Presentation delivered by Dr Haifa Madi, Director, Health Protection and Promotion at the 62nd Session of the WHO Regional Committee for the Eastern Mediterranean

1. Social Determinants of Health
Pre RC Technical Meetings
62nd Session of the WHO Regional Committee for
the Eastern Mediterranean
5-8 OCTOBER 2015, Kuwait

2. Main Objective of this Session
1. To update MS on the work done since the
61st session of the RC of 2014 in the area of
SDH and
2. To agree on the way forward.

3. The Social Determinants of Health are...
…the
conditions
in which
people
born
grow
work
age
Structural determinants:
Governance, economic, social and public
policies, culture and societal Values, social
class, gender ethnicity, education,
occupation, income and place of living
Intermediary determinants of health:
Material circumstances (living and
working conditions, food
availability, etc.),exposure to risks,
risk-behaviors, biological factors
and psychosocial factors

4. WHO’s and Government's commitment
• 2005 - Established commission on SDH - to
identify the ways to overcome health
inequities;
• 2008 - Commission submitted report to
WHA 62.14
• 2009 - WHA resolution 62.14 “Calls MSs
and WHO for reducing health inequities
through action on SDH”
• 2011 – World Conference on SDH Brazil -
Rio political declaration (governance for
health, participation, reorienting health
sector and monitoring progress)
• SDG Goal no 10 and other goals

5. Sixty-first Session of the Regional Committee, 2014
Acknowledged
 There are significant health inequities that can be reduced by acting
on SDH.
 Producing evidence for advocacy and political commitment are vital.
 Action by the whole government and non-health sectors is crucial.
 Partnership with UN organizations and stakeholders is needed.
 Progress in the 5 regional priorities cannot be achieve without acting
on SDH.
 Health Ministers have a vital role in leading action on SDH:
o Advocacy o improving health equity
o Providing and using evidence o Identifying data gaps
o Develop multi-sector
programmes
o mainstreaming health equity in all public
policies
o Developing accountability framework

6. Outcome of the 61st RC
RC requested WHO to:
• Prepare a regional strategy/strategic directions on SDH with
action-oriented framework for country plans of action;
• To conduct an inter-country meeting to discuss strategic
directions and develop a clear vision on the way forward to be
presented to the 62nd Session of the RC;
WHO response:
 A regional consultation was conducted in Tehran, in April, 2015.
 Attended by 22 participants from 13 countries, 15 experts, and
staff representing the UN Programmes and WHO.

7. Components of the SDH Framework
• Evidence-building, advocacy and capacity-building:
– Support countries in conducting in-depth assessments of health inequity
– Engage multiple departments/ministries in identifying data gaps.
– Conduct national workshop to agree on the data gap and key interventions
– Develop economic and social case studies
– Develop policy briefs for advocacy
• Governance and integration of social determinants of health in the
five WHO priority areas:
– Establish a high-level multisectoral task force,
– Incorporate SDH in national development policies and plans
– Integrate SDH in the five priority programmes
– Conduct an assessment of health system performance, and plan to
improve access to quality care.
– Integrate SDH in health, medical and nursing pre-service education.

8. Components of the SDH Framework continue
• Partnership and harmonization
– Map UN interventions in line with the SDH concept and methodology.
– Direct the UN Country Team to strengthen synergy between UN
agencies and partners on SDH interventions.
Four countries: I. R. Iran , Jordan, Morocco and Sudan. Also Palestine
expressed interest in the exercise. The 5 countries conducted or in the
process of conducting in-depth assessment on SDH and health inequity

9. Preliminary results of the in-depth assessment in
the 5 countries
Common factors:
• High political commitment
• Multi-sectoral mechanisms exist either for SDH or for other
purposes,
• Data on health inequity are available but incomplete with
significant data gaps especially at subnational level
• While social determinants are country specific, some
determinants are common to all countries
• Ministries of health of the five countries are facilitating and
coordinating the work on SDH and HiAPs and are taking the
agenda forward

10. Sudan
Key SDH for Health :
• Access to health care
• Education (women’s education)
• Gender issues
• Access to safe water and
sanitation
• Nutrition and food security
• Instability (displaced, refugees)
• Unemployment and poverty
Roadmap:
• Strengthening multisectoral
coordination structures
• Strengthening commitment of the
national Health Council and the
Parliament
• Building capacity for effective
implementation to address health
inequities
• Mainstreaming SDH in all policies,
health programmes and initiatives
• Building accountability (M&E)

11. Morocco
Key SDH for Health :
• Education (women’s education)
• Poverty
• Gender
• Residence: urban-rural and
geographical distance between
regions
Way forward:
• Conduct a national debate
• Establish a multisectoral
mechanism
• Regionalization: Development of
action plan on SDH with a regional
and local focus
• Strengthen availability and
utilization of data
• Capacity building
• Implement the WHO 5- step tool
• Advocacy and consensus
building with key actors and sectors

12. Palestine (Special Contexts)
West Bank
• Limited accessibility to
health care
• Lack of water and sanitation
• Unemployment
• Poverty
• Infrastructure damage
• Lack of social protection
• Poor food quality
Gaza
• 35% of deaths and 2.4% has
sever physical disability (2014)
• Destruction of health facilities
• Limited access to care
• Poverty 39%
• Unemployment 47%
• Food insecurity: 72% are either
food insecure or vulnerable
• Increased mental disorders and
substance use
War and occupation are the main SDH

13. Way Forward
Countries
• Countries that conducted the assessment need to develop appropriate
multisectoral plans and share experiences.
• Agree on a core set of indicators to monitor health inequities and SDH to be
integrated within the HIS.
• Monitor progress achieved with focus on impact assessment of adopted
interventions
• Other countries may wish to consider conducting the exercise
WHO and IHE:
• To prepare analysis of four country data
• To organize a regional meeting to agree on a list of core equity indicators
• To finalize the Regional strategy/strategic direction based on the results of the
country assessments
• To provide technical support especially during the national workshops