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<title>Highlights from the 7th meeting of the Commission on the Social
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<h1><b><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>Highlights from the 7<sup>th</sup> meeting of WHO’s Commission on
the Social Determinants of Health<o:p></o:p></span></font></b></h1>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>By Fran Baum (Commission member)<o:p></o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>Attendance<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><span class=SpellE><font size=2 face="Times New Roman"><span
style='font-size:10.0pt;mso-ansi-language:EN-US'>Amartya</span></font></span><font
size=2><span style='font-size:10.0pt;mso-ansi-language:EN-US'> <span
class=SpellE>Sen</span> attended for the first time<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Stephen Lewis has resigned – because of
time pressure but is supportive of role of CSDH<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Bill <span class=SpellE>Foege</span> and David <span
class=SpellE>Satcher</span> were sick<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'><o:p> </o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>Margaret Chan<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>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. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>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. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>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”. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Tackling inequity is crucial – PHC
crucial but need to <span class=SpellE>recognise</span> 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
<span class=GramE>people</span> 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?<span class=GramE>”.</span> <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>She has set up a task force on PHC chaired by
the new Deputy Director General <span class=SpellE>Asamoa</span>- Bah (Ghanaian
known as AB) – is planning for the 60<sup>th</sup> anniversary of WHO and
the 30<sup>th</sup> 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”. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>She also felt PHC “does have its
baggage” and need to look for an alternative word – she said she
needs help with this. <o:p></o:p></span></font></p>
<p class=MsoNormal><span class=GramE><font size=2 face="Times New Roman"><span
style='font-size:10.0pt;mso-ansi-language:EN-US'>Stressed that she sees PHC as
being multi-<span class=SpellE>sectoral</span>, involving community
participation and universal access.</span></font></span><font size=2><span
style='font-size:10.0pt;mso-ansi-language:EN-US'> It includes food, housing,
shelter.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>She wants to reach out to UNICEF. Big challenge
of co-ordination with other UN agencies – lots of non-alignment of them. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Noted there has never been so much investment
in health and that we “mustn’t do business as usual”. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Said WHO will have to ask the ask of
“what don’t we do?<span class=GramE>”.</span> 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”. <span
class=GramE>Will have to ask if we “can sunset some programs”.</span>
<o:p></o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>Civil society engagement<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>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. <span class=SpellE>Eugenio</span> <span
class=SpellE>Villar</span> is now main responsible officer in <span
class=GramE>WHO</span>. <span class=GramE>Considering civil society meeting in <st1:City
w:st="on"><st1:place w:st="on">Adelaide</st1:place></st1:City> back-to-back
with Indigenous Symposium at end of April.</span><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>A meeting of Francophone civil society was held
in <st1:country-region w:st="on"><st1:place w:st="on">Senegal</st1:place></st1:country-region>
and attended by Commissioner <span class=SpellE>Ndioro</span> <span
class=SpellE>Ndiaya</span> and <span class=SpellE>Hernan</span> Sandoval
– very lively and useful discussion. <o:p></o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>Knowledge networks<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>The Social Exclusion, Gender, Public Health
Conditions and Measurement networks reported. <span class=GramE>All going well.</span>
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 <span
class=GramE>WHO</span> and about increasing awareness in the organisation and
action on SDH within WHO programs. Erik <span class=SpellE>Blas</span> made
presentation – it was good and already an educational strategy for WHO is
being implemented and a “Knowledge and Practice network” established.
<o:p></o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>Other key issues<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Presentations were made on indicators –
generally <span class=SpellE>scepticism</span> from Commissioners about
investing too much time in this<o:p></o:p></span></font></p>
<p class=MsoNormal><span class=GramE><font size=2 face="Times New Roman"><span
style='font-size:10.0pt;mso-ansi-language:EN-US'>Environment – (Maria <span
class=SpellE>Neiru</span> - WHO).</span></font></span><font size=2><span
style='font-size:10.0pt;mso-ansi-language:EN-US'> Very good presentation and
highlighted the conflict between economic development and environmental
protection. <span class=GramE>Key message that polluting is done in the
“north” and disease burden is felt in the “south” e.g.
pollution/chemical dumping in <st1:place w:st="on">Africa</st1:place>.</span> <o:p></o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>International Agencies<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Ricardo Lagos and Michael Marmot made
presentations to World Bank. <st1:City w:st="on"><st1:place w:st="on">Lagos</st1:place></st1:City>’s
speech was very powerful but unsure what influence. <o:p></o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>US Commission<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Foundation funding has been found for a US
Commission. Paula <span class=SpellE>Braverman</span> will be research
director. Will meet in <st1:City w:st="on"><st1:place w:st="on">New Orleans</st1:place></st1:City>
in November – hope some Commissioners can be there. <o:p></o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>Interim Statement<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>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 <span
class=SpellE>Schreker</span> and David <span class=SpellE>Legge</span> were
particular helpful with comments on Michael Marmot’s <span class=SpellE>Harveian</span>
Lecture and the key points I made in response about the need for:<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-layout-grid-align:none;text-autospace:none'><font
size=2 face="Times New Roman"><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>• <span class=GramE>systematic</span> resource redistribution
between countries and within regions and<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-layout-grid-align:none;text-autospace:none'><span
class=GramE><font size=2 face="Times New Roman"><span style='font-size:10.0pt;
mso-ansi-language:EN-US'>countries</span></font></span><font size=2><span
style='font-size:10.0pt;mso-ansi-language:EN-US'> to enable poorer countries to
meet human needs,<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-layout-grid-align:none;text-autospace:none'><font
size=2 face="Times New Roman"><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>• <span class=GramE>effective</span> supranational regulation to
ensure that there is a social purpose in<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-layout-grid-align:none;text-autospace:none'><span
class=GramE><font size=2 face="Times New Roman"><span style='font-size:10.0pt;
mso-ansi-language:EN-US'>the</span></font></span><font size=2><span
style='font-size:10.0pt;mso-ansi-language:EN-US'> global economy, and<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-layout-grid-align:none;text-autospace:none'><font
size=2 face="Times New Roman"><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>• <span class=GramE>enforceable</span> social rights that enable
citizens and residents to seek legal redress<o:p></o:p></span></font></p>
<p class=MsoNormal><span class=GramE><font size=2 face="Times New Roman"><span
style='font-size:10.0pt;mso-ansi-language:EN-US'>where</span></font></span><font
size=2><span style='font-size:10.0pt;mso-ansi-language:EN-US'> necessary<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'><o:p> </o:p></span></font></p>
<p class=MsoNormal><span class=GramE><font size=2 face="Times New Roman"><span
style='font-size:10.0pt;mso-ansi-language:EN-US'>were</span></font></span><font
size=2><span style='font-size:10.0pt;mso-ansi-language:EN-US'> largely
supported by nearly all other Commissioners. <o:p></o:p></span></font></p>
<p class=MsoNormal><span class=SpellE><font size=2 face="Times New Roman"><span
style='font-size:10.0pt;mso-ansi-language:EN-US'>Amartya</span></font></span><font
size=2><span style='font-size:10.0pt;mso-ansi-language:EN-US'> <span
class=SpellE>Sen</span> 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. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Giovanni <span class=SpellE>Berlinguer</span>
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 <span class=SpellE>Pascoal</span>
<span class=SpellE>Mocumbi</span> 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<o:p></o:p></span></font></p>
<p class=MsoNormal><span class=SpellE><font size=2 face="Times New Roman"><span
style='font-size:10.0pt;mso-ansi-language:EN-US'>Sen</span></font></span><font
size=2><span style='font-size:10.0pt;mso-ansi-language:EN-US'> noted that we
have to position ourselves as different from MCE because that report made
people’s <span class=GramE>wellbeing<span style='mso-spacerun:yes'>
</span>look</span> like a means rather than an end. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>I somewhat heretically argued against using
phrase “causes of causes” too prominently because it encourages
linear thinking – <span class=SpellE>Sen</span> supported this on the
basis of need to acknowledge people’s agency more strongly (and so
capabilities) <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><font size=2
face="Times New Roman"><span style='font-size:10.0pt;mso-ansi-language:EN-US;
font-weight:bold;mso-bidi-font-weight:normal'>Timeline for interim statement</span></font></b><font
size=2><span style='font-size:10.0pt;mso-ansi-language:EN-US'>: June meeting
draft will be reviewed and <span class=SpellE>finalised</span> – early
July 2007 agreed statement will be ready for release and open for comment
– comments by end of September. <o:p></o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>Communicating the CSDH message<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><span class=GramE><font size=2 face="Times New Roman"><span
style='font-size:10.0pt;mso-ansi-language:EN-US'>Long discussion on how to get
central messages over the international community and governments.</span></font></span><font
size=2><span style='font-size:10.0pt;mso-ansi-language:EN-US'> Feeling a
“headline message” is needed – to engage the media<o:p></o:p></span></font></p>
<p class=MsoNormal><span class=GramE><font size=2 face="Times New Roman"><span
style='font-size:10.0pt;mso-ansi-language:EN-US'>High consciousness of need to
communicate with people/countries where English is not spoken.</span></font></span><font
size=2><span style='font-size:10.0pt;mso-ansi-language:EN-US'> <o:p></o:p></span></font></p>
<h2><b><i><font size=2 face=Arial><span style='font-size:10.0pt;mso-ansi-language:
EN-US'>Next meetings<o:p></o:p></span></font></i></b></h2>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>8<sup>th</sup> meeting Vancouver 7<sup>th</sup>-
9th June<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>9<sup>th</sup> meeting <st1:City w:st="on"><st1:place
w:st="on">Beijing</st1:place></st1:City> 24<sup>th</sup>-26<sup>th</sup>
October <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>10<sup>th</sup> meeting likely to be in <st1:country-region
w:st="on"><st1:place w:st="on">Japan</st1:place></st1:country-region> in
January <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
10.0pt;mso-ansi-language:EN-US'>Fran Baum 28/1/07<span
style='mso-spacerun:yes'> </span><o:p></o:p></span></font></p>
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