13.6 Social determinants of health: outcome of the World Conference on Social Determinants of Health (Rio de Janeiro, Brazil, October 2011)

On this page

• documents
• the issues before the Assembly
• PHM comment pre debate (and statement)
• report of debate
• PHM comment post debate

Documents

See secretariat documents A65/16 and EB130/2012/REC/1, resolution EB130.R11
Statement read to Committee A
See also WHO Watch Comment and Report from EB130

The issues before the Assembly

 The Commission on the Social Determinants of Health was established by the Director-General of WHO in spring 2005 as a, “global network of policy makers, researchers and civil society organizations”(see more) to address social causes of illness and issues of inequity. It issued its final report in 2008 (Closing the Gap in a Generation). Resolution (WHA62.14) on SDH requested the DG to convene a global event before WHA65 in order to discuss renewed plans for redressing the alarming trends of health inequities through actions on the SDH.

(A65/16) is the report by the Secretariat on the process and outcome of the World Conference on Social Determinants of Health (Rio de Janeiro, Brazil, 19–21 October 2011), and also summarizes progress on the implementation of resolution WHA62.14.

The WHA65 is invited to adopt the resolution (EB130.R11) (Outcome of the World Conference on SDH), which includes identified actions for member states (and particular actions for the donor countries), for the ‘international community’ and for the Secretariat.

PHM pre debate comment

Action on the SDH is a critical component of Primary Health Care (Declaration of Alma-Ata 1978) and a prerequisite of eliminating health inequities. The PHM welcomes the progress in the analyses mandated by Resolution WHA 62.14. However in the absence of any provision in the new GPW framework for the management and accountability for cross cutting issues such as SDH carries a serious risk that this work will be allowed to wither.

A commitment to addressing the SDH needs to be incorporated into all aspects of policy making. Political will is an essential element for work on SDH including the political will of higher income countries to support moves to a more equitable and sustainable allocation of global resources. Many higher income countries have benefited unjustly from their relationships with lower income countries and should work to rebalance the maldistribution of power and resources.

“The social determination of health is much more than a collection of fragmented and isolated “determinants” that, from a reductionist viewpoint, are associated with classic risk factors and individual lifestyles. We must not allow the concept of social determinants of health to become banal, co-opted or reduced merely to smoking, sedentary behavior and poor nutrition, when what we need is to recognize that behind those symptoms and effects lies a social construction based on the logic of a globalized hegemonic culture whose ultimate goal is the commercialization of life itself.” (Civil Society Position, Rio) The social determination of health need to be properly embedded in policy-making around non-communicable diseases, too, so as to not stigmatise individuals while letting corporate agents off the hook or dismissing the socio-economic causes of the causes.

WHO is properly concerned with measurement and evaluation. However, unless the indicators adopted for monitoring various programs are disaggregated using meaningful stratifiers, progress on the SDH remains invisible. We call for continued research, monitoring and evaluation, health impact assessments, and support to address the root causes of the inequities underlying the SDH.

WHO has a leading responsibility to demonstrate leadership on SDH within the UN system. There is a need to further develop the capacity of the Secretariat to provide technical assistance in the implementation of the Rio Declaration. We also urge Member States to approve the necessary funding for the work on SDH as detailed in the respective Report on financial and administrative implications.

WHO has a key role in ensuring that initiatives to address the SDH are included in other UN deliberations and programs, e.g. Rio+20 and the post-2015 development framework. The Health in All Policies approach demands that SDH are addressed in areas such as trade, taxation, TNCs, financial institutions, and privatization of social programs.

A major consideration is how to manage the conflicts of interest within global health decision-making institutions and we call for a code of conduct to help facilitate this process.

Statement read to Committee A

Report of discussion at WHA65

Several member states reported on progress with respect to SDH in their countries including Trinidad and Tobago, Iran, Algeria, Japan, and Chile.

Nearly every country expressed appreciation to WHO and the country of Brazil for organizing and hosting the World Conference on the Social Determinants of Health in Rio de Janiero, Brazil in October, 2011, and emphasized the importance of keeping SDH high on the agenda. Due to the fact that the inclusion of SDH in the Global Program of World as a category versus an overarching “priority” had already been discussed at length in an earlier session on WHO reform in which countries had expressed their views on and commitment to including SHD in their work and due to the late hour at which this issue was discussed, no substantive debate took place.

Many countries urged the WHO, and each other, to retain their commitment to work on SDH and to translate that into action. They also urged WHO to hold a leading role in moving this agenda forward and supporting Member States as they faced challenges within their specific country contexts. It was acknowledged that effective progress on the SDH would require partnerships within and among sectors and collective action.

Furthermore, member states called for WHO to ensure that health remains prominent in the upcoming Rio+20 Conference and to consider the five key areas in the 2011 Rio declaration in the ongoing WHO reform process. Demark emphasized the need to ensure that health inequities are taken into account in the Helsinki Conference on health promotion and several countries including Brazil, Denmark, and Thailand all highlighted the importance of developing the “health in all policies” approach which will be the focus of that meeting. Member States including Denmark, Iran, and India emphasized health systems (variously health systems strengthening, universal health coverage, and primary health care) as critical infrastructure for driving the SDH approach to address health inequality. Member states addressed the need to promote international cooperation and solidarity to address wide gaps between and within countries. Norway also emphasized the need for resources to be allocated towards these ends.

Civil society urged WHO to recognize migration as a determinant of health during the Helsinki conference; to improve upon civil society and young person’s participation in policy making; and to ensure that SDH indicators adopted for monitoring various programs are disaggregated using meaningful stratifiers.

The resolution passed without any amendments.

Post debate comment

The SDH department within WHO has been seriously underfunded since the closure of the CSDH. Presumably this reflects donor choice. Hopefully the positive comments of Norway, Belgium and Brazil may presage some additional funding when the financing dialogue takes place.

SDH is properly regarded as a cross-cutting issue with implications for communicable disease, non-communicable disease, health systems and emergencies. However, it is also an area of technical expertise with responsibilities for supporting both regions and countries and identified projects (such as HIAP) through which to drive the SDH approach.

The DG has indicated that SDH and other cross-cutting issues will be located in her office and she will take personal responsibility for ensuring it is mainstreamed. However, there has been no elaboration of a methodology to support planning, budgeting, accoutability and advocacy in relation to both the cross cutting dimensions and the technical support/ project work.