PHA-Exch> Comm on Social Determ of Hlth: Good dg -no for the prescription

[Claudio Schuftan]

*Commission on Social Determinants of Health:*

*Good Diagnosis – Now for the Prescription….*





*David Woodward*







>From the media coverage of the report of the Commission on Social
Determinants of Health, one might think it said nothing new. There are
considerable inequalities in health, particularly between rich and poor.
These arise from differences in incomes, access to health services, clean
water, sanitation and education. There is a moral imperative to act on this
social injustice. All of this could have been said at any time over the last
20 or 30 years.



In fact, the report is – by the standards of such global commissions –
little short of revolutionary. One can only suppose that those reporting on
it have read no further than the report's formal recommendations and
executive summary.



The Commission does not limit itself to the immediate causes of health
inequalities, come up with a wish-list, and pretend governments could simply
wave a magic wand and make the problem go away if they really wanted to. It
recognises that there are reasons why governments, especially in the
developing world, have been unable to secure health for all; and it traces
through what needs to happen to increase health equity from the local level
to the global.



Governments in the developing world are constrained by lack of resources,
limited infrastructure, weak administrative capacity and limited bargaining
power in international negotiations. These are, to a great extent, a result
of global economic constraints and pressures. And these constraints and
pressures, in turn, result from a system of global governance which skews
power towards the developed world, and therefore prioritises their economic
concerns over the desperate needs of the majority of the word's population.
All this is highlighted throughout the report.



The Commission's formal recommendations are inevitably constrained by its
mandate. Its report specifically states that "It was beyond the remit, and
competence, of the Commission to design a new international economic order
that balances the needs of social and economic development of the whole
global population, health equity, and the urgency of dealing with global
warming". But this is clearly what its findings imply.



The report is peppered with stinging criticisms of globalisation, market
integration, trade liberalisation, IMF and World Bank economic policies, WTO
Agreements and recent health sector reform programmes. It emphasises that
its recommendations on employment policies and social protection depend
critically on major changes in the operation of the global economy. And it
highlights the need for a major reform of global governance, not only raise
the profile of health, but also to ensure "genuine equality of influence"
for rich and poor.



This is an extraordinarily radical agenda. And, in the best traditions of
the health profession, it is backed up by an impressive array of evidence,
compiled by nine knowledge networks, bringing together leading global
experts in relevant fields. The Commission may not have had the remit to
design a new international economic order – but they have presented an
overwhelming case for the need for it, and an invaluable starting point for
developing it.



Now it is up to civil society, as a key part of the "global movement for
change" which the Commission hopes to foster, to take up the gauntlet and
translate the needs the Commission identifies into a concrete programme.
Then, perhaps, we can really hope to "close the gap in a generation".





*David Woodward is an independent development consultant, and a member of
the Knowledge Network on Globalisation and Health established under the
auspices of the CSDH, as well as a member of PHM.*
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