Equity and health Who cares about health for all in the 21st century?

This paper regrets the retreat in the 1990s from a focus on health as a social good that results from good social policy. It highlights the importance of the People’s Health Movement and the WHO Commission on the Social Determinants of Health as offering a chance to return to a more socially just quest for equity and health. I t’s been a peculiar century so far. It started off with the great and lofty thoughts that accompany centennial change. Millennium summits, domes, and plans for a peaceful century in which human health and wellbeing blossomed. With amazing rapidity, in the wake of 11 September 2001, it deteriorated into a century of funda-mentalisms, acute fear of terrorism, and an unprovoked attack on a sovereign state that was not backed by the United Nations or the majority of citizens of the countries going to war. The aftermath of the war in Iraq has become a public health nightmare1 and there are few signs of the flourishing of democracy that was meant to justify the war. Meanwhile the deeper causes of global instability persist and the USA spends more on war than it does on tackling extreme poverty. Sachs estimates that eight million people die each year because they are too poor to stay alive.2 The 21st century, then, is proving to be a disaster for Africa and many other post-colonial states who face economic dis-aster under the burden of crippling debt and the onslaught of both old (such as malaria) and new infectious diseases (most notably HIV/AIDS). Life expec-tancy in Africa is going backwards for the first time in over a century.3 Meanwhile the populations of OECD countries are experiencing growth in wealth and prosperity, albeit with increasing inequities between the rich and poor.