This document summarizes progress made in addressing social determinants of health since the 2008 WHO Commission on Social Determinants of Health report and 2011 Rio Political Declaration. It outlines global health inequalities, defines social determinants of health, and discusses the Commission's recommendations. It then summarizes implementation of the Rio Declaration's five action areas, including regional and country initiatives, and calls for continued efforts to build capacity, integrate social determinants into public health programs, and achieve health equity for all.

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