The Final Report of the Commission on Social Determinants of Health sets out key areas of daily living conditions and of the underlying structural drivers that influence them in which action is needed. It provides analysis of social determinants of health and concrete examples of types of action that have proven effective in improving health and health equity in countries at all levels of socioeconomic development. Part 1 sets the scene, laying out the rationale for a global movement to advance health equity through action on the social determinants of health. It illustrates the extent of the problem between and within countries, describes what the Commission believes the causes of health inequities are, and points to where solutions may lie. Part 2 outlines the approach the Commission took to evidence, and to the indispensable value of acknowledging and using the rich diversity of different types of knowledge. Parts 3, 4, and 5 set out in more detail the Commission s findings and recommendations. The chapters in Part 3 deal with the conditions of daily living the more easily visible aspects of birth, growth, and education; of living and working; and of using health care. The chapters in Part 4 look at more structural conditions social and economic policies that shape growing, living, and working; the relative roles of state and market in providing for good and equitable health; and the wide international and global conditions that can help or hinder national and local action for health equity. Part 5 focuses on the critical importance of data not simply conventional research, but living evidence of progress or deterioration in the quality of people s lives and health that can only be attained through commitment to and capacity in health equity surveillance and monitoring. Part 6, finally, reprises the global networks the regional connections to civil society worldwide, the growing caucus of country partners taking the social determinants of health agenda forward, the vital research agendas, and the opportunities for change at the level of global governance and global institutions that the Commission has built and on which the future of a global movement for health equity will depend.”
Equity in Health
In this background paper to the World Conference on the Social Determinants of Health, held in October 2011, the World Health Organisation (WHO) argues that poor progress in the implementation of a social determinants approach reflects in part the inadequacy of governance at the local, national and global levels to address the key problems of the 21st century. WHO proposes a number of priority strategies for action. In terms of governance, WHO argues that governments should build good governance for action on the social determinants of health by implementing collaborative action between sectors (intersectoral action). WHO further recommends that governments should promote participation by: creating the conditions for participation; playing a role as brokers in participation and ensuring representativeness; and facilitating participation by civil society. WHO also considers the role of the health sector in reducing health inequities, arguing that the sector should: execute its role in governance for social determinants; re-orient health care services and public health programmes to reduce inequities; and institutionalise equity into health systems governance. With regard to global action on social determinants, international organisations, non-governmental agencies, bilateral co-operation partners and governments need to align their efforts and priorities for addressing the social determinants of health. Progress also needs to be monitored, as governments should: use measurement and analysis to inform policies and build accountability on social determinants; identify sources, select indicators, collect data, and set targets; move forward despite unavailability of systematic data; and disseminate data on health inequities and social determinants and integrate these data into policy processes.
This article focuses on the challenge of translating science into policy and practice in Africa’s maternal, newborn and child health (MNCH) services. The article indentifies several barriers to closing the gap, such as competing health priorities in Africa that make it more difficult to keep MNCH on the health agenda, the lack of a strong, organised lobby for promoting MNCH, and poor routine data collection. It offers three strategies to help close the gap: developing MNCH policy networks that pursue a bottom-up approach and go beyond politicians and ministers to engage civil society, front-line health workers, researchers and the media; mainstreaming the use of MNCH science to develop an evidence-based approach that will support planning and monitoring processes, thereby strengthening the overall process of health planning; and investing in innovative approaches to develop and apply MNCH evidence by building local capacity to conduct relevant research for policy and implementation.
This article identifies two ‘gaps’ in maternal, newborn, and child health (MNCH): a ‘science to policy and practice’ gap, where, despite mounting research on MNCH, it has failed to achieve importance on the domestic policy agendas of African countries; and a ‘policy to practice’ gap, where, despite clear policy commitments to MNCH, substantial challenges prevent these policies from being implemented effectively. The article focuses on the ‘science to policy and practice’ gap, in the belief that action to address the second gap is already mobilised, although clearly not yet fully effective. In contrast, the first gap remains neglected. It first addresses what is already known about how scientific evidence has influenced MNCH policy and practice, then it considers some of the key challenges in closing the science to policy and practice gap, and concludes by identifying promising paths for future action: developing MNCH policy networks, mainstreaming the use of MNCH science and investing in innovative approaches to develop and apply MNCH evidence.
This report brings together a series of policy briefs and is aimed at policy-makers and others interested to improve health equity by acting within the health system and on broader governmental policy. The report provides an update and overview of the vast amount of evidence produced during the Commission on Social Determinants of Health and identifies policy options to implement the main recommendations of the Commission. It draws from the extensive work of the nine global knowledge networks set up by WHO to generate evidence for the Commission. It first considers the essential role of the health sector in reducing inequities in five areas: working towards universal coverage; public health programmes; measuring inequities in health; facilitating mobilisation of people and groups; and intersectoral action. Second, it discusses how the health sector can work with other sectors that are also vital to this task in seven additional areas: early child development; urban settings; globalisation; employment and working conditions; policy and attitudes towards women; inclusive policies; and engaging civil society. The report ends by outlining a methodology to put together a national action plan addressing these issues, in light of the different starting points and priorities found in each country.
After a century of failed tuberculosis (TB) control strategies on South Africa’s mines, and three major but ineffective enquiries and commissions, a government-led ‘TB in Mines Task Team’ is being set up to address the deepening HIV-driven crisis. The HIV-fuelled TB epidemic, compounded by rising drug resistance, is now estimated at 3,500 per 100,000 mine workers, with 40% of all autopsies on men who die working on the mines revealing they had TB. Worker migration from rural areas throughout southern Africa to Gauteng and surrounding industrial areas to work in the mining, building and other dominant sectors is a major driver of the rampant TB epidemic. National TB prevalence has increased nearly threefold in the past decade. South Africa was among the 10 worst performing countries on TB control, and Statistics SA had found that, for every 100 deaths in 2006, 13 were from TB, making it the leading cause of death. Less than 1% of all HIV-infected individuals in this country were accessing proven safe and effective Isoniazid Preventative TB Therapy.
According to South Centre, the Copenhagen Accord has five important implications and effects. First, it lays the foundation for weakening the Kyoto Protocol as the multilateral treaty instrument for developed countries’ binding emission reduction commitments. Second, it creates the potential for changing the balance of obligations under the United Nations Framework Convention on Climate Change (UNFCCC) by laying the basis for a new set of obligations for developing countries. Third, it re-interprets the commitments of developed countries to provide or mobilise climate financing to support developing countries’ climate change-related mitigation and adaptation actions in ways that are conditional and highly ambiguous. Fourth, it creates a parallel framework of climate change-related ‘commitments’ and actions, thereby laying the foundation for a shift away from the UNFCCC per se as the primary multilateral treaty instrument for global long-term cooperative action on climate change. Fifth, it recognises the science relating to a two degree centrigrade global temperature increase but does not elaborate on how this would be achieved. It also talks about equity but does not define clearly how equity considerations are to be addressed, what it means, and the modalities for achieving equity.
This article, published in Social Science and Medicine, reports on progress towards the goal of health for all, with specific reference to international development commitments made by the G7/G8 nations at the 1999, 2000 and 2001 summits. It argues that the limited progress toward achieving health for all derives largely from the failure of G8 nations to fulfil their development commitments. In particular, efforts to reduce poverty and economic security have been insufficient; and national governments have not been enabled to make basic investments in health systems, education and nutrition.
This 2012 progress report examines trends in child mortality estimates since 1990, and shows that major reductions have been made in under-five mortality rates in all regions and diverse countries. Data shows that the number of children under the age of five dying globally fell from nearly 12 million in 1990 to an estimated 6.9 million in 2011. Recommendations from the report include increasing efforts among high-burden populations, focusing on high-impact solutions and creating a supportive environment for child survival by addressing poverty, geographic isolation, educational disadvantage, child protection violations and gender exclusion. Governments should take bold steps that prioritise both efficiency and mutual accountability, and harness the growing consensus that economic and social progress should be equitable.
President Museveni of Uganda is one of the twelve winners of the Commonwealth Awards for Action on HIV/AIDS. His award was announced by Dr Neal Blewett, the former Australian Minister for Health, at an awards ceremony held at the Melbourne Exhibition and Convention Centre in Australia on 4 October.