"Please mind the gap..." is a familiar warning for all London Underground passengers! But it is becoming an increasingly important refrain in global health - gaps in geography, wealth and medicine lead to real disadvantage and discrimination for many in terms of living healthy lives.
(Wikimedia Commons/Reinhard Dietrich)
This week saw the 13th World Congress on Public Health, hosted by the Ethiopian Public Health Association in Addis Ababa. It concluded with the Addis Ababa Declaration on Global Health Equity - a call to act on closing some of the critical gaps in global health and well-being.
It is increasingly recognised that staying healthy is not just about more and more medicines, important though good health care may be. Health is something that depends on a wide range of factors in each individual's life - from conception and birth onwards. The international community is increasingly talking about "social determinants of health" - non-medical factors that can lead to better or worse health. Poverty, housing standards, employment, justice are all examples of things that profoundly affect people's health. One World Health Organisation slogan expresses this as "Why treat people... without changing what makes them sick?"
We have all heard a lot about the Millennium Development Goals (MDGs), targets which were set by the international community to achieve reductions in problems like hunger, maternal and child deaths and HIV infections, together with increases in good things like education and gender equality. The target point for these MDGs is 2015, just a few years ahead now, and some will be achieved in some countries, while others will fail. But in some cases, specific MDGs may be achieved through improvements among more privileged population groups, while the disadvantaged continue to suffer ill-health. The lack of an equity dimension to the MDGs is seen as an increasing problem - and this needs to be firmly on the global agenda for strategies and targets that might be put into place from 2015 onwards.
The Addis Ababa Declaration calls for global recognition and action on these issues, under seven important calls to Governments and other agencies:
- Promote and attain social justice and equity in health by acting through a "Social Determinants of Health" approach;
- Accelerate the attainment of national and international development goals by building and redistributing resources to strengthen international, national and local capacity and leadership in public health;
- Ensure that better context-specific, comprehensive and equitable targets covering universal health coverage and health for all are integrated into and made more visible within the MDGs as soon as possible;
- Enhance and strengthen, both numerically and in capability, the public health workforce, in addition to developing new and effective strategies to retain qualified health professionals;
- Combat fraud and corruption, as these are major determinants of health that affect all, but especially the poor and vulnerable;
- Recognize physical and mental disabilities and injury prevention as critical components of a public health approach to health equity; and,
- Fulfil their financial pledges in respect of the MDGs and to, in addition, fulfil their pledges with respect to the Paris Declaration and to the political declarations on Non-Communicable Diseases and the Social Determinants of Health.
Ever since I was a child I can remember hearing the London Underground announcements "Please mind the gap...". Let's hope it doesn't take another half-century to close some of the gaps in global health.