Poverty and poor health

(You write in your report that social injustice is killing people on a grand scale. What’s happening and where?) The two ways to look at social inequalities and their consequences for ill health is: 1) to look at differences between countries. We see a woman in a sub-Saharan African country has a life expectancy of 40, whereas a woman in Japan is 86, we call this major avoidable inequality. 2) we look within countries and the inequalities in these countries can be seen everywhere. The people in the middle in these countries, let alone the people at the bottom, have worse health than the people at the top. And it runs across the whole of society. (That seems to be sadly logical, the link between wealth and health.) This is not only about money and health care. The U.S. for example is the richest country in the world but ranks in the world about mid-30s for life expectancy. (So are you calling for changes in tax policy, or in terms of legislation?) Changes firstly should come in circumstances of daily life. There may be changes in education and the circumstances in which girls become mothers, meaningful environments in early childhood, all things that don’t necessarily mean wholescale change or changes in a tax system. (Is this something outside the responsibilities of the World Health Organization?) This is beyond us our normal mandate but it’s also not a huge departure. When the WHO was founded, we said health was not only the absence of disease but also a state of complete mental and physical well being. The WHO in a sense is a global minister of health but it can also play a social accounting role because we’re also talking about creating the conditions for people to have the freedom to lead healthy lives.