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Realizing the Rio Political Declaration: Progress in Addressing the Social Determinants of Health

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Presentation delivered during the Experts for Interns seminar last June 25, 2013 at the World Health Organization, Geneva, Switzerland

Presentation delivered during the Experts for Interns seminar last June 25, 2013 at the World Health Organization, Geneva, Switzerland


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  • 1. Realizing the Rio Political Declaration: Progress in Addressing the Social Determinants of Health Ramon Lorenzo Luis R. Guinto, MD Social Determinants of Health Unit Department of Ethics and Social Determinants of Health June 2013
  • 2. 2 | Outline Global Health Inequalities Social Determinants of Health From the Commission to the Declaration Rio Political Declaration: Progress So Far Future Direction
  • 3. 3 | Is it sufficient just to treat people… and then send them back to the conditions that made them sick?
  • 4. 4 | Life expectancy at birth (men) Glasgow, Scotland (deprived suburb) 54 India 61 Philippines 65 Korea 65 Lithuania 66 Poland 71 Mexico 72 Cuba 75 US 75 UK 76 Glasgow, Scotland (affluent suburb) 82 (WHO World Health Report 2006; Hanlon, P., Walsh, D. & Whyte, B., 2006)
  • 5. 5 | Under 5 mortality (per 1000 live births) by wealth group 0 50 100 150 200 250 300 350 Mali India Morocco Peru Kyrgyz Republic Poorest Less poor Middle Less rich Richest (Houweling et al, 2007)
  • 6. 6 | Mortality over 25 years according to level in the occupational hierarchy: Whitehall 0 10 20 30 40 50 60 70 80 40-64yrs 65-69yrs 70-89yrs Allcausemortality(per1000personyrs) Admin Prof/Exec Clerical Other (Marmot & Shipley, BMJ, 1996)
  • 7. 7 | Life Expectancy of Indigenous Peoples (Bramley et al, 2005)
  • 8. 8 | (Pinto da Cunha, 1997) Infant mortality in Brazil by race and mother's education, 1990
  • 9. 9 | The widening trend in mortality by education in Russia, 1989-2001 (probabilityoflivingto65yrswhenaged20yrs) (Murphyetal,2005)
  • 10. 10 |
  • 11. 11 | Causes of the Causes? Do we not always find the diseases of the populace traceable to defects in society? Rudolf Virchow Father of Social Medicine
  • 12. 12 | What are the social determinants of health? "The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of peoples lives – their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities – and their chances of leading a flourishing life.” WHO Commission on Social Determinants of Health, 2008
  • 13. 13 | What are the social determinants of health? “This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is a result of the toxic combination of poor social policies and programs, unfair economic arrangements and bad politics. Together, the structural determinants and conditions of daily life constitute the social determinants of health." WHO Commission on Social Determinants of Health, 2008
  • 14. 14 | Social Determinants of Health
  • 15. 15 | Commission on Social Determinants of Health  Established by WHO in March 2005 to support countries and global health partners in addressing the social factors leading to ill health and health inequities  Chaired by Professor Sir Michael Marmot with 18 other commissioners representing academics, politicians, civil society, and senior public health bureaucrats
  • 16. 16 | Why emphasize on social determinants? Social determinants of health have a direct impact on health Social determinants predict the greatest proportion of health status variance (health inequity) Social determinants of health structure health behaviours Social determinants of health interact with each other to produce health
  • 17. 17 | Commission’s Overarching Recommendations 1. Improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age. 2. Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally, and locally. 3. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.
  • 18. 18 | Since the Launching of the Report…
  • 19. 19 | World Conference on SDH, 2011 “…to convene a global event, with the assistance of Member States, before the Sixty-fifth World Health Assembly in order to discuss renewed plans for addressing the alarming trends of health inequities through addressing social determinants of health…” WHA Resolution 62.14
  • 20. 20 | Rio Political Declaration on SDH 1. To adopt better governance for health and development 2. To promote participation in policy- making and implementation 3. To further reorient the health sector towards reducing health inequities 4. To strengthen global governance and collaboration 5. To monitor progress and increase accountability
  • 21. 21 | Implementing the Rio Political Declaration The discussion paper prepared for the World Conference details the implementation steps and priority strategies approved and supported by Member States for realizing the action areas of the Rio Political Declaration.
  • 22. 22 | Action Area 1: Better Governance Summer School on Health in All Policies to train HiAP trainers was held last 2011 in Adelaide, Australia. 8th Global Conference on Health Promotion on “Health in All Policies” to be held on June 10-14, 2013 in Helsinki, Finland
  • 23. 23 | Action Area 2: People’s Participation An interactive web platform called “ACTION:SDH” was established to facilitate the development of a community of practice on SDH.
  • 24. 24 | Action Area 3: Reorienting Health Sector SDH identified as both a fundamental approach and a priority area of work in the draft of the 12th WHO General Program of Work 2014-2019 Continuing work on evidence generation, implementation, and evaluation on integrating the SDH approach in public health programs
  • 25. 25 | Action Area 4: Global Governance The UN Platform on Social Determinants of Health (WHO, ILO, UNDP, UNFPA, UNICEF, UNAIDS) gives inputs to ongoing post-2015 development agenda discussions
  • 26. 26 | Action Area 5: Monitoring and accountability  WHO Center for Health Development in Kobe, Japan developed the Urban Health Equity Assessment and Response Tool (Urban HEART), which is now adapted to island settings in the Western Pacific Region  A handbook on how to monitor health inequalities in low- and middle- income countries was developed with the support of the Public Health Agency of Canada (PHAC).
  • 27. 27 | Regional Efforts EURO PAHO
  • 28. 28 | Member State Initiatives Report from the Senate of Australia Brazilian Commission on Social Determinants of Health National Health Assembly in Thailand
  • 29. 29 | Political Commitment WHO Member States endorsed the Rio Political Declaration during the 65th World Health Assembly in May 2012 WHA 65.8 calls upon the Secretariat to take leadership in providing support to Member States in implementing the five action areas of the Rio Political Declaration
  • 30. 30 | Future Direction Establishment of a global capacity building initiative to support implementation by Member States, especially low- and middle-income countries Development of modules and guides on Health in All Policies and integrating the SDH approach in public health programs Development of social determinants of health indicators, including indicators that support the achievement of universal health coverage
  • 31. 31 | Action Towards Health Equity EVIDENCE POLITICAL COMMITMENT ACTION CSDH, 2008 Rio Political Declaration, 2011 A66/15 SDH Report, 2013
  • 32. 32 | “No one should be denied access to life-saving or health promoting interventions for unfair reasons, including those with economic or social causes. These are some of the issues being addressed by the Commission on Social Determinants of Health ... When health is concerned, equity really is a matter of life and death.”
  • 33. 33 | For further information www.who.int/social_determinants