The executive summary of the report – Just Societies: Health Equity and Dignified Lives – from the PAHO Commission on Equity and Health Inequalities in the Americas,proposes priority objectives and specific measures to reduce inequities in health. These include ensuring equity in political, social, cultural, and economic structures; protecting the natural environment and mitigating the effects of climate change; recognizing and reversing the impact of ongoing colonialism and structural racism on health equity; and assuring decent workand dignified lives for the population.
“There are dramatic exceptions to the idea that good health is simply a matter of getting richer,” said the president of the commission, Michael Marmot, from the Institute of Health Equity at University College London, while presenting the executive summary to ministers of Health at the PAHO 56th Executive Committee this week.
“If you are poor, female, indigenous, and removed from your traditional land, your chances of mortality and morbidity are higher,” said Marmot. He also highlighted that many of the inequalities reflected in health “can be resolved. It does not have to be this way,” emphasizing the recommendations of the Commission on how to ensure this.
The Director of PAHO, Carissa F. Etienne, thanked the Commission for its work, adding that she hoped it would enable countries to put into practice different levels of action to address the structural causes of health inequalities.
In 2016, PAHO established the Independent Commission on Equity and Health Inequalities in the Americas, made up of international experts who evaluated the available evidence on the factors that lead to these inequalities, and proposed actions to improve the health of the people of the Region.
The Commission studied the leading causes of health inequalities in the Americas, focusing on gender, ethnicity, and human rights, as well as social, economic, environmental, political, and cultural factors that determine health. The principles and approaches associated with the social determinants of health, the human rights-based approach to health, and the “health in all policies” strategy played an important role in the Commission’s recommendations on measures to be taken.
In the executive summary, the Commission analyzes health inequalities in the Region, which are closely related to people’s socioeconomic conditions, ethnicity, gender, disability, and life stage.It also examines the structural determinants of health inequalities generated in the political, social, cultural, and economic spheres, as well as the impact of the natural environment, climate change, and natural disasters, among other factors.
“Inequality dominates the Americas: socioeconomic inequality, but also inequalities between Indigenous and non-Indigenous people; between people of African descent and those of European origin; between genders; between disabled and non-disabled people; between people of different sexual orientation and between migrants and non-migrants. Too much inequality damages social cohesion, leads to unfair distribution of life chances, and to health inequalities,” the Commission affirms in its executive summary
The Commission’s report also addresses inequalities in daily living conditions in the early life, education, working life, and older ages, as well as inequalities in income and social protection, the impact of violence, living conditions, and the health system.
The report also presents the governance arrangements that are most effective to achieve greater health equity. These include the participation of communities and civil society, as well as effective monitoring systems that capture inequalities related to socioeconomic status, gender, ethnicity, and other dimensions of inequity. The importance of human rights is emphasized as a way of ensuring not only greater health equity, but also accountability in the Region.
The 12 recommendations include priority objectives and specific measures that should be adopted in the following general categories:
• Achieving equity in political, social, cultural, and economic structures
• Protecting the natural environment, mitigating climate change, and respecting relationships to land
• Recognize and reverse health equity impacts of ongoing colonialism and structural racism
• Equity from the start––early life and education
• Decent work
• Dignified life at olderages
• Income and social protection
• Reducing violence for health equity
• Improving environment and housing conditions
• Equitable health systems
• Governance arrangements for health equity
• Fulfilling and and protecting human rights.
“As part of this process, each country should review the priority objectives established by this Commission, to adapt them to its specific circumstances, and determine the resources, the legislative changes and the creation of capacities that are needed in order to carry forward the concrete actions. The achievement will be translated into societies more just, in which all the people can live decent life and in which health equity is an attainable goal”, concludes the Commission.
About the Commission on Equity and Health Inequalities
The full report of the Commission will be submitted at the beginning of next year.
The Commission is chaired by Michael Marmot of the Institute of Health Equity at University College London. Other members of the Commission include Paulo Buss and César Victora of Brazil, Nila Heredia of Bolivia, Tracy Robinson of Jamaica, Cindy Blackstock of Canada, María Paula Romo of Ecuador, Pastor Murillo of Colombia, Mabel Bianco and Victor Abramovich of Argentina, and David Satcher and Jo Ivey Boufford of the United States. The PAHO Secretariat and the Working Group on Cross-cutting Issues supports the Commission in a manner that ensures its independence.
Since its creation in 2016, the Commission has held meetings in Washington, D.C., Bogotá (Colombia), San José (Costa Rica), Trinidad and Tobago, and Atlanta (USA), among other places, collecting evidence and preparing its recommendations. Some 15 countries of the Americas have collaborated with the Commission to collect data, including Argentina, Belize, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, El Salvador, Jamaica, Mexico, Peru, Suriname, Trinidad and Tobago, and the United States. These countries provided information and technical assistance on case studies with the goal of improving equity and reducing health inequalities. They also made suggestions for the Commission’s final recommendations.