IFMSA in Lancet: Students’ perspective on rooting out causes of health injustice

I am reposting the commentary on social determinants of health from members of the IFMSA Small Working Group on Health Inequities, which was published in the Lancet. For those who do not have subscription in the Lancet, here is the text: http://www.lancet.com/journals/lancet/article/PIIS0140-6736(11)61628-0/fulltext.

This year, the International Federation of Medical Students’ Associations (IFMSA), which represents 1·2 million medical students worldwide, made health inequities and action on social determinants of health a key policy focus.¹ A global campaign, Root Out, Reach Out,² has been organised to coincide with the 2011 World Conference on Social Determinants of Health. We believe that the final report³ of the WHO Commission on Social Determinants of Health should have provided a watershed moment in the worldwide movement towards achieving global health justice. Although some governments have heeded the report’s recommendations, the voice of the Commission has largely gone unheard because of a lack of both political commitment and effective policy making capacity. Unless addressed, these challenges have the potential to undermine any outcomes of the World Conference on Social Determinants of Health.

We believe there remains a distinct lack of political currency in addressing health inequities through action on social determinants of health, both within and between countries. Until governments are held to account for their achievement in reducing health inequities, “closing the gap in a generation” will remain a pipedream. We therefore propose that civil society groups, for example, concerned with HIV/AIDS, maternal and child health, non-communicable diseases, and climate change, bring their agendas together. An approach that is based on the social determinants of health offers a rare opportunity to turn current disease-oriented silos into a global coalition for health equity.

Advocates for the social determinants of health, supported by WHO, should intensify efforts targeted at central government departments, such as ministries of finance, trade, and labour. A strong enough case has not yet been made to these central departments, which are in the position to correct the “toxic combination of poor social policies and programs, unfair economic arrangements and bad politics”³ that lead to health inequities.  Ultimately, the UN system must take leadership in this movement. Tackling the “inequitable distribution of power, money, and resources”³ within and between countries requires collective action not just from WHO, but from all UN agencies.

Governments are still largely ill-equipped to develop effective policy initiatives for action on the social determinants of health. There has been a wide range of interpretations of the idea of social determinants of health by WHO member states and non-governmental sectors. Thus, a common understanding of health equity needs to be established, as well as baseline methodologies that reflect an approach grounded in the social determinants of health; this would ensure global coherence in policy formulation, implementation, monitoring, and evaluation. WHO should devote more resources towards fulfilling its role as an effective knowledge broker between health workers, academia, and policy makers. It should create and support dynamic research consortia on the social determinants of health that not only develop the latest evidence, but effectively translate evidence so that it can be implemented by governments – for example, as policy tools, measurement indicators, learning modules, and programme designs.

In relation to research collaboration, WHO should partner with other agencies in developing new methods and indicators, in addition to existing ones such as the Human Development Index,⁴ that can fully encompass the breadth of social determinants and can be easily used by governments for monitoring progress. We also recognise the importance of education in sustaining this global movement. The Commission recommended the incorporation of concepts like equity and the social determinants of health in the training of health professionals.³ We propose that students from disciplines beyond the health sector, such as law, economics, business, politics, and environment, also receive training on the social determinants of health. Such cross-cutting education is necessary, so that all sectors can develop the capacity for action and fulfill their obligations to health.

Ultimately, health is an outcome of how society distributes multiple determinants of health, and thus a general indicator of societal injustice.⁵ The Commission affirmed such a view, announcing that “social injustice is killing people on a grand scale”.³ As future physicians we hope to build a social justice movement that will place equity at the centre of global development and realise the long-awaited vision of “health for all”.

Ramon Lorenzo Luis Guinto, Daniel Yore, Nilofer Khan Habibullah, Altagracia Mares de Leon, Taavi Tillman, Alex Elliott-Green and *Unni Gopinathan

International Federation of Medical Students’ Associations

International Federation of Medical Students’ Associations

IFMSA General Secretariat

c/o World Medical Association

B.P. 63

012 12 Ferney-Voltaire, Cedex

France

[email protected]

We are all members of the International Federation of Medical Students’ Associations.

We declare that we have no conflicts of interest.

1. International Federation of Medical Students’ Associations. Policy Statement on Health Inequity and the Social Determinants of Health. Jakarta, Indonesia: The 60th March General Assembly of the International Federation of Medical Students’ Associations. March, 2011. http://www.ifmsa.org (accessed Sept 26, 2011).
2. Root Out, Reach Out. International Federation of Medical Students’ Association’s Week of Global Action on Social Determinants of Health. http://root-out.org (accesed Sept 22, 2011).
3. Commission on Social Determinants of Health. CSDH final report: closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organization, 2008.
4. United Nations Development Programme. The Human Development Index  http://hdr.undp.org/en/statistics/hdi (accessed Oct 14, 2011).
5. Daniels N, Kennedy B, Kawachi I. Why justice is good for our health: the social determinants of health inequalities. Daedalus 1999; 128: 215–51.