By Emily Fisher
2011 was a major year for those looking to see health equity on the international community agenda. The World Conference on Social Determinants in Health in Rio de Janeiro, initiated by the World Health Organization (WHO) came right on the heels of the UN Summit on NCDs this November.
This World Conference on the Social Determinants of Health brought together dignitaries from across the globe to address how to enable a ‘successful, inclusive, and fair society’ and recognized that human health and well-being are key elements for such a society. Out of this meeting, the ‘Rio Political Declaration on Social Determinants of Health’ (1) was born. The authors of the Declaration centered it around four major themes for action: ‘adopting better governance for health and development; promoting participation in policy-making and implementation; further reorienting the health sector towards reducing health inequities; strengthening global governance and collaboration; monitoring progress and increasing accountability’. By outlining potential actions to target these points, the authors made it clear as to how they wanted to ensure a successful, inclusive, and fair society, yet how exactly to move forward is still somewhat ambiguous. What should this look like in developing nations with relatively weak infrastructures or government corruption? Working in collaboration to achieve these goals is necessary- and saying so is in keeping with the times- but who is responsible for overseeing these efforts on the ground and what kind of measurable targets will we hold ourselves accountable to? For those countries without the kind of support needed to engage in these activities, how will developed countries step in and how can do this fairly?
Before getting bogged down in the questions, of HOW this document will successfully elicit changes, let’s take a few steps back and think back to a much earlier, yet highly influential document: the Ottawa Charter for Health Promotion (2). The Ottawa Charter was timely in its unveiling and served to broaden the focus past individual-level efforts and disease-based treatments. Its spot on the WHO agenda meant that it received universal attention. If we compare the two documents, we can see that both the Charter and the Rio Declaration have focused on the factors above the individual level that impact health and both advocated for equity in health. But, what will the Rio Declaration achieve now, almost 25 years later, that will move us beyond the innovative energy created from the Ottawa Charter?
There are a few, yet important differences that may mean sustainable change. The first is that while the Ottawa Charter focused on community participation and involvement, the Rio Declaration takes this idea one step further in addressing the importance of participatory processes at a higher level, defined as happening throughout policy development and implementation. While this is something that may be happening across some communities, it is still very rare. Also, both the Ottawa Charter and the Rio Declaration build targets specifically around reorienting the health services: the main difference is that while the Ottawa Charter focuses on shared responsibility among stakeholders across the health sector, addresses being culturally sensitive, and lays importance on viewing and addressing the individual as a whole person, the Rio Declaration discusses healthcare reorientation in terms of achieving greater health equity so that we can ensure access for all.
It may be too soon to tell what kind of impact the Rio Declaration will have: the Ottawa Charter for Health Promotion (1986) was another document with lofty goals, yet it laid the groundwork for the field of health promotion as we know it today. As there is not enough room in this short commentary to address all the similarities, differences and implications, we hope that you will decide to take on this challenge and give us feedback in the months to come.
(1) World Health Organization (2011). Rio Political Declaration on Social Determinants of Health. Retrieved on November 28, 2011 from http://www.who.int/sdhconference/declaration/en/
(2) World Health Organization (1986). The Ottawa charter for health promotion. Retrieved on November 28, 2011 from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
Further readings: WHO released a series of case studies highlighting successes in the policy arena around reducing health inequities. Visit the website for country-specific cases: http://www.who.int/sdhconference/. Health Promotion International also released a new issue: The Ottawa Charter for Health Promotion 25 years on (December 2011; Vol. 26, suppl 2). It is available online (full text by subscription only) at: http://heapro.oxfordjournals.org/content/vol26/suppl_2/index.dtl
Published: November 2011