Key Themes from the World Conference on Social Determinants of Health
The Rio Political Declaration on Social Determinants of Health reaffirms that “health inequities within and between countries are politically, socially and economically unacceptable, as well as unfair and largely avoidable, and that the promotion of health equity is essential to sustainable development and to a better quality of life and well-being for all, which in turn can contribute to peace and security.” The declaration was adopted at 5 pm on Oct. 20, 2011 in Rio de Janeiro, Brazil.
In the declaration the countries pledge to:
1. Adopt better governance for health and development;
2. Promote participation in policy-making and implementation;
3. Further reorient the health sector toward reducing health inequities;
4. Strengthen global governance and collaboration;
5. Monitor progress and increase accountability;
6. Call for global action;
Now that the WHO World Conference on Social Determinants of Health is over, what will countries do to reduce inequities for their citizens? During the conference, experts from all over the world had advice and evidence from successful programs.
The main point that experts stressed is the importance of a multi-sectoral approach to health and reducing inequities. U.S. Department of Health and Human Services Secretary Kathleen Sebelius pointed out that the health sector cannot do it alone and that they must look to the education sector and transportation sectors among other things, to improve the lives of people. She gave the examples of schools providing healthier lunches and the transportation sector making it easier for people to walk and bike. She also stressed the importance of health in all policies. This point was stressed by a number of other speakers, as the general consensus seemed to be that ministers from across sectors must join together to make decisions. Another point that was addressed through much of the conference is the importance of sharing ideas within and between countries to address challenges.
Most participants emphasized the important role that politics plays on health. Margaret Chan, director-general of the WHO, stated that health is always political and that looking at it as merely a technical issue misses the big picture. According to Dr. Chan, health is a barometer that informs society when something is wrong. Other speakers stressed the importance of political will.
Purnima Mane of UNFPA emphasized the importance of context specific work and tailoring projects so that they are developed with and by communities. She says that recognizing, addressing and working with different cultures to develop new policies is key. She believes that it is up to people to make resolutions, holding their governments accountable in order to affect change.
A topic that came up again and again was the economic crisis and its effect on health policies as government money is spread thin across sectors. It was often referred to as the competing crises. Dr. Chan called upon governments to set their people’s health as a priority over the health of their businesses, especially as the crisis deepens. Secretary Sebelius pointed out that tough economic times are when people should especially focus on health as it will save governments a great deal of money in the long run. Currently in the United States, 75 cents of health dollar is spent on chronic disease. The Chair of the Commission on Social Determinants of Health, Sir Michael Marmot, said every dollar invested in early childhood, $7 are saved. He also asserted that it is not an economic argument, but a moral one as poor health is a social injustice and that it has a social gradient as middle income families also have more poor health outcomes than rich families.
There was some opposition to the declaration, particularly from civil society groups, which wrote an alternative Rio Declaration. They made a number of demands in their alternative document, but in particular mentioned an anti-poverty agenda. They target big corporations specifically in this document. In addition, David Sanders, of the University of Western Cape and the People’s Health Movement, who received a standing ovation for his remarks, pointed out that there was no reference in the declaration to unfair trade in skilled personnel and believes that there should be compensation for what he referred to as “brain robbery.” He also blamed agricultural subsidies for food insecurities.
In light of this opposition, many public health leaders responded saying that the Rio Declaration is a stepping-stone and the impact that it has will be up to the people. The international health community now has a clear direction and the commitment and there are no limits to what can be done. Now that this document is endorsed, it is up to us to push the Social Determinants of Health Agenda forward.
The speakers called everyone to action and said that it is time to work for sustainable health and social development all over the world. Universal coverage is important because of social protection, social justice and equity, but universal access does not always mean equitable access and countries need to keep this in mind when setting new health agendas.
This conference acknowledged that there is a lot of work yet to be done in terms of equity and the social determinants of health. Today there is a 36-year gap in life expectancy between countries. A child born in Malawi is expected to live for only 47 years, while one in Japan could live for as long as 83 year. These are only a fewexamples of the inequities that exist around the world. Will the Rio Declaration be enough to mobilize the international community to create change?
It is certainly a step in the right direction.
Gahan Furlane is a blogger for GLOBAL HEALTH Magazine.