By Commission on Social Determinants of Hea
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Extra resources for Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health
Where systematic differences in health are judged to be avoidable by reasonable action globally and within society they are, quite simply, unjust. It is this that we label health inequity. HEALTH EQUITY AND THE SOCIAL DETERMINANTS OF HEALTH Traditionally, societies have looked to the health sector to deal with its concerns about health and disease. Certainly, maldistribution of health care – not delivering care to those who most need it – is one of the social determinants of health. But the high burden of illness responsible for appalling premature loss of life arises in large part because of the conditions in which people are born, grow, live, work, and age – conditions that together provide the freedom people need to live lives they value (Sen, 1999; Marmot, 2004).
COMMISSION ON SOCIAL DETERMINANTS OF HEALTH | FINAL REPORT A GLOBAL APPROACH TO HEALTH EQUITY PART 1 36 STRUCTURAL DRIVERS OF HEALTH INEQUITIES The top ﬁfth of the world’s people in the richest countries enjoy 82% of the expanding export trade and 68% of foreign direct investment – the bottom ﬁfth, barely more than 1% (UNDP, 1999). In 1999, the developing world spent US$ 13 on debt repayment for every US$ 1 it received in grants (World Bank, 1999). Of the population in the developed nations, 20% consume 86% of the world’s goods (UNDP, 1998).
5 billion per year. Half of this money is spent on export subsidies, which damage local markets in low-income countries (Oxfam, 2002). 1: INEQUITY AND INDIGENOUS PEOPLES – THE EFFECTS OF A TOXIC COMBINATION OF POLICIES Indigenous People worldwide are in jeopardy of irrevocable loss of land, language, culture, and livelihood, without their consent or control – a permanent loss differing from immigrant populations where language and culture continue to be preserved in a country of origin. Indigenous Peoples are unique culturally, historically, ecologically, geographically, and politically by virtue of their ancestors’ original and long-standing nationhood and their use of and occupancy of the land.