No one was mincing words at yesterday’s launch of the World Health Organisation report on the social determinants of health.

“A toxic combination of poor social policies, unfair economic arrangements and bad politics is killing people on a grand scale,” said Sir Michael Marmot, chair of the WHO commission which produced the report. “Taking action to deal with preventable causes of illness means taking social action.”

For anyone interested in health, this landmark report is well worth a look. Its key finding is that health is not primarily determined by how often we see the doctor, take our medication, or see advertisements about giving up smoking, but rather, by the conditions in which we are born, grow, live and work. A girl born today in Sweden can expect to live for 80 years, a girl born in any number of African countries, less than 50 years.

The WHO report’s key recommendations focus on changing social structures and reducing inequality, in order to prevent disease and improve people’s health and happiness.

First, it calls for improving conditions for girls and women and the circumstances in which children are born and grow. Second it calls on governments to back policies that redistribute power, money and resources more fairly. Third it calls for routine measurement of health inequalities, and how social factors affect them.

“By focusing on the upstream causes of ill health, the report opens powerful new opportunities for prevention,” said the WHO Director General Dr Margaret Chan yesterday.

In fact the new WHO report argues for a prevention approach that focuses much more on changing structures and less on merely giving out information to change individual behaviour.

For example with obesity, it means more focus on changes at a community level, in schools and workplaces, to enable healthier lifestyles, and less focus on individual responsibility, says Fran Baum, public health professor at Flinders University, and a member of the WHO commission which produced the report. She cites new social inclusion policies in South Australia, and the Neighbourhood Renewal program in Victoria as examples of the way forward.

Baum also says the WHO report could inform the new national prevention strategy, currently being developed for the Rudd government.

With a touch of bravado, the report also calls for “closing the gap” — fixing health inequalities within a generation, an aim already being described as a commendable goal, but utterly unrealistic. Similarly, the report will be criticised for promoting policies of collectivism and redistribution, in an era that champions privatisation and individual responsibility.

“We ran the risk of being labelled unrealistic and idealist, but the evidence took us in that direction,” said Baum.

Peter Fray

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