Bringing SDH to Tehran and Iran to SDH

Mostly, I don’t wear hats. But if I am going to, it may as well be more than one; in the case of this meeting in Tehran, three. The short version of the story started in Tunis. Ala Alwan, Regional Director of WHO EMRO Region, wanted to put social determinants of health firmly on the agenda for his region and wanted my help to get the approval of member states at their Regional Committee in Tunis last October. I did and we did. That was the first hat: an academic getting excited, yet again, about the social determinants of health message and possibilities for action.

Now I was hooked in. The next step was a regional consultation and I felt duty bound. Advisors to the Minsters of Health in Iran said that Iran would host it. Second hat: advisor to WHO EMRO on SDH. Senior people from most of the Eastern Mediterranean countries came together to consider next steps on social determinants of health – truly exciting.

The deputy mayor of Tehran put social justice firmly on the agenda. He appeals to the Koran for this argument. I appeal to our sense of what is right. Nine years ago when the CSDH met in Tehran, I said that members of the Commission come from the world’s great religions, and from science, rationality and humanism. But if we can agree on what is the right thing to do to create a more just distribution of health, then we work together in brotherhood.

We talked about having two or three partner countries. Iran would like to be one. Although not too much is happening at the national level on SDH, Tehran is doing interesting things at the city level. They have had several city initiatives for a healthy Tehran, including Urban HEART – health equity analysis and response tool. The WHO Kobe Centre ran the CSDH Urban Settings Knowledge Network. They did a fine job and were so pleased with the activity that they developed this tool to take SDH forward at the Urban level. We visited one “Health House” that was involving community groups in setting agendas to improve their own health and well-being. There are 374 of these health houses – one for each neighbourhood of the city (although the number of neighbourhoods has now come down a fraction). Under Urban HEART, surveys of people in local areas yielded the following top seven priorities:

• being overweight and obese
• waste disposal
• being elderly
•  tobacco
• female breadwinners
• domestic violence
• unemployment

Much to do on these seven. And there is no question that central action would reinforce the local level.

My third hat was as President-Elect of the World Medical Association. The President and Board of the Iranian Medical Council invited me to a breakfast meeting with them. I told them I was trying to get the doctors involved on SDH. Could I interest them? I also noted that they were not members of the WMA. Perhaps I could interest them in that too? It looks rather positive on both counts.

Alireza Marandi was a member of the CSDH. He is an MP in Iran and President of the Academy of Medical Science. He expressed his willingness. If we think of the Academy as representing academia, and we have the doctors, the city level, and the Ministry of Health, we could be in business. Especially as the Minister assured me that he is setting up a cross-departmental commission on social determinants of health.