PHA-Exchange> PHM CSDH 7th meeting report - Jan 07

[Claudio]

Highlights from the 7th meeting of WHO's Commission on the Social Determinants of Health
By Fran Baum (Commission member)
Attendance
Amartya Sen attended for the first time
Stephen Lewis has resigned - because of time pressure but is supportive of role of CSDH
Bill Foege and David Satcher were sick

Margaret Chan
Margaret Chan spent about 45 minutes with Commission. She said that she hopes the CSDH will help her change the culture of WHO in response to the idea that Commissions don't change things. 
She noted that she was happy to hear that WHO was inclusive of NGOs as they are crucial. She noted that the WHO constitution means that NGOs can't have the same status as member states so this is a good way to include NGOs. 
She felt the WHO staff are "buying in" to the process" - and noted that "it will be important to me because it fits with my priorities". 
Tackling inequity is crucial - PHC crucial but need to recognise that the world is different to 1978 - we didn't have HIV/AIDS, chronic disease, no global players, NGOs not so evident. There is a new context and new landscape of global public health and WHO needs to work with the new players. 1.2 billion people do not receive services - this is the biggest gap. She explained that for her PHC is equal to equitable access, affordable services, community involvement, women being change agents. She asked the question "how can we adopt the principles of PHC and have a modern focus?". 
She has set up a task force on PHC chaired by the new Deputy Director General Asamoa- Bah (Ghanaian known as AB) - is planning for the 60th anniversary of WHO and the 30th anniversary of PHC (known as 60/30). She posed the question "how can WHO partner to provide services for people in greatest need - Africa is 10-15% of population, has less than 5% of the resources and 20% of the disease burden. She noted that "health is at "the receiving end of failure in others sectors". 
She also felt PHC "does have its baggage" and need to look for an alternative word - she said she needs help with this. 
Stressed that she sees PHC as being multi-sectoral, involving community participation and universal access. It includes food, housing, shelter.
She wants to reach out to UNICEF. Big challenge of co-ordination with other UN agencies - lots of non-alignment of them. 
Noted there has never been so much investment in health and that we "mustn't do business as usual". 
Said WHO will have to ask the ask of "what don't we do?". Will have to have strong discipline to do this - pandemics will be core. Have to take into account "if everything is important, then nothing is". Will have to ask if we "can sunset some programs". 
Civil society engagement
No members of civil society were present (other than those on CSDH). Invitations had been issued but the proximity of WSF meant people were unable to attend. Eugenio Villar is now main responsible officer in WHO. Considering civil society meeting in Adelaide back-to-back with Indigenous Symposium at end of April.
A meeting of Francophone civil society was held in Senegal and attended by Commissioner Ndioro Ndiaya and Hernan Sandoval - very lively and useful discussion. 
Knowledge networks
The Social Exclusion, Gender, Public Health Conditions and Measurement networks reported. All going well. Reports from most of the knowledge networks will soon be on the CSDH web site so suggest people check the site for updates. Of particular note was the presentation from the PH conditions KN which is essential internal to WHO and about increasing awareness in the organisation and action on SDH within WHO programs. Erik Blas made presentation - it was good and already an educational strategy for WHO is being implemented and a "Knowledge and Practice network" established. 
Other key issues
Presentations were made on indicators - generally scepticism from Commissioners about investing too much time in this
Environment - (Maria Neiru - WHO). Very good presentation and highlighted the conflict between economic development and environmental protection. Key message that polluting is done in the "north" and disease burden is felt in the "south" e.g. pollution/chemical dumping in Africa. 
International Agencies
Ricardo Lagos and Michael Marmot made presentations to World Bank. Lagos's speech was very powerful but unsure what influence. 
US Commission
Foundation funding has been found for a US Commission. Paula Braverman will be research director. Will meet in New Orleans in November - hope some Commissioners can be there. 
Interim Statement
The CSDH will not be issuing an interim report - instead it will put out an interim statement. A draft outline was circulated prior to the meeting together with the statement of values. Thanks to members of the steering council who provided comments on these - this helped me make interventions at the CSDH. I was generally pleased with the tenor of the discussions and am hopeful the statement will be strong about growing inequities and about strategies to make a fairer world. Ted Schreker and David Legge were particular helpful with comments on Michael Marmot's Harveian Lecture and the key points I made in response about the need for:
. systematic resource redistribution between countries and within regions and
countries to enable poorer countries to meet human needs,
. effective supranational regulation to ensure that there is a social purpose in
the global economy, and
. enforceable social rights that enable citizens and residents to seek legal redress
where necessary

were largely supported by nearly all other Commissioners. 
Amartya Sen was very supportive but argued for using term "fair distribution" instead of re-distribution because that made people feel they were going to lose something. 
Giovanni Berlinguer argued strongly that there is a social movement on SDH with long history and the CSDH needs to ensure it is part of this tradition and Pascoal Mocumbi argued for a strong note of passion in the report. Ricardo Lagos said we have to make the report part of the tradition of 1948, then Alma Ata. He also noted that arguments for SDH are well-known so we have to make practical political recommendations for action
Sen noted that we have to position ourselves as different from MCE because that report made people's wellbeing  look like a means rather than an end. 
I somewhat heretically argued against using phrase "causes of causes" too prominently because it encourages linear thinking - Sen supported this on the basis of need to acknowledge people's agency more strongly (and so capabilities) 

Timeline for interim statement: June meeting draft will be reviewed and finalised - early July 2007 agreed statement will be ready for release and open for comment - comments by end of September. 
Communicating the CSDH message
Long discussion on how to get central messages over the international community and governments. Feeling a "headline message" is needed - to engage the media
High consciousness of need to communicate with people/countries where English is not spoken. 
Next meetings
8th meeting Vancouver 7th- 9th June
9th meeting Beijing 24th-26th October 
10th meeting likely to be in Japan in January 

Fran Baum 28/1/07  
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