Marmot, M. 2007.

"Achieving health equity: from root causes to fair

outcomes." Lancet 370(9593): 1153- 63.

Women live longer than men- probably due to biological factors.

Marks of inequity appear when women have the same or lower life expectancy than men-
suggesting the influence of social factors.

Right to equal access to wealth as enshrined in WHO charter requires action to alleviate
social determinates of health.
- Greater health is enabling and for the ultimate benefit of society.

Empowerment and Freedom

Crucial need for empowerment and freedom which creates significant problems in access, in
everyday life.

3 realms of empowerment:
1. Material- need basic material pre- requisites
2. Psychosocial- need control over lives
3. Political- need voice and participation in decision making.
Requires collective action by individuals, institutions, state and civil society actors.

Inequity between men and women as important for health implications as social gradient.

AIDs epidemic in Southern Africa feminised as a women’s issue.

Reflects disempowerment at all levels from village to international levels.
- Leads to lack of economic assets, restrictions on mobility, reproduction and violence
against women.

SEWA (Self- employed women’s association) India

Poor, self- employed women vegetable sellers of Ahmedabad work from early times and
often must borrow money to buy produce- leading to harassment from local authorities.

SEWA a way of striking against this:

- Linking together of sellers to create wholesale vegetable shop- cuts out middle man.
Has led to improved income.
- Organisation of childcare as an entitlement.
- Improvement of slums through water and sanitation upgrades- in cooperation with
other sectors.
- Provision of small loans- without high interest rates of private loaners. Bank is
owned by its members- has elected board of female workers.
- Collectively organised health insurance for health cost- help prevent crises.
- Formal recognition through identity cars and licenses to stop local authority
harassment.
Marginalisation of women in India is significant. SEWA acts to challenge the legal systems to
be less discriminatory.
Conditional Income Transfer (Bolsa Familia), Brazil
Launched in 2003
Attempt to help the poorest in society and reduce poverty levels. Poor often not connected
to water and sewage, have poor education and lowered employment opportunities.

Conditional cash transfer to poorest families to address poverty and inequality.

- Stipulation that Children should regularly attend school between ages 7-15.
- Children 0-6 vaccinated and monitored.
- Prenatal care for women.