1. ^aCentre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON M5B 1W8, Canada
2. ^bDepartment of Medicine, University of Toronto, Toronto, Canada
3. ^cDepartment of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
4. ^dDivision of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada

Abstract

The Commission on Social Determinants of Health recognized the important role of health services as a determinant of health. While asserting that health was not a tradable commodity but rather a right, the Commission missed an opportunity to address how such a concept might remove a health care system from market forces. Examples include ensuring universal access to health care, not just universal insurance, severely limiting or eliminating profit-making in the delivery of health care services, and aggressive price regulations for the public good. While the Commission was appropriately sceptical of privileging efficiency as a principle for prioritization, it missed an opportunity to address how equity concerns can be incorporated into resources allocation decision making. A social justice orientation to the delivery of health care could serve as an important catalyst for equity-oriented health service change but the process is more complicated and political than that outlined in the Commission's report.