A baby girl born in Japan this year can expect to live twice as long as a girl born in Zimbabwe. Americans have one third more income than the Japanese, and yet they die nearly five years earlier. In all countries at all levels of income, health and illness follow a social gradient: the lower your socio-economic position, the worse your health. Is there a common thread tying together all these differences in health between countries and within countries?
Typically, health has been considered a function of genetics, health care or lack thereof, and our own personal lifestyle and habits. However, increasingly it has become apparent that while these factors are important, the circumstances in which people live, work and age are intimately related to risk of illness and length of life. Variations in the conditions of early childhood and schooling, the nature of employment and working conditions, the built environment, how much control you have over your life and the opportunities you have for full social engagement and participation are crucial for health, well-being and longevity.
“Significant differences can arise in children’s health depending on
where they live in Victoria”
Professor Elizabeth Waters
These can be described as the social factors or determinants of health. Professor Rob Moodie (MB BS 1976) from the Nossal Institute of Global Health has worked on HIV prevention in India. “It is not enough to focus on the immediate health issues of increasing use of condoms and clean needles. The best results come when these measures are combined with empowering communities and giving them more control over their income and their lives.”
The World Health Organization’s (WHO) 2008 report focuses on what can be done to reduce health inequities in all countries, concentrating on the social determinants of health and reducing social injustice. The report calls for closing the health gap in a generation as “social injustice is killing people on a grand scale”. Three principles of action are recommended: improve daily living conditions, tackle the inequitable distribution of power, money and resources, and measure and understand the problem and assess the impact of action. Across the University of Melbourne community, epidemiologists, health researchers, economists, it engineers, architects and early childhood development specialists, individually and in teams, are working on projects in this area.
Professor Elizabeth Waters, the Jack Brockhoff Chair of Child Public Health*, says that significant differences can arise in children’s health depending on where they live in Victoria. Children in rural areas are five times more likely to need hospitalisation for dental care than children from metropolitan areas while children from poorer areas have obesity rates of up to a third higher than those from wealthier areas. Also one in five children in low income families experience serious emotional and behavioural problems, compared with one in seven from higher income families.
The Nossal Institute for Global Health is committed to making a difference to global health practice, learning and research, and has a combined focus on development assistance, research and teaching. Learn more at www.ni.unimelb.edu.au
To learn more about the faculty of Medicine, Dentistry and Health Sciences and the Dean’s Lecture’s series go to www.mdhs.unimelb.edu.au/ and click ‘events’.
The WHO report can also be found by visiting www.who.int/whr/en/index.html
* The Jack Brockhoff Child Health and Wellbeing Program was established with the 2008 Jack Brockhoff Centenary Gift. The program will provide a fitting legacy to Sir Jack Brockhoff, who through his generosity in establishing The Jack Brockhoff Foundation, has provided significant benefit to the people of Victoria.
** The McCaughey Centre was established in 2006 with the support of the Victorian Health Promotion Foundation (VicHealth) and the Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne. It is named in honour of two outstanding Victorians, Davis and Jean McCaughey. Their commitment to “knowledge for common good” is at the heart of all of the work of the McCaughey Centre. Jean McCaughey is the Centre’s Patron.
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