The Commission On Social Determinants Of Health For The Eastern Mediterranean Region

 

The following provides brief information on an important WHO/ Eastern Mediterranean regional office activity and report.  The following text is extracted verbatim from the executive brief of the report.

The platform welcomes comments on and discussion of the report.  If you would like to share your comments on the report, please send you comments to the following email: src@aucegypt.eduComments will be posted on the platform on a weekly basis on a subsection titled (Comments and discussion). 

 

The Regional Commission on the Social Determinants of Health was established in November 2019 to review health inequities in WHO’s Eastern Mediterranean Region and issue recommendations to address these inequities.  The Commission is led by Professor Sir Michael Marmot from the Institute of Health Equity, University College London and comprises 14 regional and global experts in various fields of health and development. The Commission had five main objectives.

  1. Analyze and present existing data on health inequities and social determinants of health, including conflict, in the Eastern Mediterranean Region context.
  2. Document actions being taken by international organizations, governments, nongovernmental organizations, civil society and communities to address these issues.
  3. Build knowledge and evidence for action and offer practical, specific recommendations to reduce health inequities.
  4. Provide strategic guidance on developing plans for equity, including governance and monitoring systems for health equity.
  5. Identify opportunities to build capacity through research and evaluation of health inequities and programs for action, and establish knowledge networks across the Eastern Mediterranean Region. The inequitable impacts of the COVID-19 pandemic required another, additional, objective for the Commission to describe and make proposals to mitigate the health inequality impacts arising from COVID-19, including infection, mortality and the long-term impacts of containment measures. 

The Commission conducted an extensive review of health inequities in the Region and produced a report "Build back fairer: achieving health equity in the Eastern Mediterranean Region". The report provides a detailed analysis of the status of health inequities and a list of actionable recommendations. The work of the Commission puts social justice and health equity at the center of all action to address the social determinants of health. 

 

On March 31, 2021, the Commission’s report was launched. The report contained recommendations for action on 12 areas of concern.  These recommendations aimed to create enabling conditions for all residents of the Region to lead lives of dignity and achieve better health and in return pave the path to a fairer distribution of health—greater health equity.  The following is a list of the issues of concerns followed by their relevant recommendations

  • HEALTH INEQUITIES IN THE REGION PERSIST AND IN SOME CASES ARE WIDENING
    • Develop national social determinants and health equity plans.
    • Establish a monitoring framework and generate data on inequities in social determinants and health.
       
  • COVID-19 CONTAINMENT POLICIES ARE DAMAGING THE SOCIAL DETERMINANTS OF HEALTH AND HARMING HEALTH EQUITY
    • Reduce inequities in infection and mortality by addressing the underlying causes of inequities and taking steps to minimize inequities in exposure.
    • Mitigate the unequal impacts of containment measures on unemployment, income, hunger and gender equity.
    •  Implement equitable vaccination programs.
       
  • CONFLICT AFFECTS MORE THAN HALF THE COUNTRIES IN THE REGION, DEEPLY IMPACTING OPPORTUNITIES FOR HEALTH EQUITY
    • Focus humanitarian response to conflict and emergency situations on the social determinants of health, equity in health and dignified lives.
    •  Place the health of both migrants and host populations at the forefront of migration policy.
    • Highlight and mitigate the negative impacts of sanctions on health and the social determinants of health.
    • Abide by UN resolutions on the occupied Palestinian territory
       
  • HIGH-INCOME INEQUITIES REFLECT THE LOW PRIORITY GIVEN TO SOCIAL JUSTICE AND HEALTH EQUITY
    • Implement equitable fiscal policy.
    • Increase official development assistance to 0.7% of gross national income for wealthy countries in the Region
    • Support greater economic inclusion of refugees, migrants and IDPs.
    • Develop measures of national progress which are based on equitable social and economic development.
       
  • CULTURAL ATTITUDES ARE AFFECTING HEALTH EQUITY
    • Strengthen collaboration with religious leaders and organizations to support health equity.
    • Achieve progress in gender equity.
    • Eliminate discrimination against and exclusion of refugees, migrants and IDPs.
       
  • CLIMATE CHANGE IS ALREADY DAMAGING HEALTH IN THE REGION
    • Mitigate and adapt to climate change, increase renewable energy and support health equity in line with the Paris Agreement on Climate Change and the 2030 Agenda for Sustainable Development
    • Diversify the economy of the Eastern Mediterranean Region away from reliance on fossil fuels.
    • Increase conservation of natural resources and improve water management in the Region.
       
  • CHALLENGES TO MATERNAL AND CHILD HEALTH AND EQUITABLE EDUCATION REMAIN – AND ARE EXACERBATED BY COVID-19
    • Ensure equitable maternal and child health.
    •  Ensure that all young people in the Region complete good-quality primary and secondary education and increase equity in access to tertiary education.
    • Build on progress in gender equity in education and increase post-school training and employment of women.
       
  • HIGH UNEMPLOYMENT AND POOR WORKING CONDITIONS POSE CHALLENGES TO HEALTH AND WELL-BEING
    • Improve health equity, reduce unemployment with a focus on young people, women and the long-term unemployed.
    • Improve the quality of work to benefit health equity
    • Regularize informal employment and eliminate child labor, slavery and trafficking.
       
  • DEMOGRAPHIC SHIFTS AND LACK OF PENSIONS AND CARE SERVICES THREATEN TO LEAVE OLDER PEOPLE UNSUPPORTED
    • Expand the provision of publicly funded care for older people.
    •  Increase the provision of pensions through government subsidies.
    • Develop national strategies to improve the health and well-being of older people and focus on active aging.
       
  • RAPID URBANIZATION IS BOTH A CHALLENGE AND AN OPPORTUNITY
    • Ensure universal provision of basic services and improve housing quality.
    •  Implement sustainable and accessible transport systems.
    • Strengthen regional and national planning mechanisms.
       
  • STRONGER HEALTH SYSTEMS AND EFFORTS TO IMPROVE HEALTH ARE NEEDED
    • Strengthen universal health coverage across the Region and ensure equitable and affordable access to health care.
    • Implement and ensure essential public health functions for each country to achieve universal public health standards.
    • Develop population health systems with a strong focus on equity, prevention and action on the social determinants of health
       
  • PUTTING HEALTH EQUITY AT THE HEART OF GOVERNMENT IN THE EASTERN MEDITERRANEAN REGION

Principles for governance to build back fairer for health equity

    • Take action on social determinants of health to improve health equity.
    • Put health equity at the heart of government.
    • Do something, do more, do better.
    • Base social action for health equity on the principle of proportionate universalism – spend more on the areas of greatest need to expand social protection.
    • Involve the whole of government in policies and practices to improve health equity.
    • Involve the whole of society in improving health equity.
    • Develop strong accountability for health equity.
    • Align greater action on climate change with health equity.

 

For more information, video and report, visit the WHO Report of the Commission on Social Determinants of Health in the Eastern Mediterranean Region.