WCSDH in Rio: An uncommon approach to governance

Waruguru Wanjau from Kenya reports from Rio about the parallel session she attended on the subject “Governance to tackle the root causes of health inequalities” at the WHO World Conference on Social Determinants of Health.

Listening to the different ministers and Ministry of Health representatives, the one thing that stood out is that each country has a unique approach. Indeed, social determinants of health should be discussed in the context of culture and political structure. We should not believe that there is a single formula that will work for 7 billion people living in 204 countries in the world. This would translate into a minimum of 204 personalized approaches to SDH.

Four ministers of health (Slovenia, Peru, Ghana and Norway) and a professor from New Zealand took to the stage to discuss governance as an avenue to tackling social determinants of health. The one thing that stood out is that each of the respective governments had used a different approach to tackling social determinants of health. While intersectoral cooperation, high prioritization of health, and increased funding to health sector have all been implemented across all five countries, they also all had unique interventions tailored specifically for their countries. This customization is an important aspect as we continue to discuss SDH. We as SDH champions need to realize that the cookie cutter or one-size-fits-all approach. While we do have health inequalities across society in all areas of the world, it is fundamental that we realise that these inequalities are caused by different factors in different populations.

To give a quick example Brazil and Ghana are both tackling SDH. Brazil’s approach is to redistribute wealth and invest more in social protection, in this case health, education and prevention of child labour. On the other hand, Ghana has chosen to decentralise heath and bring it back to the hands of the community. For example, it can be normal for the community to provide accommodation for a health worker, and this way they feel that they are actively contributing to their community’s health resources. Both these countries are addressing health inequities but their approaches are quite different. I would argue that if Brazil were to “copy” Ghana or vice versa they would not achieve much success in tackling SDH.

To bring this out better I will give a snapshot of the four countries discussed during the panel:

Ghana:  The main strategy has been to decentralize health and allow the community to be directly involved and take responsibility for their heath, adopting a participatory approach.

Norway: Anne-Grete Strom-Erichsen summarized the Norwegian approach best in two statements. She made it clear that Norwegians put their people and the people’s health as one of the government’s top priority. To emphasize this, she said that Norway’s wealth does not lie in the oil in the sea but in the Norwegians. She also went ahead to explain that her position as a minister of health is of higher priority in Norway then her former position as minister of defence. It appears that health is given much higher regard as a policy goal even at the highest level of government.

Slovenia: Their approach has been to build capacity and create networks, to hone enthusiastic professionals through sharing of ideas, and to adopt a strong policy of putting health on the political agenda. Slovenia considers health as a pre-requisite for faster development and better economic growth.

Peru: The Peruvian approach is to tackle health with a focus on people and not on rules. Health is also viewed as an investment in the Peruvian people and as a process that needs to be sustained.

The take home message from this discussion was that the emphasis needs to be put on each government to tailor the solutions to SDH in a unique way. This unique way should take into account the inequalities in health in that particular country, the style of governance, and the cultural traits unique to the society. This is the lesson that countries need to learn should they desire to succeed in addressing the social determinants of health.

Waruguru Wanjau

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