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Health Equity and Dignified Lives

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Health Equity and Dignified Lives JUST SOCIETIES Health Equity and Dignified Lives Report of the Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas p JUST SOCIETIES Health Equity and Dignified Lives Report of the Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas Washington, D.C. 2019 p Just Societies: Health Equity and Dignified Lives. Report of the Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas ISBN: 978-92-75-12116-0 eISBN: 978-92-75-12126-9 © Pan American Health Organization 2019 All rights reserved. Publications of the Pan American Health Organization (PAHO) are available on the PAHO website (www.paho.org). Requests for permission to reproduce or translate PAHO Publications should be addressed to the Publication Program through the PAHO website (www. paho.org/permissions). Suggested citation. Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas. Just Societies: Health Equity and Dignified Lives. Report of the Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas. Washington, D.C.: PAHO; 2019. Cataloguing-in-Publication (CIP) data. CIP data are available at http://iris.paho.org. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. This publication contains the collective views of the members of the Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas, and does not necessarily represent the views, decisions, or policies of PAHO. The published material is being distributed without warranty of any kind either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall PAHO be liable for damages arising from its use. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of PAHO concerning the status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by PAHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The photographs in this publication are the property of PAHO or iStock. PAHO’s use of iStock photographs is in accordance with the license obtained by the Institute of Health Equity of the University College London. Permission to use any material from this publication that is attributed to a third party, such as tables, figures, or photographs must be obtained by the reader. The risk of claims resulting from infringement of any third-party-owned material used in this publication rests solely with the reader. This Report was prepared by the Institute of Health Equity, University College London (UCL), on behalf of the Commission www.instituteofhealthequity.org Commissioners Professor Sir Michael Marmot: Commission Chair and Director of the Institute of Health Equity, University College London, United Kingdom Mr. Victor Abramovich: Universidad Nacional de Lanús, Argentina Dr. Mabel Bianco: Fundación para Estudio e Investigación de la Mujer, Argentina Professor Cindy Blackstock: First Nations Child and Family Caring Society of Canada and McGill University, Canada Professor Jo Ivey Boufford: New York University College of Global Public Health and President, International Society for Urban Health, United States of America Professor Paolo Buss: Centro de Relações Internacionais em Saúde, Fundação Oswaldo Cruz, Brazil Dr. Nila Heredia: Organismo Andino de Salud – Convenio Hipólito Unanue and Comisión de la Verdad, Plurinational State of Bolivia Mr. Pastor Elías Murillo Martínez: Vice President of the United Nations Committee for the Elimination of Racial Discrimination, Colombia Ms. Tracy Robinson: The University of West Indies at Mona, Jamaica Ms. María Paola Romo: Instituto de Investigaciones Raúl Baca-Carbo, Ecuador Dr. David Satcher: The Satcher Health Leadership Institute, Morehouse School of Medicine, United States of America Professor Cesar Victora: Centro de Pesquisas Epidemiológicas, Programa de Pós- Graduação em Epidemiologia – Universidade Federal de Pelotas, Brazil JUST SOCIETIES: HEALTH EQUITY AND DIGNIFIED LIVES NOTE FROM THE CHAIR Health in the Region of the Americas, of individuals and populations, improved dramatically through the latter decades of the 20th century and the early years of the 21st century. And it has become commonly accepted that health will continue to improve, associated with better living conditions and access to ever-better standards of health care. There are, however, threats to this bright picture, commissioners, all experts from across the Region of and they take at least three forms. First, there are the Americas. They have brought their wisdom and substantial inequalities in health within countries, experience to bear on our numerous deliberations whatever the country’s level of economic and and shaped both the direction of this report and its social development, because the health benefits detail. They, along with a committed secretariat at of the aforementioned societal improvements are PAHO and at the Institute of Health Equity, University unequally distributed. Second, there continue to be College London, made the work possible. I am major inequalities in health among countries of the particularly grateful to Jessica Allen, Peter Goldblatt, Americas. Third, the rate of health improvement has and Joana Morrison for their support to the slowed in some countries or has even reversed on Commission and assistance in drafting this report. some measures; in the United States of America, life expectancy has now declined three years in a row. Because we judge that knowledge and resources exist to improve health for everybody in the The vision of PAHO Director Carissa Etienne led Americas, we label these health inequalities as to the establishment of this PAHO Commission unjust. Putting them right is a matter of social on Equity and Health Inequalities in the Americas, justice. Concern for social justice and health is the alongside a companion Commission on Universal impetus for this PAHO Equity Commission. But the Health Coverage. Dr. Etienne sees social determinants evidence of what can be done really matters. of health and universal health coverage as complementary: both are necessary to achieve health I have been asked repeatedly: In this world of equity. Dr. Etienne’s support has been accompanied postfact politics, do we really need evidence to by invaluable commitment to our mission by our 12 make policy? The PAHO Equity Commission is clear. iv NOTE FROM THE CHAIR Knowledge and evidence are critically important to We are optimistic but not complacent: optimistic shine a light on unjustifiable inequalities in health and because we see great and developing interest what can be done to improve health equity. We argue in social determinants of health and health for the recommendations in this report precisely equity; not in the least complacent because because they are based on evidence. Our mission, threats abound. Empowerment of individuals, then, is at once both moral and technical. Improving communities, and, indeed, of countries has the quality of lives people are able to lead—lives to go hand in hand with social and economic of dignity that would improve health—is a moral development. Economic inequalities, climate endeavor. This report brings together the technical change, and the continuing impact of colonialism evidence of what is needed to achieve that aim. and racism are major challenges to empowerment. Our report calls for action on inequities in the The evidence we have assembled builds on that conditions of daily life through the life course; synthesized by the WHO Commission on Social on violence and racism; on climate and the Determinants of Health and the European Review environment; and on the structural drivers of of Social Determinants and the Health Divide. health inequities. The evidence that formed the background to our work is global. Our task as the PAHO Equity We see this report as a step on a journey. The aim Commission was to gather new evidence from the now must be to encourage action by all countries Americas, and apply it to the special and hugely in the Region, and to give governments and civil varied conditions of the Region of the Americas: society the evidence that should inform action. Canada and the United States of America and Latin Could there be a more worthwhile aim than to America and the Caribbean. create the conditions for all people in the Region to lead lives of dignity and thereby advance the cause Action and knowledge generation have to go of health equity? together. We are confident in our analysis of the social determinants of health. But the evidence of “what works” to act on these social determinants to improve health equity is never sufficient. It is vital, then, to have in place robust monitoring systems to Professor Sir Michael Marmot assess the effects of the policy changes that we are Chair, PAHO Commission on Equity and Health recommending. Inequalities in the Americas v CONTENTS
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