We held the Second meeting of the European Review of Social Determinants and the Health Divide in
When we began the global Commission, the CSDH, we asked ourselves what success would look like. It never occurred to me to answer: a Commission being set up in
. But that is what happened, and is an undoubted benchmark of success. A city employee, Anna Balfours, read Closing the Gap in a Generation. She said it spoke to her. They invited Denny Vagero, a commissioner in the CSDH, to give them a seminar. Anna said: as an Englishman you like to hear a British correspondent reporting from abroad. Denny was their foreign correspondent from the world of global health and they took the decision to set up a Malmo Commission to translate th findings of the CSDH into a form suitable to address social determinants and health inequalities in their city. Malmo
The European Review meeting was hosted by leaders of the city of
, who were hospitable, generous and constructive. Their Commission for a Socially Sustainable Malmo, chaired by Sven-Olof Isaacson, was launched with a press conference on Wednesday afternoon, followed by a lecture from me, chaired by the deputy mayor, who is a member of the Malmo Commission. We then had a round table with the Commission on Friday afternoon as a way of cementing their partnership with the European Review. We had a good meeting. It warmed the cockles. On the second morning I felt the Review suddenly took off, caught fire, came alive. It was, and is, exciting. The first meeting had been in Malmo in October. There had been such delay in getting started that we began without contracts having been issued and with difficulty getting everyone together. The first meeting felt a bit anti-climactic. Our task groups, 8 topic groups and five cross-cutting, were to do the work of assembling the evidence about proposals to reduce inequalities in health and the social determinants across Madrid Europe. But without contracts they could hardly be expected to function properly, which meant our whole timetable was in danger of slipping.
In the event, the Task Groups have done a terrific job of producing interim reports with outlines of their future work. They were at somewhat different stages, some with draft chapters, others less sure of the scope. But on the whole it was very reassuring. We will have real substance, new evidence and proposals on which to draw and to deliberate. The Senior Advisors got engaged at a private session. They discussed:
· The report: audience, how political it should be, what is the narrative
· The conceptual model – they didn’t like the CSDH form of it. The general idea of social determinants as the “causes of the causes” is accepted, but getting it down on paper in a useable form is a challenge
· We re-emphasised that the Review has to deal with inequalities within and between countries
Europe has special features because of the European Union and the European Court of Human Rights.
· Partners: countries, regions, cities and sectors, including the private sector
· Should the output be approaches or specific interventions?
· The subjective reaction of people is important as is the more objective indicators. This implies enlarging the focus to include well-being.
The meeting moved the Review forward intellectually, practically and we have found a wonderful city partner to help shape our endeavours as we both, at very different scales, work to reduce health inequalities across