Social determinants of health

WHO called to return to Alma-Ata Declaration

Dr Serag challenged WHO to return to the principles of the Alma Ata Declaration

"Managing the Politics of Equity and Social Determinants of Health" - the title of the informal briefing the Commission held at the 59th World Health Assembly. The briefing drew sharper focus on the necessity of major health stakeholders to step up action on the social causes of ill-health. High-level policy makers, civil society members and WHO staff attended the briefing, proclaimed as a "historical moment" by a floor delegate. Among the attendees was Dr Halfdan Mahler considered to be the father of the Alma Ata Declaration and former WHO Director-General from 1973 to 1988.

"He gave us the dream. He launched new ideas and made us realize that it was possible to achieve health for everybody," Commissioner, Dr Giovanni Berlinguer noted. Dr Berlinguer outlined the evolution of global health politics over the past three decades and lamented the impact of changes in the political economy which saw public health recoil under the shadow of major financial institutions. He told delegates that the setting up of the Commission on Social Determinants of Health was an opportunity to add momentum to a global movement that wanted to see health inequalities addressed.

Bolivia's Health Minister Dr Nila Heredia pointed out her country's challenges to address inequalities in health, stating the low health budget and historical factors as some of the major obstacles (see her presentation below). She mentioned poverty, poor housing and low levels of education, particularly among women, as some of the key social determinants of health in Bolivia. The government was exploring several programs to address health inequalities which included a "zero malnutrition" program and the promotion of a social security system that would allow segments of society to gain free access to health.

Civil society representative, Dr Hani Serag challenged WHO and the Commission to address the "profound determinants such as violence, wars, and neo-liberal policies" and to allow the different components of the Commission to work independently. Dr Serag further challenged WHO to return to the principles of the Alma-Ata Declaration (see below). Commissioner Dr Ndioro Ndiaye stressed the importance of including sectors outside the health domain to be part of the developing healthy societies: "If we do not look at the intersectoral angle, that health is not just a medical problem … we will not succeed." The Commission already engages different ministries and sectors outside health to work collaboratively on social determinants of health and equity.