Correspondence
Health beyond health to bridge the global health gap The Editorial in The Lancet Global Health1 about global health inequity raises some important issues. The global health community long ago acknowledged the worldwide disparities in health, but it has failed to take action; most of the efforts have been made in reporting the disparities among specific population groups. In understanding and tackling health inequalities, this effort is just the beginning. The slow progress towards combating health inequalities might be because of the poor approach to understanding and acting on the social determinants of health. Responsibilities for health in the global arena go beyond a country’s Ministry of Health and WHO. Health beyond health is the concept that health is shaped by wider economic, political, and cultural contexts that require resources and skills to analyse the impact of global policies from the perspective of health, health information systems to guide effective policy, and supportive governance structures for intersectoral coordination.2 The Commission on the Social Determinants of Health 3 has recommended three ways to improve health equity: improve the conditions in which people live; tackle the inequitable distribution of power, money, and resources; and measure inequity and the impact of policy and action on health equity. Most research on equity has focused on gender, wealth, education, and geography.4 Yet the crucial challenge of measuring the factors that largely shape the social determinants of health (eg, prevailing policies, social structures, and government leadership) remains. In the context of developing countries, conducting research on health inequity and www.thelancet.com/lancetgh Vol 4 November 2016
implementing the recommendation put forth is restricted by multiple factors, including nascent surveillance systems, poor research priority, and weak coordination structures among the relevant sectors. It is important that these challenges are addressed. The Sustainable Development Goals, such as the aim of achieving universal health coverage for everyone, will be difficult to attain without first understanding the boundaries that surround health care, taking equity issues into consideration. We declare no competing interests. Copyright © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.
*Pratik Khanal, Navaraj Bhattarai
[email protected] Nepal Health Research Council, Kathmandu 44600, Nepal (PK); Global Health Unit, Institute of Medicine, Kathmandu, Nepal (PK); and Nepal Public Health Foundation, Maharajgunj, Kathmandu, Nepal (NB) 1 2
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The Lancet Global Health. Bridging the global health gap. Lancet Glob Health 2016; 4: e579. Leppo K, Ollila E, Pena S, Wismar M, Cook S, eds. Health in all policies. Seizing opportunities, implementing policies. Helsinki, Finland: Ministry of Social Affairs and Health, 2013. WHO. Commission on social determinants of health-final report. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organization, 2008. http://www. who.int/social_determinants/thecommission/ finalreport/en/ (accessed Aug 28, 2016). Blas E, Kurup AS. Equity, social determinants and public health programmes. Geneva: World Health Organization, 2010. http://apps.who.int/iris/ bitstream/10665/44289/1/9789241563970_ eng.pdf (accessed Aug 28, 2016).
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