3rd plenary - Gareth Williams, Wales; Nicole Valentine, Switzerland; Sarah Simpson, Italy; Stephen Linter, United States

Health inequalities, social justice and HIA

"...Things fall apart, the centre cannot hold
Mere anarchy is loosed upon the world
The best lack all conviction,
while the worst have passionate intensity..."

HIA is about dialogue between different stakeholders and engaging with different values

Conceptual framework for social determinants of health - which theory is the basis of a tool for HIA

SDH is based on theories of "social production of disease"

Policies on determinants of health do not necessarily tackle determinants of health inequalities

Root causes of health inequalities - systematic unequal distribution of power (social, political, economic) i.e. social position and the exposures this generates

Distal/Structural determinants = policies (more difficult to implement socially and politically)
Intermediate determinants = material resources, ...

Need broad commitment to the SDH model.

Need to strengthen health governance to address the SDH and related health inequities - lessons from Europe

Most social and global problems are 'wicked problems' difficult to tame.

Role of governance in enhancing equity and improving health - how governments and other organisations interact, relate to citizens and decide.

Adelaide Statement on Health in All Policies (HiAP) - shared governance for health and wellbeing.

HIA is a key approach in HiAP

Key pieces of WHO work:
1. Setting the political agenda to tackle health inequity in Norway, Slovenia and Scotland (published soon).
2. Online knowledge base on health system actions to tackle social determined health inequalities
3. Synthesis document

1. Analyse context
2. A tool to assess and strengthen governance capacity
3. Know the different levels of governance - cooperation (joint working group), coordination (advisory board to a government department, have resources), integrated policies (joint new policies)

We need to be specific about what level health inequalities is being tackled in relation to horizontal governance.

Challenge of managing crises in a rapidly changing world

Big issues for the World Bank

Strategic assessments are an important part of work

Protecting pro-poor health services during financial crisis - real spending can decline, weak fiscal policies mean these are cut first, reduce overseas assistance from higher income countries

Effective interventions - broad strategies, targeted interventions and social safety net

Cost of Environmental Degradation, new book on economic impacts of adverse environmental change. Case studies e.g. 18% of impacts are on health in Tunisia.

What we need to do:

Adapt to changing circumstances. Interaction with affected communities is important.


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