PHM-Exch> News on Social Determinants of Health from WHA65

[Claudio Schuftan]

From: Alice Fabbri <alealifab at gmail.com>

**

The Social Determinants of Health are a crosscutting theme coming out of
Primary Health Care and the Alma Ata conference of 1987. PHM urges WHO to
put a focus on SDH and equity in all aspects of their reform and
prioritization processes. The Assembly is invited to adopt the resolution
proposed by the Executive Board during the January session. This is an
important opportunity for discussion and an important step forward.
Please see below for more information and recommendations!

Social Determinants of Health: Outcome of the World Conference on Social
Determinants of Health (SDH) (Rio de Janiero, Brazil, October 2011)
(A65/16<http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_16-en.pdf>
) The issues before the Assembly
The Commission on the Social Determinants of Health was established by the
Director-General of WHO in spring 2005 as a, “global network of policy
makers, researchers and civil society organizations”(see
more<http://www.who.int/social_determinants/thecommission/finalreport/about_csdh/en/index.html>)
to address social causes of illness and issues of inequity. It issued its
final report in 2008 (Closing the Gap in a
Generation<http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf>).
Resolution (WHA62.14<http://apps.who.int/gb/ebwha/pdf_files/WHA62-REC1/WHA62_REC1-en-P2.pdf>)
on SDH requested the DG to convene a global event before WHA65 in order to
discuss renewed plans for redressing the alarming trends of health
inequities through actions on the SDH.

(A65/16 <http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_16-en.pdf>) is
the report by the Secretariat on the process and outcome of the World
Conference on Social Determinants of Health (Rio de Janeiro, Brazil, 19–21
October 2011), and also summarizes progress on the implementation of
resolution WHA62.14.

The WHA65 is invited to adopt the resolution
(EB130.R11<http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_R11-en.pdf>)
(Outcome of the World Conference on SDH), which includes identified actions
for member states (and particular actions for the donor countries), for the
‘international community’ and for the Secretariat.
PHM comment Action on the SDH is a critical component of Primary Health
Care (Declaration of Alma-Ata 1978) and a prerequisite of eliminating
health inequities. The PHM welcomes the progress in the analyses mandated
by Resolution WHA 62.14. However in the absence of any provision in the new
GPW framework for the management and accountability for cross cutting
issues such as SDH carries a serious risk that this work will be allowed to
wither.

A commitment to addressing the SDH needs to be incorporated into all
aspects of policy making. Political will is an essential element for work
on SDH including the political will of higher income countries to support
moves to a more equitable and sustainable allocation of global resources.
Many higher income countries have benefited unjustly from their
relationships with lower income countries and should work to rebalance the
maldistribution of power and resources.

“The social determination of health is much more than a collection of
fragmented and isolated “determinants” that, from a reductionist viewpoint,
are associated with classic risk factors and individual lifestyles. We must
not allow the concept of social determinants of health to become banal,
co-opted or reduced merely to smoking, sedentary behavior and poor
nutrition, when what we need is to recognize that behind those symptoms and
effects lies a social construction based on the logic of a globalized
hegemonic culture whose ultimate goal is the commercialization of life
itself.” (Civil Society Position,
Rio<http://www.phmovement.org/sites/www.phmovement.org/files/RIO-WCSDH-Civil-Soc-Position-English.pdf>)
The social determination of health need to be properly embedded in
policy-making around non-communicable diseases, too, so as to not
stigmatise individuals while letting corporate agents off the hook or
dismissing the socio-economic causes of the causes.

WHO is properly concerned with measurement and evaluation. However, unless
the indicators adopted for monitoring various programs are disaggregated
using meaningful stratifiers, progress on the SDH remains invisible. We
call for continued research, monitoring and evaluation, health impact
assessments, and support to address the root causes of the inequities
underlying the SDH.

WHO has a leading responsibility to demonstrate leadership on SDH within
the UN system. There is a need to further develop the capacity of the
Secretariat to provide technical assistance in the implementation of the
Rio Declaration. We also urge Member States to approve the necessary
funding for the work on SDH as detailed in the respective Report on
financial and administrative
implications<http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_16-en.pdf>
.

WHO has a key role in ensuring that initiatives to address the SDH are
included in other UN deliberations and programs, e.g. Rio+20 and the
post-2015 development framework. The Health in All Policies approach
demands that SDH are addressed in areas such as trade, taxation, TNCs,
financial institutions, and privatization of social programs.

A major consideration is how to manage the conflicts of interest within
global health decision-making institutions and we call for a code of
conduct to help facilitate this
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