Singing the same song...

... But now others are singing with you, said a WHO official.

I had just addressed a Ministerial meeting of the WHO Eastern Mediterranean Regional Committee, here in Tunis. The Regional Director of EMRO, Ala Alwan, has taken the initiative to put social determinants of health (SDH) on the agenda for EMRO. In introducing the session this morning he reminded Ministers of the five priorities for the Region: health systems strengthening towards universal coverage; non-communicable diseases; communicable diseases, particularly health security; maternal and child health; emergency preparedness and response. He said that each of these require SDH.

I had a few minutes to give it my best.

When we published Closing the Gap, the CSDH Report, in 2008, I came to the EMRO Regional Committee to present the report. The response was tepid. This time the response was summed up by the WHO official I quoted above. She said that she heard me speak before at WHO Geneva, you may be singing the same song, she said, but now others are singing with you.

We had a good response from the Ministers present. My response underlined the points they made and allowed me to emphasise a few things:

• Haven't we known about SDH since the 1970's? asked a minister. Yes, it was in Alma Ata 1978, but was ignored. WE had the Washington consensus, IMF structural adjustment, but not SDH. Our knowledge on SDH was not acted on.
• We need evidence and politics. You do the politics, Ministers; we'll do the evidence. We need to work together.
• How will we deal with high risk groups? Proportionate Universalism (sorry interpreters) - universalist policies with effort proportionate to need.
• Need commitment of the centre of government, PM or President, but also need local action.
• Related: need to take the evidence and adapt it to national and local conditions.
• Thank you for not forgetting Mental Health.
• Taking action on SDH is especially challenging in countries torn by conflict. Urgent task to work out how to go forward.

Ala Alwan told the Regional Committee he wanted their approval to work on SDH over the coming year which he proposes to do with us, IHE. I think he got it. He seems pleased.