Nineteen years ago, here in Rio de Janeiro, nations of the world agreed to put sustainable development at the centre of concerns for human development. One important aspect of sustainable development is equity between generations. However, an equally important aspect is equity within generations. A society with large social inequalities is not a sustainable society. Sustainable development depends on equitable societies.
For equity in health, equal and universal access to health care is important. But the fact that social determinants influence our health shows that our efforts to reduce health inequalities must go beyond health care. Our efforts must include:
- more equal opportunities for childhood development and education
- more equal opportunities for work in healthy work environments
- sufficient material and economic resources
- more equal opportunities for healthy life choices across the life course.
Social inequalities in health do not only concern vulnerable groups. This is not only about the healthy “us” doing something good for the unhealthy “them”. Policies to reduce health inequalities cannot rely solely on targeted measures. They must be combined with universal measures that reach whole populations. Research has shown that universal social policies often are more efficient for vulnerable groups than targeted measures. The key to success is to strike the right balance between targeted and universal policies.
Health inequalities constitute a challenge that is shared among all nations of the world. Even in my own Oslo, the capitol of one of the richest countries in the world, health inequalities are unacceptably large. Although challenges are bigger elsewhere in the world, I believe local engagement is a prerequisite for global action.
Also, global action often is a prerequisite for local change. Many of the main public health threats, like the harmful use of alcohol, will be impossible to address without international cooperation in the fields of regulation and trade. It takes courageous political leadership to counter strong market forces. But where the distribution of goods is left to market forces alone, equity will be the sacrifice.
Only by meeting, discussing, exchanging experiences and cooperating in conferences like this can we meet our common challenges and better our common future. We cannot hope to achieve more equity without more cooperation. I would like to end this statement by giving my warmest thanks to my colleagues in the Brazilian government for hosting this important event. I know the city of Rio de Janeiro has some inequity challenges of its own. But in the world of international politics, “Rio de Janeiro” means broad cooperation, bold achievements and political agreement. Let us together honour this tradition.