The best and the worst of global health politics were on show at the recent international conference on the social determinants of health in Rio, Brazil.

That is according to one of the Australian participants at the conference, Professor Sharon Friel, an ARC Future Fellow at the National Centre for Epidemiology and Population Health, the Australian National University.

In the article below, Friel assesses the conference outcomes, and looks to the future challenges for those advocating for a fairer distribution of health.

In Australia, she adds, one of the big issues is the lack of an integrated framework for addressing the social determinants of health through a health equity lens. (Some photos from the conference are at the bottom of the post).


Postcard from Rio

Sharon Friel writes:

WHO convened a global conference on 19-21 October 2011 in Rio de Janeiro, Brazil, to build support for the implementation of action on social determinants of health and health equity.

The conference brought together over 1,000 participants representing more than 125 WHO Member States and a diverse group of stakeholders including academics, civil society and government – 60 Ministers of Health attended.

The event was attended by Michel Temer, Vice President of Brazil, and Dr Margaret Chan, WHO Director-General.

This was one of the largest meetings in WHO’s history since the International Conference on Primary Health Care in 1978.

On 21 October 2011, participating Member States adopted the Rio Political Declaration on Social Determinants of Health.

The Declaration expresses global political commitment for the implementation of a social determinants of health approach to reduce health inequities and to achieve other global priorities.

The idea behind the Declaration is to help build momentum within WHO Member States for the development of dedicated national action plans and strategies.

Australia, notably, does not explicitly endorse a social determinants approach.

When I spoke with the Australian diplomatic mission at the conference, she reminded me that the government is doing a lot – Closing the gap, social inclusion, early child development, Health in All Policies (although that is a South Australia initiative, not federal).

All true but it is not being done in any sort of integrated framework and not through a health equity lens.

Which reminds me, there was a lot of mixing of concepts and approaches at the conference – talk of the social determinants of health equity when in fact it was really health services; discussions about action on the social determinants of health as if it were the same as social determinants of health equity.

The conference brought together the best and the worst of global health politics.

It was the best in terms of governments, agencies, civil society having a frank discussion on what needs to happen to address health equity through societal level factors.

It was the worst in that the process of developing an outcome and way forward largely gets sorted by diplomatic missions in Geneva and the gestalt of the conference struggles to find expression.

This was exemplified in a panel discussion when Prof David Sanders from South Africa got a standing ovation from the floor for pointing out omissions in the Declaration in relation to unfair trade, and blindness in relation to pending global environmental catastrophe.

Sadly it was too little too late to influence the final political statement.

But I think the conference did what it was always going to do – incrementally gather more support for action at the societal rather than individual level and show what has been happening across the world in these areas.

Trying to get political agreement among large numbers of Member States to move forward on difficult political issues doesn’t happen through the medium of a conference.

The real challenge is to keep global momentum and pressure on these issues.

There are many networks working to this end.

The Global Action for Health Equity Network is working to bring together policymakers, researchers and civil society to work out how to create a paradigm shift in the way we think about and improve health equity.

We held a side event on the last day of the conference – not only was the room packed after an exhausting 3 days but there was an incredible energy and desire to move forward collectively through research, training, policy development and advocacy.

“Without leadership, political courage, progressive policy, and social struggle people will continue to live with illness and die needlessly” – last line from the Asia Pacific HealthGAEN report, available at

• Prof Sharon Friel was Principal Research Fellow for the WHO Commission on Social Determinants of Health and is co-founder of HealthGAEN. Visit the HealthGAEN discussion from the conference.

Meanwhile, for more reading on related topics:

• In this article at The Huffington Post, Corinna Heineke, Head of Policy at Health Poverty Action, describes how the “distribution of money, power and resources at global, national and local levels” underpins the social determinants of health.

• An interesting suggestion in this article in Preventive Medicine (subscribers only) that health departments should use part of their budgets to sponsor initiatives by other government departments to address the social determinants of health. (I can see great potential for a Yes Minister series around trying to make that happen…).

• Previous Croakey posts related to the Rio conference: Has WHO lost the plot; and So much for health in all policies.

Thanks to Dr Belinda Loring (HealthGAEN Senior Policy Officer) for providing the photos below.





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