Inequalities: the “gap” remains; can surveillance aid in closing the gap?

Excerpt

Three years have passed since this Journal had an editorial on the surveillance of social determinants of health (SDOH, Campostrini et al. 2011), and during those years considerable literature, some ten articles alone last year in this journal, as well as several important events, documents (EC 2013) and conferences have stressed the importance of the subject. Among these salient events was the so-called Rio Declaration on Social Determinants of Health (http://​www.​who.​int/​sdhconference/​declaration/​en/​). Although without using the word surveillance (preferring monitor‐monitoring), this Declaration clearly pointed out the importance for countries to observe the health effects of the SDOH and to monitor progresses in improving the impact of these leading causes of NCDs. In addition, the Global Action Plan approved by the 66th World Health Assembly (http://​www.​who.​int/​nmh/​events/​ncd_​action_​plan/​en/​index.​html) considers it strategic to address the SDOH (named 14 times in the document) and the necessary surveillance (named 24 times). Many articles have added more and more evidence to the findings of the earlier WHO report (CSDH 2008): SDOH affects health outcomes globally, nationally, locally. Among the few attempts to measure how the effect of SDOH was evolving in recent years showed that actually things are not always going for the better (WHO-Europe 2013), and health inequality is increasing globally as well as in most countries (see for instance EC 2013): most inequality indicators between countries are decreasing, but some, e.g., the Gini index applied to life expectancy for males has increased 4 % in the last decade; and when inequality is considered between regions within the Member States, many countries––more than half––show an increase in regional inequalities (EC 2013, p 34). …