Global action on social determinants of health.

702 Closing the gap in a generation is a rousing call. 1 Did the World Health Organiza-tion's Commission on Social Determinants of Health (CSDH) really believe it to be possible? Technically, certainly. Yes, there is a greater than 40-year spread in life expectancy among countries and dramatic social gradients in health within countries. But the evidence suggests that we can make great progress towards closing the health gap by improving, as the CSDH put it, the conditions in which people are born, grow, live, work and age. These include ensuring: equity for every child from the start, healthier environments , fair employment and decent work, social protection across the life course and universal health care. To make such progress, we must also deal with inequity in power, money and resources – the social injustice that is killing on a grand scale. At a more fundamental level, our vision is to create the conditions so that every person may enjoy the freedoms that lead to improved health – what we call empowerment. In the three years since Closing the gap in a generation was published, there is no question that there is much to make us gloomy: the global financial crisis and the steps put in place to deal with it have worse impacts on the poor and relatively disadvantaged; the persistence of bad governance nationally and globally; climate change and inequitable measures for mitigation and adaptation and, in many countries, an increase in health inequity. On the positive side, however, much has happened to support my claim that I am an evidence-based optimist. First at the World Health Organization (WHO) itself, the doubting voices (what do social determinants have to do with a disease control organization?) were countered by the argument that WHO could not possibly ignore what the CSDH called " the causes of the causes " of ill-health. Specialists across WHO, who formed the CSDH's knowledge network on priority public health conditions, showed that action on social determinants of health was fundamental to disease control programmes. 2 Importantly, a resolution was passed at the World Health Assembly in 2009 that called on WHO and all Member States to take action on the social determinants. Each of the WHO Regions has expressed interest in this issue. The WHO Regional Office for the Americas will make social determinants a theme for its publication Health in the Americas 2012, has developed …