used to produce the atlases. The NUTS 2 regions are the main geographical units of analysis. Variables displayed in maps, graphs and tables represent more than 600 individual indicators.

The atlases aim not only to provide more visibility to the sub-national patterns of health and their determinants but also to analyse how such an integrated information system and its underlying data can inform policy across European countries. 

The added value is to: 

• improve insight into the regional dimension of social inequalities in health across counties; 
• provide a tool for increased engagement of the public and the media in the dialogue with the competent authorities on health policy and action; and 
• provide a pilot for a more regular monitoring and assessment of the magnitude of social inequalities in health and the impact of the relevant policies, interventions and services.

To analyse and display data, following interactive atlases have been developed in the project:

1. Correlation map atlas allows a quick visualization of two variables in maps and their association in a graph, where correlation analysis can also be performed. You may use the filter function to select only one country or country group.
2. Atlases of social inequalities allow visualization of difference between the target value and the value in a region or group of regions. The target value is the population weighted average of the most advantaged quintile of the population. Differences between the target and the individual region are visualized as absolute differences (area target differences) and as relative differences (area target ratios).
3. Regional comparison atlas allows quick comparison of several key indicators between a limited numbers of regions. Please use the Ctrl key and mouse to select the regions of interest.

Hat tip: David McDaid via the JISC Health Equity Network