Making social policies work for health
Interview with Commissioner Ricardo Lagos from Chile
Former President of Chile Ricardo Lagos officially took his position as CSDH Commissioner in Nairobi, Kenya in June 2006. In this interview he speaks about Chile's approach to social determinants of health and offers practical examples of translating social equity policies into action.
What were the critical success factors in Chile to advance the health equity agenda during your presidency?
It was the decision to put health reform with equity as the goal, as the number one priority. The previous President had invested in health infrastructure and focused on education and the judiciary. But infrastructure alone was not enough to achieve a wider impact on people's health, particularly at reaching people at all levels. We wanted to use the infrastructure more efficiently and build health through various policy interventions. We took a practical approach which involved an analysis of pathologies presented throughout the health system. We found they had changed drastically over the period of 15 years. About 56 pathologies were identified as responsible for 70% of the disease burden in Chile. We also established that about 30% of the population used the private sector while 70% went to the public sector. After analysing the pathologies, we designed evidence-base guidelines to address the 56 identified pathologies. The health reform, introduced three guarantees in addition to universal access. It introduced quality of care for all, less time spent waiting for care after diagnosis, and low cost access to care. All health provision had to be paid according to income and the ceiling was the people should not pay more than 20% of their health bills. The financing of this reform was the most difficult discussion with the opposition in parliament. It was extensive and seen as expensive. The key to change is that the decision and commitment should come from the highest level of governance. Health reform in Chile was a political decision supported by the top leadership.
How did you address the social determinants of health?
The social determinants are partially explained by access and the quality of care in hospital. But mainly, they are addressed through social policies which clearly aim at health outcomes. One example is the Chile Solidario, a programme we introduced to improve the lives of the poorest. We covered about 225 000 families. The programme offered assistance with regards to social pension, schooling for children, job skills, and family support.
Countries have different priorities according to their challenges, why not education for example?
The question is what kind of education you are providing. In many cases, there is no question that investing in education can have a greater impact. It is the goal that needs to be clearly defined. The kind of infrastructure, housing, education offered should be geared towards improving health. The effects of social policies that undermine people's health are well documented. It is a long way before going to hospital and when you do go, it is often the final step. But the hospital does not have to be the final destination if the living conditions are efficiently addressed.
What needs to change about the way health is viewed?
In a nutshell, health policies do not only belong to the ministry of health. The Commission on Social Determinants of Health should be able to demonstrate that the problem of health can be tackled through several social policies like education, infrastructure, housing, agriculture, finance and budgeting. The CSDH is aiming for recommendations and findings that offer real and tested examples of how this can happen.
