SOCIAL DETERMINANTS OF HEALTH: the role of Academies
Health inequalities between and within countries are a global challenge. The starting point of the Commission on Social Determinants of Health (2005-2008), set up by the World Health Organization and chaired by Sir Michael Marmot, was that systematic differences in health and life expectancy between and within countries are avoidable and therefore inequitable. Following a three-year process of engagement with policy-makers, civil society and researchers, including evidence gathering and knowledge synthesis, the Commission made recommendations to reduce health inequalities through action on the social determinants of health at local, national and international levels. The Commission argued that it could not make recommendations to suit every regional, national or local context, but it established three principles of action, and within these principles it made recommendations across twelve areas.
The Commission’s three principles for action are:
1) Improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age.
2) Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally and locally.
3) Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.
Following the Commission’s 2008 report, the World Health Assembly passed a resolution in May 2009 urging all member states to tackle health inequities through action on the social determinants of health and to examine the impact of policies and programmes on health inequities (www.who.int/social_determinants).
Also in light of the Commission’s recommendations, the British government invited Sir Michael Marmot to carry out a strategic review of health inequalities in England (www.marmotreview.org). The English strategic review reported in February 2010 as ‘Fair Society: Healthy Lives’, with a strong focus on delivery and implementation of its recommendations. Since publication of the report, Marmot and his team have been engaged in a process of dissemination and engagement with partners wishing to develop strategies aligned with the Review’s six policy objectives.
IAP for Health initiative
With funding from the Tides Foundation, IAP for Health hosted a workshop in Trieste, Italy, on 3-4 July 2014.
Support was provided to member academies to select a suitable expert and also to invite an appropriate government official to attend a working meeting with Professor Marmot and his team to learn about the review process and develop a work plan to take the project forward in their own country.
The workshop, ‘Promoting action on the social determinants of health’, was attended by more than 35 participants from 25 countries, including both scientists and government representatives.
The aims of the workshop were to:
• provide the opportunity for academies interested in action to document and address health inequities within their countries and to explore their potential role as evidence based advocates to and partners with government to take on these broader health challenges as outlined in the WHO report;
• provide academies with the tools for working with interested governments to conduct a national review process adapted from the work of Sir Michael Marmot (www.ucl.ac.uk/marmotreview);
• expand the understanding of academies and governments involved in the project about the health effects of systematic societal inequities; and
• create a learning community of academies to provide them with the opportunity to document and address health inequities within their countries and to explore their potential role as evidence-based advocates to, and partners with, government to take on these broader health challenges as outlined in the WHO report.
Following the Trieste meeting, IAP for Health made funds available during its 2015/16 call for projects. Successful proposals for regional workshops were received from:
• The Academy of Sciences of South Africa (in collaboration with the Nigerian Academy of Science, the Uganda National Academy of Science and the South African Young Academy of Sciences). The ‘Social Determinants of Health workshop’ was held on 7-8 November 2016 in Johannesburg, South Africa.
Workshop report available here.
• The National Academy of Science and Technology, Philippines (in collaboration with the Academy of Sciences Malaysia, the Nigerian Academy of Science and the University of the Philippines, Manila). A workshop, ‘Addressing Inequities in Health: Fostering action on social determinants’, was held on 3-4 October 2016 in Manila, the Philippines.
Workshop report coming soon.