The Commission on the Social Determinants of Health: reinventing health promotion for the twenty-first century?

This paper describes the work of the Commission on the Social Determinants of Health, established by WHO in 2005 and considers the potential for this Commission to contribute to a reinvention of health promotion for the twenty-first century. It argues that the Commission can do this by reinforcing the move that health promotion has been making since the 1980s to be less concerned with behaviour change and more concerned with creating the conditions in which health and well-being flourish. Specific contributions the Commission will make are: providing a vision of the moral importance and feasibility of a more equitable world; positioning health promotion as a task for the whole of the economy through action within the government sector and through assessment of the health equity impact of the corporate sector and neo-liberalism; through its Knowledge Networks, providing a much stronger evidence base than has previously been available on the social determinants of health and health equity including the actions and policies that are most likely to promote health and equity; providing a focus for the further growth of a global social movement advocating for health equity within and between countries; contributing to the reform of WHO and other international health agencies so that all programmes are built to take comprehensive action in communities and nationally to tackle the underlying causes of disease; adding legitimacy to moves to re-orientate health care systems to a focus on health promotion and population health.     

Health equity and sustainability: extending the work of the Commission on the Social Determinants of Health

The final report of the World Health Organization Commission on Social Determinants of Health presents opportunities to promote synergies between health equity and action on sustainability, including reducing global warming. The report makes important recommendations for political and economic reform, but stops short of calling for major change to the conventional neo-liberal model of economic development and growth. Yet the challenge of global warming appears to make growth according to this model unfeasible. In this article, we explore opportunities in the work of the Commission for combining goals of health equity and sustainability, and discuss ideas for economic reforms which further challenge the dominant model, and seek to accommodate the imperatives of reversing climate change.     

Gender and health inequities: A comment on the Final Report of the WHO Commission on the Social Determinants of Health

The Final Report of the World Health Organization (WHO) Commission on the Social Determinants of Health is a substantial and important contribution to understanding the social factors that shape global health inequities. Although gender is highlighted as a key social determinant of health, the report's conceptual approach inappropriately equates gender and health with women's health. This essay discusses the analytic and policy implications of this shortcoming.     

The World Health Organization and public health research and practice in tuberculosis in India

Two major research studies carried out in India fundamentally affected tuberculosis treatment practices worldwide. One study demonstrated that home treatment of the disease is as efficacious as sanatorium treatment. The other showed that BCG vaccination is of little protective value from a public health viewpoint. India had brought together an interdisciplinary team at the National Tuberculosis Institute (NTI) with a mandate to formulate a nationally applicable, socially acceptable, and epidemiologically sound National Tuberculosis Programme (NTP). Work at the NTI laid the foundation for developing an operational research approach to dealing with tuberculosis as a public health problem. The starting point for this was not operational research as enunciated by experts in this field; rather, the NTI achieved operational research by starting from the people. This approach was enthusiastically welcomed by the World Health Organization's Expert Committee on Tuberculosis of 1964. The NTP was designed to "sink or sail with the general health services of the country." The program was dealt a major blow when, starting in 1967, a virtual hysteria was worked up to mobilize most of the health services for imposing birth control on the people. Another blow to the general health services occurred when the WHO joined the rich countries in instituting a number of vertical programs called "Global Initiatives". An ill-conceived, ill-designed, and ill-managed Global Programme for Tuberculosis was one outcome. The WHO has shown rank public health incompetence in taking a very casual approach to operational research and has been downright quixotic in its thinking on controlling tuberculosis worldwide.     

The public versus the World Health Organization on health system performance

The World Health Organization (WHO) ranked health systems in 191 countries based on measures developed by public health experts. This paper compares the WHO rankings for seventeen industrialized countries with the perceptions of their citizens. The results show little relationship between WHO rankings and the satisfaction of the citizens who experience these health systems. The health systems of some top WHO performers are rated poorly by their citizens, including the low-income and elderly. The two rated most highly by the public rank at the bottom of the WHO ratings. These findings suggest that both public and expert views should be considered in international rankings.     

The World Health Organization policy on global women's health: new frontiers

This article reviews formal and informal mechanisms through which the World Health Organization (WHO) is promoting policies for the advancement of women's health. Specific attention is given to select examples of innovative strategies the WHO has adopted in recent years to increase political commitment to women's and children's health and influence the development of policies supportive of country efforts to achieve Millennium Development Goals 4 (MDG4) and MDG 5 (to reduce child mortality and improve maternal health, respectively).     

The World Health Organization and the transition from "international" to "global" public health

The term "global health" is rapidly replacing the older terminology of "international health." We describe the role of the World Health Organization (WHO) in both international and global health and in the transition from one to the other. We suggest that the term "global health" emerged as part of larger political and historical processes, in which WHO found its dominant role challenged and began to reposition itself within a shifting set of power alliances.Between 1948 and 1998, WHO moved from being the unquestioned leader of international health to being an organization in crisis, facing budget shortfalls and diminished status, especially given the growing influence of new and powerful players. We argue that WHO began to refashion itself as the coordinator, strategic planner, and leader of global health initiatives as a strategy of survival in response to this transformed international political context.     

Morbidity statistics: a report on current practice in member states of the World Health Organization

This paper is based on an analysis of questionnaires sent to the health ministries of Member States of WHO asking for information about the extent, nature, and scope of morbidity statistical information. It is clear that most countries collect some statistics of morbidity and many countries collect extensive data. However, few countries relate their collection to the needs of health administrators for information, and many countries collect statistics principally for publication in annual volumes which may appear anything up to 3 years after the year to which they refer. The desiderata of morbidity statistics may be summarized as reliability, representativeness, and relevance to current health problems.     

Attitudes and management of alcohol problems in general practice: descriptive analysis based on findings of a World Health Organization international collaborative survey

AIMS: To determine if general practitioners' (GPs) experience of education on alcohol, support in their working environment for intervening with alcohol problems, and their attitudes have an impact on the number of patients they manage with alcohol problems. METHODS: 1300 GPs from nine countries were surveyed with a postal questionnaire as part of a World Health Organization (WHO) collaborative study. RESULTS: GPs who received more education on alcohol (OR = 1.5; 95% CI, 1.3-1.7), who perceived that they were working in a supportive environment (OR = 1.6; 95% CI, 1.4-1.9), who expressed higher role security in working with alcohol problems (OR = 2.0; 95% CI, 1.5-2.5) and who reported greater therapeutic commitment to working with alcohol problems (OR = 1.4; 95% CI, 1.1-1.7) were more likely to manage patients with alcohol-related harm. CONCLUSION: Both education and support in the working environment need to be provided to enhance the involvement of GPs in the management of alcohol problems.