Inequality is a fact of life, but does it need to be a fact of health? Of death?
People in different social circumstances experience avoidable differences in health, well-being and length of life.
The Public Health Agency of Canada describes the situation: "The relationship between socioeconomic status and health outcomes is one of the most persistent themes in the epidemiological literature. The strong and growing evidence that higher social and economic status, and small gaps in income equality are associated with better health has led most researchers to conclude that these factors are fundamental determinants of health."
Income disparity (gap from top to bottom earners) has gradually widened and along with it, economic segregation and the gap in health.
A British study, The Marmot Review, examined the situation in England with an eye to identifying strategies to reduce health inequalities and increase fairness and social justice.
Creating a fairer society is a key to improving the health of the whole population along the economic spectrum.
Considering the social determinants of health reveals that it is no mystery why there are health inequalities in our rich societies.
Persisting inequalities provide ample explanation: inequalities in early child development and education, employment and working conditions, housing and neighbourhood conditions and standards of living all contribute to health outcomes.
There is a social gradient in health: the lower a person's social position (economic and otherwise) the worse is their health. Reducing this gradient will reduce the disparities of health.
The Marmot Review found a number of consistent messages in their work. Acting on inequality cannot be done by addressing only one social determinant of health - action on all of them is needed.
And action must not focus on only the most disadvantaged in the community. Reducing the steepness of the gradient means addressing all levels of disadvantage.
"Reducing inequalities," says the Marmot Review, "requires action on six policy objectives:"
First is giving every child their best start in life. That means ensuring access to quality health care, education and nutrition.
When we invest in a child's first few years, the payoff is forever as they enter school better prepared and able to learn, carrying that foundation through their whole lives.
Second is enabling all children young people and adults to maximise their capabilities and have control over their lives.
This carries on to the third policy objective: to create fair employment and good work for all.
And the fourth: to ensure healthy standard of living for all.
Encouraging the development of healthy and sustainable communities improves all our lives, and is a key to better health across the board.
Finally, the role of prevention is crucial to the long term viability of healthcare - it's the answer to better health for all, for that matter.
While the conclusions of the British review are not unexpected, there needs to be public and political will to achieve the aims of a fairer society, something that benefits all citizens.
Dr. Paul Martiquet is the Medical Health Officer for Rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.
