This week the World Health Organization and the Brazilian Government are jointly hosting the World Conference on Social Determinants of Health in Rio de Janeiro from 19 to 21 October (the Rio Conference). This conference came about as the result of a resolution at the World Health Assembly in 2009 to follow up the work of the commission on social determinants of health (CSDH). I was a commissioner on the CSDH and so I have an acute interest in the extent to which its recommendations have been implemented since we reported back to the WHO in 2008. In preparation for the conference a series of background papers was commissioned, which reported on the progress of work on social determinants of health, and a background paper was also drafted. The background papers (available online here) make interesting reading in terms of how governments and international organisations have approached social determinants of health. Particularly interesting case studies  are the assessment of conditional cash transfers in Brazil, reports of action on gender based violence from  a number of countries, intersectoral actions in response to cholera in Zimbabwe, social reporting from New Zealand, and the “Health in all policies” strategy from South Australia.

The background paper for the Rio Conference, however, is disappointing. The language it uses is non-specific and vague. It doesn’t advance the agenda set by the CSDH and, if anything, is a step backwards in terms of the actions needed to reduce health inequalities. People from public interest civil society groups whom I have spoken with have said that they felt the paper should have provided information on what WHO has done to address the recommendations of the CSDH yet found there was no such accountability information in the paper. It certainly does not set a clear agenda for future action by the WHO. The five “action areas” that the paper develops for the conference are prime examples of the bland sanitised language: Governance for health; Participation of all stakeholders; Reorient the health sector; Strengthen global governance for health; monitor progress and increase accountability. These are entirely unexciting and do nothing to push forward the progressive agenda of the CSDH.  Many civil society groups commented on a draft of the background paper and argued for a more progressive position but then found the revised paper did not incorporate the suggested changes. This has lead to questions about what is actually driving the agenda of the Rio conference. This WHO conference is happening at a time when the WHO is under severe budget pressure, is cutting staff, and undergoing a reform process that some analysts suggest will result in a compromised position in terms of its ability to be an outspoken voice for the right to health on behalf of the world’s poor. Perhaps the uncertainties the WHO is facing makes it less able to speak out forcefully and are reflected in some of the weak positions taken at this conference.

The meeting will produce a “Rio Declaration,” and those progressive civil society groups who are keen to see the recommendations of the CSDH implemented eagerly obtained and analysed the draft declaration. One of my roles is as co-chair of the Global Steering Council of the People’s Health Movement, and our analysis of the draft Rio Declaration led to the conclusion that it was so far from the mark in terms of what is needed to address health equity that we decided to draft an alternative declaration. One of the key factors that we felt is not covered in the draft official Rio Declaration is determining ways of curbing the growing power of transnational corporations to engage in activities that create detrimental impacts on natural environments and people’s health.  Another crucial point is that the official declaration did not acknowledge the importance of growing global people’s movements that express disquiet about the injustices that exist in terms of the distribution of power and wealth and the attack on systems of social protection. The next few days of the conference will reveal whether it is able to produce any progressive stances designed to advance the world towards greater health equity.

Fran Baum is a professor of public health. She is the director of the Southgate Institute of Health, Society, and Equity, Flinders University, Adelaide, Australia and co-chair of the Global Steering Committee, People’s Health Movement. She is an Australian Research Council Federation fellow.