Preparing for the World Conference on the Social Determinants of Health

Next month the World Health Organization (WHO) is holding a Conference on the Social Determinants of Health in Rio de Janeiro. The conference aims to strengthen commitments by member states to develop and implement national policies on the social determinants of health to reduce health inequities; and, to share experiences, challenges, and technical knowledge on how to address social determinants of health.

Recently, the Wellesley Institute hosted a consultation by the Public Health Agency of Canada (PHAC) in preparation for the conference. The discussions centred on five themes: governance, community participation, role of the health sector, aligning global priorities and stakeholders, and monitoring progress.

We’ve blogged in the past about the WHO Commission on the Social Determinants of Health and the Wellesley Institute’s submission to Pan American Health Organization/WHO Regional Consultation on the Social Determinants of Health in the Region of the Americas.

Governance is a particularly difficult question owing to the complexity of the policy problems that underlie social determinants of health. Governance structures that address the root causes of health inequities must be established; the complexity of social determinants of health cannot stand in the way of making progress. Social determinants of health are classic wicked policy challenges in that:

  • they cannot be “solved” with a program here or an investment there, but require multiple interventions – including, but not limited to, public policies – over the long term;
  • there is little agreement within policy circles on the most effective solutions, and limited evidence or predictability about the impact of interventions; and
  • the longer-term impact and implications of any policy response are uncertain and dynamic.

What we do know about these wicked problems is that they must be addressed in consistent and coordinated ways – not on an ad hoc basis. Policy frameworks must be comprehensive, connected, collaborative, integrated, aligned, deep, long-term, and grounded.

Another challenge in tackling the social determinants of health is how to monitor progress. This is difficult within jurisdictions, and is even more difficult across them. A set of initiatives to measure and analyze progress in addressing social determinants and for setting goals and milestones is a crucial step in addressing the social determinants. Having a common set of indicators and measures that include equity at their core makes identifying what works – and what doesn’t – far simpler and creates an environment where jurisdictions can easily learn from each other.

It is important, however, that the collection of data is not treated as an end in itself – data must be collected as part of a comprehensive evaluation strategy. Evaluation should also be seen, not as a scorecard, but rather as a tool to drive innovation and knowledge-sharing across organizations. The Wellesley Institute has a range of resources to support evaluation.