60 health ministers and 1000 participants from around the world are attending the Rio Conference. Wednesday afternoon was a plenary session which featured contributions from a panel of speakers. Margaret Chan, the director general of the WHO, addressed the conference and took part in a panel discussion facilitated by Zeinab Badawi (BBC World). Chan has not been known for her work on social determinants so it was pleasing to hear her address some of the underlying determinants of health. Thus she said “childhood obesity is not a failure of will power but of government power.” She also spoke of the need to control the ways in which trans-national corporations push high fat and sugar foods and said people’s health has to be put ahead of the health of corporations. She spoke of the “aggressive scare tactics” of tobacco multinationals – which she described as “dirty old dogs.” She called on countries to stand up to big tobacco and noted that this was very hard for small countries when faced with the legal teams of these companies. As an Australian I was proud to hear her congratulate the Australian government on its introduction of legislation to put all tobacco products into plain paper packaging despite the threat of legal action from Philip Morris.

There were a number of other notable contributions from the panel. Andreas Loverdos (the Greek minister of health & social solidarity) spoke while back home in Greece hundreds of thousands of people were protesting in the streets against the cuts being made by the Greek government. He presented the financial crisis as an opportunity to increase the efficiency of the health service by cutting salaries and did not address the fact that social security is being undermined, nor the legitimacy of the protests. Kathleen Sebelius (US secretary of health & human services) expressed a determination to push a prevention agenda and increase the proportion of the $2.5 trillion the US spends on health that is devoted to prevention – currently it is only 1%. She spoke of working across sectors (including transport and urban planning) and addressing education and poverty. She noted that in tough economic times promoting health requires “more aggressive strategies” and that poor health costs money because of loss of productivity. She didn’t mention the need for any redistribution of wealth or income. This contrasted with the Brazilian minister of social development, Tereza Campello, who spoke of the measures she is introducing to make “Brazil without poverty” a reality. Bolsa Familia is a comprehensive program based on conditional cash transfers which has been shown to reduce childhood malnutrition and increase school attendance. It is also supporting family farmers. Most recently there has been an intensification of efforts to improve the lot of the 16 million Brazilians living in extreme poverty. Unlike most of the world Brazil is making headway in redistributing wealth albeit from a position of very extreme inequity.

Thursday morning’s session started with Zeinab Badawi interviewing Michael Marmot, who drew on the work of the commission on social determinants of health and the UK Marmot Review to note that if we don’t act on the social determinants of health then we “are storing up huge problems for the future.” Always optimistic, Marmot stressed the positive developments since the commission. These were mostly in terms of national and city level commissions on health equity. He noted that action on social determinants is crucial at a time of economic crisis. He speculated that the riots in the UK this summer were linked to the low life expectancy in the areas where the riots occurred.  His final point was that action on social determinants is a matter of justice.

Alongside the conference, I have been working with colleagues from the People’s Health Movement and other progressive civil society organisations to draft and gain support for the “alternative Rio declaration.” The exciting news over night was that Halfdan Mahler (the former director general of WHO, and director general at the time when the Alma Ata Declaration on Health for All was adopted) sent an email in response to a copy of the alternative declaration saying, “I hereby give my full support to the alternative declaration on the social determinants of health.”  The big question on everyone’s lips is whether the alternative declaration will empower some country delegations to push the official declaration in a more progressive direction.

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.