Social determinants of health


Equitable sharing of the benefits from economic growth

The government of Chile has been committed to the economic and social development of its population through competitive integration in the global economy and decisive action in social programs to insure that the benefits of economic growth reach all sectors of society. Since 1990, the country has made notable social progress. Per capita income more than doubled. Average salaries increased 157% with a 70% rise in minimum wage. Poverty fell from 38,5% in 1990 to 18,8% in 2004. Life expectancy rose 5.06 years comparing the 1985 – 1990 and 2000 – 2005 periods. Infant mortality was reduced from 16.0 to 7.8 per 1000 live births.

The Government of Chile recognizes that this strong economic growth requires progress in equality of opportunities and comprehensive social protection to be sustainable. Following this understanding, the government is taking robust action in relevant areas of social policy. Fully 68% of the country’s public sector budget for 2007 was oriented to social expenditure, an 11.2% increase compared to 2006.

Launch of the Commission in Chile

On 18 March 2005, the World Health Organization and the Government of Chile launched the Commission on Social Determinants of Health with the participation of Chilean President Ricardo Lagos and Minister of Health, WHO Director-General and Commission Chair.

How work was organized?

Chile's activities as a Country Partner have built upon previous SDH work initiated during the Health Reform process begun in 1998. Chile established a focal point within the Ministry of Health, in the Office of the Undersecretary of Public Health, to coordinate Country Partner activities and to spearhead a particular focus on issues of child health and workers' health.

Regional Health Authorities (RHAs) have been involved in integrating SDH and HE into health sector planning and monitoring following a detailed intersectoral analysis of health inequities. The Ministry of Health is also working with municipalities and RHAs to develop a new program to support citizen participation initiatives at regional and local levels.

At the regional (supra-national) level in the Americas, Chile has signed a Memorandum of Understanding with Brazil and is supporting regional initiatives to eliminate silicosis and address occupational health issues.

The above document is a presentation of former Undersecretary of Public Health on social policy reforms in Chile, successful experiences and plans to build an equitable health system integrating the Social Determinants Approach.

Comprehensive social protection initiatives

Effective action on SDH poses several challenges. Among them, the most relevant is to trigger a process whereby actors from inside and outside the health sector adopt an SDH approach to improve health status. To succeed in this, SDH should be integrated into more comprehensive goals, such as social protection or quality of life, which may be linked to strategic goals and products of different Ministries and agencies.

The Chilean model of SDH action thus involves integrating SDH policies and programmes as part of the construction of a broader social protection system. Various components of such a system are in place in Chile and provide useful lessons about agenda setting and the implementation process. Among those are the GES (Explicit Health Guarantees) system, the social support and integration programme ‘Chile Solidario’ and Chile Crece Contigo.

"Explicit Health Guarantees" system (GES)

The Chilean model of SDH action involves integrating SDH policies and programmes as part of the construction of a broader social protection system. An interesting example of a rights-based approach to public policy is the GES (Explicit Health Guarantees) system. For a list of 40 diseases Chileans are granted the right to access care within a certain period of time; with maximum co-payments; and quality standards guaranteed by the state. Diseases under GES are the main causes of morbidity and mortality in Chile.

"Chile Solidario"

The social support and integration programme ‘Chile Solidario’ is the first intersectoral program with a systemic approach to social protection. This programme coordinate different social sectors to target families in extreme poverty to ensure access to interventions designed to enable social re-integration. Chile Solidario and GES provide insights about the requirement of a comprehensive integrated information system, to ensure social programmes reach those who need them most.

“Chile Crece Contigo” (Chile Grows Along With You)

Recognizing the critical role that plays living conditions in the early years influencing social determinants of health Chile has also prioritized a social protection system with universal coverage for the whole population throughout the life cycle, with a comprehensive network of services based on a human rights framework. The network is being built in progressively, starting with young children and the elderly. The Social Protection for Young Children component, known as “Chile Crece Contigo” (Chile growths along with you) was launched in 2007.

Implementing a SDH approach in health programs

In addition to the initiatives mentioned the government of Chile since 2008 has been implementing a strategy for the integration of a SDH approach for the design, implementation and evaluation of national health programs. The initial focus is on six prioritized areas (Workers Health, Cardiovascular Diseases, Sexual and Reproductive Health, Child and Adolescent Health, Oral Health, Red Tide). Each of these programs will review the main barriers and social determinants that generate inequities in their provision and will propose a redesign of the each including actions to address different of social determinants of health (more information).

Country Partner activities also included strengthening equity and SDH information through monitoring and revision of National Health Equity Targets. In 2006, Chile conducted a decomposition analysis of the National Quality of Life Survey to better understand how various sectors can contribute to health, and developed the first National Quality of Life Survey focused on Workers' and Employment Conditions.

Commissioner Ricardo Lagos

Ricardo Lagos Escobar is the former President of Chile. An economist and lawyer by qualification, he worked as an economist for the United Nations, served in Chile as both Education Minister and Minister of Public Works.