Coming to the Social/Natural selection approach to studying health inequalities, the dominant theory is drawn from Social Darwinism, where health inequalities are seen as a result of cold apathetic processes of Mother Nature with its motto being ‘survival of the fittest’. The pervasive finding that wealth is directly related to health, whether measured at the level of nations or at the level of individuals, might lead one to the inference that these ‘income/health gradients’ are inevitable. They might seem “to reflect the natural ordering of societies along some fixed, idealized teleology of economic development. At the individual level, the gradient might appear to be the result of the natural selection of the most “fit” members within society who are thus better able to garner socioeconomic advantage.” (Daniels, et.al, 1999, p.215) But we should remember that human beings are unique in their capacity to supersede their natural inclinations. Moreover, altruism and compassion toward fellow humans are not qualities ‘outside’ natural behaviour. To this extent, the Social/Natural Selection view of health inequalities should be treated critically. In a similar vein, the Constructionist/Artefact approach to health also reveals fundamental social injustices.
As an acknowledgement of the injustices, inequalities and disadvantages inherent in the dominant biomedical model, and also as a consolidation of the insights offered by sociological explanations of inequalities in health, a consensus is emerging within the international community toward the formation of a more equitable public health system. Such conceptions as the international development targets, which were discussed in recent WHO meetings try to deal with diseases of poverty head on. Simultaneously, there has been a growing concern from private corporations to involve themselves in civil society organizations. The global health initiative is a product of these developments. The report by WHO Commission on the Social Determinants of Health (CSDH) suggests a comprehensive array of changes to give all societies world class health care. These recommendations could have the widest impact on patients, families, and communities, including treatment of people with substance abuse and more aggressive management of obesity. If implemented properly, we may see a more equitable global health system in the not-distant future. But for this dream to be fulfilled, private corporations and government health agencies need to put in concerted and coordinated efforts based on shared values. In these times of radical change to the economic organization of the world, the need to build bridges between medicine and public health and between ethics and human rights become all the more important. (Lietz, 2006, p.372)
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