Brazil: rapid progress and the challenge of inequality

If one accepts the argument that health is a good measure of how a country is doing socially, then Brazil has come a huge distance. In the 1950s, male life expectancy in Brazil was about 25 years shorter than in the US. In 2014, it was about 6 years shorter. UNDP [1] Human Development Reports are helpful in showing quite how far Brazil has travelled along a path of development. Continuing with life expectancy as a metric of social progress, currently the range, for both sexes, is from 49 in Swaziland to 83.5 in Japan, now pipped by 84 in Hong Kong. On that scale, Brazil at 74.5 is a good deal closer to Japan than it is to Sub-Saharan Africa – 9 years behind Japan, 25 years ahead of the worst in Africa

Why Care? How Status Affects Our Health and Longevity

Professor Sir Michael Marmot has been at the forefront of research into health inequalities for the past 20 years, as principal investigator of the Whitehall studies of British civil servants, investigating explanations for the striking inverse social gradient in morbidity and mortality. Why Care? discusses inequalities and disparities in heath care across social gradients

Health Equity, Cancer, and Social Determinants of Health

Two facts on non-communicable diseases claim attention: they are global in distribution and, increasingly, show marked social inequalities—the lower the social position, the higher the risk. Inequalities in cancer mortality will, in part, be owing to inequalities in access to high-quality treatment

Inclusion Health: Addressing the Causes of the Causes

The social gradient in health describes a graded association between an individual's position on the social hierarchy and health: the lower the socioeconomic position of an individual, the worse their health. The fact that the social gradient extends from the highest echelons of society to the lowest suggests that everyone is affected to a greater or lesser extent by the social determinants of health. One component of social cohesion is making common cause between people at various points on the social ladder. However, people at the extremes can appear to be on a different scale to the rest of society. F Scott Fitzgerald famously began his story The Rich Boy, “Let me tell you about the very rich. They are different from you and me”. In societies with substantial inequality, the considerable gap between the top 0·1% of income earners and the rest of society threatens social cohesion

Social innovation: worklessness, welfare and well-being

The UK Government has recently implemented large-scale public-sector funding cuts and substantial welfare reform. Groups within civil society are being encouraged to fill gaps in service provision, and ‘social innovation’ has been championed as a means of addressing social exclusion, such as that caused by worklessness, a major impediment to citizens being able to access money, power and resources, which are key social determinants of health. The aim of this article is to make the case for innovative ‘upstream’ approaches to addressing health inequalities, and we discuss three prominent social innovations gaining traction: microcredit for enterprise; social enterprise in the form of Work Integration Social Enterprises (WISEs); and Self Reliant Groups (SRGs). We find that while certain social innovations may have the potential to address health inequalities, large-scale research programmes that will yield the quality and range of empirical evidence to demonstrate impact, and, in particular, an understanding of the causal pathways and mechanisms of action, simply do not yet exist

Comparison of physical, public and human assets as determinants of socioeconomic inequalities in contraceptive use in Colombia - moving beyond the household wealth index

Background: Colombia is a lower-middle income country that faces the challenge of addressing health inequalities. This effort includes the task of developing measures of socioeconomic position (SEP) to describe and analyse disparities in health and health related outcomes. This study explores the use of a multidimensional approach to SEP, in which socioeconomic inequalities in contraceptive use are investigated along multiple dimensions of SEP. We tested the hypothesis that provision of Public capital compensated for low levels of Human capital.Methods: This study used the 2005 Colombian Demographic and Health Survey (DHS) dataset. The outcome measures were 'current non-use' and 'never use' of contraception. Inequalities in contraceptive behaviour along four measures of SEP were compared: the Household wealth index (HWI), Physical capital (housing, consumer durables), Public capital (publicly provided services) and Human capital (level of education). Principal component analysis was applied to construct the HWI, Physical capital and Public capital measures. Logistic regression models were used to estimate relative indices of inequality (RII) for each measure of SEP with both outcomes.Results: Socio-economic inequalities among rural women tended to be larger than those among urban women, for all measures of SEP and for both outcomes. In models mutually adjusted for Physical, Public and Human capital and age, Physical capital identified stronger gradients in contraceptive behaviour in urban and rural areas (Current use of contraception by Physical capital in urban areas RII 2.37 95% CI (1.99-2.83) and rural areas RII 3.70 (2.57-5.33)). The impact of women's level of education on contraceptive behaviour was relatively weak in households with high Public capital compared to households with low Public capital (Current use of contraception in rural areas, interaction p = < 0.001). Reduced educational inequalities attributable to Public capital were partly explained by differences in household wealth but not at all by health insurance cover.Conclusions: A multidimensional approach provides a framework for disentangling socioeconomic inequalities in contraceptive behaviour. We provide evidence that material circumstances indexed by Physical capital are important socioeconomic determinants while higher provision of Public capital may compensate for low levels of Human capital with respect to modern contraceptive behaviour