Nations fail to act on shocking health inequalities at Rio meeting

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Health campaigners: Rio Declaration on health inequalities betrays the promise to "close the gap in a generation"

Press release from Baby Milk Action and Health Poverty Action

Rio de Janeiro: First issued 20 October 2011 - updated 21 October 2011

Media coverage: The Guardian 21 October. Get Involved in Global Health.

Health campaigners have expressed their disappointment with the Rio Declaration issued by the WHO World Conference on Social Determinants of Health today, 21 October. Campaigners had gathered at the meeting in Rio de Janeiro (note 1) to call on government representatives to counter what WHO's own expert Commission called “the toxic combination of poor social policies, unfair economic arrangements and bad politics that results in the unequal distribution of health-damaging experiences” (note 2). Campaigners are concerned that the Rio Political Declaration on Social Determinants of Health will do little to address growing health inequalities or to prevent the wholesale privatisation of public health systems, which some governments are already ushering in under the cover of deficit reduction strategies during the current financial crisis. 

Professor David Sanders of the University of the Western Cape received a standing ovation during the final discussion panel on the closing day of the conference after questioning why trade, climate change, the brain drain of health workers from developing countries to rich countries and other issues have been totally ignored in the official Rio Declaration.

Campaigners have issued an alternative civil society Rio Declaration (note 3), developed through widespread consultation in a process led by the People’s Health Movement.

Many of the recommendations made by civil society coincide with the recommendations of the Commission on the Social Determinants of Health, which WHO itself set up. The Commission's recommendations relating to the need to redistribute power and resources have been largely ignored – or buried, in the words of Professor of Public Health Fran Baum from Flinders University in Australia, one of the members of the Commission speaking in Rio.

Action items campaigners wanted to be introduced into the official declaration include:

  • Use of progressive taxation, wealth taxes and the elimination of tax evasion to finance action on the social determinants of health; 
  • Regulate and protect populations from health hazards emanating from commercial activities, such as those created by the tobacco, alcohol, breast-milk substitutes, high fat and sugar processed food, and the petroleum and extractive industries.
  • Develop and adopt a code of conduct in relation to the management of institutional conflicts of interest in global health decision making (note 4); 
  • Provide equitable universal health care coverage including high quality promotive, preventive, curative and rehabilitative health services throughout the life cycle, based on comprehensive primary health care;  
  • Press for high income countries to adequately compensate poor countries for their substantial losses in the form of migrant health professionals; innovative mechanisms that may include repatriation to sending countries of taxes paid by immigrant health professionals should be explored.
  • Recognise explicitly the ways in which the current structures of global trade regulation shape health inequalities and deny the right to health;
  • Develop and implement reliable measures of societal wellbeing that go beyond economic instruments.

Mike Brady, Campaigns and Networking Coordinator at Baby Milk Action, said:

"Social determinants of health is a shorthand term for the social, economic, political, cultural, and environmental factors that impact on health. WHO Director General, Dr. Margaret Chan, said during the opening ceremony, 'We have to put the health of people before the health of corporations', which is right, but we needed WHO, meaning the Secretariat and the Member States, to commit to action, not just issue platitudes. Member States must reassert their democratic legitimacy to set health policies in the public interest and face down vested interests that continue to sabotage health, often while proclaiming to be a force for good. On this occasion our leaders have failed the people they are supposed to represent."

Corinna Heineke, Head of Policy and Campaigns at Health Poverty Action, adds:

“The marginalisation of poor people is both a result and a cause of poor health. In order to tackle the shocking inequalities and health outcomes of the poorest we don’t just require doctors, nurses and well-equipped clinics. We also need to address the structural causes of poor health such as trade systems that deny the poorest access to medicines or the racism that prevents indigenous mothers from seeking skilled assistance during birth complications. Unfortunately WHO Member States have failed us on the political economic determinants of health.”

The draft official Rio Declaration included text calling for collaboration with stakeholders, including the private sector. A statement of concern from the Conflicts of Interests Coalition was distributed to delegates and the final text makes reference to conflicts of interest in three places:

"Foster collaboration with the private sector, safeguarding against conflict of interests, to contribute to achieving health through policies and actions on social determinants of health;"

"Promote inclusive and transparent governance approaches, which engage early with affected sectors at all levels of governments, as well as support social participation and involve civil society and the private sector, safeguarding against conflict of interests;"

"Promote appropriate monitoring systems that take into consideration the role of all relevant stakeholders including civil society, nongovernmental organizations as well as the private sector, with appropriate safeguard against conflict of interests, in the monitoring and evaluation process;"


Lida Lhotska, the European Coordinator of the International Baby Food Action Network (IBFAN), commented: 

"The call to safeguard against conflict of interests is much welcome. However, it should not apply only to Member States but also to WHO as an agency which will be supporting Member States in their efforts to implement the Declaration. WHO in fact does have a unique opportunity to develop a comprehensive institutional policy that would guarantee adequate safeguard against both individual and organisational conflicts of interests as part of the announced WHO's reform."



Mike Brady at - +44 20 3239 9222

Corinna Heineke at - +44 7576 754912.


Notes for editors

  1. For details of the WHO World Conference on Social Determinants of Health:
  2. For the Commission on the Social Determinants of Health report "Closing the Gap in a Generation":
  3. For the Rio Declaration by Public Interest Civil Society Organisations and Social Movements:
  4. For the Statement of Concern from the Conflicts of Interest Coalition (consisting of 147 civil society organisations and networks):