[afro-nets] WHO Comm. on Social Determ. of Health Cairo meeting 5-05

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Report to People's Health Movement Global Steering Committee
from Fran Baum, on Second meeting of WHO Commission on Social
Determinants of Health, Cairo 4th-7th May 2005
-------------------------------------------------------------

Introduction

This meeting was requested by the Commissioners at their first
meeting in Chile in order to conduct some detailed planning work
that had not been possible at the first meeting. The meeting
was, therefore called at short notice and not all Commissioners
were able to be attend. Those present were: Michael Marmot
(Chair) Fran Baum, Monique Begin (Canada), Giovanni Berlinguer
(Italy), Mirai Chatterjee (India), Manual Dayrit (Philippines),
Kiyoshi Kurokawa (Japan), Alireza Marandi (Iran), Hoda Rashad
(Egypt), Hernan Sandoval (Chile) Denny Vagero (Sweden).


Cairo Meeting Objectives
Conceptual framework

1. Discuss, shape and collectively "own" the broad conceptual
and values framework for the Commission.

2. Identify a group of Commissioners with a special interest in
further developing the conceptual framework into a final docu-
ment to be circulated and disseminated. Define the process and
constituencies.


II. Knowledge Networks

3. Agree on the priority areas of focus of the knowledge compo-
nent of the CSDH, and determine which areas require knowledge
networks (KNs) and which can be addressed through commissioned
papers or other mechanisms.

4. Finalize Knowledge inputs into CSDH.

5. Determine the organization of the knowledge process during
the first 18 months and the Commissioner interface with the pri-
ority areas of focus (KNs or other).

6. Determine follow up action and preparations toward the Sep-
tember Commissioner meeting.


III. Country Work

7. Reach broad agreement on the Commission country work as out-
lined in the Country Work Consultation document with particular
reference to: a) the selection criteria, b) next steps for set-
ting up the country work, c) WHO linkages, d) Commissioner TOR
with respect to country work.

8. Identify what should be prepared for the September Commis-
sioner meeting.


IV. Global Partners and Processes

9. Identify and discuss mechanisms for engaging global partners
and processes in the Commission.


V. General

Discuss the objectives and focus of future Commissioner meetings


Other WHO officers were present (see Appendix for details of
participants)


Conceptual paper session

Jeanette Vega presented an overview of the second paper to come
from the secretariat, "Towards a Conceptual Framework for Analy-
sis and Action on the Social Determinants of Health". This was
well-received by the Commissioners as a starting point for the
framework for the work of the Commission. There was a feeling
that the next draft will need to be more practical and clearer
on engagement with politicians, Millennium Development Goals and
civil society. Much discussion on how to persuade politicians
(Heads of State and Health Ministers) to take social determi-
nants of health and equity serious). There was strong recogni-
tion of the importance of a civil society base in terms of cre-
ating the pressure for this to happen.


Knowledge Network Working Group

Membership: Fran Baum, Hoda Rashad, Hernan Sandoval, and Denny
Vagero

I was asked to chair this working group by Michael Marmot and
concentrate on the work detailed above. Hilary Brown provided an
overview of the process to date. This has been very much driven
by secretariat and the Commissioners have not had much involve-
ment. At this meeting we reviewed the KN summaries and provided
comments for the Secretariat. They will now negotiate with bid-
ders for KN and select the final hubs. The Commissioners did
note that they were disappointed with the fact that most of the
bids come from the minority world and poorer countries were not
well represented. Some efforts will be taken to remedy this and
the idea of co-Chairs will be explored and these would prefera-
bly be appointed from majority world. Please let me know if any
PHM members would like me to nominate them as co-Chairs of any
of the knowledge networks.


There will be an EOI document for the new KN on Gender and
Women's Empowerment. There will also be a new KN on financing
which will cover both health systems financing but also financ-
ing of Governments more generally (eg taxation policy).


These KN will provide a great opportunity for PHM members to be-
come actively involved in the work of the CSDH. See the CSDH
website for details if you don't already have these -
http://www.who.int/social_determinants/en/


Country Work Group

Membership: Monique Begin, Mirai Chatterjee, Manueal Dayrit,
Alireza Marandi, Charity Ngilu, and David Satcher

This group was chaired by Monique Begin and discussed the objec-
tives above. The main output of their work was a statement of
principles for CSDH engagement with countries. Group very clear
they want to see action on the ground. Recommend that the CSDH
gains a high profile at upcoming World Health Assembly.

One salutary fact provided in the report back from this group by
Hernan Sandoval was that the global health care industry is
worth US$1.2 billion per day.


Session on Involving Global Initiatives and Processes

This session started with a presentation by Dr. Tim Evans (As-
sistant Director General, Evidence and Information for Policy
WHO). Key points from his presentation were:

a. Invitation from MDG to improve access to health services
b. MDG has an over emphasis on averages as opposed to distribu-
tion
c. MDG Magic bullet approach instead of thinking of the complex-
ity of social change
d. Over- emphasis on idea big pool of money will solve problem
e. Also over-emphasis on single strategies
f. CSDH needs to be strategic about which networks

The Commission had planned to have a third working group on this
topic but because most of the Commissioners represented here
were unable to come this group did not meet. The issue was dis-
cussed in plenary session and most of this discussion focussed
on how the CSDH should relate to Millennium Summit to be held in
New York in September.

Decided to use Stephen Lewis as main CSDH presence at the Mil-
lennium Summit following a long discussion on how to engage with
the process of the MDGs.


Engagement with Civil Society

I was asked to make a presentation on the topic "People's Health
Movement: An Example of how a global civil society organisation
would interact with the CSDH ". Once requested to do this I sug-
gested that I should make this presentation with local represen-
tatives of PHM in Egypt. This proposal was accepted and fortu-
nately I was able to meet with Hani Serag on the Tuesday before
the meeting started and he was able to arrange for two col-
leagues, Dr. Alaa Shukrallah, Amal I. Sabri, to be present at
the session on Friday despite the short notice.

I made a presentation about PHM covering PHA1 & 2, the Global
Health Watch, recent campaigns and the International People's
Health University Course. Then Dr. Shukrallah and Hani Serag
spoke about their work in Egypt and the region. There was then a
short discussion. It was evident that we needed more time. The
Commissioners agreed that next time we need to make more time
for civil society and plan to do this when we meet in India in
September.


The key points I made about engagement with civil society (and
thanks to Ravi and David Sanders for their input to my presenta-
tion) were:

* PHM2 will be an important event at which SDH are taken for
granted

* This represents a crucial event for the CSDH

* CSDH participation will have a symbolic and practical value

* Great opportunity to mingle interact with members of civil so-
ciety who are passionate about SDH

* PHM global movement with circles in many countries and links
with a wide range of civil society movements in those countries

* Engage with these circles during CSDH meetings and invite
presentations on local issues or organise field visits

* Make Civil society focus of Commissioners' meeting - starting
with India Sept 05

* PHM offers to organise "People's Hearings" so CSDH can dia-
logue with communities - in Commissioners' own countries

* Use the expertise in PHM - sophisticated research and analyti-
cal circle especially on Comprehensive PHC and trade and health
issues and political economy of structural factors underpinning
SDH

* Sign on to list server to see debates which have already in-
cluded views on CSDH PHA-Exchange@lists.kabissa.org

* Listen to debate within PHM - issues so far:

- Will CSDH be more than another report telling us what we al-
ready know?

- Do we need more knowledge or is action on SDH a matter of po-
litical will?

- Need for recognition of the structural factors underpinning
SDH

- Anti-poverty versus pro-poor

- Recognition of power and political dimension

- Need for global strategies to tackle global issues

* PHM people will be involved in Knowledge hubs/networks includ-
ing globalisation, social inclusion, health systems proposals

* Can bring a community perspective to KN

* PHM is a source of co-Chairs for KN

* Is supportive of the CSDH and lobbied for its establishment

* May be critical of CSDH work but will be constructively so

* Anticipating sharing the burden of a social vision of health
with CSDH

* Contains strong analytical and grass root credibility - the
combination is a powerful one

* Is a growing movement and strong voice in global health and
should not and will not be ignored!


Hani described the activities in the region and forthcoming con-
ference.

Many thanks to Hani for organising the PHM-Egypt input to well
and to Alaa Shukrallah and Amal Sabri for attending the meeting
at such short notice.


Next steps for the CSDH

The Commission will next meet in India in September. There are
clear plans to have a field visit organised by Dr. Mirai Chat-
terjee and to engage with PHM-India in a real and in-depth man-
ner. The meeting will be in Ahmedabad and then Delhi.

The KN hubs will be invited to India and will meet with Commis-
sioners.

Determination from Commission to "be practical" - somewhat un-
clear what this means. Most take it to mean that the CSDH should
not just leave a report behind - that there needs to be more
tangible legacy. This could be in form of: inspirational docu-
ment that challenges neo-liberal thinking, practical examples in
countries, work of the KN in terms of producing knowledge about
what does work in improving health equity and improving social
determinants of health and politics of doing this.

Michael Marmot has agreed to come to PHA2 and will take part in
a workshop and also be part of a plenary panel. I also hope that
Monique Begin will come.

Please let me have your thoughts, ideas, and contributions to
the work of the Commission - how do you think it is going so
far???

Fran Baum
Adelaide
May 2005