GHF2006 – PS02 – Determinants of Inequities in Access to Health

Session Outline

Parallel session PS02, Wednesday, August 30 2006, 16:00-17:30
Chair(s): Fred Paccaud, Switzerland, Eugenio Villar, Coordinator, Department of Equity, Poverty and Social Determinants, World Health Organization, Switzerland
The WHO Commission on Social Determinants of Health: Key Implementation Challenges
Eugenio Villar, Coordinator, Department of Equity, Poverty and Social Determinants, World Health Organization, Switzerland 
Geographical Dimensions of Access to Health
Stéphane Rican, Dpt de géographie, Université Paris X, Nanterre, France
Equity Analysis by Community: Addressing the Unpredictable Terrain
Kausar Khan, Associate professor, Department of Community Health Sciences, Aga Khan University, Pakistan

Session Documents

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Session Report

Submitted by: Brooke Bishara (ICVolunteers); Contributors: Melissa Bonnefin (ICVolunteers)

Image: Viola Krebs,

How can we increase a vulnerable person's chances of being healthy? We know there are social factors that determine access to health care, but little progress has been made in knocking down these barriers. How can a new generation of researchers, institutions and health care providers overcome the social determinants of socio-economic status, culture, political instability, lack of political voice and gender inequities that block them from reaching those who need help most? This session focused on work being done to research social determinants; systematize the body of knowledge and to apply it in diverse settings. As the first speaker, Eugenie Villar, pointed out, we are not just interested in knowledge. We need to connect knowledge to effective health policies and programmes.

Dr. Villar, Coordinator for the Equity, Poverty and Social Determinants Commission of the World Health Organization (WHO), Switzerland, opened the Symposium. The main thrust of her speech was the aim "to increase vulnerable people's chances of being healthy by promoting a core emphasis on the Social Determinants of Health". She explained that "scientifically rigorous research leading to the implementation of proposals and policies, working within national and international organizations" was of great importance. Dr. Villar drew attention to the fact that there is "no way to avoid discussion on the role of the State and Market" and discussed the ideological, political, institutional and knowledge challenges facing the Commission. Dr. Villar also pointed out the limits of merely relying on "the mobilization of more resources". One participant drew attention to the need for finding cheaper ways of reaching the people: via primary health care facilities, for instance, instead of giant hospitals. Another participant questioned Dr. Villar on the focus of the WHO Commission on democratic institutions. Dr. Villar answered that one cannot talk about social exclusion and not talk about power and representation.

Stéphane Rican, a Senior Lecturer in Geography at the University of Paris X, found large disparities in health between various geographic regions in France. Though the country has a relatively high life expectancy, there is an eight-year variance in the average life span between the southern and northern regions of the country, with a notable cluster of lower life expectancy near the north-eastern border. Prof. Rican's research showed changes in life span through three successive ten-year periods, but the main north/south split remained. He also found wide disparities in life-expectancy within the city of Paris, showing that the factors affecting health are social rather than simply regional. Since his study found that the size of a city did not affect life expectancy, Prof. Rican theorized about the various factors that did, naming physical, economic, social, and cultural influences, as well as the number of general practitioners available. After his presentation audience members questioned whether those regions with a lower life expectancy might also have been influenced by immigrant populations. Prof. Rican concluded that we need to analyze better the factors that affect health by region, as social determinants vary by region even within highly developed countries.

Mr. Sadig Bhanbhro from the Department of Community Health Sciences, Aga Khan University, Pakistan commenced his presentation with a topical example from the Union Council of Khurhra, in the District of Khairpur. Through his research of the Illness Matrix, he identified conclusively that women suffer from more diseases than men. Therefore, he dealt with the issue that women should have an increased role and involvement at the Union Council Level in order to ensure better access to health care. Mr. Bhanbhro stated "research in the community generates knowledge of disparities which should, in turn, help the community".

Following the presentations there was a lively discussion. One participant called on governments to see access to health as an economic investment and to take the task of lowering whatever cultural barriers exist, including ignorance, more seriously. Other questions focused on health programmes that seek to target particular vulnerable groups, rather than particular social determinants. Which is more effective?

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