Director-General

WHO Director-General addresses first World Conference on Social Determinants of Health

Dr Margaret Chan
Director-General of the World Health Organization

Opening address at World Conference on Social Determinants of Health
Rio de Janeiro, Brazil

19 October 2011

Excellences, honourable ministers, distinguished delegates, colleagues in public health, ladies and gentlemen,

It is a great pleasure to participate in the opening of the World Conference on Social Determinants of Health.

Brazil is an ideal place to host this first event of its kind. The country has long enjoyed a strong civil society movement, and that movement was the force pushing for health reform as a route to greater equity.

Recent reforms recognize health as more than a biomedical issue, with dimensions that stretch through every segment of society and every policy that shapes the social environment.

The country’s stunning recent improvements in key indicators of health, like child mortality and life expectancy, are proof of what can be achieved when social equity is embedded in mindsets and politics.

Ladies and gentlemen,

As we open this World Conference, much hangs in the balance.

Lives hang in the balance, many millions of them. These are lives cut short, much too early, because the right policies were not in place.

That basic human desire for a better life is at stake, as are prospects for lifting more than a billion people out of an eternal poverty trap.

Social cohesion, stability, and security are at stake, in individual nations and internationally.

The credibility of governments in the eyes of their citizens is at stake. As stated in the Constitution of the World Health Organization:

“Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.”

As we all know, far too many governments are challenged in fulfilling this basic duty.

How many countries have a safety net that catches each and every citizen before they fall into poverty because of catastrophic medical bills?

The very way that societies measure progress is at stake. For as long as anyone can remember, economic growth has been the be-all, end-all, cure-for-all.

Progress in a civilized world should mean something more than simply making more and more money.

Globalization was said to be the rising tide that would lift all boats. This never happened. Instead, it lifted the big boats but tended to sink or swamp many smaller ones.

We all know the reality. Globalization creates benefits, sometimes very big benefits, but has no rules that ensure the fair distribution of these benefits.

The same is true for the international systems that govern the way our highly interdependent and interconnected world works, whether in international trade or through global commerce.

The goal is to produce economic benefits, not to distribute them fairly or evenly.

As a result, the differences, within and between countries, in income levels, in opportunities, in health status, and in access to care are greater today than at any time in recent history.

A world that is greatly out of balance in matters of health is neither stable nor secure.

Ladies and gentlemen,

As I said, it is appropriate that this World Conference on Social Determinants is held in Brazil. In addition, it is fortuitous that the first conference on this topic takes place in the year 2011.

Let us remember that 2011 is the 25th anniversary of the Ottawa Charter for Health promotion, a turning point to understand health as well-being and as a responsibility of governments. 2011 has seen more than its fair share of disruption, disasters, downturns, and social turmoil. But it has also witnessed two momentous events.

First, the face of the Middle East has begun to change. Populations have risen up to demand democratic reforms and respect for human rights, and this includes the right to health.

The uprisings have been, at times, highly inspiring, at other times, deeply disquieting.

Like the financial crisis of 2008, the swelling tide of uprisings and protests in the Middle East seemed to take the world by surprise.

With the benefit of hindsight, political and economic analysts have identified root causes which make the turmoil understandable, even predictable.

They cite vast inequalities in income levels, in opportunities, especially for youth, and in access to social services as the cause.

And they conclude that greater social equality must be the new political and economic imperative for a safer and more secure world.

Public health is extremely well-positioned to improve equity, especially when health services are delivered according to the values, principles, and approaches of primary health care, as is the case here in Brazil.

The second momentous event occurred in September, when a special session of the United Nations General Assembly considered the severe impact, on societies and economies, of chronic noncommunicable diseases.

These diseases are on the rampage, driven as they are by powerful, universal forces, like rapid urbanization and the globalization of unhealthy lifestyles.

Left unchecked, noncommunicable diseases devour the gains of economic growth. They cancel out the benefits of modernization. They break the bank.

In some countries, for example, care for diabetes alone consumes as much as 15% of the national health care budget.

A recent World Economic Forum and Harvard University study estimates that, over the next 20 years, NCDs will cost the global economy more than $30 trillion, representing 48 percent of global GDP in 2010.

In large parts of the developing world, these chronic conditions are detected late, when patients need extensive and expensive hospital care for severe complications or acute events.

Most care for these diseases is covered through out-of-pocket payments, leading to catastrophic medical expenditures.

For all these reasons, noncommunicable diseases deliver a two-punch blow to development. They cause billions of dollars in losses of national income, and they push millions of people below the poverty line, each and every year.

Prevention is by far the better option. And prevention is entirely feasible and affordable in any resource setting.

Unfortunately, all the main risk factors that contribute to these diseases fall outside the direct control of health officials.

The health sector has no control over the cheap and convenient availability of processed junk food, the consumption of tobacco and alcohol, and the weight problems that go with sedentary city lives.

Likewise, preventive measures fall outside the purview of the health sector.

Against these diseases, public health loses its power to have a direct impact on health outcomes.

I can think of no other major health challenge facing the world today that illustrates so profoundly the need to have the right policies in place in all sectors of government.

The striking rise of these diseases illustrates the vast collateral damage to health caused by policies made in other sectors and in the international systems.

Knowing the right policies is easy. Policies that create social environments that make healthy choices the easy choices are well studied and have a proven track record of success.

But putting these policies in place is an enormous challenge. Establishing and enforcing health-promoting policies means pushing for fairness against some extremely powerful and pervasive commercial interests.

Every corner of the global is now struggling with a skyrocketing prevalence of obesity and overweight. Rates of obesity in children are rising several times faster than in the adult population.

This is not a failure of individual will power, but a failure of political will at the highest level.

Kids the world over love the same cartoon characters that tell them what to eat and drink.

Just twelve days ago, France announced plans to impose a so-called “fat tax” on sugary drinks. One multinational beverage producer immediately retaliated with threats of an investment freeze.

When we look at the tobacco industry, we see that you really can teach a dirty old dog some new tricks.

Big Tobacco’s efforts to subvert the WHO Framework Convention on Tobacco Control have reached new heights. Tactics that were previously covert are now out in the open and extremely aggressive.

The high-profile commercial and investment arbitrations targeting Uruguay and Australia are deliberately designed to instil fear in other countries wishing to introduce similarly tough tobacco control measures.

Numerous other countries are being subjected to the same kind of aggressive scare tactics. It is hard for any country to bear the financial burden of this kind of litigation, but most especially so for small countries.

In the face of such pressures and tactics, my advice is this: a health-wise population fights back street-wise. Educate your citizens. Teach them well. Stand firm together. Do not bow to pressure.

Ladies and gentlemen,

These are some of the forces undermining health that are being addressed during this conference. The challenges are enormous.

Will governments now finally put the health of people before the health of corporations, especially at a time when the economic downturn keeps getting deeper?

In my view, this world conference must be the third momentous event of the year.

We know enough to act. We have extremely compelling reasons, also economic ones, to act.

We need to change the rules that govern this world. We need to persuade other sectors and systems to make equity an explicit policy objective.

We know the results: greater social cohesion, security, and stability.

In this messy, lopsided world beset by so much turmoil, that is a prize worth fighting for, in health and multiple other sectors.

Thank you, Brazil, for hosting this conference and for leading by example.

I thank all of you for your attention.

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