Today, we launch the UCL Institute of Health Equity. It is a statement of looking forward, of optimism about making a difference. When we began the WHO Commission on Social Determinants of Health (CSDH), as chair I declared, with the naiveté unique to an academic: we want to foster a social movement for health equity through action on the social determinants of health. Naïve dream it may have been, but much has happened to suggest that that such a movement is active, influential and growing. The creation of the Institute of Health Equity is both an expression of that social movement and will play its part in continuing to foster it.
We look forward. But it is also worth reflecting briefly on how we got here. In the preface to Fair Society Healthy Lives, the English Review of health inequalities, I said that we stood on the shoulders of giants in the field of health inequalities. Three of the tallest died in 2009, the year before we published Fair Society Healthy Lives: Jerry Morris, Peter Townsend, and Donald Acheson. Jerry Morris was a pioneer epidemiologist concerned, among other things, with society and health. Peter Townsend had a deep abiding concern with poverty and inequality. Both were members of the Black Committee on Health Inequalities that, in a way, defined the field as a matter for public policy. Picking up the mantle, nearly twenty years later, Donald Acheson again brought the evidence to the attention of policy makers.
I want to acknowledge two other giants who had great influence on my thinking. Len Syme is very much alive and active at UC Berkeley. He showed me that my untutored meanderings in society and health could be made the subject of rigorous scientific enquiry. If anything Len Syme was more entranced by my demonstration of the social gradient in mortality in the Whitehall Study than was I.
Geoffrey Rose, who died two decades ago, by careful thought and analysis reasoned his way to a view of social causes of ill-health, not so different from Syme’s. I learnt much from Geoffrey Rose, including that the determinants of individual differences in health may be different from the determinants of difference between social groups and populations, and it was from him that I borrowed the phrase “the causes of the causes” which became a mantra of the CSDH and subsequent work.
In the decade that followed the Acheson report, health in England improved rapidly for all socioeconomic groups, including for the worst off. Although I was pleased to be a member of the Acheson scientific advisory group, I am not suggesting cause and effect. That said, the improvement in the worst off was welcome, whatever the reason for it. There is a “but”: health improved marginally more rapidly for the better off, so the health inequality gap did not narrow.
I was then asked to conduct a review of health inequalities in England. The question was how the findings of the global WHO CSDH could be applied to one European country. This review was reported as Fair Society Healthy Lives. The Review was commissioned by a Labour Government. Thereby hung a question: would the Coalition Government in Britain take on the recommendations of a review commissioned by the previous government? The Review occupied centre stage in one part of the Coalition Government’s Public Health White Paper.
We continue to bring the evidence to the attention of policy makers: the new Institute will house the European Review of Social Determinants and the Health Divide which will report to the WHO European Regional Committee in September 2012. And the Institute has wider ambitions to advocate for health equity at local, national and international level, to build capacity to tackle health inequalities and recommend and support implementation of the most effective actions to reduce the tragic and preventable waste of life and good health, which we see across the world.
The Institute will be funded by the Department of Health, UCL and the BMA. UCL will house the IHE and it has been my home for 26 years where I built the research operation that gave rise to much of my insights on health inequalities. The BMA is interesting. Although I have spent my academic career emphasising the evidence that the key determinants of health lie outside the health care system, I was invited to spend a year as President of the BMA. They supported the health equity agenda enthusiastically. Through the BMA I have engaged with the Medical Royal Colleges, with the World Medical Association and with National Medical Associations, who are keen to ask how medical professionals can engage with the health equity agenda.
The Institute of Health Equity builds on a lifetime’s work of many people. It gives me the privilege of overseeing an independent organisation whose job it will be to continue to advocate for a SD approach to reduce health inequity within and between countries by developing the evidence base, through partnerships on research, evaluation, monitoring and review; the development of policy and interventions to tackle health inequalities; and building capacity by organising and contributing to workshops and training events to spread the knowledge and experience needed to widen expertise.
As I said in another context, quoting Don Quixote: the dogs are barking, Sancho; it is a sign we’re moving.