PROGRESS ON COMMISSION ON SOCIAL DETERMINANTS OF HEALTH Sir Michael Marmot Chair of the Commission on Social Determinants of Health

Key Messages Social, economic and political circumstances affect life and well-being and health; Policies should address early life development, working age, and ageing; Action on the determinants of health should involve the whole of government; Action on SDH should be founded on evidence.

Health Equity & Core Values Health equity can be defined as: –“The absence of unfair and avoidable or remediable differences in health among groups defined socially, economically, demographically or geographically“; –Both within countries and between countries Governments are accountable; Tackling health inequities requires action on SDH.

Commission Activities

A Structure of Work Streams  Commissioners  Knowledge Networks  Country Work  Civil Society Work  Global Initiatives  WHO Reference Group

Commissioner Meetings Chile – March 2005 Egypt – May 2005 India – September 2005 Iran – Jan 2006 Kenya – June 2006 Brazil – Sept 2006

CSDH Knowledge – the Causes of the Causes GLOBALIZATION HEALTH SYSTEMS CULTURE, RELIGION, SOCIAL SYSTEM, HUMAN RIGHTS, LABOUR MARKET, EDUCATION SYSTEM INCOME, EDUCATION, GENDER, ETHNICITY, AGEING LIVING AND WORKING CONDITIONS, HEALTH-RELATED BEHAVIOURS BIOLOGICAL PROCESSES HEALTH SOCIAL CONTEXT STRUCTURAL DETERMINANTS INTERMEDIARY DETERMINANTS

Integrating Knowledge for Action

Commission’s SDH Thematic Areas Sonia was born to a poor family in a remote rural village. With no formal schooling, her mother works as casual labour. Her father is unemployed, after losing his small-holding to creditors. She attends a local primary school, when she is not looking after her younger brothers, and when she is not sick. She has had bouts of illness from birth, but has given up going to the health centre where she is looked down on and treated badly, and rarely has the money to pay the fees. Ageing Migration Aid Mental Health Env. Change Alcohol Food Rural Settings Psychosocial Medical Education Education Violence Gender Social Excl Globalisation Health Systems Urban Settings PPHC Working Conditions ECD Evidence/Measurement

Putting Knowledge to Work The Globalisation KN looks both at ways in which globalisation can improve social and economic conditions, and at how it needs to be fair; The Employment Conditions KN looks at how processes of global economic integration and power relations at the local level interact to affect conditions of labour; The Urban Settings KN looks at the natural, physical, social and economic capital of the urban environment; Urbanisation is understood in the context of rural issues such as patterns of land-holding, and food access and availability.

Putting Knowledge to Work The Gender KN focuses on disparities between the sexes in opportunities for participation along the life course; The Health Systems KN focuses on cross-government stewardship for health, in which the health care system plays a central role; The Early Child Development KN is working to strengthen approaches to physical, emotional and cognitive development from the beginning; The Social Exclusion KN emphasises the impact across society of selective marginalisation of groups.

CSDH Country Work

AMRO / PAHO Chile (Formal Partner) Brasil (Formal Partner) Canada (Formal Partner) Bolivia (Formal Partner) Peru (Formal Partner) Nicaragua (Exploring) EURO Sweden (Formal Partner) England (Formal Partner) Kyrgyzstan (Formal Partner) Norway (Exploring) AFRO Kenya (Formal Partner) Senegal (Exploring) Mozambique (Sending Letter - Exploring) Malawi (Exploring) Tanzania (Exploring) Zambia (Exploring) WPRO Mongolia (Exploring) New Zealand (Exploring) EMRO Iran (Formal Partner) Exploring with regional office SEARO India (Exploring) Sri-Lanka (Formal Partner)

Country Knowledge into Action Developing a national SDH equity plan of action, and participatory process; – –Whole of government, cross-sectoral action to address the disadvantages Sonia experiences; Baseline situation analysis and implementation/ evaluation of specific policies/programmes; – –Recognising, identifying and acting on community needs.

Setting up national health equity information systems; – –Ensuring sustainable and timely information to underpin government strategy Making the economic case for investing upstream in health; – –Increasing investment in the causes of the causes Building evidence and knowledge of good practice; – –Strengthening the community of knowledge – –Capacity building

Civil Society

Plurality of perspectives, and direct representation Understanding how civil society can effect policy Partnership strengthening the sustainability of the SDH movement Civil Society Work

Regional Meeting National Meeting Country Participants Update Regional and Regional activities

Global Initiatives

Global Targets Ageing Migration Aid Mental Health Env. Change Alcohol Food Rural Settings Psychosocial Medical Education Education Violence Gender Social Excl Globalisation Health Systems Urban Settings PPHC Working Conditions ECD Evidence/Measurement Global Fora Donors Regional Orgs. UN IFIs

Global Initiatives Engage global institutions –To foster globalisation that protects equity; –To take into account equity in health in their policies, and support national policy space for health; –To increase investments towards action on social determinants of health. Engaging with multiple stakeholders, including G8, the World Bank, ECOSOC, the UN; Aiming regionally (in LAC) to engage with ECLAC, OAS, IADB and others.

CSDH: Reporting and Action

2008: A Global Launch A historical opportunity? ; A global media launch – CNN; A global movement – a critical mass of world leadership; Engaging all levels – heads of state, country governments, regional champions – to build and institutionalise sustainable commitment to the SDH agenda.

Joint meeting of global Commission on Social Determinants of Health and Brazilian National Commission on Social Determinants An opportunity to explore collaboration around: Knowledge, advocacy and action; At national, regional and global level –Nordic, Asian and Latin American