Published 8 July 2010, doi:10.1136/bmj.c3658
Cite this as: BMJ 2010;341:c3658
Editor's Choice
Dreaming of a fairer world
Fiona Godlee, editor, BMJ
I wrote about the paper by David Stuckler and colleagues when
it went online two weeks ago (
BMJ 2010;340:c3311, doi:
10.1136/bmj.c3311).
Now it’s in print, and it couldn’t be more relevant
to the debate in the UK and elsewhere about how much to cut
from social welfare budgets and what the cuts will do to health.
Much damage, is the answer from these authors. They conclude
that spending on social welfare may be more important for health
than spending on health care. Over the past 30 years when social
spending in Europe was high mortality fell, but when it was
low, mortality rose substantially.
They quote Michael Marmot: "Austerity need not lead to retrenchment
in the welfare state. Indeed the opposite may be necessary."
The opposite—by which I assume he means investment in
welfare—seems unlikely in the UK at the moment, but other
governments may be in a position to show greater wisdom for
the long term.
Michael Marmot gets his own slot in this week’s journal,
in an edited version of the speech he gave last week at his
inauguration as president of the BMA. You can read the full
speech on bmj.com (
BMJ 2010;341:c3617, doi:
10.1136/bmj.c3617).
Highlighting the 44 year difference in life expectancy between
women in Zimbabwe and Japan, he puts before us again the uncomfortable
fact that this is not due to biology but to social injustice.
Rather than focusing solely on known causes of health inequality
such as smoking and obesity, we must also deal with "the causes
of the causes," by which he means our unfair economic and social
arrangements. Paraphrasing former WHO director general Halfden
Mahler, Marmot says, "If we really want to fight the alligators
of health inequalities, we have to drain the swamp."
Is there a role for doctors here? Marmot says there is, but
I wonder how easy it is for each of us to see where and how
to make our contribution. Within the UK, GPs are being asked
by the National Audit Office to target the neediest groups with
health inequalities initiatives—prescribing for high blood
pressure and cholesterol, and smoking cessation services (doi:
10.1136/bmj.c3558). Meanwhile at a meeting in London last week,
delegates discussed how to get the millennium development goals
(MDGs) back on track, particularly the goals to reduce child
mortality by two thirds and maternal mortality by three quarters
by 2015 (doi:
10.1136/bmj.c3521). They heard the depressing news
that little has changed since these goals were set 10 years
ago. Worldwide 29 000 children under five die each day, mostly
from preventable diseases, and only one in four women in sub-Saharan
Africa has access to contraception. But they also heard that
there are three "straightforward actions" that are cost effective
and could make a big difference: promoting free access to health
care for the poor, strengthening the healthcare workforce in
developing countries, and involving affected communities in
decision making.
Tackling local and global health inequalities is perhaps the
great challenge of our generation. Marmot invites us to dream
of a fairer world but also calls on us to take the necessary
practical steps to achieve it.
Cite this as: BMJ 2010;341:c3658
Numa cerimônia especial denominada “Fumar é feio: como a indústria do tabaco engana as mulheres”, a Dra. Roses insistiu na adoção das medidas que constam na Convenção-Quadro da OMS para o Controle do Tabaco e indicou que oito países da Região das Américas estão livres de fumaça de tabaco: Canadá, Colômbia, Guatemala, Panamá, Paraguai, Peru, Trinidad e Tobago e Uruguai.
