Abstract
To improve population health and reduce health inequities, it will be necessary to orient policy toward the non-health sector such as housing, taking into account the environment, and especially the built environment, in which people live, work, and play. Seven principles for the analysis of health inequities and a model framing the impact of the non-health sector on health are put forward. Numerous illustrations are given to show how non-health sector policies may influence health. These include the economy, employment, inclusion of disabled people, education, and environment. Non-health sector determinants of health are identified, and the importance of discrimination, neighborhoods, housing, urban policy, and intersectoral and participatory action is stressed. Reference is made to Health in All Policies and health impact assessment. Scientific and political challenges are outlined, and different approaches to tackling health inequities are reviewed. In conclusion, reorienting policy toward the non-health sector taking into account widening inequality is supported by substantial evidence and is a matter of elementary social justice.
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Notes
- 1.
“The fact that health is largely constructed outside the health sector has been known not only for decades but even for centuries” Rose G. A history of public health. Expanded edition. First edition 1958. Baltimore: The John Hopkins University Press; 1993.
- 2.
“Ainsi donc de quelque manière que l’on s’y prenne, le même résultat surgit toujours; c’est. que la mortalité dans les divers arrondissements de Paris, est. en général, en raison inverse de l’aisance de leurs habitants.”
- 3.
Furthermore, we are very conscious that it is largely based on European and North American experience. For a wider perspective on worldwide urban health incorporating experience from India, South America, and Africa, readers are recommended to consult the Lancet Commission findings: Rydin et al., 2012.
- 4.
The WHO website gives the following definition through answering the question “What are health inequities or inequalities?” Health inequities are avoidable inequalities in health between groups of people within countries and between countries. See http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/ consulted 20 September 2015.
- 5.
To criticize inequality and to desire equality are not, as is sometimes suggested, to cherish the romantic illusion that people are equal in character and intelligence. It is to hold that, while their natural endowments differ profoundly, it is the mark of a civilized society to aim at eliminating such inequalities as having their source, not in individual differences but in social and political organization Tawney (1931).
- 6.
It is interesting to reflect on the Cuba paradox which suggests that combining community health approaches (highlighting the role of social determinants and health promotion) with modern clinical medicine may be the ideal mix for achieving good health outcomes (Evans, 2008).
- 7.
Loi n° 2005–102 du 11 février 2005 pour l’égalité des droits et des chances, la participation et la citoyenneté des personnes handicapées.
- 8.
Furthermore, it should not be considered unjust if those who have previously be subjected to unfair treatment or oppression receive benefits and privileged treatment as a righting mechanism to favor social justice.
- 9.
In tackling this sensitive issue, Gravlee (2009) takes the “opportunity to refine the critique of race in three ways: (1) to reiterate why the race concept is inconsistent with patterns of global human genetic diversity; (2) to refocus attention on the complex, environmental influences on human biology at multiple levels of analysis and across the life course; and (3) to revise the claim that race is a cultural construct and expand research on the sociocultural reality of race and racism.” One may add however that biology of course should not be used as the one and only yardstick to measure discrimination and the impact of inequality. Other indicators may of course be used. But beyond this idea in principle, all forms of oppression and discrimination are wrong and should be fought against. Measuring them is one means to achieve that end. However, it is important to bear in mind the words of Simon Weil,
Equality is a vital [human need]. It consists in recognition, at once public, general, effective and genuinely expressed in institutions and customs, that the same amount of respect and consideration is due to every human being because this respect is due to the human being as such and is not a matter of degree. (Weil, 1949, p. 26)
- 10.
See also http://www.nber.org/mtopublic/.
- 11.
See, for instance, the collaborative initiative of Jacedde http://www.jaccede.com.
- 12.
See, for example, the work of C2 Connecting Communities Ltd. http://blogs.bmj.com/bmj/2015/02/04/jonathan-stead-on-transforming-disadvantaged-communities/.
- 13.
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Sherlaw, W., Harpet, C., Heritage, Z., Raude, J. (2018). Improving Health and Tackling Health Inequities Through the Non-health Sector. In: Fisher, E., et al. Principles and Concepts of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-93826-4_15
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