The final day of the Rio conference was on Friday and the official declaration from the conference still doesn’t deal with the underlying factors that are driving health inequalities between and within countries. Perhaps this is not surprising as addressing these factors (which include trade policy and the need to redistribute wealth more fairly) would directly challenge the global status quo of power and resources. The importance of these factors was emphasised by David Sanders (paediatrician, member of the People’s Health Movement, University of the Western Cape, South Africa) who, in one of the final plenary sessions, emphasised that both over and under nutrition have their roots in unfair trade. He also spoke of the “brain-robbery” that is draining Africa of its nurses and doctors as they leave to fill the gaps in rich countries. When he spoke many of the audience, especially civil society members, leapt to their feet and applauded loudly. Ron Labonte (University of Ottawa) gave a superb presentation on the impact of economic globalisation on health and laid bare the ways in which the existing status quo is, quite literally, killing us. The opening video shown on Friday morning also addressed the importance of challenging power structures, and the need for governments to regulate the private sector to promote and protect health. The video (see WCSDH website) emphasised the importance of the post-war social welfare systems and the need for governments to invest in the health and wellbeing of their citizens.
As I leave Rio and reflect on the conference, the strengths for me have been that there is clearly a strong network of public servants, public interest civil servants, and academics all committed to the principle of achieving a fairer world in which health is more equally distributed. These networks have created a social movement for health equity and judging by the passion of many at the conference the movement is a force to be reckoned with.
The conference discussions and papers have also completely avoided the “lifestyle drift” that David Hunter and colleagues (BMJ 2010;340:c684) have warned is a real danger in policy designed to address the social determinants of health. There is broad acceptance that improving population health equitably requires changes in policies and environments that shape people’s opportunities for health. I’ve not heard anyone suggesting that it is a matter of people changing their lifestyles without first changing their conditions of everyday life. That health equalities can be reduced is being shown in Brazil with the success of their health and social reforms.
There is also broad acceptance that while access to effective, accessible, affordable health care is vital, it is not enough to ensure health equity. Another consensus view emerging is that, as expressed by the South African Health Minister Aaron Motsoaledi is that “health is not just another commodity but is a human right.” The denial of this right to many indigenous people, especially through the impact of colonialisation has also been assessed. The ways in which loss of land and culture has had a profound impact on indigenous people was pointed out forcefully by Papaarangi Reid from New Zealand. She noted that improving health means analysing not just the situation of those who are denied health but also the fact that “when some people are getting less, other people are getting more.” Again the discussion dug down to the underlying determinants of health. There has also been open discussion of the need to control the power of corporations. Some felt this could happen through persuasion while most civil society people and some of the politicians showed distrust of markets because of their sole mandate to produce profit.
So as I leave for the airport I am heartened by these positive factors. While disappointed with the official declaration, I’m glad that an alternative declaration was drafted which can now be circulated and used to advocate for more progressive positions from WHO and countries (see www.phmovement.org). Globally we are facing environmental, financial, and social crises and responding to these in a way that reduces inequity and promotes health is perhaps the greatest challenge we face.
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.