Commission on Social Determinants of Health

Official Launch Raúl Prebisch Auditorium, ECLAC

Santiago, Chile
18 March 2005

Mr President, Members of the Commission, Honourable Ministers, colleagues, ladies and gentlemen,

"Dadme un punto de apoyo y levantaré el mundo" — "Give me a place to stand and I will lift the earth," Archimedes said. All of us who work for health say the same today to our new Commission on the Social Determinants of Health. Give us a place to stand and we will lift the burden of ill health that is crushing so many people so unnecessarily in the world today.

Archimedes meant that with a long enough lever and the right place to exert pressure, he could lift any weight, however heavy. He is known as the man who discovered mechanics and physics about 22 centuries ago. That knowledge continues to change the way we live. The commissioners may need to discover something equally important in their turn. Each of them with their own outstanding ability and expertise is looking for better ways to work for health. By combining their talents they are multiplying their chances of success.

Medical science has achieved an impressive amount and we expect it to go on achieving more. But now we need some breakthroughs in what we might call social determinant science. Otherwise we could find ourselves as exposed to health hazards as our ancestors were. The challenges we now face include antimicrobial resistance, emerging disease pandemics, and the continued spread of existing epidemics. They require social solutions now just as urgently as biomedical ones.

From WHO's point of view there are two public health needs in the world: to improve health security globally, and to improve health status within countries. It is not possible to achieve one without the other.

We are fully engaged in initiatives to meet these needs. The activities include developing a global outbreak alert and response network, getting treatment to people living with AIDS, preventing infectious disease, eradicating polio, protecting the health of mothers and their children, and a large number of others. All such efforts have a strong social component.

If you take just one example, polio eradication, this is not hard to see. Polio prevention depends on a vaccine, but that vaccine itself exists because a very strong social movement funded and motivated the research for it in the 1950s. The same social impetus made the vaccine, once it had been discovered, available without delay and on a large scale. Furthermore, the fact that polio has not yet been eradicated globally is due almost entirely to social challenges rather than medical ones.

In the same way, national health programmes in rich and poor countries alike are grappling with social factors, such as education, living and working conditions, and economics. However good a health technology is, it cannot work if people are denied access to it. Where health workers struggle blindly with these social factors their projects are liable to fail. Where they work with open eyes, using what is known and uniting their efforts with those of colleagues in other sectors, they can be highly effective.

A great deal is known around the world about the social determinants of health, but that knowledge needs to be drawn together, more clearly understood and put more systematically to use. To help achieve this, all regions of the world are represented on the Commission. In addition, some members are more from the world of action and others more from the world of knowledge. Our hope is that they will inspire each other to enlighten their action and activate their knowledge even further, to make them highly effective and applicable in many situations.

Being here in Avenue Dag Hammarskjöld is an inspiring reminder of Chile's global vision. Dag Hammarskjöld, who was the second Secretary-General of the United Nations, was born 100 years ago this July. His life was devoted to international service and solidarity, which he saw as indispensable for the future of the world. Our new commission can help to recover and strengthen that understanding.

The fullest recent expression of the UN's social purpose is the Millennium Development Goals, adopted by the General Assembly in 2000. Those eight goals place a strong emphasis on health. Health indicators are perhaps the best means we have of assessing human well-being.

Many other promising initiatives are in progress, in addition to the Millennium Goals, and they will add to the Commission's strength. I think in particular of the Africa Commission and the current G8 and European Union efforts to reduce poverty through debt relief, new financing mechanisms and increasing development aid. I think also of national initiatives such as the Chile Solidario system and all the programmes we saw on yesterday’s site visits; Chile’s achievement of universal access to antiretroviral treatment and its progress towards building a strong health system; and the Regional Programme on Bioethics, whose centre is here at the University of Chile. Activities such as these are the ones that can contribute most directly and effectively to improving and protecting people’s health.

The Commission on Social Determinants of Health can be a powerful means of catalysing and strengthening such activities in all countries. It will complete its initial work in 2008. That will be 30 years after the Declaration of Alma-Ata (in 1978), and 60 years after the beginning of WHO (1948). Those were moments of great clarity about the needs and opportunities for health in the world. We should now start preparing, with the help of this Commission, for another such moment of clarity.

On behalf of health workers everywhere, and of all those who need them, I thank the Commissioners for joining this effort. and I wish them every success.

Thank you.