Dr Margaret Chan: Greater equity in health should be a progress indicator

In a powerful address to the United Nations Secretary-General’s Forum on Advancing Global Health in the Face of Crisis, 15 June 2009, the Director General of the WHO called for "transformational change" in the policies that govern international relations. Blind faith in economic growth and gain has been misplaced and now, in light of the financial crisis, global leaders should recognise health as a worthy pursuit in its own right.


Many of the points made in the speech, Dr Margaret Chan conceded, were self-evident to health professionals who have been calling for such change for decades, if not longer. However, as a result of multiple crises (including a fuel crisis, a food crisis, and a financial crisis) some of the arguments are now being voiced by experts and leaders in other sectors, including sectors with far more political clout than health.

Radical policy changes, she said, could address the global health imbalances that are today greater that at any time in recent history. Differences within and between countries, in income levels, opportunities and health status bear testament to the existence of hugely vulnerable populations and health systems that exclude the poor. Dr Chan stressed the fact that a health system is a social institution that, if properly managed, can contribute to social cohesion and stability.

The public health argument has powerful support in the findings of the Commission on Social Determinants of Health, and leaders at the G20 summit in London spoke of a fundamental re-engineering of the international systems in order to respond to social values and concerns. Now is the time, therefore, to see greater equity in the health status of populations integrated as a key indicator of how civilised society is making progress. Public health, when supported by the right policies in other sectors can solve social problems in a "sustainable, efficient, evidence-based and equitable way."

The financial crisis has prompted a whole host of questions to discover what went wrong and why, and this period of self-reflection must be seized as an opportunity and not squandered. In Europe and beyond, health inequalities have been widening for decades, and the public health community has been pointing to the existence of vulnerable populations and a strong social gradient in health for just as long. However, in light of the financial crisis that has brought the issue to the headlines, and has put more groups at risk of ill health and social exclusion, there is now an opportunity for a change of paradigm.

For more information

World Health Organisation

WHO Social Determinants of Health

Last modified on July 2 2009.