Washington, D.C, 1 October 2019 (PAHO/WHO) – Inequity lies at the very heart of poor health outcomes in the Americas and must be urgently addressed if the Region is to achieve health for all, says a groundbreaking report from the Pan American Health Organization’s (PAHO) Commission on Equity and Health Inequalities in the Americas.

The report, Just Societies: Health Equity and Dignified Lives, proposes priority goals across a range of action areas to reduce inequities in health. It was launched today at the 57th Directing Council of PAHO, which is taking place this week in Washington, D.C.

man childAccording to the report, much of the Region’s poor health outcomes are determined not by biology but by social structures that perpetuate unequal access to education, decent work, income and social protection, to name just a few.  

“There are two concepts central to health equity: social justice and the right to health,” said PAHO Director Carissa F. Etienne. “Our Region faces a number of challenges, but I choose to focus on what we have in common: our desire for freedom, for justice, for economic opportunity and for health and well-being. We cannot and must not leave anyone behind.”

As a result of these structural inequities, certain groups in the Region of the Americas continue to face inequalities in health both within and among countries, by reason of their socioeconomic position, ethnicity, gender, sexual orientation, disability status, or being migrants, the Commission says in its report. These inequalities start at the beginning of life: in Bolivia, for example, the under-5 mortality rate for indigenous children is more than three times higher than that of non-indigenous children. The inequalities persist until the end of life; for example, life expectancy for women in Haiti is just 66, while for women in Canada it is 84.

For president of the commission, Michael Marmot, from the Institute of Health Equity at University College London, creating just societies is key to “improving health and enhancing health equity.”

The report makes 12 recommendations for action by the countries of the Americas:

  • Achieving equity in political, social, cultural, and economic structures
  • Protecting the natural environment, mitigating climate change, and respecting relationships to land
  • Recognizing and reversing the health equity impacts of ongoing colonialism and structural racism
  • Equity from the start – early life and education
  • Decent work
  • Dignified life at older ages
  • Income and social protection
  • Reducing violence for health equity
  • Improving environment and housing conditions
  • Equitable health systems
  • Governance arrangements for health equity
  • Fulfilling and protecting human rights

The recommendations as a whole propose a renewed focus on groups most left behind, a whole-of-government approach to addressing inequality, and collaboration with other sectors beyond health.

The report also calls for better use of data in order to analyze exactly where inequalities are occuring. “Averages hide inequalities” said the Vice-President of Costa Rica, Epsy Campbell Barr during the presentation of the report, stressing the need for countries to generate and use more desaggregated data.

Commission on Equity and Health Inequalities

PAHO established the independent Commission on Equity and Health Inequalities in the Americas in 2016. It was made up of international experts who evaluated the available evidence on the factors that lead to these inequalities, and proposed actions to improve the health of people in the Region.

The Commission was chaired by Michael Marmot of the Institute of Health Equity at University College London. Other Commission members included Paulo Buss and Cesar Victoria of Brazil, Nila Heredia of Bolivia, Tracy Robinson of Jamaica, Cindy Blackstock of Canada, Maria Paula Romo of Ecuador, Pastor Murillo of Colombia, Mabel Bianco and Victor Abramovich of Argentina, and David Satcher and Jo Ivey Boufford of the United States. The PAHO Secretariat and the Working Group on Cross-cutting Themes supported the Commission in a manner that ensured its independence.


— Just Societies: Health Equity and Dignified Lives. Report of the Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas
— 57th Directing Council
— Working Document – Report of the Commission on Equity and Health Inequalities in the Americas