A Global Challenge to Health Inequities: Alternative Health Declaration and Report

The World Health Organization’s World Conference on Social Determinants of Health ended last week with an official declaration on reducing health inequities. Yet the failure to propose concrete actions prompted social movement organizations to denounce the declaration and call for “decisive measures to address the deep and persistent inequities in power and opportunities which prevent a majority of the world’s population from enjoying their right to health.”

In a process led by the People’s Health Movement, social movement organizations developed an alternative declaration on Protecting the Right to Health through Action on the Social Determinants of Health:

“Urgently required actions by Member States and WHO on the key areas:

  1. Implement equity-based social protection systems and maintain and develop effective publicly provided and publicly financed health systems that address the social, economic, environmental and behavioural determinants of health with a particular focus on reducing health inequities.
  2. Use progressive taxation, wealth taxes and the elimination of tax evasion to finance action on the social determinants of health.
  3. Recognise explicitly the clout of finance capital, its dominance of the global economy, and the origins and consequences of its periodic collapses.
  4. Implement appropriate international tax mechanisms to control global speculation and eliminate tax havens.
  5. Use health impact assessments to document the ways in which unregulated and unaccountable transnational corporations and financial institutions constitute barriers to Health for All.
  6. Recognise explicitly the ways in which the current structures of global trade regulation shape health inequalities and deny the right to health.
  7. Reconceptualise aid for health from high income countries as an international obligation and reparation legitimately owed to developing countries under basic human rights principles.
  8. Enhance democratic and transparent decision-making and accountability at all levels of governance.
  9. Develop and adopt a code of conduct in relation to the management of institutional conflicts of interest in global health decision making.
  10. Establish, promote and resource participatory and action oriented monitoring systems that provide disaggregated data on a range of social stratifiers as they relate to health outcomes.”

The alternative declaration describes current challenges to the right to health as follows:

  • sustainable development is in crisis with neoliberalism, consumerism individualism over-riding the values of community and international solidarity;
  • conflict and violence which erupt and burn in households, communities, cities and regions and blight millions of lives have complex roots in culture and governance, including the prevailing global economic regime which sanctions unbridled competition, gross inequality and obscene greed;
  • the crises of development, finance, food and global warming deny for hundreds of millions of people the right to decent employment, social protection, food security, housing; in fact all the social determinants of health;
  • violence, poverty and climate change contribute to large scale migrations, to cities and across national borders; in many cases migrants are discriminate against and denied their human rights;
  • inequalities in income and wealth, within and between countries, are growing rapidly; and
  • as a consequence there is a rising popular demand for governments to fulfill their obligations to act to guarantee social rights and state protection.

The WHO’s official declaration, the Rio Political Declaration on Social Determinants of Health, released on October 21, 2011, gives the impression of a well-intended document rendered meaningless by its vagueness and lack of concrete actions.

Here are excerpts of some of the official declaration’s stronger passages:

 4. We reaffirm that health inequities within and between countries are politically, socially and economically unacceptable, as well as unfair and largely avoidable, and that the promotion of health equity is essential to sustainable development and to a better quality of life and well-being for all, which in turn can contribute to peace and security.

[…] 6. Health inequities arise from the societal conditions in which people are born, grow, live, work and age, referred to as social determinants of health. These include early years’ experiences, education, economic status, employment and decent work, housing and environment, and effective systems of preventing and treating ill health. We are convinced that action on these determinants, both for vulnerable groups and the entire population, is essential to create inclusive, equitable, economically productive and healthy societies. Positioning human health and well-being as one of the key features of what constitutes a successful, inclusive and fair society in the 21st century is consistent with our commitment to human rights at national and international levels.

7. Good health requires a universal, comprehensive, equitable, effective, responsive and accessible quality health system. But it is also dependent on the involvement of and dialogue with other sectors and actors, as their performance has significant health impacts. […]

8. We recognize that we need to do more to accelerate progress in addressing the unequal distribution of health resources as well as conditions damaging to health at all levels. Based on the experiences shared at this Conference, we express our political will to make health equity a national, regional and global goal and to address current challenges, such as eradicating hunger and poverty, ensuring food and nutritional security, access to safe drinking water and sanitation, employment and decent work and social protection, protecting environments and delivering equitable economic growth, through resolute action on social determinants of health across all sectors and at all levels. […]

9. The current global economic and financial crisis urgently requires the adoption of actions to reduce increasing health inequities and prevent worsening of living conditions and the deterioration of universal health care and social protection systems.


The WHO conference in Rio also saw the launch of Global Health Watch 3, the alternative world health report. This third alternative health report was compiled by activists and researchers across the world, as a collaborative initiative coordinated by the Peoples’ Health Movement, Medact, Medicos International, Health Action International and Third World Network.

It features a case study on the Healthcare Is a Human Right campaign in Vermont, led by the Vermont Workers’ Center.

The Global Health Watch proposes an alternative vision of health located in the principles of equity, rights and empowerment.

The U.S. launch will take place at the APHA meeting at the end of this month; check for upcoming excerpts of the report.