PHA-Exchange> WHO Comm on Social Determs of Hlth Cairo meeting 5-05

[Claudio]

Report to People's Health Movement Global Steering Committee from Fran Baum, on Second meeting of WHO Commission on Social Determinants of Health, Cairo 4th-7th May 2005Report to People's Health Movement Global Steering Committee from Fran Baum, on Second meeting of WHO Commission on Social Determinants of Health, Cairo 4th-7th May 2005

 

 

Introduction

 

This meeting was requested by the Commissioners at their first meeting in Chile in order to conduct some detailed planning work that had not been possible at the first meeting. The meeting was, therefore called at short notice and not all Commissioners were able to be attend. Those present were: Michael Marmot (Chair) Fran Baum, Monique Begin (Canada), Giovanni Berlinguer (Italy), Mirai Chatterjee (India), Manual Dayrit (Philippines), Kiyoshi Kurokawa (Japan), Alireza Marandi (Iran), Hoda Rashad (Egypt), Hernan Sandoval (Chile) Denny Vagero (Sweden).

 

Cairo Meeting Objectives

 

. Conceptual framework 

1.      Discuss, shape and collectively "own" the broad conceptual and values framework for the Commission.

2.      Identify a group of Commissioners with a special interest in further developing the conceptual framework into a final document to be circulated and disseminated. Define the process and constituencies.

 

II. Knowledge Networks

3.      Agree on the priority areas of focus of the knowledge component of the CSDH, and determine which areas require knowledge networks (KNs) and which can be addressed through commissioned papers or other mechanisms. 

4.      Finalize Knowledge inputs into CSDH. 

5.      Determine the organization of the knowledge process during the first 18 months and the Commissioner interface with the priority areas of focus (KNs or other).

6.      Determine follow up action and preparations toward the September Commissioner meeting.

 

III. Country Work

7.      Reach broad agreement on the Commission country work as outlined in the Country Work Consultation document with particular reference to: a) the selection criteria, b) next steps for setting up the country work,  c) WHO linkages,  d) Commissioner TOR with respect to country work.

8.      Identify what should be prepared for the September Commissioner meeting. 

 

IV. Global Partners and Processes 

9.      Identify and discuss mechanisms for engaging global partners and processes in the Commission. 

 

V. General 

Discuss the objectives and focus of future Commissioner meetings

 

Other WHO officers were present (see Appendix for details of participants) 

 

Conceptual paper session

Jeanette Vega presented an overview of the second paper to come from the secretariat, "Towards a Conceptual Framework for Analysis and Action on the Social Determinants of Health". This was well-received by the Commissioners as a starting point for the framework for the work of the Commission. There was a feeling that the next draft will need to be more practical and clearer on engagement with politicians, Millennium Development Goals and civil society. Much discussion on how to persuade politicians (Heads of State and Health Minsters) to take social determinants of health and equity seriousl). There was strong recognition of the importance of a civil society base in terms of creating the pressure for this to happen. 

 

 

Knowledge Network Working Group

Membership: Fran Baum, Hoda Rashad, Hernan Sandoval, and Denny Vagero

I was asked to chair this working group by Michael Marmot and concentrate on the work detailed above. Hilary Brown provided an overview of the process to date. This has been very much driven by secretariat and the Commissioners have not had much involvement . At this meeting we reviewed the KN summaries and provided comments for the Secretariat. They will now negotiate with bidders for KN and select the final hubs. The Commissioners did note that they were disappointed with the fact that most of the bids come from the minority world and poorer countries were not well represented. Some efforts will be taken to remedy this and the idea of co-Chairs will be explored and these would preferably be appointed from majority world. Please let me know if any PHM members would like me to nominate them as co-Chairs of any of the knowledge networks. 

 

There will be an EOI document for the new KN on Gender and Women's Empowerment. There will also be a new KN on financing which will cover both health systems financing but also financing of Governments more generally (eg taxation policy). 

 

These KN will provide a great opportunity for PHM members to become actively involved in the work of the CSDH. See the CSDH website for details if you don't already have these -  http://www.who.int/social_determinants/en/

 

Country Work Group

Membership: Monique Begin, Mirai Chatterjee, Manueal Dayrit, Alireza Marandi, Charity Ngilu, and David Satcher

This group was chaired by Monique Begin and discussed the objectives above. The main output of their work was a statement of principles for CSDH engagement with countries. Group very clear they want to see action on the ground. Recommend that the CSDH gains a high profile at upcoming World Health Assembly. 

 

One salutary fact provided in the report back from this group by Hernan Sandoval was that the global health care industry is worth US$1.2 billion per day. 

 

Session on Involving Global Initiatives and Processes

This session started with a presentation by Dr. Tim Evans (Assistant Director General, Evidence and Information for Policy WHO). Key points from his presentation were:

  a.. Invitation from MDG to improve access to health services 
  b.. MDG has an over emphasis on averages as opposed to distribution 
  c.. MDG Magic bullet approach instead of thinking of the complexity of social change 
  d.. Over- emphasis on idea big pool of money will solve problem 
  e.. Also over-emphasis on single strategies 
  f.. CSDH needs to be strategic about which networks 
 

The Commission had planned to have a third working group on this topic but because most of the Commissioners represented here were unable to come this group did not meet. The issue was discussed in plenary session and most of this discussion focussed on how the CSDH should relate to Millennium Summit to be held in New York in September. 

Decided to use Stephen Lewis as main CSDH presence at the Millennium Summit following a long discussion on how to engage with the process of the MDGs. 

 

 

Engagement with Civil Society

I was asked to make a presentation on the topic "People's Health Movement: An Example of how a global civil society organisation would interact with the CSDH  ". Once requested to do this I suggested that I should make this presentation with local representatives of PHM in Egypt. This proposal was accepted and fortunately I was able to meet with Hani Serag on the Tuesday before the meeting started and he was able to arrange for two colleagues, Dr. Alaa Shukrallah, Amal I. Sabri, to be present at the session on Friday despite the short notice. 

 

I made a presentation about PHM covering PHA1 & 2, the Global Health Watch, recent campaigns and the International People's Health University Course. Then Dr. Shukrallah and Hani Serag spoke about their work in Egypt and the region. There was then a short discussion. It was evident that we needed more time. The Commissioners agreed that next time we need to make more time for civil society and plan to do this when we meet in India in September. 

 

The key points I made about engagement with civil society (and thanks to Ravi and David Sanders for their input to my presentation) were:

n      PHM2 will be an important event at which SDH are taken for granted

n      This represents a crucial event for the CSDH 

n      CSDH participation will have a symbolic and practical value

n      Great opportunity to mingle interact with members of civil society who are passionate about SDH

n      PHM global movement with circles in many countries and links with a wide range of civil society movements in those countries

n      Engage with these circles during CSDH meetings and invite presentations on local issues or organise field visits

n      Make Civil society focus of Commissioners' meeting - starting with India Sept 05

n      PHM offers to organise "People's Hearings" so CSDH can dialogue with communities - in Commissioners' own countries

n      Use the expertise in PHM - sophisticated research and analytical circle especially on Comprehensive PHC and trade and health issues and political economy of structural factors underpinning SDH

n      Sign on to list server to see debates which have already included views on CSDH PHA-Exchange at lists.kabissa.org 

n      Listen to debate within PHM - issues so far:

Ø     Will CSDH be more than another report telling us what we already know?

Ø     Do we need more knowledge or is action on SDH a matter of political will?

Ø     Need for recognition of the structural factors underpinning SDH

Ø     Anti-poverty versus pro-poor

Ø     Recognition of power and political dimension

Ø     Need for global strategies to tackle global issues

n      PHM people will be involved in Knowledge hubs/networks including globalisation, social inclusion, health systems proposals

n      Can bring a community perspective to KN

n      PHM is a source of co-Chairs for KN

n      Is supportive of the CSDH and lobbied for its establishment

n      May be critical of CSDH work but will be constructively so

n      Anticipating sharing the burden of a social vision of health with CSDH

n      Contains strong analytical and grass root credibility - the combination is a powerful one

n      Is a growing movement  and strong voice in global health and should not and will not be ignored!

 

Hani described the activities in the region and forthcoming conference. 

Many thanks to Hani for organising the PHM-Egypt input to well and to Alaa Shukrallah and Amal Sabri for attending the meeting at such short notice. 

 

 

Next steps for the CSDH

 

The Commission will next meet in India in September. There are clear plans to have a field visit organised by Dr. Mirai Chatterjee and to engage with PHM-India in a real and in-depth manner. The meeting will be in Ahmedabad and then Delhi. 

 

The KN hubs will be invited to India and will meet with Commissioners. 

 

Determination from Commission to "be practical" - somewhat unclear what this means. Most take it to mean that the CSDH should not just leave a report behind - that there needs to be more tangible legacy. This could be in form of : inspirational document that challenges neo-liberal thinking, practical examples in countries, work of the KN in terms of producing knowledge about what does work in improving health equity and improving social determinants of health and politics of doing this. 

 

Michael Marmot has agreed to come to PHA2 and will take part in a workshop and also be part of a plenary panel. I also hope that  Monique Begin will come. 

 

 

Please let me have your thoughts, ideas, and contributions to the work of the Commission - how do you think it is going so far???

 

Fran Baum

Adelaide

May 2005 

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