By The Lancet Public Health, October 17, 2019
On Oct 1, 2019, the Pan American Health Organization (PAHO) published Just Societies: Health Equity and Dignified Lives, the report of the Commission on Equity and Health Inequalities in the Americas—a Commission established by PAHO, chaired by Sir Michael Marmot, and tasked to analyse the effect of drivers influencing health, while proposing actions to address health inequalities in the region.
The report finds that, although there have been substantial health improvements in the region over the past 20–30 years, these have not been shared across its diverse countries and individuals. The PAHO Commission advocates for far-reaching policy changes that address a colonial legacy of power imbalance, structural racism, and current wealth inequalities to achieve a more equitable health future.
The region of the Americas as a whole has seen average life expectancy increase over the past decade, but at the country level average life expectancy ranges widely—from 66 years for women and 60 years for men in Haiti to 85 years for women in Bermuda and 80 years for Canadian men. This disparity between countries is repeated across a multitude of health outcomes, including a difference of up to 18 years in average years of healthy life, an under-5-year-old mortality that ranges from less than ten up to 70 per 1000 livebirths, adult mortality due to tuberculosis ranging from 0 up to 25 per 100 000 population, and a homicide rate that ranges from less than five per 100 000 population in Canada and Chile up to a staggering 70 per 100 000 population in El Salvador. These figures highlight the huge differences in life outcomes between the countries of the Americas, but most striking are the within-country disparities between people of different economic and demographic backgrounds.