나는 임의표본을 추출한 경우 그 표본의 어떤 변수값의 신뢰구간을 제시하는 것이 의미없는 일인 줄 알았다. 그런데 황승식 교수의 설명으로는 의미없는 일이 아니란다. 메신저로 들은 바를 옮겨놓자면...

임의표본이라고 하지만 그 자체로 표본추출된 결과이므로 신뢰구간은 당연히 제시하여야 한다. 물론 제대로 된 표본추출법으로 추출한 표본의 경우 임의표본에 비해 모집단의 대표값을 더 정확하게 추정할 수 있다는 장점이 있다. 임의표본 일반이 모집단을 상정하기 어려운 것이라고 볼 수도 있지만, 그렇게 따지면 임상연구에서 신뢰구간을 제시하는 것이 무의미한 일이 된다.

이것을 "중심극한정리"로 생각하여볼 수도 있겠다. 즉, 어떻게 표본을 뽑든 표본평균이 모집단의 평균을 대표할 수 있다는 것이다. 물론 정확한 의미는 그것이 아니지만. 이를테면, 한번의 표본추출을 통해 나온 값이 좀 크거나 낮게 나와도 100번을 반복해서 수행하면 어떤 범위가 만들어질테고 그 구간내에 모평균이 있을 확률은 95%가 된다고 증명되어 있다.

이것은 역학에서 말하는 외적 타당도와는 좀 다른 의미로 이해하여야 한다. 물론 참값이 있을 확률이 95%다 라고는 절대 이야기할 수 없다. 그리고 만일 표본추출이 좀 더 정교하다면, 95%가 아니라 더 작은 오차를 갖고 모집단의 파라미터를 예측할 수 있게 된다.

'신뢰'구간의 '신뢰'에 너무 큰 의미를 두지 말고 어떤 자료의 정밀도를 제시하는 정도다, 포인트 밸류(point value)만 제시하는 것보다 구간으로 제시하는 것이 정보가 더 많다, 는 정도로 이해하자.  

해도 해도 너무한 SAS의 라이선스 정책에 대처하기 위하여 다른 통계 소프트웨어 패키지를 찾던 끝에 만난 것이 Stata. 그 전부터 도키나 이기홍 교수님이 쓰고 있던 것을 아는 터였다. SAS 라이선스 정책에 정나미가 떨어진 상태인데다 내가 언제 SAS를 꼭 써야 할 만큼 큰 자료를 만질 일이 있겠나 싶어 작년 초에 질러버렸다. 그렇게 지른 후 계속 묻어두던 Stata를 얼마 전부터 꺼내 하나씩 익히기 시작하였다.

Stata에 관한 인터넷 웹사이트 주소를 정리해둔다.

Stata 공식 홈페이지

http://www.stata.com/

JasonTG

http://www.jasontg.com/

네이버 카페 statausers

http://cafe.naver.com/statausers.cafe

한국STATA학회

http://stata.co.kr/

An introduction to Stata for Health Researchers

http://www.folkesundhed.au.dk/uddannelse/stata/introduction

UNC Stata Tutorial

http://www.cpc.unc.edu/services/computer/presentations/statatutorial

Princeton Stata Tutorial

http://www.princeton.edu/~erp/stata/main.html

UCLA ATS Resources to help you learn and use Stata

http://www.ats.ucla.edu/stat/stata/

Eschermania: 카테고리> 역학통계

http://azygos.egloos.com/category/%EC%97%AD%ED%95%99%ED%86%B5%EA%B3%84

국민학교 때 배운 적이 있었지. 그런데 요즘은 회의 형식을 잘 구분하지 않고 이름을 남용하는 면이 있다. 일단은 재정리하지 않고 국립국어원 표준국어대사전과 네이버 엔사이버를 찾아 옮겨보았다.

심포지엄(symposium)

특정한 문제에 대하여 두 사람 이상의 전문가가 서로 다른 각도에서 의견을 발표하고 참석자의 질문에 답하는 형식의 토론회. '집단 토론 회의', '학술 토론 회의'로 순화.
¶ 심포지엄을 열다/훈민정음에 관한 심포지엄을 개최하다. [표준국어대사전]

세미나(seminar)

1. 대학에서, 교수의 지도 아래 특정한 주제에 대하여 학생이 모여서 연구 발표나 토론을 통해서 공동으로 연구하는 교육 방법. 상호 간의 토론을 통하여 의문점을 깊이 있게 추구함으로써 연구자로서의 자질을 향상시키는 데에 목적이 있다.

2. 전문인 등이 특정한 주제로 행하는 연수회나 강습회. '발표회', '연구회', '토론회'로 순화. [표준국어대사전]

워크숍(workshop)

1. 연구 집회. '공동 수련', '공동 연수'로 순화.

2. 연구 협의회. [표준국어대사전]

본디 '일터'나 '작업장'을 뜻하는 말이었으나, 지금은 연구협의회를 뜻하는 교육용어로 사용된다. 집단사고·집단작업을 통하여 교육자의 전문적인 성장을 꾀하고, 교직(敎職) 수행상의 제문제를 해결하려는 두 가지의 목적을 동시에 달성할 수 있다.

절차는 문제에 따라 다르지만 문제제기, 문제해결을 위한 조언, 문제해결법의 강구와 해결, 잠정적 결론의 형성 등으로 나뉜다. 협의에 의하여 얻어진 결론은 어디까지나 가설적인 성격을 지니고 있으며, 실천을 통해 그 결론의 타당성을 평가하게 된다. [네이버 엔사이버]

패널 토의(panel discussion)

논제에 관한 전문가 또는 각종 의견의 대표자(패널 구성원)가 먼저 토의하고, 그 다음에 청중이 참가해서 사회자를 중심으로 전체토의를 한다. [네이버 엔사이버]

심포지엄(symposium)

몇 사람의 강연자가 논제에 대해서 서로 다른 각도에서 강연을 하고, 그 후에 청중이 참가해서 질문이나 의견을 제시한다. [네이버 엔사이버]

콜로키(colloquy)

몇 사람의 청중 대표가 먼저 문제를 제시하여, 배석한 몇 사람의 전문가의 의견을 구하는 형식을 중심으로 하는데, 필요에 따라 청중도 참가해서 토의를 한다. [네이버 엔사이버]

포럼(forum)

청중의 참가라는 의미가 강한데, 한 사람의 강사에게 강의를 하도록 한 다음에 청중이 토의를 하는 렉처 포럼(lecture forum), 대표자의 토론이 끝난 다음에 청중이 의견을 나누는 디베이트 포럼(debate forum), 영화나 슬라이드를 보고 난 뒤에 의견을 나누는 필름 포럼(film forum) 등의 방법이 있다. [네이버 엔사이버]

정말 오랫만에, 무슨 생각에서 그랬는지 네이트온 메신저를 켜놓았는데, 보건연 혜진 씨에게 당했다.

내년 1월 말에 [보건의료 진보포럼]이라는 행사가 있는데, 그 때 [사전예방의 원칙]에 관해서 강의를 하란다. 그것도 역사적인 사례를 들어 재밌게! 정말인지, 아닌지 모르겠지만 상윤이와 석균 선배가 날 추천했다니, 날 뻔히 알면서 도대체 왜 그러는 거얏! 내가 이 주제를 잘 모른다는 것도 알테고 강의가 엄청 지루하다는 것도 알텐데, 정치적 흑심이 있거나 날 개망신시키려는 의도임이 분명하다. OTL...

주영수 선생님에게 전화를 했다가 이 문제를 깊이 아는 인간들이 이리도 없나, 아님 그런 사람을 아는 인간이 주위에 이리도 없나, 이런 좌절감을 느끼면서, "아놔, 내가 할래..." 그만 승낙해버렸다.

원고 마감과 강의가 다가올수록 후회하고 있을 내 모습이 벌써 그려진다.

몇 사람 더 연락을 해볼 걸 그랬나?

혹시 좋은 강사가 있으면 알려들 주시길.

엊그제 연세대 홍훈 교수님이 쓴 [경제학의 역사]를 읽다가 "폴 사무엘슨"이라는 이름을 발견했다. 문득 이런 생각이 들었다. 요즘은 노벨상 수상으로 주가를 올리는 폴 크루그먼이 각광을 받고 있지만, 신고전파 종합을 완성시켰다는 (잊혀진) 현대 경제학의 거장, 폴 사무엘슨이 최근 미국발 경제 위기를 어떻게 보는지 궁금했다.

구글을 검색했더니, 나왔다. 일본 아사히 신문의 인터뷰 기사가 있었다(영문). 케인지언 사무엘슨의 면모를 확인할 수 있었고, 부시 대통령이 미국 역사상 최악의 대통령으로 기록될 거라는 노교수의 일갈이 눈길을 끌었다. 그보다는 사무엘슨을 인터뷰하겠다는 아사히 신문 편집자의 안목에 더 감탄하였다. 한국의 언론이 같은 사안을 놓고 어떻게 접근했는지, 누굴 인터뷰했는지가 궁금해졌다.

INTERVIEW/ Paul Samuelson: Financial crisis work of 'fiendish monsters'

http://www.asahi.com/english/Herald-asahi/TKY200810310085.html

올해에는 한 해 동안 고마웠던 분들에게 인사를 드려야겠다고 생각했다. 다른 누구보다도, 자기 시간을 쪼개 학생들에게 강의를 해주신 분들이 가장 고맙다. 몇 해 전부터 그런 생각을 하긴 했었다. 강의한 과목이 끝난 직후나 그 해 연말쯤 연하장이든, 작은 선물이든 고마움을 표하자고. 이번에는 실천에 옮겨야겠다.

의료관리학: 권영대

의료현장의 이해: 이재호, 이명수, 박유미, 공정옥, 이중규, 강영아, 노광을, 김명일, 이명세, 우석균, 안양수, 이상윤

보건대학원: 손미아, 조희숙

무릎 통증 사례 관리 설문지 입력 및 코딩 지침 수정

ILO-HIV/AIDS 워크숍 발표문

전염병 FMTP 종합평가대회 발표 자료 검토하고 코멘트

의료 정책 및 관리 수업 슬라이드 자료

안녕? 사회주의 원고

보건학 연구방법론 논문 작성법 강의 자료

일차의료 현황 네덜란드 편

에이즈 전문 인력 사이버 교육 프로그램 코멘트

Declaration of Alma-Ata

International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978

The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following

Declaration:

I
The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

II
The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

III
Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.

IV
The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.

V
Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.

VI
Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of selfreliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

VII
Primary health care:

1. reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience;
2. addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly;
3. includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;
4. involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors;
5. requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate;
6. should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need;
7. relies, at local and referral levels, on health workers, including physicians, nurses,
   midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.

VIII
All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country's resources and to use available external resources rationally.

IX
All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.

X
An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share.

The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order. It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, nongovernmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries. The Conference calls on all the aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of this Declaration.

ILO fourth agenda report 요약

대학원 의료 정책 및 관리 수업(11월 7일)

대학원 의료 정책 및 관리 수업(11월 21일)

대학원 의료 정책 및 관리 수업(12월 5일)

보건대학원 보건학 연구 방법론 수업(11월 29일)

보건대학원 보건학 연구 방법론 수업(12월 13일)

보건대학원 노인보건 수업(11월 1일)

석사 학위 논문(김형모, 이성범)

박사 학위 논문(김동환, 이경희, 최지숙)

일차의료 개념 정의 논문 번역과 이차 출판

Pickard S, Sheaff R.

National Primary Care Research and Development Centre, University of Manchester, UK.

Primary care groups and NHS rationing: implications of the Child B Case.

Health Care Anal. 1999;7(1):37-56. 

Implementing The new NHS and the 1997 NHS (Primary Care) Act will gradually extend cash-limiting into primary health care, especially general practice. UK policy-makers have avoided providing clear, unambivalent direction about how to 'ration' NHS resources. The 'Child B' case became an epitome of public debate about NHS rationing. Among many other decision-making processes which occurred, Cambridge and Huntingdon Health Authority applied an ethical code to this rationing decision. Using new data this paper analyses the rationing criteria NHS managers and clinicians used at local level in the Child B case; and the organisational structures which confronted them with such decisions. Primary Care Groups are likely to confront similar rationing decisions in respect of 'gate-kept' NHS services. However, such rationing processes are not so easily transposed to open-access services such as general practice. NHS rationing decisions, especially in PCGs, will require a much more specific ethical code than hitherto used.

28 August 2008 | GENEVA -- A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17 400; in Afghanistan, the odds are 1 in 8. Biology does not explain any of this. Instead, the differences between - and within - countries result from the social environment where people are born, live, grow, work and age.

These "social determinants of health" have been the focus of a three-year investigation by an eminent group of policy makers, academics, former heads of state and former ministers of health. Together, they comprise the World Health Organization's Commission on the Social Determinants of Health. Today, the Commission presents its findings to the WHO Director-General Dr Margaret Chan.

"(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible," the Commissioners write in Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. "Social injustice is killing people on a grand scale."

"Health inequity really is a matter of life and death," said Dr Chan today while welcoming the Report and congratulating the Commission. "But health systems will not naturally gravitate towards equity. Unprecedented leadership is needed that compels all actors, including those beyond the health sector, to examine their impact on health. Primary health care, which integrates health in all of government's policies, is the best framework for doing so."

Sir Michael Marmot, Commission Chair said: “Central to the Commission’s recommendations is creating the conditions for people to be empowered, to have freedom to lead flourishing lives. Nowhere is lack of empowerment more obvious than in the plight of women in many parts of the world. Health suffers as a result. Following our recommendations would dramatically improve the health and life chances of billions of people.”

Inequities within countries

Health inequities – unfair, unjust and avoidable causes of ill health – have long been measured between countries but the Commission documents "health gradients" within countries as well. For example:

• Life expectancy for Indigenous Australian males is shorter by 17 years than all other Australian males.
• Maternal mortality is 3–4 times higher among the poor compared to the rich in Indonesia. The difference in adult mortality between least and most deprived neighbourhoods in the UK is more than 2.5 times.
• Child mortality in the slums of Nairobi is 2.5 times higher than in other parts of the city. A baby born to a Bolivian mother with no education has 10% chance of dying, while one born to a woman with at least secondary education has a 0.4% chance.
• In the United States, 886 202 deaths would have been averted between 1991 and 2000 if mortality rates between white and African Americans were equalized. (This contrasts to 176 633 lives saved in the US by medical advances in the same period.)
• In Uganda the death rate of children under 5 years in the richest fifth of households is 106 per 1000 live births but in the poorest fifth of households in Uganda it is even worse – 192 deaths per 1000 live births – that is nearly a fifth of all babies born alive to the poorest households destined to die before they reach their fifth birthday. Set this against an average death rate for under fives in high income countries of 7 deaths per 1000.

The Commission found evidence that demonstrates in general the poor are worse off than those less deprived, but they also found that the less deprived are in turn worse than those with average incomes, and so on. This slope linking income and health is the social gradient, and is seen everywhere – not just in developing countries, but all countries, including the richest. The slope may be more or less steep in different countries, but the phenomenon is universal.

Wealth is not necessarily a determinant

Economic growth is raising incomes in many countries but increasing national wealth alone does not necessarily increase national health. Without equitable distribution of benefits, national growth can even exacerbate inequities.

While there has been enormous increase in global wealth, technology and living standards in recent years, the key question is how it is used for fair distribution of services and institution-building especially in low-income countries. In 1980, the richest countries with 10% of the population had a gross national income 60 times that of the poorest countries with 10% of the world's population. After 25 years of globalization, this difference increased to 122, reports the Commission. Worse, in the last 15 years, the poorest quintile in many low-income countries have shown a declining share in national consumption.

Wealth alone does not have to determine the health of a nation's population. Some low-income countries such as Cuba, Costa Rica, China, state of Kerala in India and Sri Lanka have achieved levels of good health despite relatively low national incomes. But, the Commission points out, wealth can be wisely used. Nordic countries, for example, have followed policies that encouraged equality of benefits and services, full employment, gender equity and low levels of social exclusion. This, said the Commission, is an outstanding example of what needs to be done everywhere.

Solutions from beyond the health sector

Much of the work to redress health inequities lies beyond the health sector. According to the Commission's report, "Water-borne diseases are not caused by a lack of antibiotics but by dirty water, and by the political, social, and economic forces that fail to make clean water available to all; heart disease is caused not by a lack of coronary care units but by lives people lead, which are shaped by the environments in which they live; obesity is not caused by moral failure on the part of individuals but by the excess availability of high-fat and high-sugar foods." Consequently, the health sector – globally and nationally – needs to focus attention on addressing the root causes of inequities in health.

“We rely too much on medical interventions as a way of increasing life expectancy” explained Sir Michael. “A more effective way of increasing life expectancy and improving health would be for every government policy and programme to be assessed for its impact on health and health equity; to make health and health equity a marker for government performance.”

Recommendations

Based on this compelling evidence, the Commission makes three overarching recommendations to tackle the "corrosive effects of inequality of life chances":

• Improve daily living conditions, including the circumstances in which people are born, grow, live, work and age.
• Tackle the inequitable distribution of power, money and resources – the structural drivers of those conditions – globally, nationally and locally.
• Measure and understand the problem and assess the impact of action.

Recommendations for daily living

Improving daily living conditions begins at the start of life. The Commission recommends that countries set up an interagency mechanism to ensure effective collaboration and coherent policy between all sectors for early childhood development, and aim to provide early childhood services to all of their young citizens. Investing in early childhood development provides one of the best ways to reduce health inequities. Evidence shows that investment in the education of women pays for itself many times over.

Billions of people live without adequate shelter and clean water. The Commission's report pays particular attention to the increasing numbers of people who live in urban slums, and the impact of urban governance on health. The Commission joins other voices in calling for a renewed effort to ensure water, sanitation and electricity for all, as well as better urban planning to address the epidemic of chronic disease.

Health systems also have an important role to play. While the Commission report shows how the health sector can not reduce health inequities on its own, providing universal coverage and ensuring a focus on equity throughout health systems are important steps.

The report also highlights how over 100 million people are impoverished due to paying for health care – a key contributor to health inequity. The Commission thus calls for health systems to be based on principles of equity, disease prevention and health promotion with universal coverage, based on primary health care.

Distribution of resources

Enacting the recommendations of the Commission to improve daily living conditions will also require tackling the inequitable distribution of resources. This requires far-reaching and systematic action.

The report foregrounds a range of recommendations aimed at ensuring fair financing, corporate social responsibility, gender equity and better governance. These include using health equity as an indicator of government performance and overall social development, the widespread use of health equity impact assessments, ensuring that rich countries honour their commitment to provide 0.7% of their GNP as aid, strengthening legislation to prohibit discrimination by gender and improving the capacity for all groups in society to participate in policy-making with space for civil society to work unencumbered to promote and protect political and social rights. At the global level, the Commission recommends that health equity should be a core development goal and that a social determinants of health framework should be used to monitor progress.

The Commission also highlights how implementing any of the above recommendations requires measurement of the existing problem of health inequity (where in many countries adequate data does not exist) and then monitoring the impact on health equity of the proposed interventions. To do this will require firstly investing in basic vital registration systems which have seen limited progress in the last thirty years. There is also a great need for training of policy-makers, health workers and workers in other sectors to understand the need for and how to act on the social determinants of health.

While more research is needed, enough is known for policy makers to initiate action. The feasibility of action is indicated in the change that is already occurring. Egypt has shown a remarkable drop in child mortality from 235 to 33 per 1000 in 30 years. Greece and Portugal reduced their child mortality from 50 per 1000 births to levels nearly as low as Japan, Sweden, and Iceland. Cuba achieved more than 99% coverage of its child development services in 2000. But trends showing improved health are not foreordained. In fact, without attention health can decline rapidly.

Is this feasible?

The Commission has already inspired and supported action in many parts of the world. Brazil, Canada, Chile, Iran, Kenya, Mozambique, Sri Lanka, Sweden, and the UK have become 'country partners' on the basis of their commitment to make progress on the social determinants of health equity and are already developing policies across governments to tackle them. These examples show that change is possible through political will. There is a long way to go, but the direction is set, say the Commissioners, the path clear.

WHO will now make the report available to Member States which will determine how the health agency is to respond.

Comments from the Commissioners

Fran Baum, Head of Department and Professor of Public Health at Flinders University, Foundation Director of the South Australian Community Health Research Unit and Co-Chair of the Global Coordinating Council of the People’s Health Movement: "It is wonderful to have global endorsement of the Australian Closing the Gap campaign from the CSDH established by the WHO. The CSDH sets Closing the Gap as a goal for the whole world and produces the evidence on how health inequities are a reflection of the way we organize society and distribute power and resources. The good news from the CSDH for Australia is that it provides plenty of ideas on how to set an agenda that will tackle the underlying determinants of health and create a healthier Australia for all of us"

Monique Begin, Professor at the School of Management, University of Ottawa, Canada, twice-appointed Minister of National Health and Welfare and the first woman from Quebec elected to the House of Commons: "Canada likes to brag that for seven years in a row the United Nations voted us "the best country in the world in which to live". Do all Canadians share equally in that great quality of life? No they don't. The truth is that our country is so wealthy that it manages to mask the reality of food banks in our cities, of unacceptable housing (1 in 5), of young Inuit adults very high suicide rates. This report is a wake up call for action towards truly living up to our reputation."

Giovanni Berlinguer, Member of the European Parliament, member of the International Bioethics Committee of UNESCO (2001–2007) and rapporteur of the project Universal Declaration on Bioethics: "A fairer world will be a healthier world. A health service and medical interventions are just one of the factors that influence population health. The growth of inequalities and the phenomena of increased injustice in health is present in low and middle income countries as well as across Europe. It would be a crime not to take every action possible to reduce them."

Mirai Chatterjee, Coordinator of Social Security for India’s Self-Employed Women’s Association, a trade union of over 900 000 self-employed women and recently appointed to the National Advisory Council and the National Commission for the Unorganised Sector: "The report suggests avenues for action from the local to national and global levels. It has been eagerly awaited by policy-makers, health officials, grassroot activists and their community-based organizations. Much of the research and evidence is of particular relevance to the South-East Asian region, where too many people struggle daily for justice and equity in health. The report will inspire the region to act and develop new policies and programmes."

Yan Guo, Professor of Public Health and Vice-President of the Peking University Health Science Centre, Vice-Chairman of the Chinese Rural Health Association and Vice-Director of the China Academy of Health Policy: “A man should not be concerned with whether he has enough possessions but whether possessions have been equally distributed”, this is a time-honored teaching in China. Constructing a harmonious society is our shared aspiration, and equity, including health equity, composes the prerequisite for a harmonious development. Eliminating determinants that are adverse to health under the efforts from all of the society, promoting social justice, and advancing human health are our shared goals. Let’s join our hands in this grand course!”

Kiyoshi Kurokawa, Professor at the National Graduate Institute for Policy Studies, Tokyo, Member of the Science and Technology Policy Committee of the Cabinet Office, formerly President of the Science Council of Japan and the Pacific Science Association: "The WHO Commission addresses one of the major issues of our global world - health inequity. The report’s recommendations will be perceived, utilized and implemented as a major policy agenda at national and global levels. The issue will increase in importance as the general public become more engaged via civil society movements and multi-stakeholder involvement."

Alireza Marandi, Professor of Pediatrics at Shaheed Beheshti University, Islamic Republic of Iran, former two-term Minister of Health and Medical Education, former Deputy Minister and Advisor to the Minister and recently elected to be a member of the Iranian Parliament: "According to the Islamic ideology, social justice became a priority, when the Islamic revolution materialized in Iran. Establishing a solid Primary Health Care network in our country, not only improved our health statistics, but it was an excellent vehicle to move towards health equity. Now through the final report of the CSDH and implementing its recommendations we need to move much faster in our own country toward health equity."

Pascoal Mocumbi, High Representative of the European and Developing Countries Clinical Trials Partnership, former Prime Minister of the Republic of Mozambique, former head of the Ministry of Foreign Affairs and the Ministry of Health: "The Commission on Social Determinants of Health report will help African leaders adapt their national development strategies to address the challenges to health. These are derived from the current systemic changes taking place in the global economy that affects heavily on the poorest segments of Africa’s population."

Amartya Sen, Lamont University Professor and Professor of Economics and Philosophy at Harvard University, awarded the Nobel Prize in Economics in 1998: "The primary object of development - for any country and for the world as a whole - is the elimination of 'unfreedoms' that reduce and impoverish the lives of people. Central to human deprivation is the failure of the capability to live long and healthy lives. This is much more than a medical problem. It relates to handicaps that have deep social roots. Under Michael Marmot's leadership, this WHO Commission has concentrated on the badly neglected causal linkages that have to be adequately understood and remedied. A fuller understanding is also a call for action."

David Satcher, Director of the Center of Excellence on Health Disparities and the Satcher Health Leadership Institute Initiative, formerly the United States Surgeon General and Assistant Secretary for Health and also Director of the Centers for Disease Control and Prevention: "The United States of America spends more on health care than any other country in the world, yet it ranks 41st in terms of life expectancy. New Orleans and its experience with Hurricane Katrina illustrate why we need to target social determinants of health (SDH) — including housing, education, working and learning conditions, and whether people are exposed to toxins—better than any place I can think of right now. By targeting the SDH, we can rapidly move towards closing the gap that unfairly and avoidably separates the health status of groups of different socio-economic status, social exclusion experience, and educational background."

Anna Tibaijuka, Executive Director of UN-HABITAT and founding Chairperson of the independent Tanzanian National Women’s Council: "Health delivery is not possible for people living in squalor, in dehumanizing pathetic conditions prevailing in the ever growing slum settlements of cities and towns in developing countries. Investment in basic services such as water and education will always remain constrained if not wasted unless accompanied by requisite investment in decent housing with basic sanitation."

Denny Vågerö, Professor of Medical Sociology, Director of CHESS (Centre for Health Equity Studies) in Sweden, member of the Royal Swedish Academy of Sciences and of its Standing Committee on Health: "Countries of the world are presently growing apart in health terms. This is very worrying. In many countries in the world social differences in health are also growing, and this is true in Europe. We have been one-sidedly focused on economic growth, disregarding negative consequences for health and climate. We need to think differently about development."

Gail Wilensky, Senior Fellow at Project HOPE, an international health education foundation. Previously she directed the Medicare and Medicaid programmes in the United States and also chaired two commissions that advise the United States Congress on Medicare: "What this report makes clear is that improving health and health outcomes and reducing avoidable health differences—goals of all countries-- involves far more than just improving the health care system. Basic living conditions, employment, early childhood education, treatment of women and poverty all impact on health outcomes and incorporating their effects on health outcomes needs to become an important part of public policymaking. This is as true for wealthy countries like the United States as it is for many of the emerging countries of the world, where large numbers of people live on less than $2 per day."

For more information or interviews, please contact:

Sharad Agarwal
Communications Officer
WHO, Geneva
Tel.: +41 22 791 1905
Mob.: +41 79 621 5286
Email: agarwals@who.int

Felicity Porritt
Head, Communications
CSDH, UCL Secretariat
London
Mob.: +44 773 941 9219
Email: felicity.porritt@mac.com

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