National Association of County & City Health Officials  [Printer-friendly version]
March 16, 2005


Resolution 05-02

WHEREAS, according to the Ottawa charter of the World Health
Organization, "The fundamental conditions and resources for health are
peace, shelter, education, food, income, a stable ecosystem,
sustainable resources, social justice and equity. Improvement in
health requires a secure foundation in these basic prerequisites."[1]

WHEREAS, multiple UN Human Rights documents and charters establish the
linkage between equity, social justice, human rights, and health and
specifically Article 25 of the Universal Declaration of Human Rights,
adopted by the United Nations General Assembly in 1948, states
"Everyone has the right to a standard of living adequate for the
health and well-being of himself and of his/her family, including
food, clothing, housing, and medical care;"[2] and

WHEREAS, with regard to almost every disease and chronic illness,
socioeconomic disadvantage causes or contributes to early death and
preventable disease and principal causes of socioeconomic disadvantage
are classism, racism, and sexism;[3] and

WHEREAS, social justice is a core value of public health, and the
birth of public health was rooted in the principles of social
justice;[4] and

WHEREAS, inequities in the fundamental resources and conditions needed
for health are avoidable; and

WHEREAS, health inequities harm the entire society, wasting human
potential and financial resources; and

WHEREAS, the disadvantages producing inequitable outcomes in health
status are interconnected, cumulative, intergenerational;[5]

THEREFORE, BE IT RESOLVED THAT the National Association of County and
City Health Officials (NACCHO) supports the incorporation and adoption
of principles of equity, social justice, and human rights into social
policy, public health curricula, workforce development initiatives,
and in the design of program evaluation measures, as strategies to
maximize health outcomes and minimize health inequities; and

BE IT FURTHER RESOLVED that NACCHO supports the transformation of
public health practice to include: a) training in the principles and
practice of equity, social justice, and human rights, b) inclusion of
the principles of equity, social justice, and human rights in public
policy and c) the development and regular application of social
indicators that measure the nation's social health and well being,
including inequities in health status, on a regular basis, similar to
the way the nation uses economic indicators; and

BE IT FURTHER RESOLVED that NACCHO will collaborate with partner
organizations, government agencies, and community groups in the
promotion of equity, social justice and human rights as a critical
strategy to improve health outcomes and decrease health inequities

Proposed by Health and Social Justice Committee

Adopted by NACCHO Board of Directors March 16, 2005


[1] World Health Organization, Ottawa Charter for Health Promotion,

[2] Note, this was also echoed in the constitution of the World Health
Organization and was ratified by subsequent international covenants
and conventions. For a detailed discussion of health and human rights,
see Sofia Gruskin and Daniel Tarantola, "Health and Human Rights," in
R. Detels, J. McEwen and R. Beaglehole, H. Tanaka, eds. Oxford
Textbook on Public Health. Oxford, England: Oxford University Press,
2002: Chapter 4. See also United Nations, Office of the High
Commissioner for Human Rights, International Covenant on Economic,
Social and Cultural Rights, Geneva: Switzerland, 1976.

[3] Douglas Black, Margaret Whitehead, et al. Inequalities in Health,
Harmondsworth: Penguin, 1992; Donald Acheson, Independent Inquiry into
Inequalities in Health. London: The Stationery Office, 1998. Available
from the Publications Centre, PO Box 276, London SW8 5DT; Kawachi,
Ichiro, Bruce P. Kennedy, and Richard G. Wilkinson. The Society and
Population Health Reader: Income Inequality and Health. New York: The
New Press, 1999; James W. Lynch and George A. Kaplan, "Understanding
How Inequality in the Distribution of Income Affects Health" 2 Journal
of Health Psychology (1997): 297-314; Kawachi, Ichiro. "Income
Inequality and Health," in Social Epidemiology, Lisa Berkman and
Ichiro Kawachi, eds. New York: Oxford University Press, 2000; R. G.
Wilkinson, Unhealthy Societies. New York,: Routledge, 1996; Mary Shaw,
Danny Dorling and George Davey Smith, "Poverty, Social Exclusion and
Minorities," in Social Determinants of Health, Michael Marmot and
Richard Wilkinson (eds.) New York: Oxford University Press, 1999;
Ichiro Kawachi and Bruce Kennedy; Dennis Raphael, "The Question of
Evidence in Health Promotion" 15 Health Promotion International
(2000): 355-67. It should be noted that the documentation of the
relationship between health inequalities and income inequality was
developed in the 1970s. See for example, A. Wagstaff and E. Van
Doorslaer, "Income Inequality and Health: What Does the Literature
Tell Us? 21 Annual review of Public Health (2000): 543- 67.J.W. Lynch
with George Kaplan, E.R. Pamuk, et al. "Income Inequality and
Mortality in Metropolitan Areas of the United States." American
Journal of Public Health 1998; 88:1074-1080; David R. Williams with C.
Collins. "U.S. Socioeconomic and Racial Differences in Health:
Patterns and Explanations." Annual Review of Sociology. 1995;
21:349-386; Commonwealth Fund. U.S. Minority Health: A Chartbook. New
York, May, 1999; R.G. Evans, M.L. Barer, and T.R. Marmot, eds. Why Are
Some People Healthy and Others Are Not? Determinants of Health of
Populations. New York: Aldine de Gruyer, 1994.

[4] See Christopher Hamlin, Public Health and Social Justice in the
Age of Chadwick: Britain 1800-1854. London: Cambridge University
Press, 1998; Nancy Krieger, "A Vision of Social Justice as the
Foundation of Public Health: Commemorating 150 Years of the Spirit of
1848," 88 (11) American Journal of Public Health (November, 1998):

[5] See George Davey Smith, C. Hart, D.Blane, C. Gillis, and V.
Hawthorne. "Lifetime Socioeconomic Position and Mortality: Prospective
Observational Study" 314 British Medical Journal (1997): 547-52; D.
Kuh and Y. Ben-Shilmo, A Lifecourse Approach to Chronic Disease
Epidemiology. Oxford: Oxford University Press, 1997.