Tuesday, 20 December 2011

The New Jerusalem

This is only partly metaphorical. WHO Euro held a consultation on the draft of its new public health strategy: Health 2020. The meeting was in Jerusalem – perhaps a reason why although most, not all, of the 53 member states were represented.
Listening to the comments by government representatives at the high level meeting, when asked to comment, I offered the following:

Do we need a health strategy for Europe that takes social determinants of health into account? The answer is empirical: the Venice Office of WHO reports that 33 of the 53 member states have already requested help with developing strategies on social determinants and/or health equity. The European Review will give evidence-based recommendations. What follows, I told the delegates, includes insights from the Review

Exclusion is a process and is linked with the social gradient in health. The insight from Jennie Popay and her colleagues on our social exclusion task group is that we should be thinking not about labelling the excluded as such, implying that somehow being excluded is a personal characteristic. Rather we should look at the societal processes that exclude people. This links social exclusion to the social gradient in health. There is not an excluded group at the bottom, but processes of exclusion that may act to varying degrees along the gradient. Hence our stated approach of proportionate universalism

We take a life-course approach. I don’t need to spell this one out any further here.

Left right. Are social determinants of health only for left of centre governments? Empirically, the answer has to be no. There are examples where centre-right governments have taken this on. In Britain, the centre-right coalition government issued a public health white paper that put reduction of health inequalities at the heart of its public health strategy. Accepting the recommendations of the Marmot Review it put action on the social determinants of health as key to its strategy

Health and other outcomes go together. One answer to the question of why other sectors should be interested to work with the health sector, is that good “outcomes” in education, social cohesion, environment tends to go along with good outcomes in health and health equity. Where this is not the case, it should be for the health sector to point this out. For example, in Britain, a transport minister thought it a good idea to relax motorway speed limits from 70mph to 80. Presumably, he thought this served some social goal. But, evidence shows that traffic fatalities will rise as speed increases. Further, CO2 outputs per km travelled rise as speed rises. A decision on speed that might fit with one agenda suiting the owners of fast, modern cars, conflicts with health and environmental concerns. It is our job to enter into this debate.

To return to the new Jerusalem: Israel is a member state belonging to the European Region of WHO. WHO has held meetings in Israel previously. That said, this WHO meeting in Jerusalem created frissons. Rumours went round the meeting as to what was going on. One rumour had it that the Arab League had complained to Ban Ki-moon, UN Secretary-General, who passed the complaint on to WHO in Geneva, who passed it... (Surely the time to complain was before delegates from all across the European Region had gathered in Jerusalem.) It was not entirely clear, but the concern appeared to be focussed particularly on having the meeting in Jerusalem, because of its symbolic importance. A further refinement of the rumour had it that 29 November was a particularly sensitive date as that was the date of the 1947 UN vote that agreed on the partition of Palestine into a Jewish and a Palestinian state. More buzzing as to whether the meeting would go ahead, but move from Jerusalem.

On Sunday 27 November and Monday 28 November we met in Jerusalem. Then the Israeli Director of Health announced that the Minister of Health wanted the delegates to see an Israeli hospital (lucky delegates!) so that on Tuesday 29 November the meeting would be held at a hospital in Tel Aviv.

Health, political?

1 comment:

  1. I’d have thought the highest expert on inequalities (in health) would recognize an injustice at first sight.

    Is prof Marmot aware that the reasons why the “WHO meeting in Jerusalem created frissons (sic!)” are that:
    • There is plenty of evidence of the State of Israel's poor track record as an occupying power in upholding international human rights and international humanitarian law, including the right to health?
    • Israel’s system of military occupation imposes many barriers to the right to health for Palestinians in the West Bank (including East Jerusalem) and Gaza; their physical access to health services, but also their access to basic resources are restricted by the military regime of roadblocks, barriers, permits and closed areas. Many UN reports, including WHO reports, have detailed that access to water, health, education, food, livelihood, movement and human security are key factors (‘Social Determinants of Health’) which the Israeli occupation determines?
    • Israel occupied the West Bank and Gaza in 1967 and then unilaterally annexed East Jerusalem, which is illegal under international law. Further, Israel’s designation of the city as its capital has not been recognized by almost all world governments, including the European governments because of the lack of a negotiated political solution to the conflict?
    • Locating a high profile UN conference in Jerusalem gives tacit political support to these violations of international law, as well as legitimatizing the continuation of the violation of human rights of the Palestinian people, including their right to health and to access services in East Jerusalem?
    • The points above were included in (to my knowledge) two open letters to the Regional Director for Europe signed by several international and civil society organizations asking for
    o change of the location of the conference from Jerusalem;
    o Israel to fully meet its obligations as occupying power under international law;
    o Include critique of the key determinants of health for Palestinians living under Israeli occupation in West Bank (including East Jerusalem) and Gaza, as part of the conference objective of addressing inequalities in health?

    It’s one of the two: either prof Marmot does not know these facts, or he is aware of them and does not care. In both instances I believe it is outrageous that an international personality of such a caliber prefers not to be “political”.

    Angelo Stefanini
    Bologna, Italy