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Cited by 683Global Public Health Policies and EpidemiologyPublic health and occupational medicinePublic Health and Social Inequalities

The political origins of health inequity: prospects for change

Open access
Ottersen, Ole Petter, Dasgupta, Jashodhara, Blouin, Chantal, Buss, Paulo, Chongsuvivatwong, Virasakdi, Frenk, Julio, Fukuda-Parr, Sakiko, Gawanas, Bience P +16 more·2014·The Lancet
DOI 10.1016/s0140-6736(13)62407-1
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Abstract

Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven.Although the health sector has a crucial role in addressing health inequalities, its eff orts often come into confl ict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.This is the starting point of The Lancet-University of Oslo Commission on Global Governance for Health.With globalisation, health inequity increasingly results from transnational activities that involve actors with diff erent interests and degrees of power: states, transnational corporations, civil society, and others.The decisions, policies, and actions of such actors are, in turn, founded on global social norms.Their actions are not designed to harm health, but can have negative sideeff ects that create health inequities.The norms, policies, and practices that arise from global political interaction across all sectors that aff ect health are what we call global political determinants of health.The Commission argues that global political determinants that unfavourably aff ect the health of some groups of people relative to others are unfair, and that at least some harms could be avoided by improving how global governance works.There is an urgent need to understand how public health can be better protected and promoted in the realm of global governance, but this issue is a complex and politically sensitive one.Global governance processes involve the distribution of economic, intellectual, normative, and political resources, and to assess their eff ect on health requires an analysis of power.This report examines power disparities and dynamics across a range of policy areas that aff ect health and that require improved global governance: economic crises and austerity measures, knowledge and intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent confl ict.The case analyses show that in the

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  • Global health hazards have common underlying causes such as dangerous pathogens, unhealthy behaviours, or unsafe environments.

    “(ii) they have common underlying causes, such as dangerous pathogens, unhealthy behaviours, or unsafe environments;”

    From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [4]

    The ‘Under-regulation of transnational activities and effects on health equity’ section describes environmental toxins as health hazards, supporting the unsafe-environments example. But ‘Market dominance’ calls biological and behavioural factors immediate causes of illness, while ‘Power asymmetries and competing norms’ places the root causes of avoidable health outcomes beyond the health sector. The paper does not present dangerous pathogens, unhealthy behaviours and unsafe environments together as common underlying causes of global health hazards. Page numbers were not available in our copy. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Global governance for health requires a global economic and political system rooted in global solidarity and shared responsibility.

    “The Commission noted that global governance for health requires a global economic and political system that is rooted in commitments to global solidarity and shared responsibility.4”

    From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [4]

    The section “Strengthen and transform mechanisms for global solidarity and shared responsibility” says that global governance for health must be rooted in commitments to solidarity and shared responsibility. It does not say that this requires a global economic and political system; that added requirement goes beyond the passage. (LLM, conf=0.81)

    Experimental — accuracy not yet measured

  • Norms, policies, and practices from transnational interaction are political determinants that cause and perpetuate health inequities.

    “emphasising that norms, policies, and practices arising from transnational interaction serve as political determinants of health that cause and perpetuate health inequities.4”

    From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [4]

    The ‘Political determinants of health’ section defines these determinants as transnational norms, policies, and practices, and ‘Political determinants at work’ says some such rules and practices cause health inequities. But the paper also says political determinants are ‘neither inherently good nor bad’; the claim omits that qualification and implies they uniformly cause and perpetuate inequity. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The 2014 Lancet-Oslo Commission concluded that health must no longer be regarded only as a technical, biomedical issue, and that global cross-sectoral action and justice are needed to address health inequality.

    “In adopting this definition, our report builds on the 2014 Lancet-University of Oslo Commission on Global Governance for Health (Lancet-Oslo Commission), which concluded that “we must no longer regard health only as a technical, biomedical issue, but acknowledge the need for global cross-sectoral action and justice in our efforts to address health inequality.”4”

    From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [4]

  • Global health hazards require a coordinated, multi-sectoral global response.

    “(iv) they require a coordinated, multi-sectoral global response.”

    From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [4]

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Authors
Ottersen, O. P., Dasgupta, J., Blouin, C., Buss, P., Chongsuvivatwong, V., Frenk, J., Fukuda-Parr, S., Gawanas, B. P., Giacaman, R., Gyapong, J., Leaning, J., Marmot, M., McNeill, D., Mongella, G. I., Moyo, N., Møgedal, S., Ntsaluba, A., Ooms, G., Bjertness, E., Lie, A. L., Moon, S., Roalkvam, S., Sandberg, K. I., & Scheel, I. B.
Affiliations
  • University of Oslo (NO)
  • Institut National de Santé Publique du Québec (CA)
  • Fundação Oswaldo Cruz (BR)
  • Prince of Songkla University (TH)
  • Harvard University (US)
  • Ministry of Health and Social Services (NA)
  • Birzeit University (PS)
  • University of Ghana (GH)
  • University College London (GB)
  • Mandela Institute for Development Studies (ZA)
  • Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
  • Instituut voor Tropische Geneeskunde (BE)
Corresponding author
Ottersen, Ole Petter
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2014-02
Volume
383
Issue
9917
Pages
630-667
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(13)62407-1
OpenAlex
W2003767156
Cited by
683
References
172
Citations by year
2026: 30 · 2025: 41 · 2024: 26 · 2023: 46 · 2022: 33 · 2021: 93 · 2020: 80 · 2019: 70 · 2018: 55 · 2017: 47 · 2016: 63 · 2015: 57 · 2014: 40 · 2013: 1
FWCI
151.44
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • Harvard University
  • Harvard Global Health Institute
  • British Heart Foundation (RG/07/008/23674)
  • Universitetet i Oslo
  • Utdannings- og forskningsdepartementet
  • Direktoratet for Utviklingssamarbeid
  • Economic and Social Research Council (ES/F02679X/1)
Topics
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
  • Social Sciences › Political Science and International Relations › Public health and occupational medicine
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
health disparities, global governance, power disparities, multinational corporations, globalization, austerity, intellectual property, food security, irregular migration, violent conflict, public health policy, global health governance
MeSH terms
Health Policy, Humans, International Cooperation, Politics, Power, Psychological, Socioeconomic Factors, Global Health, Healthcare Disparities

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