Wealth, health and equity: convergence to divergence in late 20th century globalization.

INTRODUCTION OR
BACKGROUND: Debate over relationships between economic growth, wealth, health and health inequity is long-standing and ongoing. The main message of this paper is that economic growth, while necessary, is not a sufficient condition in itself for achieving equitable health. SOURCES OF DATA: This review surveys and draws on research into principal factors commonly linked with improving health-income, health care, individual behavior-suggesting, using work from the Commission on Social Determinants of Health, that these are better understood in a broader social determinants of health framework. AREAS OF AGREEMENT: The paper acknowledges that post-war globalization has seen significant growth, poverty reduction and greater economic resources at individual and household levels all of which can contribute to better health. But it also highlights renewing inequity in global health during the period. AREAS OF CONTROVERSY: It argues that over-reliance on market-driven growth, which fails to address deep-rooted social inequalities in economic resources key to accessing social determinants of health, and in the key determinants of health themselves have contributed to increasing inequity in health outcomes. GROWING POINTS: Commitment to market-driven growth remains evident in national policy-making worldwide. AREAS TIMELY FOR DEVELOPING RESEARCH: With increasing health inequity, and calamitous global economic events in 2008-09, the centrality of this commitment needs urgently to be reviewed.