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In 2008 Professor Sharon Friel was in London leading the Scientific Secretariat of the World Health Organisation’s Commission on Social Determinants of Health. On Tuesday 4 September 2018 she reflected on the impact of the Commission over the past decade as well as the lessons learned with audiences at ANU.
The Commission ran from 2005–2008 and culminated in an authoritative evidence-based report on how structural and societal issues impact health inequalities. One of the Commission’s biggest challenges was to change the policy focus from one of individual responsibility to that of societal level factors. This included broadening the scope to consider issues such as urban planning, employment conditions, early child development, trade and investment, financing, and health systems.
“We were charged with setting forth a policy agenda to address the societal-level factors that affects people’s health and particularly to reduce the inequalities in health globally,” said Professor Friel.
As Professor Friel recounted, “We framed our messages very deliberately… many people when they think about health will automatically think about medicines and health care. The Commission was trying to highlight that there are so many other things about society that affects health.”
In the years just before the Global Financial Crisis and the corresponding Occupy Wall Street movement, the topic of distribution was considered controversial. However, as Professor Friel argued, “unless you think about the societal level factors from an equity perspective you’re not necessarily going to reduce inequalities in health outcomes…it’s a shift to not just the average but the social distribution.”
While there were some initial concerns about the Commission’s direct approach to naming the issues of power, money, and resources as the causes of health inequalities, the final report was successfully adopted by the World Health Assembly and a resolution was passed.
Professor Friel attributes the success of the Commission to a variety of factors such as having a clear goal and strong evidence, as well as an understanding of the behind-the-scenes realpolitik.
“There’s the question of identifying the differing actors, who’s involved in shaping each of the different policy agendas … but there is also luck and there’s an interesting literature on luck and policy. You’ve just got to live with the fact that it requires a bit of luck,” she said.
Ten years on, Professor Friel sees a continuing need to shift the focus to the societal level to effect widescale improvements in health and health inequalities. As further progress is made on mainstreaming the societal-level framework it won’t be just public health that will benefit but also other crucial policy areas such as climate change and inequality more generally.
By CAP Student Correspondent Diana Tung