On the first morning of the conference in Rio de Janeiro I commented to Zeinab Badawi (BBC World superstar who was interviewing me) that the fate of most Commission reports is to end up in the dustbin. This one (the Commission on Social Determinants of Health’s) ended up in Rio. Altogether a better option.
Several people came up to me in Rio and said, metaphorically rubbing their eyes, could you have believed even five years ago, that we would be at The World Conference on Social Determinants of Health – the biggest event WHO has organised since Alma Ata in 1978?
No, me neither.
This was a remarkable event – despite some annoying “airbrushing” (see my blog below on “Who gets the credit”). From the D-G, Margaret Chan’s opening, to the closing, 48 hours later, people talked social determinants of health. It was my turn to rub my eyes. For my whole life, this conversation had been beyond the pale: global health was about disease control or health systems. Nationally, public health was about screening for cancer, smoking clinics, or disposition of health services; not about the issues we covered in the CSDH and the English Reviews: the conditions of daily life and the structural drivers of those conditions. A large proportion of the 60 government ministers who attended spoke at the meeting. Not all showed awareness that social determinants meant anything more than access to health care. One who did was the Finnish Minister who spoke eloquently of the importance of the Finnish Welfare state and education system. The civil society activists understood the issues and were a welcome, and vigorous, presence.
The background: the Commission on Social Determinants of Health had, among its other recommendations, called for a global meeting where all countries reported on what they were doing on social determinants of health and health equity. I never thought I would reach the point in life when I thought that a resolution at the World Health Assembly was important. But the one in 2009 endorsed the CSDH recommendations, including the one for a global summit, and Brazil offered to host it.
There was a rumour that some powerful people didn’t want a big summit, with lots of politicians present. Who would have believed that! Or if there were to be a meeting, it should be a narrow technical meeting. Brazil said “no” and “no”. They argued for a big political meeting with 120 countries represented. Brazil won.
Was the meeting good? Of course, it was good. Not primarily for the good things that happened, nor for the Rio declaration (see the blog below), but because the fact that the meeting happened at all was sensational. The CSDH called for a global movement on social determinants of health. It was evident, in a big way, in Rio de Janeiro. Now, we need to keep up the momentum.