Commission on Social Determinants of Health Commissioners Meeting Positioning the CSDH in the Global environment 18 January, 2006
Focus With whom and within what areas of policy synergy can the Commission work globally to generate policy and political momentum? With whom and through what forms of new or existing institutional action at global level will the Commission lever the institutional environment for sustained follow up after it is dissolved?
Explores most significant global themes and policies within which the Commission is locating its message and work global institutional environment and the possibilities for securing institutional continuity and influence Global financing mechanisms for actions on social determinants
What global themes resonate with the Commission agenda? Human security Social justice- global obligations to meeting human needs and social development.
Military, coercive responses to outside threat Global themes. Human security Mid 1900s and before Millennium summit National human needs global inequalities National social insurance? Global norms/ Global public goods/ new global financing? BUT
Social justice- and social development C-PHC S-PHC Reforms & Minimum Packages MDG Scaling-up WHO 1948 UN Alma Ata 1978 Selective, Market reforms 1982 ICESCR 1993 CSD 2000 Poverty reduction GFATM GPG s 2002 MDGs 2005
Social justice & social development.. Comprehensive, redistributive, universal vs targeted, selective approaches Positioning social policy and human needs centrally in development
Institutional actors and champions Strong Support Champions! Specific country leaders? Specific global leaders? Regional Economic communities? Weak Global Civil Soc. WSF, PHM UNDP UNICEF UN ECOSOC and UN DESA World Bank ILO, UNESCO, UNRISD TNCs WHO UN CEB Strong Power/ Influence G8 WTO, IMF Weak
Institutional actors and champions Support Position Champions! Amplify the message Carry forward concrete proposals Global Civil Soc. WSF, PHM UNDP UNICEF UN ECOSOC and UN DESA World Bank ILO+ TNCs WHO UN CEB Power/ Influence G8 WTO, IMF Oppose
What specific global policies will further the Commission agenda? Commission for Social Development UNDP HDR Poverty Reduction Strategies ICESCR MDGs Other sector specific issues..
Specific global policies.. Millennium Development Goals A major global focus CSDH perspective on and approaches for MDGs Opportunity of a comprehensive vision Risk of selective targets and approaches Implications of CSDH agenda of upstream action Focus of country, international, global planning, resources, action CSDH advancing country experience globally
Specific global policies. Political action for a comprehensive agenda Experience and voice from countries, regional communities, civil society Advancing the Right to health Committee on ICESCR article 12 core obligations linked to Alma Ata PHM campaign on the right to health
What institutional action at global level will advance the Commission agenda? Within Within WHO to countries to advocate support action for & act on SDH on SDH Global institutions to promote policy & support action CSDH
Institutional action at global level. Asymmetry and weakness democracy deficits with power concentrated in few governments coherence deficits within governments and within the UN compliance deficits in implementing decisions taken. Helsinki Process
Institutional action at global level. Policy coherence for intersectoral action ECOSOC (ILO), CEB, UN interagency mechanisms Engage GIs, including in CSDH KN, country work Champion national policy and action GI involvement in and barriers and facilitators for country action Multicountry coalitions; regional and south- south networks
Institutional actors and champions Regional communities? Eg: AU ECLAC UN and GI partnerships? South-South? Weak Strong Global Civil Soc. WSF, PHM Weak Support UNDP UN ECOSOC and UN DESA ILO+ Sector agencies / funds eg. UNICEF Global funds UNDG World Bank WHO Multi-country alliances Champions! UN CEB TNCs Strong Power/ Influence WTO, IMF G8
What Global resources?
Net outflow of resources from low to high income, public to private institutions Net transfer of financial resources 1994-2002 Billions of US dollars 10 0 50 0-50 -100-150 -200-250 Developing economies Transition economies Year Source: World Economic & Social Survey 2003, UN Secretary General report 2003
Global resource options? New global public financing? Global taxes Global Fund impacts on country action on SDH Improved link between debt write off/ PRs and national spending on SDH Magnitude, quality of, mechanisms for development financing and ODA (UN Monterrey proposals)
What Global financing? Impact of IMF, WTO policies and mechanisms World Bank investment, lending and social policies Spectrum of debate and critique New mechanisms More detailed institutional audit of policies, mechanisms, entry points Country experience as an entry and focal point
Institutional actors and champions Regional communities? Weak Strong Global Civil Soc. WSF, PHM Support UNDP UN ECOSOC and UN DESA ILO Sector agencies eg. UNICEF ODA Global funds UNDG World Bank Treasuries WHO Champions! Country alliances UN CEB Strong Power/ Influence TNCs WTO, IMF G8 Weak
How will this global environment differ by 2008? Compelling messages and options for advancing human security, social justice & development, the right to health, amplified through ECOSOC ++ Momentum on upstream action on MDGs backed by country experience, and by political & social pressure Proposals on GI barriers/ facilitators to action on SDH raised directly, & in the CEB and in ECOSOC Proposals based on country experience raised with global/ international financing institutions
POSITIONING THE COMMISSION IN THE GLOBAL ENVIRONMENT? A global champion with own identity clear, consistent and compelling message Perceived as rooted in country, community experience, action, policy, demand and bringing this to global attention Catalyst of country, WHO leadership for SDH agenda globally Facilitator of multi country alliances, regional networks