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?