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rotect|ng the k|ght to nea|th through act|on on the Soc|a| Determ|nants of nea|th
A Dec|arat|on by ub||c Interest C|v|| Soc|ety Crgan|sat|ons and Soc|a| Movements
k|o de Iane|ro, 8raz|| (18th Cctober 2011)
UkGLN1L kLUIkLD AC1ICNS 8 MLM8Lk S1A1LS AND WnC CN 1nL kL AkLAS
1. lmplemenL equ|ty-based soc|a| protect|on sysLems and malnLaln and develop effecLlve pub||c|y prov|ded and
pub||c|y f|nanced hea|th systems LhaL address Lhe soclal, economlc, envlronmenLal and behavloural deLermlnanLs of
healLh wlLh a parLlcular focus on reduclng healLh lnequlLles.
2. use progress|ve taxat|on, wealLh Laxes and Lhe ellmlnaLlon of Lax evaslon Lo flnance acLlon on Lhe soclal
deLermlnanLs of healLh.
3. 8ecognlse expllclLly the c|out of f|nance cap|ta|, lLs domlnance of Lhe global economy, and Lhe orlglns and
consequences of lLs perlodlc collapses.
4. lmplemenL approprlaLe lnLernaLlonal tax mechan|sms Lo conLrol g|oba| specu|at|on and ellmlnaLe Lax havens.
S. use healLh lmpacL assessmenLs Lo documenL Lhe ways ln whlch unregu|ated and unaccountab|e transnat|ona|
corporat|ons and flnanclal lnsLlLuLlons consLlLuLe barrlers Lo PealLh for All.
6. 8ecognlse expllclLly Lhe ways ln whlch Lhe currenL sLrucLures of g|oba| trade regu|at|on shape hea|th |nequa||t|es
and deny Lhe rlghL Lo healLh.
7. 8econcepLuallse a|d for hea|th from hlgh lncome counLrles as an |nternat|ona| ob||gat|on and reparaLlon
leglLlmaLely owed Lo developlng counLrles under baslc human rlghLs prlnclples.
8. Lnhance democrat|c and transparent dec|s|on-mak|ng and accounLablllLy aL all levels of governance.
9. uevelop and adopL a code of conduct ln relaLlon Lo Lhe managemenL of |nst|tut|ona| conf||cts of |nterest ln global
healLh declslon maklng.
10. LsLabllsh, promoLe and resource parLlclpaLory and acLlon orlenLed monlLorlng sysLems LhaL provlde d|saggregated
data on a range of soc|a| strat|f|ers as Lhey relaLe Lo healLh ouLcomes.
1. We, members of publlc lnLeresL clvll socleLy organlsaLlons and soclal movemenLs, parLlclpanLs ln Lhe World Conference
on Lhe Soclal ueLermlnanLs of PealLh (WCSuP) noLe LhaL Lhls Conference ls Laklng place aL a Llme when:
susLalnable developmenL ls ln crlsls wlLh neollberallsm, consumerlsm lndlvlduallsm over-rldlng Lhe values of
communlLy and lnLernaLlonal solldarlLy,
confllcL and vlolence whlch erupL and burn ln households, communlLles, clLles and reglons and bllghL mllllons of llves
have complex rooLs ln culLure and governance, lncludlng Lhe prevalllng global economlc reglme whlch sancLlons
unbrldled compeLlLlon, gross lnequallLy and obscene greed,
Lhe crlses of developmenL, flnance, food and global warmlng deny for hundreds of mllllons of people Lhe rlghL Lo
decenL employmenL, soclal proLecLlon, food securlLy, houslng, ln facL all Lhe soclal deLermlnanLs of healLh,
vlolence, poverLy and cllmaLe change conLrlbuLe Lo large scale mlgraLlons, Lo clLles and across naLlonal borders, ln
many cases mlgranLs are dlscrlmlnaLe agalnsL and denled Lhelr human rlghLs,
lnequallLles ln lncome and wealLh, wlLhln and beLween counLrles, are growlng rapldly, and
as a consequence Lhere ls a rlslng popular demand for governmenLs Lo fulflll Lhelr obllgaLlons Lo acL Lo guaranLee
soclal rlghLs and sLaLe proLecLlon.
2. 1he parLlclpanLs ln Lhls Conference, Lhe WPC SecreLarlaL, member sLaLe delegaLlons and parLlclpanLs have an hlsLorlc
obllgaLlon Lo address Lhe causes of Lhe mulLlple crlses and Lo ensure LhaL Lhe concluslons and recommendaLlons of Lhls
Conference do engage wlLh Lhe baslc dynamlcs Lhrough whlch populaLlon healLh globally ls deLermlned. 8ehlnd Lhe
lmmedlaLe deLermlnanLs of healLh (educaLlon, houslng, decenL [obs, food securlLy, soclal proLecLlon and unlversal healLh
care) lle Lhe deeper sLrucLural deLermlnanLs lncludlng unequal power relaLlons and unequal access Lo resources and
declslon maklng. Wldenlng lnequallLles and lnsLlLuLlonallzed dlscrlmlnaLlon across axes of class, race, gender, eLhnlclLy,
casLe, lndlgenelLy, age and ablllLy conLrlbuLe Lo Lhe lmposslblllLy of good healLh. AcLlon on Lhese sLrucLural deLermlnanLs
of healLh ls essenLlal Lo overcome Lhe economlc, envlronmenLal, developmenL and food crlses.
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3.1. We hlghllghL Lhe evldence assembled by Lhe Commlsslon on Soclal ueLermlnanLs of PealLh (CSuP) ln lLs reporL
, and lLs concluslon
unequal dlsLrlbuLlon of healLh-
3.2. We recall LhaL Lhe WPC ConsLlLuLlon afflrms Lhe hlghesL aLLalnable sLandard of healLh as a fundamenLal and
unlversal human rlghL.
3.3. We noLe LhaL Ceneral CommenL 14 of Lhe lnLernaLlonal CovenanL on Soclal, CulLural and Lconomlc 8lghLs expllclLly
afflrms key healLh deLermlnanLs wlLhln Lhe rlghL Lo heal
3.4. We relLeraLe Lhe call for comprehenslve prlmary healLh care, as lald ouL ln Lhe Alma ALa ueclaraLlon, ln order Lo
creaLe accesslble and equlLable healLh care whlch can advocaLe ln oLher secLors of soclal pracLlce (houslng, envlronmenL,
lndusLry, eLc) for acLlon on Lhe soclal deLermlnanLs of healLh.
4. 1here are alLernaLlve models of healLh and developmenL, for mlllenlum lndlgenous people have llved ln harmony wlLh
Lhe land and developed susLalnable models of llvlng and heallng. ln Lhe pasL few hundred years Lhere have been
numerous examples of alLernaLlve soclal and economlc models whlch have resulLed ln good healLh and healLh equlLy.
3. We call upon Lhe World PealLh CrganlsaLlon, boLh Lhe SecreLarlaL and Member SLaLes, Lo Lake declslve measures Lo
address Lhe deep and perslsLenL lnequlLles ln power and opporLunlLles whlch prevenL a ma[o
populaLlon from en[oylng Lhelr rlghL Lo healLh.
We call upon Lhe WPC, lncludlng Lhe SecreLarlaL and Lhe Member SLaLes, Lo drlve Lhe lmplemenLaLlon of Lhe
recommendaLlons of Lhe CSuP Lhrough a concreLe programme of acLlon wlLh approprlaLe budgeL allocaLlon.
6. llve key acLlon areas
lnLervenLlons Lo address Lhe soclal deLermlnanLs of healLh reflecL naLlonal and local needs and conLexLs and Lake lnLo
accounL dlfferenL soclal, culLural and economlc reallLles. llve key acLlon areas are crlLlcal:
romoLe lnLersecLoral acLlon and healLh pollcy coherence aL all levels Lo creaLe Lhe condlLlons for beLLer healLh,
Lnsure popular parLlclpaLlon ln pollcy-maklng,
8eorlenL Lhe healLh secLor Lowards prlmary healLh care, lncludlng lnLersecLoral acLlon and communlLy moblllsaLlon
around Lhe soclal deLermlnanLs of healLh,
uemocraLlslng global healLh governance, lncludlng Lhe governance of Lhe economlc and pollLlcal condlLlons whlch
shape populaLlon healLh, and
MonlLorlng progress and holdlng governmenLs and lnLernaLlonal agencles accounLable for acLlon on Lhe soclal
deLermlnanLs of healLh.
7. romoLe lnLersecLoral acLlon aL all levels Lo creaLe Lhe condlLlons for beLLer healLh
7.1. LxlsLlng knowledge ls now avallable Lo supporL declslve acLlon Lhrough lnLer-secLoral publlc pollcles Lo address Lhe
soclal deLermlnanLs of healLh and promoLe healLh equlLy.
7.2. We call upon Lhe WPC, Lhe SecreLarlaL and Lhe member sLaLes, Lo:
Lnsure Lhe full lmplemenLaLlon of World PealLh Assembly resoluLlon WPA62.14, and show clear evldence of how Lhe
work programmes of WPC are lmplemenLlng Lhe recommendaLlons of Lhe flnal reporL of Lhe Commlsslon on Soclal
ueLermlnanLs of PealLh,
romoLe lnLersecLoral acLlon ln publlc pollcy maklng aL all levels, drawlng upon avallable knowledge and precedenLs,
Lo address lnequlLles and soclal deLermlnanLs of healLh, lncludlng:
! lmplemenL soclal proLecLlon sysLems and unlversal and comprehenslve access Lo healLh and soclal servlces LhaL
are expllclLly deslgned Lo promoLe equlLy and afflrmaLlve acLlon on behalf of vulnerable secLlons of Lhe
populaLlon,
! use of progresslve LaxaLlon, wealLh Laxes and Lhe ellmlnaLlon Lax evaslon Lo flnance acLlon on Lhe soclal
deLermlnanLs of healLh,
! Lnsure gender equlLy and Lhe promoLlon and proLecLlon of early chlldhood developmenL ln all pollcles,
! LnacL pollcles LhaL progresslvely ensure full employmenL of Lhe worklng-aged populaLlon, healLhy worklng
envlronmenLs and secure condlLlons of employmenL,
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! 8egulaLe and proLecL populaLlons from healLh hazards emanaLlng from commerclal acLlvlLles, such as Lhose
creaLed by Lhe Lobacco, alcohol, breasL-mllk subsLlLuLes, hlgh faL and sugar processed food, and Lhe peLroleum
and exLracLlve lndusLrles.
8. Lnsure popular parLlclpaLlon ln pollcy-maklng
8.1. LffecLlve acLlon on Lhe soclal and sLrucLural deLermlnanLs of healLh calls for governance sLrucLures LhaL glve full
conslderaLlon Lo healLh lmprovemenL and healLh equlLy, Lhe capLure of declslon maklng by vesLed lnLeresL ls a barrler Lo
such acLlon.
8.2. Cpenlng up declslon processes Lo wlder scruLlny and parLlclpaLlon ls necessary Lo proLecL Lhe lnLegrlLy of declslon
maklng.
8.3. We call upon Lhe WPC, Lhe SecreLarlaL and Lhe Member SLaLes Lo:
Lnhance democraLlc and LransparenL declslon-maklng and accounLablllLy aL all levels of governance, lncludlng Lhrough
enhanclng access Lo lnformaLlon, access Lo [usLlce and popular parLlclpaLlon
romoLe a more equlLable dlsLrlbuLlon of resources and opporLunlLles by enabllng and supporLlng dlsadvanLaged and
marglnallsed groups such as lndlgenous peoples and dlsplaced communlLles Lo parLlclpaLe ln pollcy maklng and
lmplemenLaLlon.
uevelop and adopL a code of conducL ln relaLlon Lo Lhe managemenL of lnsLlLuLlonal confllcLs of lnLeresL ln global
healLh declslon maklng, Lhls should seL ouL a clear framework for lnLeracLlng wlLh companles and oLher organlsaLlons
wlLh commerclal lnLeresLs Lo proLecL pollcy developmenL and program managemenL,
8ecognlze and enable Lhe conLrlbuLlons and capaclLles of communlLy organlsaLlons and publlc lnLeresL clvll socleLy
organlsaLlons Lo advocaLe for acLlon on Lhe soclal and sLrucLural deLermlnanLs of healLh.
9. 8eorlenL Lhe healLh secLor Lowards comprehenslve prlmary healLh care, lncludlng lnLersecLoral acLlon and communlLy
moblllsaLlon around Lhe soclal deLermlnanLs of healLh
9.1. unlversal access Lo quallLy healLh care ls a powerful soclal deLermlnanL of healLh. Comprehenslve prlmary healLh
care can ensure equlLy, efflclency and quallLy healLh care lncludlng flrsL conLacL and conLlnulng care and access Lo more
speclallzed servlces.
9.2. 1he prlmary healLh care model also provldes for engagemenL beLween provlders and communlLles regardlng Lhe
soclal deLermlnanLs of healLh and supporL for lnLersecLoral collaboraLlon (food, houslng, [obs, eLc) and communlLy
moblllzaLlon for behavloural and pollcy change for beLLer healLh.
9.3. rlvaLe flnanclng and prlvaLe secLor provlslon are unable Lo provlde unlversal access Lo lnLegraLed comprehenslve
prlmary healLh care. 8obusL research sLudles demonsLraLe LhaL Lhey can aggravaLe lnequallLles ln healLh care and healLh
ouLcomes. 1hey presenL barrlers Lo Lhe recognlLlon of and acLlon upon Lhe soclal deLermlnanLs of healLh.
9.4. We call upon WPC, Lhe SecreLarlaL and Lhe Member SLaLes, Lo:
MalnLaln and develop effecLlve publlcly provlded and publlcly flnanced healLh sysLems LhaL address Lhe soclal,
economlc, envlronmenLal and behavloural deLermlnanLs of healLh wlLh a parLlcular focus on reduclng healLh
lnequlLles,
rovlde equlLable unlversal healLh care coverage lncludlng hlgh quallLy promoLlve, prevenLlve, curaLlve and
rehablllLaLlve healLh servlces LhroughouL Lhe llfe cycle, based on comprehenslve prlmary healLh care,
SupporL communlLy engagemenL ln monlLorlng and plannlng, democraLlse publlc healLh sysLems,
8ulld, sLrengLhen and malnLaln publlc healLh capaclLy lncludlng reform of healLh professlonal educaLlon Lo lncorporaLe
a sLrong emphasls on Lhe soclal deLermlnanLs of healLh and healLh care of Lhe ma[orlLy,
8egulaLe Lhe prlvaLe medlcal secLor Lo mlLlgaLe Lhe negaLlve lmpacL of buslness lnLeresLs on healLh and enhance Lhe
capaclLy of Lhe publlc healLh sysLem,
ress for hlgh lncome counLrles Lo adequaLely compensaLe poor counLrles for Lhelr subsLanLlal losses ln Lhe form of
W/
lnclude repaLrlaLlon Lo sendlng counLrles of Laxes pald by lmmlgranL healLh professlonals should be explored.
10. uemocraLlslng global healLh governance, lncludlng Lhe governance of Lhe economlc and pollLlcal condlLlons whlch
shape populaLlon healLh
10.1. 1he scope for naLlon sLaLes Lo effecLlvely regulaLe for healLh has been progresslvely reduced over Lhe lasL 30 years
Lhrough:
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Lhe growlng power of LransnaLlonal corporaLlons whlch are largely unaccounLable excepL Lo Lhelr shareholders and
Lhe sLock markeLs,
Lhe rapld exLenslon of Lrade and lnvesLmenL agreemenLs whlch reduce Lhe scope for democraLlc declslon maklng,
replaclng lL wlLh obllgaLlons and sancLlons whlch are overwhelmlngly sLrucLured around Lhe lnLeresLs of powerful