Major inequalities in health and life expectancy persist worldwide, according to an independent World Health Organization commission which on Thursday called for all countries to offer universal health care.
Huge discrepancies also exist within countries, including Scotland where a boy born in the deprived Glasgow suburb of Calton can expect to live 28 years less than one born in affluent Lenzie, just 13 km (8 miles) across town, it said.
"The health inequities we see in the world are absolutely dramatic in their scale," said Michael Marmot, a WHO health researcher, who chaired the commission, told reporters.
"Between countries we have life expectancy differences of more than 40 years. A woman in Botswana can expect to live 43 years, in Japan 86 years."
The Commission on Social Determinants of Health, composed of 19 independent experts, handed over its findings to the World Health Organization (WHO). The United Nations agency ordered the report three years ago.
"One of the recommendations in the Commission's report is that there should be universal health care systems that are available to people regardless of ability to pay," said Marmot, head of the epidemiology and public health department at University College London.
"Virtually all advanced countries have universal health care systems but we don't think that should be limited to high-income countries. We think that could be much more broadly available," he added.
The sustainability of health care systems is a concern for all countries, amid growing "commercialization" of services, according to the commission. It favored financing health care through general taxation and/or mandatory universal insurance.
Systems must be based on access to primary health care, which in poor areas could target the most disadvantaged groups first. Brazil and Venezuela offered examples of how large-scale targeted health care programs can work towards universalism.
"We are distressed by the reports we see of health care simply being unavailable to people because of inability to pay. We see that throughout low- and middle-income countries," Marmot said.
Health care is also a key issue in the U.S. presidential campaign, with both Democrat Barack Obama and Republican John McCain proposing to fix what they call a broken system.
45 million in U.S. are uninsured
Some 15.3 percent of Americans had no public or private health insurance in 2007, down from 15.8 percent in 2006, according to the latest U.S. figures released on Monday. A total of 45.7 million people were uninsured, down from 47 million.
"It's not perhaps the best use of the money that is being spent. And there are a lot people who feel that and would actually like to see coming out of the current campaign in the U.S. proposals for a universal health insurance," Marmot said.
Margaret Chan, WHO director-general, said WHO's Executive Board would examine the report at its January meeting and submit proposals to the annual meeting of its 193 member states in May.
Chan said that focusing on the "upstream" causes of poor health should lead to better disease prevention programs.
"The importance of prevention continues to grow, partly because of escalating health care costs. We simply cannot afford the way we go about doing health care nowadays without tackling and doing more prevention," she said.
Economics Nobel laureate Amartya Sen, former Chilean president Ricardo Lagos Escobar and former Mozambique health and foreign minister Pascoal Mocumbi served on the commission.