This appeared in the Commission on Social Determinants of Health
March/April Newsletter.
-------------------
Fran Baum's article 'Can we afford justice and equity?' in Issue 6 of the
CSDH Newsletter admirably expressed some of the greatest challenges for the
Commission. If her perspective is adopted then we have every reason to be
hopeful with regard to the Commission's potential for meaningful
achievement. In particular, the Commission will have to travel far upstream
and directly confront the root causes of economic inequality, racism and
patriarchy if it is to fulfill its task. If this is to happen, it will be
necessary to name, to analyze and to address directly the phenomena of
structural violence and of neo-liberal macroeconomic and social policies.

Structural violence - suffering caused through public policy - probably
operates in every country in the world. Addressing the human costs of
unjust public policies necessitates the development of a conceptual
framework capable of encompassing
injustices ranging from the denial of access to health care for all, to
'extraordinary rendition', war and genocide. The CSDH must not fail to
examine the relative and absolute impacts on health of differing
macroeconomic policies. There is already a large body of evidence
demonstrating that the riches and inequalities of the neo-liberal economic
North (not to mention the 'structurally adjusted'
South) are themselves the direct causes of much of the world's poverty and
deprivation. The Commission must consider and respond to this evidence.
Prescribing the solution is inevitably less straightforward than the
diagnosis of the problem, but 'economics as if people mattered'
increasingly features in global public policy discourse. The Commission's
report has the potential to make the greatest contribution to global health
development since the 1978 Alma-Ata Declaration. The opportunity must not
be missed.

Dr Alex Scott-Samuel
EQUAL (Equity in Health Research and Development
Unit) Division of Public Health University
of Liverpool

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