Scientific journals usually do not comment on world events. This journal does, in our editorial pages. Public health nutrition, as distinct from clinical nutrition, is concerned with the social (including political), economic and environmental determinants of well-being, health and disease, as well as the biological and behavioural causes of disease(1). Public health, which includes public health nutrition, has a very broad responsibility. We are not politicians or economists, but we do need to be aware of the events that bear down on public health and their impact on our work. In our field, there is reliable witness to the devastation of public health in countries whose resources and integrity have been drained or crushed by foreign debt and by invasion and war(Reference Black, Morris and Bryce2).
The end of individualism
The immediate biological causes of disease are just one aspect of health, and economic, social and environmental factors are usually more significant. By their nature, epidemics are not diseases of multiplications of individuals. It is obviously absurd to attribute undernutrition, tuberculosis or shistosomiasis merely to unwise ‘lifestyle’ choices. The children of families in Somalia, Haiti and Afghanistan often suffer from continuous debility, but this is not because their mothers neglect to read the nutrition labels in local supermarkets. The same general point applies to obesity, cancer and osteoporosis. Such conditions and diseases, currently more common in higher-income countries, also have deeper causes.
A new beginning
A few years ago, the WHO rather boldly appointed a Commission on the Social Determinants of Health. Its report, with the challenging title Closing the Gap in a Generation – Health Equity through Action on Social Determinants of Health, is now published(3). Some of its most prominent statements, emphasised by a drafting group headed by Commission chair Michael Marmot of University College, London, are unusually to the point; thus: ‘Social injustice is killing people on a grand scale’.
The Commission’s report is now resonating in a way that could not have been foreseen at the time it was commissioned. Its analysis and conclusions, well supported by evidence gathered as its work was developed, contain no surprises for a farmer and his family in Mexico, a smallholder and her children in Kenya, or an adolescent worker in a special economic zone in China, should they have time to read it. The main importance of the report is its agenda-setting qualities, where it reminds decision makers, as well as those of us who are training tomorrow’s decision makers, about the lack of fairness in the shares of health, wealth and access to good food and decent housing that children are provided with, within and between countries(Reference Black, Morris and Bryce2, Reference Boerma, Bryce, Kinfu, Axelson and Victora4).
The role and development of this journal
This journal will play its part. Undernutrition especially of mothers and children in lower-income countries and in impoverished communities everywhere, recently addressed in our editorial pages(Reference Margetts5–Reference Waterlow7) as well as in the Lancet series of papers on maternal and child undernutrition(Reference Bryce, Coitinho, Darnton-Hill, Pelletier and Pinstrup-Andersen8–Reference Victora, Adair, Fall, Hallal, Martorell, Richter and Sachdev12), will remain one of our main themes. In this issue, in the wake of the Social Determinants report, we have assembled a substantial series of papers from all over the world concerned in one way and another with equity. Also, as from the next issue, the first for 2009, we are strengthening our editorial pages. Signed editorials such as this one will remain at the front of the journal, and the other editorial pages, including invited commentaries, our Out of the Box column and correspondence, will be grouped at the back of the journal, restyled in order all to be available on-line in due course.
The editors wish all our readers a contemplative Christmas/alternative other December holiday and a sociable New Year.
