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Closing the gap in a generation

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Health equity through action on the social determinants of health
Commission on Social Determinants of Health and the World Health Organization
Publication Date: 
28 Aug 2008

Description: A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17 400; in Afghanistan, the odds are 1 in 8. Biology does not explain any of this. Instead, the differences between - and within - countries result from the social environment where people are born, live, grow, work and age. Social factors, rather than genetics, are to blame for huge variations in ill health and life expectancy around the world, this report concludes. This report is the outcome of a three-year analysis that the World Health Organisation (WHO) has carried out on the "social determinants" of health. The report concludes "social injustice is killing people on a grand scale". As part of the recommendation for improving daily living conditions, the report identifies the importance of equity from the start. "Early child development (ECD) &em; including the physical, social/emotional, and language/cognitive domains &em; has a determining influence on subsequent life chances and health through skills development, education, and occupational opportunities. Through these mechanisms, and directly, early childhood influences subsequent risk of obesity, malnutrition, mental health problems, heart disease, and criminality. At least 200 million children globally are not achieving their full development potential. This has huge implications for their health and for society at large." "Investment in the early years provides one of the greatest potentials to reduce health inequities within a generation. Experiences in early childhood (defined as prenatal development to eight years of age), and in early and later education, lay critical foundations for the entire lifecourse." … "Preschool educational programmes and schools, as part of the wider environment that contributes to the development of children, can have a vital role in building children's capabilities. A more comprehensive approach to early life is needed, building on existing child survival programmes and extending interventions in early life to include social/emotional and language/cognitive development." The final report on early childhood development, "Early childhood development: A powerful equalizer" prepared for the World Health Organization's Commission on the Social Determinants of Health to inform the larger report, is also available online through the link above.