Abstract
On 20 March 2015, Professor Johan Mackenbach of the Erasmus University Medical Centre was awarded a doctorate honoris causa by the Catholic University (Université Catholique) of Louvain, Belgium, for his outstanding contribution to the analysis of health inequalities in Europe and to the development of policies intended to address them. In this context, a debate took place between Professor Mackenbach, Professor Maniquet, a well-being economist, and a representative of the Federal Health Ministry (Mr. Brieuc Vandamme). They were asked to debate on three topics. (1) socio-economic inequalities in health are not smaller in countries with universal welfare policies; (2) Policies needs to target either absolute inequalities or relative inequalities; (3) The focus of policies should either address the social determinants of health or concentrate on access to health care. The results of the debate by the three speakers highlighted the fact that welfare systems have not been able to tackle diseases of affluence. Targets for health policies should be set according to opportunity cost: health care is increasingly costly and a focus on health inequalities above all other inequalities runs the risk of taking a dogmatic approach to well-being. Health is only one dimension of well-being and policies to address inequality need to balance preferences between several dimensions of well-being. Finally, policymakers may not have that much choice when it comes to reducing inequality: all effective policies should be implemented. For example, Belgium and other European countries should not leave aside health protection policies that are evidence-based, in particular taxes on tobacco and alcohol. In his final contribution, Professor Mackenbach reminded the audience that politics is medicine on a larger scale and stated that policymakers should make more use of research into public health.
Highlights
Johan Mackenbach (JM) is Professor of Public Health at the Erasmus University Medical Centre, Rotterdam, in the Netherlands
JM has acknowledged the role of Lorant and D’Hoore International Journal for Equity in Health (2015) 14:97 ethnicity and migration as other important determinants, in a globalised world [8]. Another important contribution was to move away from description and to pay attention to both risky behaviour [9, 10] and healthy behaviour [11]. As these behaviours are affected by public policy, he scrutinised the performance of public health policies in Europe and found that, for a given income level, some countries, including a rich country like Belgium, could do much better [12, 13]
Should-we aim to reduce inequalities in health care, or in health behaviours, or in the structural determinants of health? BV emphasised two priorities from the point of view of the government: improving access to health care and reducing financial barriers to health care
Summary
JM is Professor of Public Health at the Erasmus University Medical Centre, Rotterdam, in the Netherlands. Lorant and D’Hoore International Journal for Equity in Health (2015) 14:97 ethnicity and migration as other important determinants, in a globalised world [8] Another important contribution was to move away from description and to pay attention to both risky behaviour [9, 10] and healthy behaviour [11]. As these behaviours are affected by public policy, he scrutinised the performance of public health policies in Europe and found that, for a given income level, some countries, including a rich country like Belgium, could do much better [12, 13]. He helped to put policies and political factors [14, 15] back on the research agenda, in the last decade when economic crises were putting our health care system at risk [16]
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