PHA-Exchange> Launch of WHO Commission on Social Determinants of Health

[María Hamlin Zúniga]

Our congratulations to Fran Baum, Commissioner! 
  _____  


 <http://www.who.int/en> 

  _____  

 

The President of Chile and the WHO Director-General launch global Commission
to tackle the "causes behind the causes of ill-health"

 

Today, the President of the Republic of Chile, His Excellency Mr Ricardo
Lagos Escobar and World Health Organization Director-General, Dr LEE
Jong-wook launched the Commission on Social Determinants of Health, a new
body to spearhead action on the social causes behind ill-health.

The new Commission includes leading global experts on health, education,
housing and economics. Commissioners will work to recommend the best ways to
address health's social determinants and safeguard the health of poor and
marginalized populations, and to break the "poverty equals ill-health'
cycle.

"Social standing plays a big part in whether people will live to be 40 or
80, whether they will be treated for a curable disease, and whether their
children survive their fifth birthday. People should not die young because
they are poor. This commission will assist countries, no matter how rich or
poor, to implement strategies that will help people who are poor and
marginalized live longer, healthier lives," said Dr Lee at the official
launch in Santiago, Chile. "This effectively places the needs of the
disadvantaged first on the health agenda in the 21st century."

Social determinants are the conditions in which people live and work. They
are the "causes behind the causes" of ill-health. They include poverty,
social exclusion, inappropriate housing, shortcomings in safeguarding early
childhood development, unsafe employment conditions, and lack of quality
health systems.

The core of the Commission's work will be to identify, evaluate, adapt and
distribute effective strategies to address social determinants, with the aim
of supporting governments to scale-up interventions. The Commission will
operate for three years from this month.

"A great share of health problems is attributable to social conditions, and
this is why the poor carry the greatest burden of ill-health. On a global
scale, we must ensure that health policies move beyond exclusively
disease-focused solutions and include the social environment," said
Commission Chair Michael Marmot. "I am honoured to be working with
Commissioners of such a high calibre. We will arm policymakers with the best
evidence to ensure that poverty does not sentence a person to a shorter,
unhealthy life."

Social determinants are intrinsically linked to inequities in health. They
help to explain why poor and marginalized people get sick and die sooner
than people in better social positions. They are a significant reason behind
the world's vast difference in average life expectancy, which ranges from 34
years in Sierra Leone (lowest in the world) to 81.9 in Japan (highest in the
world). Social determinants also account for the majority of health
inequities within countries. In Indonesia, under-five mortality is nearly
four times higher in the poorest fifth of the population than in the richest
fifth. In England and Wales, the latest data shows a 7.4 year gap in life
expectancy between men in professional occupations and men in unskilled
manual occupations (1997-1999 figures).

Some countries—such as Chile, Sweden, and the United Kingdom—are already
advancing innovative health programmes that address social determinants
through a comprehensive inter-sectoral approach. For instance, social
welfare programmes with benefits conditional on children's school
attendance, regular medical check-ups, and other health-promoting actions
are helping to reverse the "poverty equals ill-health" trend. Health
inequity assessments resulting in the declaration of "health action zones"
and health promotion campaigns targeting disadvantaged people are also
safeguarding the health of vulnerable groups.

The Commission will identify successful strategies now underway in
countries. It will work with national authorities to determine ways to
replicate success in other countries and settings. Whereas, to date, the
greatest progress in tackling social determinants has occurred in
high-income countries, the Commission will focus especially on identifying
and promoting policies applicable in developing countries, where the adverse
health effects of social determinants are greatest. Overcoming these social
barriers represents a prime opportunity to reduce global health inequalities
and ensure that health gains are sustainable over time.

The Commission will focus the attention of the world's top experts and
researchers on specific social determinants such as urban settings, social
exclusion, and employment conditions. These "Knowledge Networks" will push
the limits of current information to better define the links between social
determinants and health, particularly in developing countries.

The Commission on Social Determinants of Health will work with national
authorities to incorporate social determinants approaches into efforts to
meet the Millennium Development Goals (MDGs). The MDGs recognize the
interdependence of health and other social conditions, and present an
opportunity to promote health policies that tackle the social roots of
unfair and avoidable human suffering.

The Commission on the Social Determinants of Health 

 


Frances Baum: Australia 

Professor of Public Health, Flinders University, Adelaide; Global Steering
Committee, People's Health Movement 


Monique Bégin: Canada 

Professor Emeritus, Faculty of Health Sciences, University of Ottawa; former
Canadian Minister of National Health and Welfare 


Giovanni Berlinguer: Italy 

Member of European Parliament; Professor of Hygiene, Occupational Health and
of Bioethics (Emeritus), University "La Sapienza", Rome 


Mirai Chatterjee: India 

Coordinator of Social Security, Self-Employed Women's Association (SEWA) 


Manuel Dayrit: Philippines 

Secretary of Health, Philippines 


William Foege: USA 

Emeritus Presidential Distinguished Professor of International Health, Emory
University, and Gates Fellow; former Director of the US Centers for Disease
Control and Prevention 


Kiyoshi Kurokawa: Japan 

President of the Science Council of Japan 


Ricardo Lagos: Chile 

President of the Republic of Chile 


Stephen Lewis: Canada 

United Nations Special Envoy for HIV/AIDS in Africa 


Alireza Marandi: Iran 

Professor of Pediatrics at Shaheed Behesti University, Tehran; former
Minister of Health and Medical Education, Islamic Republic of Iran 


Michael Marmot: UK 

Commission Chair and Director, International Centre for Health and Society,
University College London 


Charity Ngilu: Kenya 

Minister of Health, Kenya 


Hoda Rashad: Egypt 

Research Professor and Director, Social Research Centre, American University
of Cairo; Member of El Shoura Council of the Senate 


Amartya Sen: India 

1998 Nobel laureate in economics; Lamont University Professor, Harvard
University, Cambridge 


David Satcher: USA 

Interim President of the Morehouse School of Medicine, Atlanta, Georgia;
former Surgeon General of the USA 


Anna Tibaijuka: Tanzania 

Executive-Director, UN-HABITAT 


Denny Vagero: Sweden 

Director of the Centre for Health Equity Studies (CHESS), Stockholm
University/ Karolinska Institute 

The Commissioners

Frances Baum

Frances Baum is Head of Department and Professor of Public Health at
Flinders University and Foundation Director of the South Australian
Community Health Research Unit. She is a past National President of the
Public Health Association of Australia. She is the regional representative
for the People's Health Movement in Australia and the Pacific, and a member
of its Global Steering Committee.

Professor Baum is one of Australia's leading researchers on the social and
economic determinants of health. Currently, she is the Lead Investigator on
a $2.4 million grant entitled the 'Australian Health Inequities Program'
funded by the Australian National Health and Medical Research Council.

Professor Baum's numerous publications relate to social and economic
determinants research and evaluation in community health, theories of health
promotion, Healthy Cities, social capital and health promotion, and the
political economy of health.

Giovanni Berlinguer

Dr Giovanni Berlinguer is a member of the European Parliament. He serves two
Commissions: "Environment and Health" and "Culture, Education and
Information".

Dr Berlinguer was responsible for Italy's first National Health Plan under
the Economic Development Programme approved by Parliament (1968). He served
in the Chamber of Deputies of Italy (from 1972 to 1983) and in the Senate of
the Republic (from 1983 to 1992). In the Italian Parliament, he worked for
the Commissions on environment and health.

Dr Berlinguer is currently a member of the International Bioethics Committee
of UNESCO (2001-2007) and rapporteur on the project "Universal Declaration
on Bioethics". He is one of the founders of Legambiente (the leading
environmental association in Italy), and has worked with Italian and
Brazilian unions on the relationship between work, health and security.

Ricardo Lagos Escobar

His Excellency President Ricardo Lagos Escobar is the President of the
Republic of Chile.

 
<http://www.presidencia.gob.cl/view/viewArticulo.asp?idarticulo=293&Seccion=
Biografia%20> Official presidential biography - in Spanish 

Monique Bégin

Dr Monique Bégin, PC, FRSC, OC, is Professor Emeritus, Faculty of Health
Sciences, and Visiting Professor, School of Management, University of
Ottawa.

A sociologist, Dr Bégin was the first woman from Québec elected to the House
of Commons. Re-elected three times, she was twice appointed Minister of
National Health and Welfare. She remains best known for the Canada Health
Act (1984). An academic since she left politics, Dr Bégin taught in Women's
Studies at Ottawa and Carleton Universities before becoming Dean of the
Faculty of Health Sciences at University of Ottawa.

Dr Bégin co-chaired the Royal Commission on Learning of Ontario and served
on the International Independent Commission on Population and Quality of
Life. A Fellow of the Royal Society of Canada, she received several honorary
doctorates in recognition of her contribution to human rights and to public
policies. In 1998, she was invested as Officer of the Order of Canada.

Mirai Chatterjee

Dr Mirai Chatterjee is Coordinator of Social Security for India's
Self-Employed Women's Association (SEWA) - a trade union of over 200,000
self-employed women. She is responsible for SEWA’s Health Care, Child Care
and Insurance programmes. Before this, she was General Secretary of SEWA for
three years and Coordinator of SEWA Health Team for twelve years.

Dr Chatterjee is on the boards of several organizations in India, including
the Friends of Women’s World Banking (FWWB) and HealthWatch. She has been a
member of national task forces on social security, health and poverty
reduction. Most recently, she was appointed to the National Advisory Council
and the National Commission for the Unorganised Sector.

Manuel Dayrit

Dr Manuel Dayrit is Secretary of Health of the Philippines. He is a
physician by profession as well as an epidemiologist and health care manager
whose expertise lies in the fields of public health, disease control,
primary health care and health communications.

Dr Dayrit served as Assistant Secretary of Health from 1992 to 1997. Before
his appointment, he was Assistant Vice-President of United Laboratories,
Inc. as well as Vice-President and General Manager of Health Delivery
Systems, Inc. Before that, he was Vice-President for Medical Services of
Aetna Health Care, Inc.

Dr Dayrit is a recipient of numerous grants and awards, among them as
British Council Scholar (1981-82) and Outstanding Young Scientist in 1990.
Dr Dayrit has authored and co-authored 40 local and international
publications on infectious disease control and community health. He has
served as President of the Philippine Society of Epidemiology since 1996.

William Foege

Dr William H. Foege is Emeritus Presidential Distinguished Professor of
International Health, Emory University, and a Gates Fellow.

Dr Foege, an epidemiologist, worked in the successful campaign to eradicate
smallpox in the 1970s. Dr Foege became Chief of the CDC Smallpox Eradication
Program, and was appointed director of the U.S. Centers for Disease Control
and Prevention in 1977. In 1984, Dr Foege co-founded the Task Force for
Child Survival, a working group for WHO, UNICEF, The World Bank, UNDP, and
the Rockefeller Foundation.

Dr Foege served The Carter Center between 1986-1992 as its Executive
Director, Fellow for Health Policy and Executive Director of Global 2000.
Between 1992-1999, he contributed to the Centre's work as a Fellow and as
Executive Director of the Task Force for Child Survival and Development.
Between 1999-2001, Dr Foege served as Senior Medical Advisor for the Bill
and Melinda Gates Foundation.

Kiyoshi Kurokawa

Dr Kiyoshi Kurokawa is President of the Science Council of Japan and the
Pacific Science Association. He is also Adjunct Professor, Research Center
for Advanced Science and Technology of the University of Tokyo; Adjunct
Professor of the Institute of Medical Sciences of Tokai University; and
Professor Emeritus of the University of Tokyo.

Dr Kurokawa has served in many ministerial committees in Japan. He was
Science Advisor for the Ministry of Education, Sciences and Culture. He was
also member of the Executive Committee and Chair of the Special Committee
for Drug Evaluation of the Ministry of Health and Welfare, and the National
Health Policy Council of the Ministry of Health and Welfare. He currently
serves as Member of the Science and Technology Policy Committee of the
Cabinet Office and in additional committees for the Prime Minister’s office.

Dr Kurokawa was a recipient of Order of Purple from the Government of Japan
for Excellence in Academic Achievements in 1999.

Stephen Lewis

Mr Stephen Lewis is UN Special Envoy for HIV/AIDS in Africa, appointed by UN
Secretary General Kofi Annan in 2001. From 1995 to 1999, Mr Lewis was Deputy
Executive Director of UNICEF in New York. He was first appointed as Special
Representative for UNICEF in 1990.

In 1997, in addition to his work at UNICEF, Mr Lewis was appointed by the
Organization of African Unity to a Panel of Eminent Personalities to
Investigate the Genocide in Rwanda. The 'Rwanda Report' was issued in June
of 2000. In 1993, he became coordinator for the Graca Machel study on the
"Consequences of Armed Conflict on Children".

>From 1984 through 1988, Stephen Lewis was Canadian Ambassador to the United
Nations. In this capacity, he chaired the Committee that drafted the
Five-Year UN Programme on African Economic Recovery. He also chaired the
first International Conference on Climate Change, which drew up the first
comprehensive policy on global warming.

Alireza Marandi

Dr Alireza Marandi is Professor of Pediatrics at Shaheed Beheshti
University, Islamic Republic of Iran.

Dr Marandi is former two-term Minister of Health (and Medical Education).
During his nine years in office, medical education was integrated with
health care delivery. In each of the 29 provinces, one University of Medical
Sciences was established, thus making the country self sufficient in health
human resources. In addition to being Minister, Dr Marandi also served as
Deputy Minister and Advisory to the Minister.

Dr Marandi is Chairman of the Iranian Society of Neonatologists; the Board
of Directors of the Islamic Republic of Iran Breastfeeding Promotion
Society; and the National Committee for the Reduction of Perinatal Mortality
and Morbidity. He is also the laureate recipient of the United Nations
Population Award (1999) and WHO's Eastern Mediterranean Region's Shousha
Award (2000).

Michael Marmot - Commission Chair

Michael Marmot, MBBS, MPH, PhD, FRCP, FFPHM, is Director of the
International Centre for Health and Society, and Professor of Epidemiology
and Public Health, University College London.

Professor Marmot has been at the forefront of research into health
inequalities for the past 20 years, as Principal Investigator of the
Whitehall studies of British civil servants, investigating explanations for
the striking inverse social gradient in morbidity and mortality. He chairs
the Department of Health Scientific Reference Group on tackling health
inequalities and chairs the National Institute for Clinical Excellence
(NICE) Research and Development Committee. He also chairs committees of the
BHF and the Wellcome Trust. He was a member of the Royal Commission on
Environmental Pollution for six years.

Professor Marmot is a Vice President of the Academia Europaea; a member of
the RAND Health Advisory Board; and a Foreign Associate Member of the
Institute of Medicine. He was awarded the Balzan Prize 2004 for Epidemiology
and was Knighted by HM the Queen in 2000 for services to epidemiology and
understanding health inequalities.

Charity Ngilu

Mrs Charity Kaluki Ngilu is the Minister of Health of Kenya. Before taking
office, she was a member of the National Assembly of Kenya representing the
Democratic Party.

Mrs Ngilu was the Social Democratic candidate for the Presidency of Kenya in
the 1997 elections. Since 1989, she has been a leader of the Maenbeleo ya
Wanawake organization, the national women’s movement.

Before entering politics, Mrs Ngilu was Managing-Director of a
food-manufacturing company in Nairobi.

Hoda Rashad

Dr Rashad is Director and Research Professor of the Social Research Center
of the American University in Cairo. She is member of the Senate (El Shoura
Council), one of the two parliamentary bodies in Egypt. She serves on the
National Council for Women, which reports to the President of Egypt and is
chaired by the First Lady.

Dr Rashad is a member of the Higher Council for Policies of the National
Party. She is also Chair of the Committee on Women in the Policy Secretariat
of the National Party. A resource person and consultant to a number of
regional and international organizations, Dr Rashad is currently a
Vice-Chairman of the Dutch Development Assistance Research Council (RAWOO).

In the past, Dr Rashad served on the governing body of the Global
Development Network (GDN), and as a member of the Scientific and Technical
Advisory Group of the UNDP/UNFPA/WHO/World Bank Special Programme of
Research, Development and Research Training in Human Reproduction.

David Satcher

Dr David Satcher is Interim President of Morehouse School of Medicine,
National Centre for Primary Care.

Dr Satcher served simultaneously as United States Surgeon General and
Assistant Secretary for Health from February 1998 through January 2001.
While in these posts, he spearheaded the development of Healthy People 2010,
which included the elimination of racial and ethnic disparities in health as
one of its two goals. He also released 14 Surgeon General’s reports on
topics that included tobacco and health; mental health; suicide prevention,
oral health; sexual health; youth violence prevention; and overweight and
obesity.

>From 1993 to 1998, Dr Satcher served as Director of the Centers for Disease
Control and Prevention and Administrator of the Agency for Toxic Substances
and Disease Registry. Dr Satcher is a former Robert Wood Johnson Clinical
Scholar and Macy Faculty Fellow. He is the recipient of over 40 honorary
degrees and numerous distinguished honors. In 2004, he received the “Voice
of Conscience Award” from Aetna for his work toward eliminating health
disparities. In 2002, he received the “Rhoda and Bernard Sarnat
International Prize in Mental Health” and the “City of Medicine Award.”

Amartya Sen

Dr Amartya Sen is Lamont University Professor and Professor of Economics and
Philosophy at Harvard University.

Dr Sen has served as President of the Econometric Society, the Indian
Economic Association, the American Economic Association and the
International Economic Association. He was formerly Honorary President of
OXFAM and is now its Honorary Advisor.

Dr Sen is a Fellow of the British Academy, Foreign Honorary Member of the
American Academy of Arts and Sciences, and a member of the American
Philosophical Society. Among the awards he has received are the “Bharat
Ratna” (the highest honour awarded by the President of India); the Senator
Giovanni Agnelli International Prize in Ethics; the Alan Shawn Feinstein
World Hunger Award; the Edinburgh Medal; the Brazilian Ordem do Merito
Cientifico (Grã-Cruz); the Presidency of the Italian Republic Medal; the
Eisenhower Medal; and Honorary Companion of Honour (U.K.). In 1998, Dr Sen
was awarded the Nobel Prize in Economics.

Anna Tibaijuka

Mrs Anna Tibaijuka is Executive Director of UN-HABITAT. During her first two
years in office, Mrs Tibaijuka oversaw major reforms that led the UN General
Assembly to upgrade the United Nations Centre for Human Settlements to a
fully-fledged UN programme.

Mrs Tibaijuka has spearheaded UN-HABITAT’s main objective of improving the
lives of slum dwellers in line with the Millennium Development Goals.
UN-HABITAT is responsible for leading the effort on Target 11 of those
goals: improving the lives of 100 million slum dwellers by the year 2020.

Apart from her UN-HABITAT activities, Mrs Tibaijuka is dedicated to the role
and rights of women in development. The founding Chairperson of the
independent Tanzanian National Women's Council (BAWATA), she is also the
founding Chairperson of the Barbro Johansson Girls Education Trust dedicated
to promoting high standards of education for girls in Africa.

Denny Vågerö

Dr Denny Vågerö is Professor of medical sociology and Director of CHESS
(Centre for Health Equity Studies), a research institute set up by Stockholm
University and the Karolinska Institute. He is a member of the Royal Swedish
Academy of Sciences, and of its standing committee on health.

Dr Vågerö's present research focuses on health inequalities and on how
health is determined at different stages of life. The on-going Russian
public health crisis, and its historical roots, is another of his research
interests. Dr Vågerö has been a key figure in European health inequalities
research and is presently Vice-President of the European Society of Health
and Medical Sociology.

Dr Vågerö was involved in the Swedish Government´s Commission on Work,
Environment, and Health, where he wrote its report about “jobs exposed to
special health risks” and formulated policies to combat them. He has worked
in the Swedish Parliament´s Census Commission and is Scientific Advisor to
the Swedish National Board of Health and Welfare.

Facts and figures

During the three-year mandate of the Commission, the Scientific Secretariat
at the University College London will issue updated facts and figures on
topics relevant to social determinants of health. 

Examples of health inequities

March 2005

Between countries

*   Mortality among children aged under five ranges from between 316 per
1000 live births in Sierra Leone (highest in the world) to three per 1000 in
Iceland (lowest in the world). [1] 

*   Life expectancy at birth ranges from 34 years in Sierra Leone (lowest in
the world) to 81.9 in Japan (highest in the world). [1] 

*   The probability of a man dying between ages 15 and 60 is 8.3% in Sweden,
46.4% in Russia, 90.2% in Lesotho. [2] 

*   Births attended by skilled health personnel range from 100% in Sweden to
12% in Bangladesh and 6% in Ethiopia. [3] 

Within countries

*   In Indonesia, under-five mortality is nearly four times higher in the
poorest fifth of the population than in the richest fifth. [4] 

*   In the USA, there is a twenty-year gap in life expectancy between the
least and most advantaged. [5] 

*   In England and Wales there was a 7.4 year gap in life expectancy between
men in professional occupations and men in unskilled manual occupations
(1997-1999 figures). [6] 

*   In Australia, there is a 20-year gap in life expectancy between
Australian Aboriginal and Torres Strait Islander peoples and the Australian
average (1999 – 2001 figures). [7] 

*   The postneonatal (28 days-11 months) death rate for American Indians and
Alaska Native people is almost double that of white Americans. [8] 

*   In Northern Ireland among women, those in the lowest social class are
60% more likely to experience some form of neurotic disorder than those in
the highest social class. [9] 

Sources

[1] World Health Organisation. The World Health Report 2004: Changing
History. WHO, Geneva. 

[2] World Health Report 2003: Shaping the Future. WHO, Geneva). 

[3] The Human Development Report 2004, United Nations Development Programme.


[4] Victora CG, Wagstaff A, Schellenberg JA, Gwatkin D, Claeson M, Habicht
JP. Applying an equity lens to child health and mortality: more of the same
is not enough. Lancet 2003; 362:233-41. 

[5] Murray, C. J. L., Michaud, C. M., McKenna, M. T., and Marks, J. S. U.S.
Patterns of Mortality by County and Race: 1965-94. 1-97. 1998. Cambridge,MA,
Harvard Center for Population and Development Studies. 

[6] Donkin, A., P. Goldblatt, and K. Lynch. 2002. Inequalities in life
expectancy by social class, 1972-1999. Health Statistics Quarterly, no.
15:5-15. 

[7] Aboriginal and Torres Strait Commissioner, Statistics, Human Rights and
Equal Opportunities Commission. A statistical overview of Aboriginal and
Torres Strait Islander peoples in Australia, 2003). 

[8] "Health, United States, 2004", US Department of Health and Human
Services (2202 Figures). 

[9] Ministry for health, social services, and public safety. Investing for
Health. Belfast: Northern Ireland Assembly, 2002.
<http://www.dhsspsni.gov.uk/publications/2002/investforhealth.asp>
http://www.dhsspsni.gov.uk/publications/2002/investforhealth.asp.

For more information contact:

Young-Ae Chu
Telephone: +41 22 791 4367
Email:  <mailto:chuy at who.int> chuy at who.int

Christine McNab
Telephone: +41 22 791 4688 
Email:  <mailto:mcnabc at who.int%20> mcnabc at who.int 

Maritza Labraña
Telephone: +56 26 300 412 or 413
Email:  <mailto:mlabrana at minsal.gov.cl> mlabrana at minsal.gov.cl






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