As David Sanders mentioned in last week’s guest-editorial, the Rio Political declaration on Social Determinants of Health was adopted during the World Conference on Social Determinants of Health on 21 October 2011. The declaration expresses global political commitment for the implementation of a social determinants of health approach to reduce health inequities and to achieve other global priorities. It will help build momentum within WHO Member States for the development of dedicated national action plans and strategies.
The Rio declaration is definitely a step in the right direction. But it also raises many more questions than it answers. A description is still lacking of the micro-mechanisms required to address the inequalities in different cultural, economic and political settings all over the world. The declaration also fails to provide a “gap analysis”, exploring where the inequalities are situated and what the underlying (political, cultural, social, economic or other) factors are. Unless this gap analysis is done, it will be difficult to pinpoint the focus for action. It is mainly due to these shortcomings that some of the organisations announced an alternative declaration by Public Interest Civil Society Organisations and Social Movements. Others have raised other vital issues that the Rio declaration has failed to address, like the medical students’s associations federation (IFMSA) in a sharp piece in response to the Declaration. It points out that the declaration is rather silent on how tackling health inequities will be financed and also on the role civil society and youth organizations should play in addressing the issue further.
In the Indian context, defining poverty as ‘people earning less than half a dollar per day’ only shows that we are currently reducing poverty by reducing the poverty line, and this in a situation where inflation is steadily rising. Reducing poverty by juggling statistics is mere politics and not a serious attempt to deal with poverty. India’s Human Development Index is still slightly better than Bangladesh’s HDI, but as Dreze and Sen mentioned in a piece in Outlook last week, Bangladesh has overtaken India in terms of a range of basic social indicators by now, in spite of a much lower per capita income.
The HDI in India has risen only slightly over the past few decades, in spite of the economic boom. A widening gap between the rich and the poor and massive corruption are some of the reasons for this slow progress. That’s why the Anna Hazare movement is timely; it has already greatly affected the life of each Indian. Due to the movement, the political parties are increasingly getting the message that people are no longer going to tolerate corruption. Many ministers were sacked after allegations of corruption. The government of India is discussing a strong Lokpal-bill to control corruption; if due to this, corruption in India were to decrease, the spare money would then be available for development goals and would thus contribute to bringing down prices and inflation. It’s likely that India’s HDI would improve too. The Dalai Lama has said that corruption is a form of violence, whereas Anna Hazare has said corruption is the root cause of inflation and rising prices. The average Indian thinks corruption is like a cancer that is gradually eating away at their daily livelihood. Hopefully India is all set now to move into an era of a cleaner public life in the years to come.
As is obvious from the Indian example, political commitment to tackle the social determinants is easy to declare but by no means easy to implement. The ‘Health for All’ declaration of Alma-Ata already argued forcefully for this agenda, many decades ago. We all know what happened next. We hope the Rio declaration awaits a different fate. But until we innovate by developing the right mechanisms, monitor progress and fill the gaps and have a good transparent government taking a leadership role, Rio may turn out to be yet another declaration missing the point. It’s up to all of us to prevent this.
Omesh Kumar Bharti