Social Determinants of Health: Redistribution, Regulation and Rights

This week the first World Conference of Social Determinants of Health (WCSDH) is held in Rio de Janeiro. This global event, organised by WHO and the government of Brazil, is organised as an outcome of the resolution WHA62.14, adopted by the World Health Assembly in 2009 (“Reducing health inequities through action on the social determinants of health”).

The evidence for political action is assembled by the Commission on Social Determinants of Health (CSDH) in its report ‘Closing the gap in a generation: Health equity through action on the social determinants of health’ (2008). It concluded that “unequal distribution of health-damaging experiences is […] the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics”. It provides the basis for a moral imperative to take equity as a core principle in the health sector and as priority for general government, both at national levels and within the global sphere. 

There has been some excellent analysis and updates written on the WCSDH and its directions, amongst others by Dirk van der Roost on the International health Policies blog by the Institute of Tropical medicine in Antwerp, by Fran Baum of the People’s Health Movement in a blog of the British Medical Journal, as well as an analysis by Ted Schrecker of the university of Ottowa in the Healthy Policies blog. 

A lot can be said, and has been discussed last days here in Rio, on the concept plus action on social determinants for health (SDH). In essence, the core issues of our time that affect health and well-being are discussed rather cautiously by the government delegations during this ministerial meeting. The recent financial, food and fuel crisis and the ‘slow-burn’ climate and development crises are acknowledged by all, but states fail to agree upon binding and coherent global frameworks to deal with these issues. The key to health equity and protecting the right to health is related to regulation of these sectors and keeping actors accountable for their actions. These principles are also presented in the Global Health Watch 3, an alternative world health report that was launched yesterday in Rio, and also in a press release from Baby Milk Action and Health Poverty Action.
 

Popular movements are fed up with the greedy corporate behaviour of wealthy elite and trans-national cooperations that undermine basic rights for people like the access to food, clean water and health care. Action and mobilisation on the SDH is hence linked to the OCCUPY movement: the 99% of the people that demand accountability and rights of the 1% that speculate with people’s financial savings, debts, taxes, lands and dignity. 

A framework for action is six years ago described by Bob Deacon and colleagues in a policy brief of the Globalism and Social Policy program. They call upon securing ‘the 3 Rs’ of  redistribution, regulation and rights which are fundamental to our wider social vision. These policies should provide for:

• systematic resource redistribution between countries and within regions and countries to enable poorer countries to meet human needs,
• effective supranational regulation to ensure that there is a social purpose in the global economy, and
• enforceable social rights that enable citizens and residents to seek legal redress where necessary against unjust or ineffective governments at whatever level.

Six years later, health inequities within and between countries have grown; because the financial sector, transnational cooperations working in the food, energy and mining sectors, as well as political elites did not agree upon or respect these policies. Rather they function in a clout of ‘self-regulation’ and ‘voluntary codes’, often part of the so-called corporate social responsibility.

That is why there is so strong voice here by many participants to enforce corporate social accountability, not merely by big commercial actors, but similarly via advocating parliamentarians and governments that they have the obligations to respect their citizens’ rights above the drive for unsustainable economic growth. 

Alas, the WHO member states present agreed upon a rather general, soft-toned Rio political declaration (draft version), while a group of public interest civil society organizations, academia and individuals produced an Alternative Rio Declaration that addresses the health and social crises much more upfront. 

The final day of the World Conference on Social Determinants of Health will guide the future path for action. If required we can still decide to OCCUPY WHO! 

Remco van de Pas

Wemos 

Conference website: WHO
Thematic guide and debates: MMI