The fight against social inequalities in health and disease: Is there an end?

feature-AFR_Social_Protection_20121218Source:  Di Cesare, Inequalities in non-communicable diseases and effective responses. The Lancet, vol 381, 585-597 Feb16, 2013

Does your social status determine your risk of developing disease? How about whether it determines your risk of dying from cancer, diabetes or heart disease? The answers to these questions have long been a centre of debate, research and endless publications with the focus around social and economic inequalities in health and disease.

NCDs (non-communicable diseases) include illnesses such as cancer, diabetes and heart disease, and have been major causes of death in developed countries. Such diseases have been reported to cause 35 million of the 53 million deaths annually, where more than three-quarters of these deaths now occur in vulnerable, low and middle-income countries.

A series of publications in the journal The Lancet have looked deeper into health inequalities both globally and within-countries. They have also highlighted key actions to tackle NCDs, their risk factors and related social inequalities. The authors have emphasised on the key risk factors of NCDs, which are said to be increasingly concentrated in low and middle-income populations. They include smoking, alcohol abuse, unhealthy eating, obesity and high blood pressure. When looking at deaths caused by NCDs, it was reported that mortality appears to be higher in people with a low education, income or social class. Additionally, other vulnerable groups included marginalised ethnic groups and those living in poor communities. Using obesity as an example, regions such as the Middle East, Latin America and southern Africa are reported to have higher rates of overweight and obesity in comparison to high-income countries. Could westernisation of such communities be more of a health burden than a case of moving forward?

Access to healthcare, healthcare use and quality were other issues of inequality highlighted in the publication. Poor access to screening and treatment subsequently lead to a poor prognosis in people of developing countries where NCD rates are high. For example, if you are person with cancer living in a high-income country, your chances of survival are twice as high than those living in India or Africa.

In order to continue the fight against NCDs, the authors believe that success is only achievable if governments worldwide address health problems of their most vulnerable and disadvantaged groups. They have also highlighted key areas to reduce NCDs and NCD inequalities both globally and within countries and they include:

  • Investment in early childhood development programs and high quality education
  • Provision of employment security for disadvantaged groups
  • Regulation and control of tobacco, dietary salt, processed foods high in sugar and fat
  • Improved access to high-quality health care including implementation of universal health insurance

Could these provide a solution to the NCD epidemic and the abolishment of health inequalities? The debates about why such inequalities exist should shift into actions as to how they can end.

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