Addressing the Social Determinants of Health

By Joia Mukherjee, Chief Medical Officer, Partners in Health

The movement to realize Universal Health Coverage has roots drawn from the fundamental concept that health is a human right, but also from the fact that UHC cannot be achieved without addressing the social determinants of health: lack of food, water, and sanitation, to name a few. The significance of returning to this place, at this time, is lost on no one. Challenges to the fulfillment of the Declaration of Alma-Ata have constrained the development of robust health systems in the world’s vulnerable countries, however the seedling planted forty years ago has begun to bear fruit.

Why is this moment different? Many things have changed since 1978. The Cold War is over, globalization has changed the movement of people and resources, and global access to AIDS treatment efforts have succeeded in helping governments and communities treat millions of people around the world. The intervening 40 years have proven that UHC is no longer an ideal, but an attainable reality. In countries as diverse as Norway and Rwanda, health for all is the goal of the government. The right to health is written into national constitutions, and governments are committing more of their internal resources to finance the public provision of care as they see it as a driver of economic growth.

The work I have had the privilege of doing over the past 20 years as Chief Medical Officer for Partners In Health, working hand in hand with colleagues from around the world, has shown that provision of high quality care is attainable in some of the hardest to reach and least-resourced settings when patient-centered approaches are prioritized. I’ve witnessed colleagues in ministries of health with beautifully written national health plans ask, “but how do we go from plan to delivery strategy?” At this critical moment as the world comes together to advocate for redoubled efforts to invest in strong primary care platforms to achieve UHC, I share a few of these approaches that have started to show positive results:

1. Taking a patient-centered approach, mapping the entire disease burden for each specific catchment area, measuring population-based targets, and aligning inputs to progressively achieve UHC (rather than starting with the limitations of a truncated budget envelope).

2. Strengthening district health management through decentralized funding and decision-making, mentorship, and capacity building.

3. Professionalizing community health worker cadres who are well-trained, equipped, compensated, and supervised to serve as the backbone of a functioning healthcare system.

4. Addressing the social determinants of health is equally important to treating immediate diseases or conditions and must be a core component of every level of the health system.

5. Working with countries to support their development of strong national health plans, and to support implementation at district levels, is essential for guiding delivery and coordinating external and domestic funds.

If we can achieve this today in some of the poorest nations in the world, we can definitely do it across the globe. Universal health coverage is an ideal whose benefits are clear, whose time has come, and whose expense is nothing compared to the cost of continued delays.