Transcript of WHO podcast - 02 September 2008
The WHO Commission on Social Determinants of Health submits its final report to the WHO Director-General.
Veronica Riemer: You’re listening to the WHO podcast. My name is Veronica Riemer and this is episode 44.
In this episode, we talk about the World Health Organization's Commission on the Social Determinants of Health.
Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death.
A child in a Glasgow suburb in Scotland can expect a life 28 years shorter than another living only a few kilometres away.
A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17 400; in Afghanistan, the odds are 1 in 8.
Biology does not explain any of this. Instead, the differences between -- and within -- countries result from the social environment where people are born, live, grow, work and age. These "social determinants of health" have been the focus of a three-year investigation by a group of policy-makers, academics, politicians and former ministers of health. This week, the Commission presented its findings to the WHO Director-General Dr Margaret Chan.
Five of the commissioners from this eminent group have given us their views on the social determinants of health around the world.
David Satcher is Director of the Center of Excellence on Health Disparities and the Satcher Health Leadership Institute Initiative. He spoke to Dick Thompson about the meaning of social determinants and why we should care about them.
David Satcher: I think when we talk about the determinants of health, we are talking about the major factors that influence health outcome. And, certainly one of those factors relates to social policies and social conditions that affect the way in which people are born, where they grow, where they learn, where they live, even where they age. So those social policies and social conditions which impact the environment in which people live and develop, are social determinants of health.
Dick Thompson: You said that these are the major factors that influence health outcomes, but isn't it the availability of doctors and technology and medicines that really determines that?
David Satcher: It is interesting because clearly one of the determinants of health outcome is access to quality health care. It is only one and it accounts for probably no more than 15% of the variation in outcome. But I want to make it clear that, when people live in a situation where they don't have access to health care, then access to health care becomes a social determinant of health.
Veronica Riemer: Denny Vågerö, Professor of Medical Sociology and Director of the Centre for Health Equity Studies in Sweden spoke to us about how we need to change the way we think about our health.
Denny Vågerö: Traditionally we have thought about health like something medical, something you fix at the doctors. We have to think much more about health as something that is routed in daily life, everything we do, everything we experience has potential impact on our health and we need to understand that much more and think about the policies which could address conditions in daily life, improve daily life so that we get healthier.
My personal message is that business as usual is not an option any more. We have to treat the global health problem on the same level as we discuss poverty or climate change. It is one of the fundamental human struggles to improve global health and in particular to make sure that everyone is on the boat, that we don't leave people behind as we do now.
Veronica Riemer: We spoke on the telephone to Frances Baum who is a Professor of Public Health at Flinders University and Foundation Director of the South Australian Community Health Research Unit.
Frances Baum: We need to decide as a society and in our governments that promoting health and well-being is absolutely crucial to all areas of activity in our society and that we should establish that as a goal of our society. We should start looking at our health as a measure of how well we are doing as a global society and we should really strive to make as many countries as equal as possible and also do that at a national level.
Veronica Riemer: Ndioro Ndiaye is the Deputy Director-General of the International Organization for Migration and was formerly Minister for Social Development and Minister for Women’s, Children’s and Family Affairs in Senegal. We asked her about the main goal for the members of the commission in writing this report.
Voiceover: Under the leadership of Sir Michael Marmot we tried to help countries understand what changes they can introduce, to help ministers of health work more closely with their colleagues in the same government, to put in place programmes that will help ministries of health when preparing their programmes. The social determinants of health steered us to adopt a multisectorial approach, an integrated approach to health problems, to build an efficient health system that will help the population as a whole.
Mirai Chatterjee is the Coordinator of Social Security for India’s Self-Employed Women’s Association, a trade union of over 900 000 self-employed women. She spoke to us about the implications of gender in social determinants of health.
Women in country after country , do not have equal access. It is not just a question of access to health services, it is a question of the status of women. Persistent discrimination against women in country after country has a direct impact on their health in so many ways. Access, but also violence against women, so many issues. Women get the worst work, so occupational health also has a differential impact on women as opposed to men in every community wherever we visited all over the world. If you are disempowered, you have no voice, if you are not organized like how our sisters were 40 years ago, then how can you be healthy. Because all the conditions that keep us sick and in ill heath, have to do with inequality, injustice, gender discrimination and they cannot be addressed until we come together, organize, build strong people's organizations and really struggle and fight against the forces that keep us sick, poor and constantly in debt.
Veronica Riemer: You can learn more about this report by going to the WHO web site at www.who.int/social_determinants/.
That's all for this episode of the WHO podcast. Thanks for listening. If you have any comments on our podcast or have any suggestions for future health topics drop us a line. Our email address is Podcast@who.int.
For the World Health Organization, this is Veronica Riemer in Geneva.