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Fairness in Policy

Last week I had the pleasure of attending the prestigious Hastings Lecture, named for Toronto's first Medical Officer of Health, Dr. Charles Hastings. The event was moderated by the current Medical Officer of Health, Dr. David McKeown, who introduced Sir Michael Marmot as a "health equity rockstar." The title is a fair for the man who is currently Director of the Institute of Health Equity and a Professor in Epidemiology at University College, London, UK. Sir Marmot is best known for his work on the Whitehall II study, as well as leading the World Health Organization's Commission on the Social Determinants of Health. Like the rest of the 350-person crowd I sat captivated, only breaking to laugh at Sir Marmot's well-delivered jokes – or at the panel's comments on local politics.

PhotobyRyanVarga

Sir Marmot opened with the bold statement that "social injustice is killing on a grand scale." He asserted that a society's success can be judged by the health of its population. Governments, however, tend to focus on only lowest end of the gradient in society, even though health inequality affects all of us. A health system for the poor is a poor health system. Sir Marmot stressed that while inequality exists on a national level, it can also be seen within the same city. In Glasgow, the life expectancy differs by as much as 28 years in different neighbourhoods. In the small town of Lenzie, the average male life expectancy is 82. In the district of Calton, the male life expectancy is only 54 years of age.

To counter this imbalance, Sir Marmot suggested that all ministers operate as ministers of health - as is the practise in Norway, where health performs as a social accountant. Governments should focus on policies which increase the standard of living for all:

  1. Give every child the best start in life.
  2. Enable all children, young people and adults to maximise their capabilities and have control over their lives.
  3. Create fair employment and good work for all. (Marmot shared some disturbing statistics about unemployment and the damaging effects of health – and on economics)
  4. Ensure healthy standard of living for all.
  5. Create and develop healthy and sustainable places and communities.
  6. Strengthen the role and impact of ill health prevention.

Individuals can only be responsible (and be held responsible) when they have the conditions to do so. Fair policies create the necessary conditions. Fairness should sit at the very core of health policies. Ever the evidence-based optimist, Sir Marmot closed his lecture with words of encouragement, "Dream of a world where social justice is taken seriously. Then take the pragmatic steps necessary to achieve it."

Following the inspirational lecture, Sir Marmot was joined in discussion by Dr. Kwame McKenzie and Dr. Charles Pascal. Dr. McKenzie, the director of the Canada Institutes of Health Research Social Aetiology of Mental Illness Training Centre and a senior scientist of Social Equity and Health Research at the Centre for Addiction and Mental Health, used John David Hulchanski's theory of the three Torontos to draw local relevance to Marmots remarks. Dr. Pascal, a professor of Human Development and Applied Psychology at OISE/University of Toronto, bemoaned short term thinking about policy, and advocated for policies with "teeth."

 

Resources:

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Comments 1

 
Guest - Diane Buhler on Wednesday, 06 June 2012 15:19

A health system for the poor is a poor health system - that's a really interesting comment, and does provoke thinking about a determinants-focused approach.

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A health system for the poor is a poor health system - that's a really interesting comment, and does provoke thinking about a determinants-focused approach.