Launch of the final report of the Commission on Social Determinants of Health
Dr Margaret Chan
Director-General of the World Health Organization
Friends and colleagues, ladies and gentlemen,
First and foremost, let me extend my warm personal thanks to you, Sir Michael, to your fellow commissioners, and to the hundreds of experts worldwide. Many of these experts are within the UN system, but many more are outside the system. These people contributed their knowledge and experience during the past three years.
The Commission’s main finding is straightforward. The social conditions in which people are born, live, and work are the single most important determinant of good health or ill health, of a long and productive life, or a short and miserable one.
As the report shows, the great discrepancies that occur along the social scale – from marginalization and deprivation to privilege and power – are the main reason for the vast differences seen throughout the world in health outcomes and life expectancy.
This finding holds true no matter how world is looked at: between countries, within countries, in different racial and ethnic groups, in men and women, and in the young and very old.
This ends the debate decisively. Health care is an important determinant of health. Lifestyles are important determinants of health.
But, let me emphasize, it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place.
In my view, the report’s significance lies in the way it interprets the implications of this central finding. Conditions of social deprivation have characterized human history and undermined human health since the beginnings of civilization. Sir Michael said it, we knew it, what is the difference? The difference lies, let me put it, in what we often call the “know and do gap”. We know the problem, but we don't do anything to solve that problem. That is exactly where we are.
But today, under the unique conditions of the 21st century, a focus on the social determinants of health has unprecedented relevance.
First, by focusing on the upstream causes of ill health, the report opens powerful new opportunities for prevention. It also opens options for greater efficiency and sustainability.
The importance of prevention continues to grow, partly because of escalating health care costs. We simply cannot afford the way we go about doing health care nowadays, without doing more for prevention. This is especially true if we want to get ahead of the AIDS epidemic. Again the emphasis is also on prevention in partnership with cure, treatment and care. And also partly because of the rise of chronic diseases, more than 60% of deaths are due to non-communicable disease, like heart disease, diabetes, and cancer.
Faced with the costs of long-term, often life-long treatment, prevention is by far the better approach.
Addressing the “causes of the causes” is arguably the most efficient form of prevention. Let me illustrate. High-tech medical care can often save the life of a severely malnourished child. But what happens when the child is returned to the same conditions that caused it to nearly starve to death in the first place? Where is the benefit?
What is the benefit of high-tech treatment without solving the conditions, the social environment in which people live?
Second, the report clearly treats these upstream preventive options as matters to be addressed by government policies and regulations. It places the responsibility for taking action on political leaders and policy-makers.
Social deprivation is not a matter of fate. It is a marker of policy failure.
At the same time, the report acknowledges the power of civil society and the activist community to generate the grassroots pressure that can ignite policy change. Civil society is brought on board as a full partner with a welcome voice.
Third, the report recognizes that nearly all social determinants of health fall outside the direct control of the health sector.
In response, it issues a strong call for a whole-of-government approach in which policies in all sectors are assessed in terms of their impact on health. In other words, the famous phrase of “health in all policies”, which becoming part of the vocabulary in many countries.
Finally, the report has lessons for overall development. We have learned from studies conducted in Latin America which show that even a little redistribution of income, through progressive taxation and targeted social programmes, can do a great deal to reduce poverty.
Ladies and gentlemen,
Let me conclude with some brief personal observations.
I am pleased by the special emphasis given to gender equity.
I am pleased that the report puts primary health care forward as a model for a health system that acts on the underlying social, economic, and political causes of ill health.
And I am pleased that the Commission’s main premises align so well with the major commitments and initiatives that are currently driving health development.
The deep concern with fairness and social justice echoes statements in the Millennium Declaration, which describes our central challenge as ensuring that globalization becomes fully inclusive and equitable.
Let me quote from the Millennium Declaration. “Those who suffer or benefit least deserve help from those who benefit most.”
The Commission’s recommended strategic approach is likewise in alignment. The Millennium Development Goals are all about tackling the root causes of poverty and ill health, and doing so in ways that link the actions of multiple sectors. And you have named a few: the importance of the linkage between health, education and employment.
Finally, I have long been disturbed by situations where public health is left to cope with the adverse effects arising from policies made by other sectors.
This is true for the health effects of climate change. And this is true for the health effects of soaring food prices.
It is my fervent hope that, with the weight of the Commission’s findings as a support, the health sector will have greater power to persuade other government sectors to pay close attention to the impact their policies will have on health.
Again, Sir Michael, please accept my heartfelt thanks to you and through you to all the Commissioners and experts who have contributed to this extremely important landmark report.