This post was written by James Busumtwi-Sam, Member of the Project Management Team and Project Advisory Committee as well as Associate Professor at the Department of Political Science at Simon Fraser University.
What is health? According to the 1946 WHO constitution it is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Today this definition is widely accepted, as is the notion that, in addition to its biomedical and technical elements, we should be concerned with the broader social determinants of health as shaped by the distribution of money, power and resources at global, national and local levels. This broadened understanding of and approach to health reflects increased awareness that health issues are affected by factors traditionally considered outside the health sector. Globalization and the proliferation of non-governmental actors and institutions (public and private) strongly influence the ability of national and local authorities to protect and promote public health, but profound health disparities exist across the globe. Situating health within the context of broader social determinants provides a better understanding of the sources of health inequities.
The absence of equity in the provision of health services is considered to be one of the major impediments to achieving positive health outcomes. The WHO’s 1998 World Health Report Health for All in the 21st Century, linked good health to the advancement of human rights, greater equity, and gender equality among other things. Social determinant of health generate health inequalities. An emphasis on health equity implies that need — not income/wealth, power and privilege — should be the major determinant of health-care access and ultimately of health outcomes. This notion was embodied in the 1978 Alma Ata Declaration. However, the profound disparities in health opportunities and outcomes across the world today, indicate quite a divergence between recognizing a ‘right to health’ in principle and in practice.