To what extent the Rio Declaration normative statement will trickle down into changed behaviours within governments?

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Do you consider that WCSDH achieved its objective of defining strategies to combat health inequities through action on SDH? What would you emphasize in this regard?

The WCSDH went part of the distance in achieving its aims, but primarily in terms of issuing normative statements. Among the most important of these is the affirmation that inequities in health within and between countries are unacceptable by any standard invoked: political, social or economic. It also calls on adoption of actions to prevent deteriorating living conditions and loss of social protection in the wake of the global financial crisis. The five key strategic areas (better health governance, meaningful public participation in SDH policy discussions, health systems oriented to reducing health inequities, stronger and better global governance for health, and improved measurement and accountability) are all quite fine. They are also not new, but it is good to have them re-affirmed. The various pledges governments have made in the Rio Political Declaration are also helpful reference points for holding them to account; but what is missing is a clear statement of what will be done. There are no targets; no specific policy strategies; and no commitment to report back on whether the pledges will be honoured. This raises the important question: to what extent does an intergovernmental normative statement trickle down into changed behaviours within governments once they return home? I think that pledging to a few of the key specific policy choices raised in the CSDH final report, and by the strong civil society and academic communities at the WCSDH, would be more likely to have political traction once the national delegates (who mostly represented health ministries) try to convince their finance, foreign affairs and social protection sectors to take SDH seriously.

What steps in short and medium terms member countries should adopt to comply with the commitments made at this conference?

They need to meet with other ministers, senior policy workers, civil society groups and media in their home countries to de-brief on the meeting, and to state quite clearly the specific policy agenda they will be pursuing. The Alternative Declaration issued by civil society at the Rio WCSDH does contain many such good measures, including: increased funding for equity-based social protection, full closure of offshore tax centres, progressive taxation to finance redistributive SDH programs within their borders, a global financial transaction tax to fund meaningful and ecologically sustainable development, a review of trade policies and trade treaty negotiation positions to ensure that trade deals support, and at least do not harm, health equity goals.

What are the main changes in technical cooperation activities that should be undertaken by WHO and other international organizations to support countries in implementing national plans and programs to combat health inequities?

There is, now, an emerging consensus amongst many of the UN agencies on the importance of enhanced social protection spending in such areas as welfare support, universal health coverage, active labour market policies, the ‘decent work’ agenda, early child development, universal education access and so on. This directly challenges the austerity measures now being undertaken voluntarily or being imposed on many countries directly by central banks and the IMF or indirectly through the credit ratings of different rating agencies (pricing the cost of government financing out of reach). Estimates of the wealth lying untaxed in offshore financial centres, or of the revenues potentially earned by worldwide and technically collectible financial transaction taxes (to say nothing of rolling back upper-income tax breaks enacted in recent years in many countries) would be ample to finance these measures. These are clear policy choices governments could make, and which the Rio Political Declaration, had the health delegations here chosen to be bold, could have affirmed. It also sets the bar high for WHO, in terms of adding its health voice to the human development, labour, children’s and other UN sectoral agencies call for interventions to reduce the inequalities in wealth and resources now threatening social cohesion in many countries around the world.

What other aspects would you like to point out?

Regrettably, there has been virtually no mention of the WCSDH or the issues it was tackling in any of the media, at least of which I am aware. There was no mention in Canada, and none (I have been told) even here in Brazil. This raises questions about the ‘brand’ of SDH – does it resonate with the broader public? Or is it simply a matter of political indifference or media capture by the scintillations of medical science? On a positive note: Brazil made a very strong mark in terms of describing its successes in reducing poverty and improving health through improved social spending and redistribution; with very strong commitments for ongoing pro-health equity programs and reforms into the future. There was probably no better country at the moment to host an event such as the WCSDH.