From: <b class="gmail_sendername">Taavi Tillmann</b> <span dir="ltr"><<a href="mailto:taavi.tillmann@gmail.com">taavi.tillmann@gmail.com</a>></span><br><div class="gmail_quote"><br><br><a href="http://ifmsa.wordpress.com/2011/10/21/medical-students-perspective-to-the-rio-statement-on-the-social-determinants-of-health/" target="_blank">http://ifmsa.wordpress.com/2011/10/21/medical-students-perspective-to-the-rio-statement-on-the-social-determinants-of-health/</a><div>
<br></div><div><br><div class="gmail_quote"><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:center;line-height:normal" align="center">
<b><span style="font-size:20.0pt;color:#1F497D" lang="SL"><br></span></b></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:center;line-height:normal" align="center"><b><span style="color:rgb(31, 73, 125)" lang="SL">Medical
students’ perspective on the Rio Declaration</span></b></p>
<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"> </span></p>
<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"> </span></p>
<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">The
10-member delegation of the <b>International
Federation of Medical Students’ Associations (IFMSA)</b>, 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. </span></p>
<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"></span></p>
<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">The
delegation welcomes the <b>Rio Declaration</b>
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.</span></p>
<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"> </span></p>
<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">The main
problem of the Rio Declaration is that it failed to explicitly tell us how the <b>unfair distribution of power, resources and
wealth</b> 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. </span></p>
<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"> </span></p>
<ol style="margin-top:0cm" start="1" type="1">
<li style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">We believe that <b>democracy</b> 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.</span></li>
</ol>
<p style="margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:36.0pt;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"> </span></p>
<ol style="margin-top:0cm" start="2" type="1">
<li style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">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 <b>specific role of the private sector in reducing health inequities</b>
and to clearly draw the lines governing engagement between government and
the private sector.</span></li>
</ol>
<p style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"> </span></p>
<ol style="margin-top:0cm" start="3" type="1">
<li style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">Global <b>economic governance</b> 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 <b>health impact assessments </b>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 <b>transparency,
accountability and democracy</b> as that urged of Member States.</span> </li></ol>
<p class="MsoNormal" style="margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:18.0pt;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"> </span></p>
<ol style="margin-top:0cm" start="4" type="1">
<li style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">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 <b>innovative financing schemes</b> 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.</span></li>
</ol>
<p style="margin-bottom:0cm;margin-bottom:.0001pt;line-height:normal"><span lang="SL"> </span></p>
<ol style="margin-top:0cm" start="5" type="1">
<li style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">Although the Declaration
recognizes the importance of engaging with <b>civil society</b>, 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.</span></li>
</ol>
<p style="margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:36.0pt;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"> </span></p>
<ol style="margin-top:0cm" start="6" type="1">
<li style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">Finally, we would
have hoped that the Declaration explicitly include the <b>inclusion of young people and youth
organizations</b> 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.” </span></li>
</ol>
<p style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL"> </span> </p>
<p style="margin-bottom:0cm;margin-bottom:.0001pt;text-align:justify;text-justify:inter-ideograph;line-height:normal"><span lang="SL">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.</span></p>
<p style="margin-bottom:0.0001pt;text-align:justify">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.</p>
</div><br></div>
</div><br>