CSU 40/2008: The Social Determinants of Health/Primary Health Care, Full Circle

Thursday, 9th of October 2008

CSU 40/2008: The Social Determinants of Health/Primary Health Care, Full Circle

The Commission on the Social Determinants of Health, headed by the epidemiologist Sir Michael Marmott, has just issued its report, in six languages. The report, 'Closing the Gap in a Generation,' is available on the Web at http://www.who.int/social_determinants/final_report/en/index.html

Even a glance at the graphics calls up simple questions such as why vaccination coverage is still very often a function of the child's socio-economic quintile. In general, the thirty years since the Alma Ata Declaration have seen, at best, irregular progress in most countries in closing gaps to access in most countries.

The Commission, because of its broad terms of reference, does not look at individual diseases, but at the reasons why, across countries and decades, the poor and women are less likely to survive and less likely to thrive.

The prescriptions of the Commission are not of the order 'vaccinate more babies' or 'use more bednets.' They cut across vertical lines.This is where the Commission will find an unsympathetic reception in some quarters, even among some of the international agencies charged with assisting governments in achieving the Millennium Development Goals.

In a stimulating number of the WHO Bulletin, Dr Halfdan Mahler looks at the 'health for all' and 'selective primary health care' approaches 30 years after the adoption of the Alma Ata Declaration. This interview and the rest of the October issue are at http://www.who.int/bulletin/volumes/86/10/en/index.html

Good reading.