World Conference on Social Determinants of Health

Rio de Janeiro, October 19-21, 2011

World Health Organization (WHO)

Guest post by Margot Lettner

With not one but two Declarations on the floor as the Conference closed, Marie-Paule Kieny, Assistant Director-General, WHO, described the relationship between U.N. agencies and social movements.

On October 21, 2011, the Rio Political Declaration on Social Determinants of Health was signed by Heads of Government, Ministers and government representatives of Member States attending the Conference. The declaration represents a collaborative imagining, negotiating and drafting process that began this spring as the Conference discussion paper took shape, then continued over the summer as the first iteration of the final agreement was circulated.

Not surprisingly, the declaration picks up all five of the Conference themes that emerged from these pre-conference consultations – better governance, participatory policy-making and implementation, reorientation of the health sector, strengthened global collaboration, and enhanced monitoring and accountability for results. However, these themes aren’t exclusive; the declaration is clear that they illustrate but don’t define its scope of practice.

From its title on, the positioning of the Rio declaration is significant in three respects. It is a “Political Declaration” of political will by Member States, one that sees health equity as a “shared responsibility” that means taking global action to achieve “all for equity” and “health for all”:

Our common values and responsibilities towards humanity move us to fulfill our pledge to act on social determinants of health. We firmly believe that doing so is not only a moral and a human rights imperative but also indispensable to promote human well-being, peace, prosperity and sustainable development.

In the roundtable discussion, Dr. Purnima Mane, Deputy Executive Director, Assistant Secretary-General, UNFPA, noted “the resolution is a peer-group kind of pressure.”

The declaration also legitimizes the threat of  the current global crisis that has mobilized civil society organizations and citizens in occupying actions worldwide:

The current global economic and financial crisis urgently requires the adoption of actions to reduce increasing health inequities and prevent worsening of living conditions and the deterioration of universal health care and social protection systems.

Finally, it signals an emerging consensus or pointed reiteration of support for five specific priorities or best practices ranging from new ways for people to talk with their government, to the ethics of public-private partnership, to health quality.  There is a sense here of engagement with a renewed social contract.

First, governance should not only be inclusive and transparent, it should “engage early” with civil society and the private sector “safeguarding against conflicts of interest.” Public health is an essential partner in health care whose capacity must be strengthened. Primary care should be “comprehensive and integrated” as part of “high quality, promotive, preventive, curative and rehabilitative health services throughout the life cycle.” Equity should be integrated in the design and delivery of health services and public health programmes.  Gender-related aspects and early childhood education should be given special attention in policy and service delivery. And “social protection floors” should be strengthened through the work of both the U.N. and the International Labour Organization.

These may be “statements of nice intentions,” as one participant said.  Public interest civil society organizations and social movements attending the Conference issued an “alternative declaration” on October 18, Protecting the Right to Health Through Action on the Social Determinants of Health. This declaration is clear that sustainable development is in crisis:

Behind the immediate determinants of health … lie the deeper structural determinants including unequal power relations and unequal access to resources and decision making. Widening inequalities and institutionalized discrimination across axes of class, race, gender, ethnicity, caste, indigeneity, age and ability contribute to the impossibility of good health.

Five of the ten “urgently required actions by Member States and WHO” critique our global economic order.  “The clout of finance capital, its dominance of the global economy, and the origins and consequences of its periodic collapses” must be recognized, as well as how global trade regulation shapes health inequalities.  Global speculation must be controlled and progressive taxation used to finance action on social determinants of health.  Finally, how “unregulated and unaccountable transnational corporations and financial institutions constitute barriers to Health for All” must be documented.

For the first time during the Conference, a plenary session took on real meaning as participants and panelists opened up the discussion.  Some felt the WHO declaration watered down the 2008 recommendations of its own Commission on the Social Determinants of Health.  Some saw the declaration as a tool, a set of talking points in an iterative process of influence and change.  Some considered it inconsequential, feel-good puffery.  Some pointed to what was left out, for example, trade, climate change, the unsustainable and amoral pattern of South-subsidization of North-consumption.

William Lacy Swing, Director-General, International Organization for Migration, highlighted the declaration’s silence about the massive displacement that has made 740 million people into migrants, stressing that “the concept of the nation state is changing.”  He couldn’t have underscored the shifting fundamentals, the emerging inequalities, the accelerating damage, any better.

Or the imperative to understand the context of our problems, decide what we value and act.  Differences aside, both declarations name or suggest many of the same threats.  Global economic structures with crushing social consequences.  Diminishing quality of life and well-being.  The impossibility of sustainable development without health in all policies.  And they advocate many of the same solutions.  Democratizing health governance. Ethical conduct and conflict of interest protocols.  Primary health care with public health capacity. Equity, with express recognition of women and indigeneous peoples. Social protection, labour and employment standards.  Early childhood education. The need for disaggregated, stratified, population-based data. Significantly, both declarations show independent yet workable congruence between their five action areas.

Sérgio Cabral Filhio, Governor of the State of Rio de Janeiro, pointed to the black canvas walls of the Conference tent and suggested that if we could all see the ocean outside, we could imagine better things. If optimism is an act of political resistance, as another participant reminded us, perhaps we can.

Margot Lettner is Principal, Wasabi Consulting and an Associate of The Wellesley Institute. She is currently in Rio de Janeiro as a delegate to the World Conference on Social Determinants of Health. In 2010, she facilitated WHO’s pre-conference Advisory Group consultation on social determinants of health. She is also an editor of Influency Salon, a magazine of contemporary Canadian poetry. She can be reached at ml.wasabi@rogers.com.

The Alternative Declaration, which so far has been endorsed by 22 civil society organizations and many individuals, lists 10 areas for urgent action by member states and the WHO on the social determinants of health, including developing publicly-funded health systems, implementing progressive taxation, enhancing democratic and transparent decision-making, and improving monitoring systems.

Margot Lettner, Principal at Wasabi Consulting and an Associate of The Wellesley Institute, is in Rio de Janeiro and will be blogging about reactions to both the official Rio declaration and the Alternative Declaration.

Guest post by Margot Lettner

“Why should a Japanese cow enjoy a higher income than an African citizen?”

This is how Dr. David Sanders of the People’s Health Movement contrasted subsidies available to livestock and people while launching Global Health Watch 3: An Alternative World Health Report at the World Conference on Social Determinants of Health, Rio de Janeiro, on October 19.

The launch, held as a pre-opening stakeholder event, introduces a contrarian but constructive look at global health inequities, their ideological underpinnings and our current policy responses.

Global Health Watch 3 is a collaborative global health critique by health activists and academics coordinated by five civil society organizations: People’s Health Movement (PHM), Health Action International, Medact, Medico International, and the Third World Network. Previous reports issued in 2005 and 2008.

The report comments on several issues in health systems, three of which stand out. First, the comprehensive vision of primary health care agreed to by WHO Member States in 1978, known as the Alma Alta Declaration, has been replaced by “selective” care and a return to a vertical, medicalized service delivery model that values technical efficiencies rather than root causes – breastfeeding is widely seen to prevent childhood diarrhea, yet food security is not. Second, mental health should be viewed in the context of the growing worldwide inequalities that often compromise it – structural problems of inequity, rising consumerism and marginalization of communities. Third, the report argues that present reward-and-review systems often remove research from the concerns of local communities – and the documented benefits of community-based research.

But the report’s realpolitik lies in its timely analysis of our global political and economic architecture, including “the three F’s” of our current financial, food and fuel crises. In this season of “increasing disquiet” in streets around the world, in our “post-democratic time” as plutocracy rises, as Conference participants put it, how do we hold international organizations accountable? How can U.N. agencies like WHO be accountable if they partner with organizations that are not? As Member States and so its major stakeholders, what influence do governments have on WHO’s mandate? More broadly, is the public interest now a myth? Is “venture philanthropism” its replacement? What of the continuing resistance to regulation in favour of self-assessing voluntary measures?

The morning after Global Health Watch 3 launched, Andreas Loverdos, Greek Minister of Health and Social Solidarity, speaking at the Conference’s opening roundtable, noted that demand for mental health services has increased during Greece’s current fiscal crisis. He added that overall demand for health care in Greece has increased 40% while he has 20% fewer resources. Occupy Wall Street, speaking to a very human crisis, has come to Rio.

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Read more about Global Health Watch 3 at www.ghwatch.org; for information about PHM and Canada’s Country Circle go to www.phmovement.org. Margot Lettner is Principal, Wasabi Consulting and an Associate of The Wellesley Institute. She is currently in Rio de Janeiro as a delegate to the World Conference on Social Determinants of Health. She is also an editor of Influency Salon, a magazine of contemporary Canadian poetry. She can be reached at ml.wasabi@rogers.com.

As far as GDP is concerned, bad news can be good news. Operations like the oil sands can be great for GDP – not only do you get the economic benefit from all the oil that is extracted over the years, but you also get to count the clean-up and the health and environmental costs that will continue for decades to come.

More importantly, GDP is a bad measure of progress. Since 1994, GDP in Canada has increased by 31 percent, but GDP cannot tell us who has benefited, who is being left behind, or how our society is faring overall.

This is the challenge that the Canadian Index of Wellbeing (CIW) addresses in their latest report. CIW uses 64 separate indicators within eight categories – community vitality, democratic engagement, education, environment, healthy populations, leisure and culture, living standards, and time use – to measure the health of Canadian society.

Overall, the well-being of Canadians increased by 11 percent between 1994 and 2008. The problem is that this progress was not shared equally across all of society.

In measuring the health of our population, there was an overall increase in wellness of 6.6 percent. Life expectancy has increased, smoking rates are down, more seniors are getting flu shots, and overall access to public health services is good. However, the CIW found that health is intricately connected to income, and the income disparities between the richest 20 percent and the poorest 20 percent of Canadians has widened since 1994. This means that poor health disproportionately affects the poorest members of society.

Likewise, while overall living standards improved by 26 percent since 1994, these gains were not spread across the population. There are fewer families living in poverty and the median income of families has improved, but again, the wealthiest Canadians are enjoying the bulk of the increases to their standard of living. Not only did the income gap between rich and poor increase, but so did the gaps in economic security, employment quality and housing affordability.

Tools like the CIW are incredibly important in policy-making because they offer insights into where inequities exist within our economy and society. Simply targeting increased GDP growth as a prescription for prosperity doesn’t work. Policy makers need to take into account fairness and equality to ensure that everyone benefits from progress.

Download:

Tiny savings from cutting Toronto community support: Wellesley Institute policy backgrounder

Core Services Flip sheet

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Role of vibrant community sector in reducing disparities and improving population health: New research.

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Take care of the health of our city: Key resources on Toronto’s Core Services Review and municipal budget process.

South Riverdale Community Health Centre is a non-profit, multi-service centre that provides primary health care, social and community outreach services with an emphasis on health promotion to residents of Riverdale and South East Toronto.

South Riverdale Community Health Centre has entered into a partnership with WoodGreen Community Services and the Massey Centre for Women to conduct a community based research project in the geographic area referred to as NoDa (North of the Danforth).

Please see the attached for more details:

Job Posting Researcher NODA Oct 20 2011  

Applications must be received by 4:00 P.M., Thursday October 20 2011. 

http://www.gopetition.com/petitions/tell-canada-to-show-up-for-health.html

http://www.who.int/topics/social_determinants/en/

Wellesley Institute Deputation Sept 19

Additional resources on the Core Services Review process:

Toronto 300 speak out…

All cuts aren’t created equal (Wellesley Institute commentary in The Toronto Star)

Rushed policy process leaves no opportunity for due diligence (Wellesley Institute submission to Executive Committee)

Gutting Toronto’s Affordable Housing Office undercuts ‘housing first’ approach to ending homelessness