Last year, the World Health Organisation’s Commission on the Social Determinants of Health (CSDH) released its final report after a long process of evidence gathering, consultations with governments and civil society groups, and careful deliberation.

The report described many of the fundamental determinants of poor health and inequality. It stated in stark terms that “social injustice is killing people on a grand scale” and that the unequal distribution of health-damaging experiences “is not in any sense a ‘natural’ phenomenon, but is the result of a toxic combination of poor social  policies and programmes, unfair economic arrangements, and bad politics”.

Two weeks later, Global Health Watch 2, an alternative world health report, was released and echoed many of the findings of the CSDH. It noted: “The current paradigm for development is fatally flawed and ineffective – it does not deliver on poverty reduction; it does not deliver on reducing greenhouse gas emissions; and it does not deliver on health. On the contrary, it is rigged in many ways to do the opposite”. Today, as the global financial crisis unravels and leads into a global economic recession, there is even more need for fundamental reforms to the way economic arrangements are governed at the global level.

A critical recommendation of the CSDH was for the international community to re-commit to “a multilateral system in which all countries, rich and poor, engage with an equitable voice”. The report argued that it would only be through “a system of global governance that places fairness in health at the heart of the development agenda and genuine equality of influence at the heart of its decision-making”, that coherent attention to global health equity would be possible.

Presently, the response to the global financial crisis has been woefully inadequate. Instead of the fundamental reforms required, a shallow and incomplete set of policy options have been proposed. Instead of an inclusive and democratic process, global economic policies and systems look set to be framed by the G20, an informal grouping of countries dominated by rich nations and without the mandate and authority of the United Nations.

The injustice of trillions of dollars being committed to bail out the failed banking systems and high consumption economies of rich countries while rich country governments are already making cuts in their development assistance budgets, has not gone un-noticed.

At the same time, the rise in food prices that occurred last year, the prospect of shrinking public budgets, and the growing threats of climate change represent a global health emergency for millions of people.

Although it is natural to feel over-whelmed by the enormity and complexity of these challenges, basic public health principles actually offer a pathway for reform. By placing health and other social goals at heart of policy making, the decisions and actions required to simultaneously tackle poverty, climate change and global inequity become more readily apparent.

We hope eg4health will help you and your organisation to take action.