OPINION:The conditions in which people live and work can help create or destroy their health - that's why governments must take health inequality seriously, write Jane Wilde and Helen McAvoy.
THE WORLD Health Organisation Commission on the Social Determinants of Health today launches its final report which discusses how social, environmental, economic and political factors affect health and health inequalities.
The report emphasises that, while health services make an important contribution, it is really social and economic conditions that determine whether people get ill in the first place.
To coincide with the launch of the WHO report, the Institute of Public Health in Ireland (IPH) and Combat Poverty have produced a country report for Ireland and Northern Ireland.
The report highlights findings on the extent of health inequalities on the island and emphasises how decisions made in the area of Government strategy and spending on the built environment, transport, social welfare and education have profound impacts on health.
The report notes that in the Republic of Ireland 38 per cent of those at risk of poverty (ie living on an income of less than €209 per week) reported suffering from a chronic illness, compared with 23 per cent of the general population. In Northern Ireland, 47 per cent of unskilled workers suffer from long-standing illness, compared with 30 per cent of professionals and managers.
These reports are timely. As Ireland enters a new era of economic slowdown we must carefully consider how we are going to address the health consequences of rising unemployment and rising costs of living, most notably in relation to mortgage repayments, food and fuel prices.
These reports agree that, while health services can help to prevent and treat the resulting burden of inequality, we need more concerted action on the social determinants of health.
Without this action, a person's chances of having a long and healthy life are likely to become more and more of a social lottery, dependent on being born into the "right" circumstances, be that living in an advantaged area, having wealthy parents, or even attending a top school. Our health depends on the links between our social, psychosocial, environmental and biological worlds. To consider one without the others is to lose the essential knowledge which will help us prevent ill-health.
Earlier this month, IPH also published figures on a range of health and social indicators, including life expectancy, by county in the Republic of Ireland and by local council area in Northern Ireland. The data showed that women in Derry had the lowest life expectancy in Northern Ireland.
From the perspective of social determinants of health, this finding is hardly surprising in light of the higher levels of poverty and other markers of social deprivation in the Derry council area.
For example, over 40 per cent of adults and 15 per cent of children live in income support households in the Derry council area, nearly twice the Northern Ireland average; and 38 per cent of children in the area live in poverty.
The impact of the social and economic environment on health is not beyond our control.
The commission's work points to the Nordic countries as an example of how good social policies designed to promote equal opportunities in education, employment and housing positively influenced health for everybody, but for lower socio-economic groups in particular.
An article published this month by the Nordic Centre for Health Equity Studies (Chess) describes how the growth of the welfare state in the Nordic countries has been accompanied by considerable improvements in public health. Several of the Nordic countries are world leaders in life expectancy and low infant mortality.
In Ireland, we have poor public health compared with many other European countries, and the report published by IPH and Combat Poverty highlights the health implications of our poor record on child poverty, the provision of affordable housing, fuel poverty and the appalling levels of health recorded among Travellers. These issues must be challenged within a social-determinants agenda.
That's why it's so important that we build commitment to a social-determinants approach into all other efforts at improving health on the island.
To turn this round we need to advocate for all public policies to support rather than undermine health, and reduce rather than increase health inequalities. This action needs to be driven by a commitment to sharing knowledge, skills and expertise across disciplines and across sectors.
There is recognition in both departments of health that we have a serious problem, but to make any effective inroads we need action happening in every department of both governments. Disease control and medical care are vital but insufficient.
At the very least we should ensure that health systems do not perpetuate and exacerbate injustice and stratification by unfair charging or unequal distribution of care.
The commission's analysis is timely and its aim to galvanise us in Ireland is welcome. But the real test of its success will not be in reports or research, rather in the resources and responsibility that we are prepared to commit to wiping out the systematic and shocking inequity in health. Global and local health inequalities are man made. The causes are social, so too must be the solution.
• Dr Jane Wilde is chief executive of the Institute of Public Health in Ireland; Dr Helen McAvoy is senior policy officer at the institute