Advancing the social determinants of health, in the Americas and beyond

Meeting on Social Determinants of Health

Participants in a special side event to the 52nd Directing Council described successful efforts to address the social determinants of health in countries of the Americas as well as in other regions.

PAHO Director Carissa F. Etienne noted that the Region of the Americas is “the region that champions the social determinants of health,” not only through advocacy but through implementing policies and programs to address them.

Despite living in one of the world’s most unequal regions, she said, “We have the region that pays more attention to equity, and we are advancing at a higher rate in addressing the inequity that is among us.”

Luiz Galvao, head of PAHO’s Special Program on Sustainable Development and Equity, noted that PAHO is working to improve the capacity of the health sector to provide leadership on intersectoral action and policies. PAHO has supported countries’ participation in regional and global forums on this issue, has documented best practices in intersectoral work, and is planning a special issue of the Pan American Journal of Public Health on the social determinants of health.

Rüdiger Krech, Director of Ethics and Social Determinants of Health at WHO, described efforts in other WHO regions to address the social determinants of health. “You are spearheading action here, but there is a lot going on in other countries too,” he said.
He noted that 105 of the 120 WHO country cooperation strategies that are currently in effect have made social determinants of health one of their priorities. In Europe, the social determinants of health are the “backbone” of the regional “Health 2020” policy.

In the Western Pacific Region (WPRO), the focus is on capacity building for implementing health in all policies, that is, “how you bring health to other policies,” said Krech.  The social determinants of health are also being addressed in the Eastern Mediterranean Region (EMRO) in dialogues between ministries of health and ministries of other sectors, with the goal of bringing health into the debate surrounding the region’s social and political upheaval.

Krech also noted that other United Nations agencies are working on the social determinants of health, “without using the term.” He said it is important “to establish a common UN language” on these issues.

Eduardo Bustos Villar, Deputy Minister of Health of Argentina, described a comprehensive, interdisciplinary, and intersectoral effort that dramatically improved quality of life for the residents of the Cuenca Matanza Riachuelo area of Buenos Aires province. Interventions included environmental clean-ups, the establishment of primary health care centers and networks, training of municipal health teams, identification of groups at environmental risk, comprehensive solid waste management, the creation of recycling cooperatives, the relocation of shanty-town dwellers into high quality housing, development of parks and recreation, and improvements in potable water and water quality monitoring.

The program was only possible through the involvement of virtually all the country’s ministries, including ministries of health, social development, education, economy, science and technology, labor, foreign affairs, industry, defense, housing, and planning.

Hilda Davila Chavez, Director General of International Relations in Mexico’s Ministry of Health, described five major programs instituted in Mexico over the last decade to address the social determinants of health: Seguro Popular (health coverage), Oportunidades (poverty reduction), Zonas Prioritarias (human development), ANSA (nutrition), and IMESEVI (road safety).

More recently, Mexico’s National Crusade Against Hunger program is applying a social determinants of health approach in 400 municipalities. It seeks to promote community participation in efforts to improve heath, basic services, and housing, and includes specific performance indicators to facilitate monitoring.

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