Session outline Throughout the world, vulnerable and socially disadvantaged people have less access to health resources, get sicker and die earlier than people in more privileged social positions. These unfair gaps are growing in spite of an era of unprecedented global wealth, knowledge and health awareness. By far the greatest share of health problems is attributable to broad social conditions. In 2005, WHO Director-General Dr LEE Jong-wook called for the formation of the Commission on Social Determinants of Health (CSDH), the Commission was charged with recommending interventions and policies to improve health and narrow health inequalities through action on social determinants. Over the past three years, the CSDH has brought together leading scientists and practitioners that have provided evidence on policies that improve health equity outcomes by addressing the social conditions which people live and work.
The work of the CSDH is now coming to a close. Chaired by Sir Michael Marmot of University College London, the Commission will present its final report to the WHO Director-General in the coming weeks and a final report will be released later this year.
The conclusions of the final report have not been yet released but as recently indicated by Professor Marmot during a technical briefing on the report at the World Health Assembly (May 21th), three linked areas for action will be highlighted in order to formulate sound recommendations:
The conditions in which people grow, live, work and age have a powerful influence on health. Inequalities in these conditions lead to inequalities in health.
Health inequities are the result of a complex system operating at global, national, and local levels. The Commission has tried to understand and articulate the causes of these inequities. These structural drivers would be subject to specific actions.
The Commission has developed an evidence base for political action. Its work highlighted the need of monitoring inequities in health and building capacities in this field of research. Research on social determinants and health equity should be mainstreamed as it constitutes a prerequisite to identify points of entries to concrete actions.
Professor Ndioro Ndiaye, Deputy Director-General of the International Organization for Migration and member of The Commission on the Social Determinants of Health will present some of the preliminary findings and key recommendations of the CSDH report. The discussion will then allow the members of the panel and the audience to discuss how these findings relate to their respective areas of work and how all actors intend to incorporate these recommendations and take concrete action to implement them.
Questions What are concrete examples of social determinants of health interventions?
How at a country level incorporate the recommendations of the CSDH?
What can we learn from countries that have already started to take action? How these local experiences could benefit other countries?
How will the report’s recommendations be diffused and discussed at a local, regional and global level? How will it be diffused outside the health sector?
The social determinants calling for an intersectorial approach which type of coordination, governance should be put in place at a national/global level to leverage action outside the health sector?
How will we track improvements?
References Reports/background papers
Interim Statement of the Commission on Social Determinants of Health 2007 Civil Society’s Report to the Commission on Social Determinants of Health
Social Medicine, Volume 2, Number 4, October 2007 Action on the social determinants of health: Learning from previous experiences This paper was prepared for the first meeting of the Commission on Social Determinants of Health by the Commission secretariat, based in the WHO Health Equity Team, Office of the Assistant Director-General, Evidence and Information for Policy Cluster, March 2005, WHO Geneva
From the CSDH website:
Editorials, policy and research on social determinants of health Editorials, policy and research on equity and social determinants of health, the role of health promotion, the Commission on Social Determinants of Health and its Knowledge Networks, civil society action, health inequities and the social determinants of health in Australia: Health Promotion Journal of Australia, December 2006.
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Health in an unequal world Commissioner Michael Marmot's lecture presented at the Royal College of Physicians, London: inequalities in health between countries and inequalities within: the Lancet, 368:2081-2094, 9 December 2006.
The Lancet lecture
Editorials on social determinants of health Equity and the social determinants of health by Fran Baum and Liz Harris; A global perspective on health promotion and the social determinants of health by David Sanders; The social determinants of health: what are the three key roles for health promotion? by Dennis Raphael; Are social determinants of health the same as societal determinants of health? by Barbara Starfield: Health Promotion Journal of Australia, 2006.
AHPA journal editorials
Tackling social determinants of health through community based initiatives BMJ analysis and comment on gender and health; basic development needs programmes; effect of basic development needs programmes; challenges and opportunities; sustaining community based initiatives: BMJ 2006;333:854-856, 21 October.
Promoting global action on the social determinants of health Article by Commissioner Hoda Rashad in Diabetes Voice: policy, action and leadership to address social factors can improve health and access to healthcare, September 2006.
Dibates Voice article by Hoda Rashad [pdf 233kb]
The Commission: tackling the social roots of health inequities The Commission on Social Determinants of Health: its goals, challenges and action areas. Jeannette Vega et al, PLoS Medicine, 3 (6), June 2006.
Full text article Untreated social ills make for higher medical costs Second opinion by Andre Picard on Canada's welfare system, social programs, and health costs: The Globe and Mail, June 2006.
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Effects of self-reported racial discrimination and deprivation on Maori health and inequalities in New Zealand Cross-sectional study to assess the effect of self-reported racial discrimination and deprivation on health inequalities: Ricci Harris et al, The Lancet, vol 367, June 2006.
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Indigenous health in Latin America and the Caribbean Review of the current state of indigenous health, and discussions on importance of indigenous health systems and medicines: Raul Montenegro, Carolyn Stephens, The Lancet, vol 367, June 2006.
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Health of indigenous people in Africa Case studies of the Central African Pygmy peoples and the San of Southern Africa to illustrate recurring issues in indigenous health in the continent: Nyang Ohenjo et al, The Lancet, vol 367, June 2006.
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Disappearing, displaced, and undervalued: a call to action for indigenous health worldwide Paper on the health of indigenous peoples, describes the poor health indicators, helps to put indigenous health into an international context: Carolyn Stephens et el, The Lancet, vol 367, June 2006.
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Addressing the social causes of illness Panel discussion hosted by Canada’s International Development Research Centre (IDRC) by Stephen Dale: looking beyond genes and germs, health and economics, budgeting for better health, April 2006.
Health disparities and health equity: concepts and measurement This paper aims to clarify the concepts of health disparities/inequalities and health equity, focusing on the implications of different definitions for measurement, Annual Review of Public Health, April 2006.
Annual Reviews article
Indigenous health in Australia, New Zealand, and the Pacific Discussion on the key policy initiatives that have been developed to address indigenous health disadvantage: Ian Anderson et al, The Lancet, vol 367, May 2006.
Download article [pdf 989kb] State of the art in research on equity in health Essay on history of the concept of equity in health, current evidence regarding infuences on health relevant to equity: Barbara Starfield, Journal of Health Politics, Policy and Law, vol 31, February 2006.
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Public health is a social issue Comment on social causes of health and disease, links between poverty and health system: LEE Jong-wook, WHO Director-General, The Lancet, vol 365, March 2005.
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Tackling health inequalities since the Acheson inquiry Policies are in place that could make a difference: Michael Marmot, Journal of Epidemiology and Community Health, 58:262-263, 2004.
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Tackling health inequalities: new approaches in public health A multisectoral approach to policy design and implementation is urgently needed to confront disease burdens in developing countries: Jeanette Vega, Alec Irwin, WHO Bulletin, 82 (7), July 2004.
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Incorporating concepts of inequality and inequity into health benefits analysis Inequality indicator for health benefits analysis: J.Levy et al, International Journal for Equity in Health 2006, 5:2, March 2006.
Creating healthier societies The solid facts summarizing social determinants of health: Michael Marmot, Bulletin of the World Health Organization, 82 (5), May 2004.
Full text article
The Commission on Social Determinants of Health: Tackling the Social Roots of Health Inequities Irwin A, Valentine N, Brown C, Loewenson R, Solar O, et al. PLoS Medicine Vol. 3, No. 6