Closing the health gap in a generation: the work of the Commission on Social Determinants of Health and its recommendations

The statements from the Prime Minister and Secretary of State is exactly what we wanted to hear. We have all been feeling in the last two days that it may be a trick of the light, but the world looks to be a slightly more hopeful place than it did before. Hearing the Prime Minister and Secretary of State, adds to my sense of hopefulness. I want to give you a brief overview of what we were trying to do. I think that the messages in our report have been well summarised by the Prime Minister and Secretary of State. Let me say right at the beginning, we were pushed in the CSDH to take an economic view. We were pushed to make the argument that closing the gap, reducing health inequities, would only be listened to by politicians if we made the economic case. We resisted that argument. We said that the reason for taking action on health inequity is a matter of social justice; the reason for doing it is because it is the right thing to do. People value having health, not because having health gets them a better job or they can live in a better neighbourhood, but because they value health. Where, in our judgement, these differences in health, these systematic inequalities in health are avoidable and are not avoided, then they are unfair. Hence, putting them right is a matter of social justice. At the centre of what we are trying to achieve is empowerment of individuals, of communities and indeed of whole countries. We think of empowerment as material, psycho-social and political. Material means having the resources to feed your children. John Humphrys said that it is the business of journalists to simplify. It is the business of academics to say it is more complicated. It is not material, but having control of your life. That’s the psychosocial aspect; also having voice. We want to create the conditions for people to lead flourishing lives. The Commission was set up by Dr J. W. Lee, the former Director General of WHO, and was launched in Chile. President Lagos hosted the launch and later joined the Commission. Dr Lee said the goal of the Commission is not an academic exercise, but to marshal scientific evidence as a lever for policy change aiming towards practical uptake among policy makers and stakeholders in countries. That was very much our orientation. Dr Lee, at the launch, emphasised the issue of health inequities within and between countries, and this was indeed part of our brief. To come back to the question posed at the beginning – isn’t it simply that poor people have poor health because of their poverty? Why, I would ask