www.thelancet.com Published online October 20, 2011 DOI:10.1016/S0140-6736(11)61628-0 1
Students’ perspective on rooting out causes of health injustice
This year, the International Federation of Medical Students’
Associations (IFMSA), which represents 1·2 million
medical students worldwide, made health inequities
and action on social determinants of health a key policy
focus.1 A global campaign, Root Out, Reach Out,2 has been
organised to coincide with the 2011 World Conference on
Social Determinants of Health. We believe that the fi nal
report3 of WHO’s Commission on Social Determinants
of Health should have provided a water shed moment
in the worldwide movement towards achieving global
health justice. Although some governments have
heeded the report’s recommendations, the voice of
the Commission has gone largely unheard because of a
lack of both political commitment and eff ective policy
making capacity. Unless addressed, these challenges have
the potential to undermine any outcomes of the World
Conference on Social Determinants of Health.
We believe there remains a distinct lack of political
commitment in addressing health inequities through
action on social determinants of health, both within
and between countries. Until governments are held
to account for their achievement in reducing health
inequities, ”closing the gap in a generation” will
remain a pipe dream. We therefore propose that civil
society groups, for example, concerned with HIV/AIDS,
maternal and child health, non-communicable diseases,
and climate change, bring their agendas together. An
approach that is based on the social determinants of
health off ers a rare opportunity to turn current disease-
orientated silos into a global coalition for health equity.
Advocates for the social determinants of health,
supported by WHO, should intensify eff orts targeted
at central government departments, such as ministries
of fi nance, trade, and labour. A strong enough case has
not yet been made to these central departments, which
are in the position to correct the “toxic combination
of poor social policies and programs, unfair economic
arrangements and bad politics”3 that lead to health
inequities. Ultimately, the UN system must take
leadership in this movement. Tackling the “inequitable
distribution of power, money, and resources”3 within
and between countries requires collective action not just
from WHO, but from all UN agencies.
Governments are still largely ill-equipped to develop
eff ective policy initiatives for action on the social
determinants of health. There has been a wide range
of interpretations of the idea of social determinants of
health by WHO member states and non-governmental
sectors. Thus, a common understanding of health
equity needs to be established, as well as baseline
methodologies that refl ect an approach grounded in
the social determinants of health; this would ensure
global coherence in policy formulation, implementation,
monitoring, and evaluation. WHO should devote more
resources towards fulfi lling its role as an eff ective
knowledge broker between health workers, academia,
and policy makers. It should create and support dynamic
research consortia on the social determinants of health
that not only develop the latest evidence, but eff ectively
translate evidence so that it can be implemented by
governments—for example, as policy tools, measurement
indicators, learning modules, and programme designs.
In relation to research collaboration, WHO should
partner with other agencies in developing new methods
and indicators, in addition to existing ones such as the
Human Development Index,4 that can fully encompass
the breadth of social determinants and can be easily
used by governments for monitoring progress. We also
recognise the importance of education in sustaining
this global movement. The Commission recommended
the incorporation of concepts like equity and the
social determinants of health in the training of health
professionals.3 We propose that students from disci-
plines beyond the health sector, such as law, economics,
business, politics, and environment, also receive training
in the social determinants of health. Such cross-cutting
education is necessary, so that all sectors can develop the
capacity for action and fulfi l their obligations to health.
Ultimately, health is an outcome of how society
distributes multiple determinants of health, and thus
a general indicator of social injustice.5 The Commission
affi rmed such a view, announcing that “social injustice is
killing people on a grand scale”.3 As future physicians we
hope to build a social justice movement that will place
equity at the centre of global development and realise
the long-awaited vision of health for all.
Ramon Lorenzo Luis Guinto, Daniel Yore,
Nilofer Khan Habibullah, Altagracia Mares de Leon,
Taavi Tillman, Alex Elliott-Green, *Unni Gopinathan
October 20, 2011
For World Conference on Social
Determinants of Health see
Comment Download full-text
www.thelancet.com Published online October 20, 2011 DOI:10.1016/S0140-6736(11)61628-0
International Federation of Medical Students’ Associations,
IFMSA General Secretariat, c/o World Medical Association,
01212 Ferney-Voltaire, France
We are all members of the International Federation of Medical Students’
Associations. We declare that we have no confl icts of interest.
1 International Federation of Medical Students’ Associations. Policy
statement on health inequity and the social determinants of health.
Jakarta, Indonesia, 60th March General Assembly of the International
Federation of Medical Students’ Associations. March, 2011. http://www.
ifmsa.org (accessed Sept 26, 2011).
2 Root Out, Reach Out. International Federation of Medical Students’
Association’s week of global action on social determinants of health.
http://root-out.org (accessed Sept 22, 2011).
Commission on Social Determinants of Health. Closing the gap in a
generation: health equity through action on the social determinants
of health. Geneva: World Health Organization, 2008.
United Nations Development Programme. The human development
index. http://hdr.undp.org/en/statistics/hdi (accessed Oct 14, 2011).
Daniels N, Kennedy B, Kawachi I. Why justice is good for our health: the
social determinants of health inequalities. Daedalus 1999; 128: 215–51.