Has the WHO lost the plot, when it comes to tackling the social determinants of health?

Predictably, the international conference on the social determinants of health held in Brazil this week failed to generate widespread media interest – even though related issues were in the news thanks to the globalisation of the Wall Street sit-in movement.

One exception was this piece from Time Magazine, How Economic Inequality Is (Literally) Making Us Sick, which begins:

Imagine there was one changeable factor that affected virtually every measure of a country’s health — including life expectancy, crime rates, addiction, obesity, infant mortality, stroke, academic achievement, happiness and even overall prosperity. Indeed, this factor actually exists.

It’s called economic inequality. A growing body of research suggests that such inequality — more so than income or absolute wealth alone — has a profound influence on a population’s health, in every socioeconomic group from rich to middle class to poor.

Meanwhile, Fran Baum, professor of public health at Flinders University and one of an Australian contingent at the Rio conference, has thrown down a challenge to the WHO in an article at BMJ Group Blogs, expressing her disappointment with its work in this area.

Baum says the background paper prepared by the WHO for the Rio conference failed to advance the agenda set by the Commission on the Social Determinants of Health, or CSDH (on which Baum was a commissioner).

“It certainly does not set a clear agenda for future action by the WHO,” she wrote.

“The five “action areas” that the paper develops for the conference are prime examples of the bland sanitised language: Governance for health; Participation of all stakeholders; Reorient the health sector; Strengthen global governance for health; monitor progress and increase accountability.

“These are entirely unexciting and do nothing to push forward the progressive agenda of the CSDH.”

Baum says that many civil society groups commented on a draft of the background paper, and argued for a more progressive position but then found the revised paper did not incorporate the suggested changes.

“This WHO conference is happening at a time when the WHO is under severe budget pressure, is cutting staff, and undergoing a reform process that some analysts suggest will result in a compromised position in terms of its ability to be an outspoken voice for the right to health on behalf of the world’s poor. Perhaps the uncertainties the WHO is facing makes it less able to speak out forcefully and are reflected in some of the weak positions taken at this conference.”

Baum says the draft conference declaration is also disappointing. She is co-chair of the Global Steering Council of the People’s Health Movement, which has drafted an alternative conference declaration.

Baum writes: “One of the key factors that we felt is not covered in the draft official Rio Declaration is determining ways of curbing the growing power of transnational corporations to engage in activities that create detrimental impacts on natural environments and people’s health.

“Another crucial point is that the official declaration did not acknowledge the importance of growing global people’s movements that express disquiet about the injustices that exist in terms of the distribution of power and wealth and the attack on systems of social protection. “

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Tracking disadvantage in regional Victoria

Meanwhile, on related themes, the Department of Planning and Community Development in Victoria, has a report, Change and disadvantage in regional Victoria: an overview that may be of interest/use to those with concern for health inequalities.

The report identifies areas of disadvantage, and describes the population make up of the most disadvantaged suburbs and towns.

It shows that in some areas disadvantage is characterised by an aging population, in others by a working population that is precariously employed, in others by a diverse group of welfare recipients.

These differences mean different strategies may need to be adopted across the localities, the report says.

It notes that regional Victoria is changing – both economically and demographically, and says three major changes that impact on disadvantage are:

1. Economic restructure that is resulting in decreased economic opportunities for some residents. The economy has been substantially restructuring in regional Victoria. The primary industry of agriculture is transforming from one dominated by many small family run farms to one characterised by larger corporate ones run with new production methods to increase productivity.Towns that were once reliant on agricultural support are changing. Some have become more reliant on manufacturing, tourism and service provision. Manufacturing in some places is also in decline.

2. Shifting population compositions that result in the need for services and business to restructure. The economic changes described in point 1, particularly in agriculture, are causing the purpose of many regional towns to change. As a result, many places also have changing population compositions. Some localities are experiencing decline and aging as they are no longer needed as service support towns for small farms. Others are growing as they become the new large service towns or as they become attractive to “amenity migrants” – weekenders, commuters, “downshifters” or affluent retirees.

3. Rising house prices that result in some populations becoming concentrated in low service areas.

The report says: “These findings highlight the importance of collaborative planning for examining solutions matched to disadvantaged locality’s economy, assets, demographics, needs and interests. The complex and multidimensional nature of disadvantage means that the efforts of a range of agencies will be needed to reduce it or lessen its impacts. No single agency holds all the levers to the factors outlined in the beginning of this report as making a difference to social and economic wellbeing…”

From regional Victoria to Rio…