ENVIRONMENT & HEALTH

Intellectual Property

Sustainability

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The Right to Health: WHO Commission on Social Determinants of Health

Broader than the concern of right to health advocates that the global intellectual property rights regime impairs the realization of the right to health is the recent attention being paid by the World Health Organization (WHO) to addressing the social determinants (i.e., root economic, social, and cultural causes) of health problems.

In May 2005, the WHO launched the Commission on Social Determinants of Health (CSDH). The Commission completed its initial work in August 2008. It consisted of twenty Commissioners and was chaired by Sir Michael Marmot of the University College, London. The Commission brought together leading scientists and practitioners to provide evidence on policies that improve health by addressing the social conditions in which people live and work. In addition, it collaborated with countries to support policy change and monitor results.

The stated main goals of the Commission included:

  • Supporting policy change in countries by promoting models and practices that effectively address the social determinants of health;
  • Supporting countries in placing health as a shared goal to which many government departments and sectors of society contribute; and
  • Helping build a sustainable global movement for action on health equity and social determinants, linking governments, international organizations, research institutions, civil society, and communities.

The Commission pursued its mandate through nine subject-matter working groups known as “knowledge networks ,” the goal of which was to “synthesize knowledge about the social determinants of health.” The CSDH knowledge networks included:

  • Early Child Development;
  • Employment Conditions;
  • Globalization;
  • Social Exclusion;
  • Health Systems;
  • Priority Public Health Conditions;
  • Women and Gender Equity;
  • Urban Settings; and\
  • Measurement and Evidence.

The Measurement and Evidence Knowledge Network (MEKN) was particularly important as it provided support to the other eight knowledge networks by developing methodologies that could be used to effectively measure the “causes, pathways and health outcomes of policy interventions to tackle the social determinants of health and health inequities” which the other knowledge networks were tasked with compiling. The MEKN published its research principles in a 2006 report entitled, “The Development of the Evidence Base about the Social Determinants of Health .”

The MEKN published its Final Report in October 2007. Addressed to policy makers, researchers, and practitioners, the report outlined “six problems which make developing the evidence base on the social determinants of health potentially difficult.” It suggested tools that could be used to help overcome these problems, and gave guidance on what constitutes an effective evidence-based approach to establishing the social determinants of health. Finally, the report advised policy makers on how to develop effective solutions to health inequities using the social determinants of health approach. Some of their recommendations included:

  • Looking to address the causes of inequities in health, rather that focusing solely on “general health improvements;”
  • Taking into account the needs of specific groups within a population;
  • “Equity proofing” social determinants of health solutions;
  • Involving other social sectors other that the health sector in addressing the social determinants of health;
  • Continuous monitoring of the impact of implemented policies; and
  • Conducting “cross cultural and cross national research” in order to facilitate monitoring and comparison.

In 2007, the Commission issued its Interim Statement . The Interim Statement set out the Commission’s vision and goals, the problems it sought to ameliorate, and the intellectual foundation for a social determinants approach. The Commission viewed the Interim Statement as “a resource for stakeholders concerned with social determinants of health and health equity, as they build towards a global movement.”

Recommendations for action, based on the evidence gathered across all the Commission’s work streams, were made in the Final Report, published in August 2008. Entitled, “Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health ,” the Final Report concluded that health equity is significantly influenced by global economic and political systems, and therefore requires a global remedy in which the international community has an obligation to engage. The Report detailed three overarching recommendations on how to achieve health equity, including:

  • Improving the conditions of daily life;
  • Tackling the “inequitable distribution of power, money, and resources;” and
  • Measuring and understanding the problem of health inequities and assessing the impact of governmental actions on health.


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