PHM-Exch> Medical students on Rio Declaration on social determinants of health

[Claudio Schuftan]

From: Taavi Tillmann <taavi.tillmann at gmail.com>


http://ifmsa.wordpress.com/2011/10/21/medical-students-perspective-to-the-rio-statement-on-the-social-determinants-of-health/


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*Medical students’ perspective on the Rio Declaration*





The 10-member delegation of the *International Federation of Medical
Students’ Associations (IFMSA)*, a unique network of 106 national
organizations in 99 countries, was thrilled to be part of this inspirational
conference that has no doubt changed us all.

The delegation welcomes the *Rio Declaration* as it symbolizes a major step
in the quest for global health equity. However, we also wish to express some
of our concerns regarding the Declaration and the most important points that
it missed.



The main problem of the Rio Declaration is that it failed to explicitly tell
us how the *unfair distribution of power, resources and wealth* will be
addressed, especially by Member States. The WHO Commission on Social
Determinants of Health has been adamant about the need to tackle this
lingering issue, as health inequities within and between countries are
rooted in power relations and resource maldistribution. We understand that
changing the current dynamics of power will not happen overnight. However,
we believe that this Declaration could have been the watershed moment for
leaders to make a strong commitment in making this world a fairer place.



   1. We believe that *democracy* is the key instrument in fixing the
   existing imbalances in power and in ultimately reducing health inequities.
   However, the Declaration is weak in emphasizing the value of democracy in
   all processes – from decision-making to evaluation – and at all levels –
   from community to global level. The Declaration should have encouraged the
   creation of democratic institutions within and between countries that will
   allow active engagement among all sectors.



   1. We noted that the Declaration mentioned the line “private sector,
   safeguarding against conflict of interest” three times. It is established
   that large multinational corporations wield disproportionately large power
   in influencing both intermediate (i.e. tobacco, alcohol, unhealthy food,
   breastmilk substitutes, working conditions) and structural (i.e.
   intellectual property and trade agreements) determinants of health. The
   Declaration could have been a perfect opportunity to specifically define the
   *specific role of the private sector in reducing health inequities* and
   to clearly draw the lines governing engagement between government and the
   private sector.



   1. Global *economic governance* institutions, such as the IMF, WTO and
   World Bank, wield disproportionately large power in influencing many of the
   upstream determinants of health, i.e. through loan conditionalities, free
   trade agreements, TRIPS+ provisions and agricultural subsidies. We welcome
   the mention of *health impact assessments *and call for this to become a
   mandatory step when creating FTAs and imposing IMF conditionalities. The
   Declaration should also ask of these powerful institutions the same
   standards of *transparency, accountability and democracy* as that urged
   of Member States.



   1. It cannot be denied that action on social determinants of health will
   require substantial funding. However, the Declaration is silent about how
   tackling health inequities will be financed. Commitment to adoption
of *innovative
   financing schemes* such as progressive taxation on capital gains or
   extremely-high earners, implementing a financial transactions tax, as well
   as preventing tax evasion, should have been enshrined in the Declaration.



   1. Although the Declaration recognizes the importance of engaging
with *civil
   society*, we feel that it should specifically advocate for the creation
   of spaces for dynamic dialgogue, venues that will enable civil society to be
   heard and to also directly hear from governments. The writing of the
   Declaration has been disappointing, as civil society, which could have
   meaningfully contributed in strengthening the Declaration, was shunned away
   in the official process. Governments should value the voice of civil society
   as these groups, having been working on reducing health inequities for many
   decades, have the capacity to see these defects and propose innovative
   solutions.



   1. Finally, we would have hoped that the Declaration explicitly include
   the *inclusion of young people and youth organizations* such as ours in
   the movement for action on social determinants of health. As early as now,
   young people should be made to understand the principles of equity and
   social determinants to ensure smooth transfer of knowledge and deeds and
   eventually the sustainability of this global movement. Moreover, youth today
   has the sheer capacity to effect positive change, a capacity which remains
   largely untapped. With their innate energy, fresh vision, and advanced grasp
   of technology, young people, who will be inheritors of global health sooner
   rather than later, can largely and meaningfully contribute in advancing the
   movement for “health and equity for all.”



Now, as we all go back to our respective homes, we medical students ask all
conference participants to take time to look at the Declaration once more,
to reflect on the discussions and lessons of the conference, to consider the
voice of civil society and young people, and to think of the next bolder
steps that will move us forward in reshaping the distribution of power and
combating health inequalities around the world.

On our part, we medical students commit ourselves to continue engaging with
all sectors involved in the work towards global health equity, spreading
awareness of the social dimensions of health to our fellow young
people, mobilizing them to take action in their respective communities and
countries, doing our part, little by little, but with courage, consistency,
and conviction.
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