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On: Dec. 15, 2011 Building Health Equity: Saskatoon’s Dr. Cory Neudorf Shares Lessons Learned

Diane Dyson is Director of Research & Public Policy, Strategic Initiatives Unit at WoodGreen Community Services, and is guest blogging for us today.  You can read her blog at http://belongingcommunity.wordpress.com.

A few days ago, the Saskatoon Poverty Reduction Partnership, an intersectoral approach to poverty spearheaded by the Saskatoon Health Region, released an update of its progress over the past three years on health equity among its residents, and its plan for the next five years. The approach taken by the Saskatoon Health Region serves as an example of how collaborative efforts can work to solve some of the harder social problems we face.At a recent Health Equity Forum hosted by Wellesley Institute, Dr. Cory Neudorf, Chief Medical Health Officer for Saskatoon Health Region, described the lessons learned over the past five years in his city.

1. Build a strong evidence base.

Robust data made the case for the need to change local health interventions.  A 2006 Health Disparity by Neighbourhood Income study compared a set of low- and high-income neighbourhoods with each other and with the City average and found wide health disparities. Research found that low-income neighbourhoods, lying in the shadows of a leading acute-care children’s hospital, reported half the immunization rates of higher income neighbourhoods and four times the infant mortality rates. In these poor neighbourhoods, life expectancy was dropping.

Saskatoonians were appalled to find some of the highest levels of urban inequality in Canada were within their own neighbourhoods.Under Dr. Neudorf, the Health Region set about building a stronger evidence base. The result was the 2008 report, Health Disparity in Saskatoon: Analysis to Intervention, co-authored with Dr. Mark Lemstra. The report scanned over 10,000 articles for evidence-based policy solutions to the inequities identified. With further consultation, they were able to identify some concrete options for Saskatoon.Dr. Neudorf also worked with the Canadian Population Health Initiative and colleagues like Dr. David McKeown, Toronto’s Medical Officer of Health, and epidemiologist Dianne Patychuck to produce a cross-Canadian examination in the Reducing Gaps in Health: A focus on Socio-Economic Status in Urban Canada report. It was the first time the issue had been looked at nationally at such a small geographic level. (Around the same time, the Public Health Department in the City of Toronto produced a parallel report, The Unequal City, showing similar levels of disparity.)Three strategic directions emerged: a housing strategy, an employment strategy for Aboriginals, and a poverty-reduction strategy.

2. Build political will.

Data like these got people to the table, ready to talk and ready to look for solutions.  Dr. Neudorf intentionally began to test public awareness and receptivity. Out of that came 200 community consultations and randomized surveys of 5,000 residents (including those without phones) exploring possible solutions and their levels of commitment to them. Forty-six policy options with a strong popular base were identified in areas such as income, housing, education and aboriginal self-governance.
Dr. Neudorf purposefully looked to include people beyond the “usual suspects” in exploring solutions to these problems. Business leaders, people in poverty with “first voice,” Aboriginal groups, faith groups, community associations, and others who weren’t usually at policy tables were asked to weigh in. The wider community found consensus on about twenty of the policy options.After convening another community roundtable, Dr. Neudorf asked community leaders and organizations to commit to a newly-minted and broad-based Leadership Group, out of which a smaller Coordinating Group and more specifically focused Action Groups emerged.

3. Work across sectors.

Because health disparities have roots in many other fields, they are “wicked problems,” as Wellesley’s Director of Policy Bob Gardner calls them, with no agreed solution and requiring multiple players. Dr. Neudorf explained this work has to be done in coalitions and partnerships – as evidenced by the 63 letters of support which lead off the 2008 report.Dr. Neudorf worked with the already-established Saskatoon Regional Intersectoral Committee to develop a community action plan on the range of social determinants of health. More focused community action groups emerged out of this plan.The City of Saskatoon, local school boards, and other regional agencies also launched a common data portal, CommunityView, to make data sharing among human service organizations easier and to improve community planning.As Saskatoon’s Medical Officer of Health, Dr. Neudorf also began to re-shape the delivery of public health services, building health equity audit tools. Low-income schools also became one of the new areas of intervention, despite some pushback from parents. Immunizations were also enhanced. Health programs underwent equity audits, identifying barriers to quality health care at both the patient and the service level.

Finally, the Region of Saskatoon formed the Poverty Reduction Partnership to develop a common plan, which has just been launched. Stakeholders are also exploring innovative ideas such as an idea incubator, with seed money from local philanthropists, to respond to some of the proposals coming forward. The work of the Saskatoon Poverty Reduction Partnership can be found at www.saskatoonpoverty2possibility.ca.

The Region of Saskatoon has committed to advocating for real change in the region, recognizing that poverty levels are determined by the public’s tolerance of them. Public health units, Dr. Neudorf explained, can lead the way by doing the research, implementing evidence-based interventions, reporting regularly on progress made, and facilitating intersectoral solutions to reduce health disparities.The idea that poverty and inequality lead to poorer health outcomes is not new. Dr. Neudorf began by referring to the now commonplace civic themes of health disparities, health equity, and closing the gaps. What has shifted, is the field of public health’s return to an examination of the significance of the wider social determinants of health and how “non-health” interventions can be one of the best forms of prevention.

To watch Dr. Neudorf”s presentation at the Wellesley Institute’s Health Equity Forum, click here.

 

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On: Nov. 14, 2011 Living In Auspicious Times: health as a human right

World Conference on Social Determinants of Health

Rio de Janeiro, October 19-21, 2011

World Health Organization (WHO)

Margot Lettner

“We live in very auspicious times for participation. It sails the winds of history.”

Among the many papers I picked up at the Rio Conference is one authored by Bernardo Kliksberg, Honorary Professor, University of Buenos Aires. Reading it at Galeo Airport – one long wait for Delta Flight 60 and the wilting salgados have lost all savoury appeal – I came across his simple way of seeing how social participation can transform public policies that fight health inequities.

A world conference hosted by a United Nations agency such as the WHO, like the Rio Conference that just ended, is an event: 1,200 delegates (450 representing 60 Member States, 750 experts and civil society members); a big tent; a brand; star moderators in Zeinab Badawi and Riz Khan from BBC World News and Al Jazeera English, respectively; a president, assorted government ministers, a chorus of independent voices. Script, actors, audience and certainly patrons are decided far in advance and – in this particular theatre tradition – improvisation is limited.

Formal planning for the Rio Conference began at least a year in advance, with an advisory group of about 20 health policy experts drawn from WHO Member States who met on Wasan Island, Ontario in September 2010 to brainstorm themes. But its real genesis was even earlier. The Commission on Social Determinants of Health chaired by Sir Michael Marmot reported to the WHO in 2008, Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Then in 2009, the World Health Assembly passed Resolution 62.14 requiring the WHO to follow up on the report’s recommendations.

By this spring, the draft conference Discussion Paper was open for comments. Member States began negotiating the text of the Rio Declaration this past summer. The conference agenda was set by September.

So by the time we all arrived in Rio, much of the writing was already on the page.

It’s important to keep this context in mind while being there, as well as when reflecting later on what happened. As a participant, your real opportunity to contribute is limited. Only one plenary session opened up for comments and questions from the floor; and this was the final plenary that presented the just-approved Rio Declaration to delegates. It was electric but cut short because some panelists had to leave. While the smaller breakout sessions that ran during the conference included some moderated discussion, the relatively large number of participants, over 100 in each group, limited meaningful conversation and learning.

The conversations with most meaning, then, that held the most provocative and novel ideas and experiences, that offered the most hope as well as the deepest disquiet, happened away from the podium. Here are the conversations I heard most often as I talked with people; and which also came to resonate the most with me.

We need to name and formalize the right to health as a human right. We need new forms of civil society and broader citizen participation in public policymaking, an activist agenda that not only reclaims and reconfigures the democratic, but also resists the public service’s chronic reluctance to change. We need to join up agendas: as the WHO’s Commission on Social Determinants of Health argued in Closing the Gap in a Generation, we must make common cause with people active in, and affected by, sustainable development, the environment and climate change, education from early childhood to learning across the lifecycle, employment and working conditions and anti-poverty campaigns.

We need a global health ethics that mandate protocols for health governance, given a pre-eminently market-driven global economic model weak on equity and accountability. We need to use the declarations tabled at Rio – both the official and the alternative ones – to develop local action plans based on local evidence and local mechanisms for policymaking, practice and monitoring. And we need to reconnect our priorities with frontline health: to resource and measure the basics of primary health and public health and the people who practice them. Building the “we” as the foundation to this work – an inclusive, participatory, and activist voice – is imperative.

“All for equity,” the Rio rally, faces immediate challenges within the UN itself. The WHO has committed to provide technical assistance to Member States on how to implement a determinants approach, on “what works, what doesn’t,” chiefly through its regional offices. It also raises its own capacity as an issue. First, the WHO and other UN agencies have not always worked collaboratively on determinants-based issues (as the conference closed on October 21, agency representatives met in Rio to explore a better way – a sign of change?)

Second, and of greater concern, some Member States continue to press the WHO hard to restructure its current governance, partnerships and operations, believing that their funding entitles them to greater say over WHO decisions and activities. What non-sovereign influences may also come through this back door; and how transparent will their identity and influence be? Health as a commodity, health care as a commercial transaction – whose values are valued, who is accountable? WHO is already experiencing financial pressures, in part from lagging Member contributions, that have resulted in staff reductions. The UN and its agencies are not only an expression of our international political will towards consensus or disagreement, they also embody our international public service.

In a post-Rio presentation hosted by The Wellesley Institute on December 6, I will be talking about these themes in greater detail, including my visit with the Fundação Oswaldo Cruz (FIOCRUZ), the public health foundation partnered with Brazil’s Ministry of Health. Most importantly, the session will be open for conversations about what concrete work can be done now to move determinants-based approaches into practice here, in Ontario; as well as where the political and social openings are that will build momentum, advocates and better outcomes across communities and policy sectors. Event details will be posted on the Wellesley Institute website shortly.

Here are some other significant ideas, achievements and events profiled at the conference that may spark new collaborations on December 6.

 

Provocations

1.     It’s the wealth distribution model, not necessarily the economic model, that influences health status – Luiz Odorico Monteiro de Andrade, National Secretary for Strategic Planning and Participation, Ministry of Health, Brazil
2.     A strategic plan is a social determinants of health plan. The ideal plan, of course, would place communities at the centre of the plan with services around them – Kevin Buckett, Director of Public Health, South Australian Department of Health

3.     Why don’t we report social indicators daily just as we do economic indicators? – David Sanders, University of the Western Cape

 

Tools

1.     WHO launched its new global community of practice tool for social determinants www.actionsdh.org (information at actionsdh@who.int). Membership is free and gives users access to downloadable content, conversation forums, opportunity to contribute evidence, examples, and resources and a newsletter.

2.     People’s Health Movement (PHM) launched its new global Right to Food and Nutrition Watch 2011 as a companion advocacy, accountability and research-into-practice tool to its just-released Global Health Watch 3: An Alternative World Health Report (www.rtfn-watch.org, www.ghwatch.org, www.phmovement.org).

 

Frontline health, Brazilian milestones

1.    In 1988, health care as a citizen’s right and corresponding duty of the state was added to the Brazilian Constitution.

2.    Over the past 40 years, Brazilian health sector reform has been driven by civil society rather than by governments, political parties or international organizations. Social participation in health sector strategies, policies, implementation and evaluation is constitutionally legislated through health councils and conferences at all three levels of government, with membership made up of 50% users, 25% health workers and 25% health managers/providers. A proportion of municipal or state health budgets is a participatory budget and decided by citizens through popular vote. ParticipaSUS, the national policy for strategic and participatory management, continues to integrate social participation in health decision making.

3.     Bolsa Família, Brazil’s social security system with an intersectoral policy focus, includes a conditional cash transfer program for families that supplements household income and is tied to school enrolment and use of primary health care services such as vaccinations. R$13 billion was distributed to 10.5 million families in 2008, with over 90% of payments going directly to mothers. (For six detailed papers that critically examine outcomes and opportunities in Brazil’s health policies, see The Lancet, “Health in Brazil,” May 2011.)

 

The case for evidence

1.  It’s radical to measure, and measuring the right thing is powerful. What gets measured, gets done – Michael Marmot, University College, London.

2.     The rub of inequities lies in their invisibility and their magnitude. For better data about determinants we need disaggregated measures that trend over time; that reflect increasingly real-time results; that capture outcomes beyond survival (e.g., morbidity, disability, mental health and other burdens of ill health, as well as the benefits of well-being); and that cluster stratifiers so that relationships among specific determinants are tested. To get these data we need population-based surveys, health equity audits and dissemination portals that combine information with advocacy – Hoda Rashad, Social Research Centre, The American University in Cairo.

3.     Decentralizing policymaking and program delivery to municipalities results in the creation of nuanced local data critical to planning and measuring but often difficult to capture in larger data sets – Maria Guzenina-Richardson, Minister of Health and Social Services, Finland.

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Margot Lettner is Principal, Wasabi Consulting and an Associate of The Wellesley Institute. She has just returned from Rio de Janeiro as a delegate to the WHO World Conference on Social Determinants of Health. In 2010, she facilitated WHO’s pre-conference Advisory Group consultation on social determinants of health. The title quote is taken from “Strategies and Methods for Promoting Social Participation in the Development and Implementation of Public Policies to Fight Health Inequities,” Bernardo Kliksberg, World Health Organization (WHO), 2011, p.24. She is also a board member and editor of Influency Salon, a magazine of contemporary Canadian poetry. She can be reached at ml.wasabi@rogers.com.

 

 

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On: Nov. 1, 2011 A Diagnosis for Equity: A Dialogue on Mental Health, Addiction, Chronic Disease and Sexual Health in South Asian Communities

St. James Town Initiative’s Nasim Haque delivered a presentation at the conference, A Diagnosis for Equity: A Dialogue on Mental Health, Addiction, Chronic Disease and Sexual Health in South Asian Communities, organized by the Council of Agencies Servicing South Asians (CASSA). The conference was held at the Centre for Addiction and Mental Health on October 24, 2011.

Dr. Haque’s presentation was part of the plenary panel discussion about health equity in South Asian communities and presented findings from community-based research involving the South Asian immigrant community in St. James Town. The presentation addresses how to re-think health from an equity perspective to successfully meet the needs of diverse populations.

Cassa camh conference 24 oct2011

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On: Nov. 1, 2011 Welfare Reform in New Zealand: Lessons for Ontario?

Welfare reform has been on the agenda in New Zealand for some time, with both the previous Labour-led and current, more conservative National-led government musing about how to fix a system that many believe is broken. With a general election coming up in just under a month, the National Party has released its welfare platform and is promising a significant shake-up of the welfare system, particularly in its expectations of workforce participation. National is widely expected to win the election, so it can be assumed that at least the structure of this platform announcement will be implemented.

The plan has two key elements:

  • combining the Unemployment and Sickness Benefits into a Jobseeker Support Benefit and requiring recipients to undergo work-testing and look for full-time work; and
  • replacing the Domestic Purposes Benefit (a benefit to support sole parents) with Sole Parents Support and requiring recipients to undergo work-testing once their youngest child turns one and to work at least part-time once their youngest child turns five.

The proposed changes are expected to result in 46,000 fewer people receiving social assistance. People who receive social assistance are amongst the most vulnerable in society, so reducing access to social assistance will disproportionately affect those who are already disadvantaged. The cost of implementing the changes would be $130,000 per year and would result in cost savings in the welfare budget of $1 billion over four years.

There are several elements of the proposed changes that would have equity impacts, and analyzing the details show that adverse effects would be felt by the most vulnerable:

1.   Work-testing is a blunt instrument that doesn’t recognize the episodic nature of disability

Many types of health issues and disabilities are episodic in nature, meaning that periods of acuity are followed by periods of remission. This is particularly true of mental illness. Using a point-in-time work-testing tool cannot accurately determine whether a person with a disability is truly able to make a successful transition into the workforce.

 

2.     Combining the Unemployment and Sickness Benefits doesn’t recognize the different needs of people who are unemployed and people who have disabilities

These two groups have very different needs. People who are disabled often find it difficult to find paid employment that can accommodate their particular needs, even if they are ready and able to participate in the workforce. Thus people with disabilities need supports that allow them to move between paid employment and social assistance as their condition allows.  This includes the provision of health supports that continue even when the person is in the workforce.

People who are unemployed, on the other hand, may require different types of support, such as vocational training or re-training and job-seeking support and advice. Health supports are also essential given the low level of income supports this group often receives.

 

3.     Deeming people on social assistance as work-ready may force people into low wage jobs with no benefits

The best way to permanently transition from social assistance to paid employment is to provide supports that allow people to find – and keep – good jobs: jobs that are well-paid, secure, and provide health benefits. Simply deeming a person to be work-ready may force people on social assistance to take the first job that becomes available, regardless of whether this is the best job for them.  This creates a situation where people come and go from the welfare system.

 

4.     Requiring sole parents to work must include complementary supports such as subsidized/free child care and transportation

The New Zealand government has suggested that changes to the welfare system will include supports to help people get ready for work, such as child care and transportation supports. This is positive, but they must be flexible enough to ensure that parents are able to rely on these supports while they establish themselves in the workforce. These kinds of supports are more effective when linked to income level rather than welfare status.

 

If the New Zealand government does not address these policy challenges and chooses to move towards a one-size-fits-all social assistance system that does not reflect individual need or enhance opportunities, the most vulnerable people will be the most severely affected. And if this occurs, savings in the welfare budget may lead to increased costs in the health budget, which has major system implications.

These are lessons that should be learned closer to home as the Commission for the Review of Social Assistance in Ontario completes its deliberations. Wellesley Institute was part of a broad partnership of health sector leaders that came together to ensure that health and health equity are emphasized in the review. Our submission sets out a range of recommendations that would create a health-enabling social assistance system, including the development of a basket of essential supports, providing enhanced opportunities for workforce participation and training that reflect individual need and capacity, and enhanced policy coordination and alignment across government.

I’ll be blogging over the coming weeks about how to make this happen, so stay tuned. Next week’s Wellesley Institute newsletter will also include our submission to the Commission (be sure to sign up for our newsletter to receive a copy as soon as it’s available).

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On: Oct. 31, 2011 Health Equity and the Occupy Movements

With Occupy movements, born out of Occupy Wall Street, happening in Canada and around the world, social and economic inequality are on the agenda. More and better jobs, more equitable distribution of wealth, and greater corporate responsibility and accountability are important goals, and the Occupy movements have made great progress in making these issues mainstream.

One important element that needs to be built into public debate is health. We know that poorer people have worse health outcomes than richer people. In Toronto, men from the poorest income bracket have a life expectancy that is 4.5 years less than men from the richest income bracket. For women, the gap is two years. But health inequities don’t just affect mortality; they also affect quality of life. Over three times as many people in the lowest income group report their health to be only fair or poor compared to those in the highest income group. The routine activities of a quarter of low income people are limited by pain, twice that of high income people. The Wellesley Institute has funded a range of research on health inequities, including Sick and Tired and the Street Health Report.

These differences do not have to exist. Health inequities are differences in health outcomes that are avoidable, unfair and systematically related to social inequality and disadvantage. This means that with the right policies and priorities, built into a comprehensive strategy, health inequities can be eliminated.

The Wellesley Institute has a range of resources to help organizations to build equity into their planning and service delivery:

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On: Oct. 27, 2011 Addressing Systemic Access Barriers: the Potential of Peer Health Ambassadors and other Community-Based Innovation

Addressing systemic barriers in access to care is one of the crucial challenges facing the Ontario health system. One such area is inequitable access to screening and preventative care, inequities that can have devastating outcomes. Some very promising collaborations are underway in Peel Region to improve access to cancer screening for South Asian populations. I spoke to a recent knowledge exchange forum there on the potential of peer health ambassadors and community involvement in service planning.

Peel cancer screening ke forum oct 2011
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On: Oct. 27, 2011 Local Collaborations to Advance Health Equity

Building broad local partnerships and collaborations among service providers, community agencies and residents is one vital part of driving health equity into action on the ground. I spoke to a tremendously interesting group coming together in the Jane-Humber area of north-west Toronto. I highlighted the experience and impact of the South East Toronto Organization, a community-based collaboration that has been working for over twenty years in south-east Toronto to address equity barriers, connect providers working in marginalized communities and address challenges such as access to dental service, non-insured people, homeless young moms, harm reduction and other fundamental equity issues (see an overview of South East Toronto Organization’s development and our review of comprehensive community initiatives). I also spoke to the overall potential of community level multi-sectoral collaboration and networks as one crucial ingredient in acting on health inequities.

Jane humber – potential of local networks advancing health equity

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On: Oct. 27, 2011 Public Health, Priority Populations and Driving Health Equity Into Action

Public health have long been leaders in health equity strategy (see Sudbury’s Ten Promising Practices). One key direction has been working with local communities and those marginalized and vulnerable populations facing the most inequitable health outcomes or barriers to services and support. I spoke at an Ontario Public Health Association forum on how to engage with priority populations to identify key service gaps, population needs and levers for change, and to design and deliver the best mixes of programs and resources to enhance the opportunities for good health for all. We spoke of a number of key challenges: how to frame the need to act on underlying social determinants of health in understandable and energizing ways; how to balance coherent overall equity strategies that can connect many specific initiatives with focused programs and investments to improve the health of the worst off fastest; and how to stay grounded in and responsive to diverse community needs and perspectives.

Health equity and priority pop’n opha hpo forum oct 2011

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On: Oct. 24, 2011 One Conference, Two Declarations

“Civil society is fantastic in the sense that they push us”

 

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.

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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.

 

 

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On: Oct. 21, 2011 Alternative Civil Society Declaration on Protecting the Right to Health through action on the Social Determinants of Health

With the WHO Conference on the Social Determinants of Health wrapping up today, the official Rio Political Declaration on Social Determinants of Health has just been released. While this will likely garner the most media attention, it is also important to take note of the Alternative Civil Society Declaration on Protecting the Right to Health through action on the Social Determinants of Health, which was released yesterday.

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.

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