27 November 2011


Mercoledì 30 Novembre 2011 - Dalle 9.30 alle 14.00
Auditorium “A. Ducci” del Comune di Arezzo (Via Cesalpino 53, Arezzo)

Incontro formativo nazionale per amministratori e tecnici della Rete Italiana Città Sane promosso dalla Rete Italiana Città Sane/OMS e dal Comune di Arezzo
in collaborazione con Istituto Superiore di Sanità (ISS), Ministero della Salute, CNR, Federazione Nazionale degli Ordini dei Medici Chirurghi e Odontoiatri (FNOMCeO), Regione Emilia Romagna, Coordinamento Agende 21 Locali, Associazione Medici per l’Ambiente (ISDE Italia), Consorzio Mario Negri Sud, Agenzia Regionale di Sanità (ARS) Toscana.

Programma e la scheda di iscrizione

Ore 9.30 Saluti
Ore 9.40 Introduzione alla Vis: barriere e stereotipi
Ore 10.10 Approfondimento su:
• VIS strumento di sanità pubblica
• VIS strumento di partecipazione e di comunicazione
• VIS strumento di valutazione di prodotto e di processo
• VIS strumento di valutazione integrata ambiente e salute
• VIS strumento di pianificazione territoriale
Ore 11.30 Esperienze in corso
Ore 11.50 Dall’esperienza Moniter prospettive per le Amministrazioni Pubbliche
Ore 12.10 Tavola rotonda
Ore 13.00 Discussione
Ore 14.00 Chiusura dei lavori

Il Workshop è gratuito ma a numero chiuso fino a un massimo di 100 partecipanti. Per partecipare è necessario iscriversi inviando entro il 25 Novembre 2011 alla Segreteria organizzativa via fax o e-mail l’apposita SCHEDA D’ISCRIZIONE (qui di seguito). La Segreteria invierà conferma di accettazione. Per evitare problemi si consiglia comunque di portare al Convegno copia della scheda inviata.

Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda

Really interesting paper and as it's open access I've highlighted the thing bit that caught my eye rather than the summary points (abstract).

Some of it seems really hard to me! The whole paper is worth a read.

Characteristics of Third Wave Health Research Strategies and Methodologies
  1. Go beyond the behavioral and other individual determinants of illness.
  2. Examine the intersections among different social hierarchies, such as class and gender, and their cumulative impacts on health status and health inequities.
  3. Examine the levels, pathways, and power connections across the “upstream” determinants or root causes of health inequities—that were central to the CSDH's conceptual framework—and the more traditionally investigated determinants of health inequities, such as risk factors or access to care.
  4. Treat patterns of health inequity as a social reality in their own terms, requiring social (economic, sociological, political, and cultural) explanation that adds on to the aggregation and interpretation of individual biomedical processes and outcomes.
  5. Consider the dynamic (rather than static) nature of equity in different country contexts, introducing a temporal dimension when investigating social structures, public policies, and impacts over the life course.
  6. Describe the social institutions and processes that influence the generation and allocation of resources related to health and its social determinants.
  7. Focus on how the global context affects choices about resource allocation at national and sub-national levels.
  8. Build on active collaboration among researchers and other knowledge producers from different disciplines.
  9. Recognize that certain kinds of evidence, such as results from randomized controlled trials, cannot be generated with respect to many interventions that address social determinants of health; therefore, a need exists to embrace diverse methodologies—fit for purpose—including a wide range of study designs, generating qualitative and quantitative data, that provide critical insight on the questions being examined.
  10. Involve affected populations, which is often essential to appropriate research designs and their execution.

Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda.
Östlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L, et al. (2011)
PLoS Med 8(11): e1001115. doi:10.1371/journal.pmed.1001115

Click here to go to the full article.

Hat tip: David McDaid, Health Equity Email Network, UK

24 November 2011

Epidemiological transition in a rural community of northern India

A single paper does not prove a theory but I've strongly believed for a while that there are more similarities than differences in the health, wellbeing and disease profile of high, middle and low income countries and communities. This trend particularly so in the latter half of the 20th Century.

The paper below shows that chronic non-communicable diseases are the single biggest category of deaths in a rural community in India.

But, there's at least one counterargument to my theory. Given diarrhoeal diseases have declined, it could certainly be the case that long term communicable disease interventions have significantly reduced the impact of communicable diseases in that part of rural India (e.g. clean water, sanitation, improved rural incomes, access to primary health care, etc.).

From a HIA perspective, it does strengthen the argument that it is important to consider both non-communicable as well as communicable disease outcomes/impacts in low and middle income countries.

Background Information on causes of death is vital for planning of health services. However, vital events registration systems are weak in developing countries. Therefore, verbal autopsy (VA) tools were incorporated in a community-based surveillance system to track causes of death.

Method and Findings: Trained fieldworker identified all deaths and interviewed a living relative of those who had died during 1992–2009, using VA, in eight villages of Haryana (11 864 populations). These field reports detailing events preceding death were reviewed by two trained physicians, who independently assigned an International Classification of Disease-10 code to each death. Discrepancies were resolved through reconciliation and, if necessary, adjudication. Non-communicable conditions were the leading causes of death (47.6%) followed by communicable diseases including maternal, perinatal and nutritional conditions (34.0%), and injuries (11.4%). Cause of death could not be determined in 6.9% cases. Deaths due to cardiovascular diseases showed a significant rise, whereas deaths due to diarrhoeal diseases have declined (p<0.01). Majority (90.0%) of the deceased had contacted a healthcare provider during illness but only 11.5% were admitted in hospital before death.

Conclusion Rising trend of cardiovascular diseases observed in a rural community of Haryana in India calls for reorientation of rural healthcare delivery system for prevention and control of chronic diseases.

Epidemiological transition in a rural community of northern India: 18-year mortality surveillance using verbal autopsy . Rajesh Kumar, Dinesh Kumar, J Jagnoor, Arun K Aggarwal, P V M Lakshmi
J Epidemiol Community Health published 2 November 2011, 10.1136/jech-2011-200336

21 November 2011

Labour Migration: opportunities and challenges for mountain livelihoods

“While working in Hong Kong I experienced many things – the way people treat a dependent or independent woman. I have gained much experience and my confidence has grown. Now, I have a say in decision-making at home. My husband does not shout at me. I have bought a piece of land and four rickshaws and I am creating a means of livelihood for four other families...”.
Sushila Rai, a Nepalese migrant domestic worker, (Jolly and Reeves 2005, in ICIMOD Summer 2011 periodical)

The latest edition of the International Centre for Integrated Mountain Development Periodical Summer 2011 focuses on:

  • labour migration in the Himalayas and Nepal a very interesting topic evidencing the positive and negative economic, social and environmental impacts of labour migration in mountain communities;
  • impact of environmental change on human migration;
  • internal and international migration in the Peruvian Andes;
  • feminisation, ageing of agriculture and farmer's changing livlihoods in South Western China; and
  • the use of remittances in natural or political crises in Pakistan.

My highlights are the many quotes of people that ICIMOD have talked to.

“We are dependent on agriculture, which is totally dependent on good weather conditions. The biggest problem we face is food insecurity. If the weather was good, with timely rain and better food security, we would never opt to migrate. Why would we want to leave our families and travel to another place and work like animals?”
Village Development Committee (VDC) Secretary, Dailekh district, Nepal (ICIMOD, unpublished)

Click here to download the periodical.

Hat tip: Loreley Fortuny via IAIA Connect.

18 November 2011

On the Varieties of People's Relationships With Places: Hummon's Typology Revisited

I found this very interesting, unfortunately the full article is behind a paywall.

On the Varieties of People’s Relationships With Places: Hummon’s Typology Revisited. Maria LewickaEnvironment and Behavior September 2011 vol. 43 no. 5 676-709

Numerous studies show that place attachment correlates positively with age, length of residence and strength of local ties and negatively with community size, education, and economic development of the region of residence. Does that mean that along with education, mobility, economic development and urbanization and with the decrease in importance of local ties and territorial belonging, place attachment will wane?

In a large representative survey carried out in Poland (N = 2,556) new measures of relationships with place and of identity (both territorial and nonterritorial) were used. 

Cluster analysis revealed five clusters: two types of place attachment (traditional and active attachment) and three types of nonattachment (alienation, place relativity, and placelessness), corresponding to David Hummon’s five types of sense of community. Whereas correlates of traditional attachment replicated the pattern known from other studies (e.g., traditional attachment was strongly positively correlated with age and negatively with education), active attachment was related positively to education and curvilinearly to age, with middle-aged participants the most frequently represented. Traditional place attachment was based solely on local identity, active place attachment was associated with European and nonterritorial identity, along with the local attachment. A number of other measures differentiated the five types: values, measures of social and cultural capital, self- and group-continuity measures, and general life satisfaction. It is concluded that places do preserve their importance in times of intensive urbanization, migration, and economic development, but that the form of place attachment changes: the active- and self-conscious attachment replaces the traditional attachment.

News from Human Impact Partners

News from Human Impact Partners in the US. As always they've been doing impressive work.


The HIA we conducted on the I-710 Corridor Project in Los Angeles was sent to the California Department of Transportation (Caltrans) this week by the Gateway Cities Council of Governments.  Caltrans is now considering whether/how to include the HIA in the draft Environmental Impact Report/Environmental Impact Statement that is due in the spring of 2012 and the HIA will be made public after that.  This has been a long and difficult project for many reasons and we’ll be writing a case study to share the valuable lessons we’ve learned including, for example, that conducting an HIA within the Environmental Impact Assessment process creates many limitations, and these limitations must be considered when deciding to do so.  More later…
In the next few weeks, we’ll also be finishing HIAs on:
The Lake Merritt BART Specific Plan in Oakland on which we’ve been working with Public Health Law and Policy, Asian Pacific Environmental Network, Asian Health Services, TransForm, and East Bay Asian Local Development Corporation. The City of Oakland has eagerly engaged in the process and is now considering our findings and recommendations.
A series of federal housing proposals – including the Rental Housing Revitalization Act, Rental Assistance Demonstration project, and Senate Bill 1596 – on which we’ve been working with Advancement Project and National People’s Action (NPA).  To provide local perspectives, they have engaged Community Voices Heard (CVH) and Good Old Lower East Sides (GOLES) in New York, Communities United for Action (CUFA) in Cincinnati, People Organized for West Side Renewal (POWER) in LA, and Causa Justa:Just Cause in Oakland. These bills would collectively re-shape the management and ownership structures of public housing such that private and non-profit companies would be allowed to manage America’s public housing stock.
School discipline policies in LA, Oakland, and Salinas, California, in which we’ve been looking at zero tolerance policies as well as alternatives being considered and/or implemented, such as Positive Behavioral Interventions and Supports (PBIS) and Restorative Justice (RJ).  The LA work will be completed first and our partners at CADRE are already using our findings to encourage the LA Unified School District to fully implement PBIS.
As part of our more general work to encourage the consideration of health in decision-making, we completed work with a collaborative of partners around the state to develop a set of health and equity metrics to be incorporated into Regional Transportation Plan (RTP) processes in California. Senate Bill 375 (2008) requires that Metropolitan Planning Organizations (MPOs) prepare a Sustainable Communities Strategy as a new element of their RTPs. MPOs typically select a set of metrics to use as criteria for judging potential scenarios under consideration, and it is our hope that using these health- and equity-based metrics to judge future scenarios will lead to the development and selection of RTPs with better health and equity outcomes. The final metrics and a one page summary  are now available. We’ve now started work with local advocates in LA, Fresno, and Sacramento to disseminate the metrics (including methods for measuring them and health evidence that supports them) to MPOs. We are starting to see some positive results – for example, the Southern California Association of Governments (SCAG) released final metrics that reflect many of the collaborative’s suggestions.

We’ve also recently finished some smaller research projects on the health impacts of paid family leave policies in California and of a paid sick days ballot measure in Denver.

One new project starting up that we’re particularly excited about is an HIA we’re conducting with WISDOM in Wisconsin. As part of a broader campaign to advance alternatives to incarceration, the HIA will assess the moving of funds from incarcerating people in state prisons to county-based alternatives such as drug and mental health courts. Wisconsin has had very high rates of African Americans incarcerated, and by highlighting the health impacts of incarceration on the incarcerated, their families, and their communities, the potential to address disparities and equity through the project is great. WISDOM recently received a grant for this campaign from the Robert Wood Johnson Foundation and is funding HIP to conduct the HIA component.


HIP helped organize and host the 3rd HIA of the Americas workshop that took place in Oakland in October, and brought together over 80 HIA practitioners from the US, Canada, and, for the first time, Brazil. The workshop had a variety of sessions on HIA, including: consideration of equity, communicating and framing, evaluation, quality of evidence, stakeholder engagement, and discussions of the previously released HIA Practice Standards. We all learned a lot from the experiences of others in the field and it was fabulous to spend time with so many friends and colleagues.
One exciting part of the workshop was the launch of the Society of Practitioners of Health Impact Assessment (SOPHIA), which we have also been helping to organize over the last year.  SOPHIA is an association of individuals and organizations providing leadership and promoting excellence in the practice of health impact assessment. We hope that it will be a leading network of health impact assessment practitioners. By promoting and practicing a thorough and systematic consideration of health in decision making, SOPHIA members will work towards achieving better health for all.  More information about the new association and information about joining are available at www.hiasociety.org.


In the past few months, we’ve facilitated HIA trainings for the Massachusetts Department of Public Health, Columbia University, The City of Philadelphia, Michigan Department of Community Health, Cuyahoga County (OH) Board of Health, and Alameda County Public Health Department. Over the last 3 years, we’ve led over 25 trainings, many of which have resulted in the start of successful HIAs.
We’ve also been spreading the word about HIAs through shorter trainings and talks at conferences. Recently, we helped facilitate trainings at the American Public Health Association (APHA) national conference, the Society for Public Health Education (SOPHE) national meeting, and at a national YMCA meeting.  We also moderated a session on HIA at APHA, gave a talk at the California Conference of Local Health Officers (CCLHO) meeting, participated in an HIA panel on tools and strategies to improve equity in PolicyLink’s national Equity Summit, and will be presenting at a roundtable for the Chicago Metropolitan Planning Council.


Recently, a number of national efforts have highlighted HIA as a useful and necessary tool in preventing disease.  In June, the  National Prevention Strategy (which was developed by the National Prevention Council, formed by the Affordable Care Act, that included 17 federal agencies and was chaired by the Surgeon General) recommended HIA as a way to “Integrate health criteria into decision making, where appropriate, across multiple sectors” – one of eight strategies it focused on. 
And last month, the National Research Council of the National Academies of Science released a book called “Improving Health in the United States: The Role of Health Impact Assessment.  The recommendations in the book align closely with how HIP conducts HIA and our work was highlighted in the book.
HIP’s co-founder and Board member, Rajiv Bhatia, one of the pioneering practitioners of HIA in the United States, developed a “Guide to the Practice of Health Impact Assessment” in an effort to continue the support for high quality HIA practice.  The Guide describes the key tasks and activities for HIA as well as the issues and challenges that arise in the course of practice. It includes illustrative examples from practice, as well as suggestions for stakeholder participation and the integration of health analysis in the environmental impact assessment process.


The Inaugural National Health Impact Assessment Meeting will be held April 3-4, 2012 in Washington D.C. in response to the burgeoning national interest in HIA. Please visit  http://www.regonline.com/NationalHIAMeeting2012 for more information.

As you can see, it has been a busy time for us and for other HIA practitioners. It is clear that this way of thinking about equity, health, and public policy resonates with many people and we are not expecting the momentum the field has gained to slow.  Though we wouldn’t mind if it slowed a little over the upcoming holidays.

15 November 2011

Using a Soda Bottle as a Solar Light Source

I just found this so inspiring that I had to post it. Plus it shows that mitigation and enhancement can be a win-win-win for local people, the local environment and the local economy

Hat tip: California Examiner

12 November 2011

Health Risks and Benefits of Cycling in Urban Environments (Spain) Compared with Car Use

To estimate the risks and benefits to health of travel by bicycle, using a bicycle sharing scheme, compared with travel by car in an urban environment.

Health impact assessment study.

Public bicycle sharing initiative, Bicing, in Barcelona, Spain.

181 982 Bicing subscribers.

Main outcomes measures 
The primary outcome measure was all cause mortality for the three domains of physical activity, air pollution (exposure to particulate matter <2.5 µm), and road traffic incidents. The secondary outcome was change in levels of carbon dioxide emissions.

Compared with car users the estimated annual change in mortality of the Barcelona residents using Biking (n=181 982) was 0.03 deaths from road traffic incidents and 0.13 deaths from air pollution. As a result of physical activity, 12.46 deaths were avoided (benefit:risk ratio 77). The annual number of deaths avoided was 12.28. As a result of journeys by Bicing, annual carbon dioxide emissions were reduced by an estimated 9 062 344 kg.

Public bicycle sharing initiatives such as Bicing in Barcelona have greater benefits than risks to health and reduce carbon dioxide emissions.

The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study
David Rojas-Rueda, Audrey de Nazelle, Marko Tainio, Mark J Nieuwenhuijsen
BMJ 2011;343:doi:10.1136/bmj.d4521 (Published 4 August 2011)

See also two interesting responses here and here and the study authors' reply.

7 November 2011

Disaster Preparedness and the Public Health Agenda webinar

Event status:Not started (Register)

Click here to go to the Webex page
with the webinar details
Date and time:Tuesday, 8 November 2011 14:00
GMT Time (London, GMT) 
Tuesday, 8 November 2011 9:00
Eastern Standard Time (New York, GMT-05:00)
Tuesday, 8 November 2011 17:00
Saudi Arabia Time (Riyadh, GMT+03:00)
Tuesday, 8 November 2011 22:00
Singapore Time (Singapore, GMT+08:00)
Panelist(s) Info:
Dr. John Ashton CBE, Director of Public Health and County Medical Officer, UK

Organised by the University of Liverpool, England, UK
Duration:1 hour
Join this exclusive webinar on disaster preparedness and the public health agenda. Dr. John Ashton CBE, Director of Public Health and County Medical Officer, will discuss the role of the public health profession in the preparation, management, and response to disasters, critical, and major incidents; and the need for a multidisciplinary approach to disaster preparedness.

His presentation will explore:
  • The need for a multidisciplinary and multiagency approach to disaster preparedness in a global and local context
  • The current response to disaster preparedness at a global level
  • The role of public health in disaster management
  • Community impact of disasters, critical, and major incidents; and the subsequent recovery phase
  • How contingency planning and disaster preparedness has evolved; and how can we learn from our experiences

6 November 2011

What is a Child Friendly City?

It is a city, or more generally a system of local governance, committed to fulfilling children's rights, including their right to:
  • Influence decisions about their city
  • Express their opinion on the city they want
  • Participate in family, community and social life
  • Receive basic services such as health care and education
  • Drink safe water and have access to proper sanitation
  • Be protected from exploitation, violence and abuse
  • Walk safely in the streets on their own
  • Meet friends and play
  • Have green spaces for plants and animals
  • Live in an unpolluted environment
  • Participate in cultural and social events
  • Be an equal citizen of their city with access to every service, regardless of ethnic origin, religion, income, gender or disability
A child friendly city is the embodiment of the Convention on the Rights of the Child at the local level, which in practice means that children’s rights are reflected in policies, laws, programmes and budgets. In a child friendly city, children are active agents; their voices and opinions are taken into consideration and influence decision making processes.

5 November 2011

2nd Healthy Communities Conference: Building Systems to Integrate Community Development and Health

On Monday, November 7, Robert Wood Johnson Foundation, the Federal Reserve Bank of San Francisco and The Pew Charitable Trusts will host the 2nd National Healthy Communities conference in Washington, D.C.  The all-day event will showcase the collaboration between the community development and health sectors to improve lives in low-income neighbourhoods in the US.

The event will feature experts in finance, urban planning, housing, and government including:
  • Risa Lavizzo-Mourey, President and CEO, Robert Wood Johnson Foundation
  • Todd Park, Chief Technology Officer, U.S. Department of Health and Human Services
  • Raphael Bostic, Assistant Secretary, Department of Housing and Urban Development
  • David Erickson, Director, Center for Community Development Investments, Federal Reserve

There's some HIA practitioners speaking during the day. I'll let you work out who they are!

View the live webcast above or click the link below or follow the Twitter hashtag #FedHealth on Monday November 7, between 8:45 a.m. -5:15 p.m. ET.

Even if you can't make it for the livestream it looks like some/all of the videos are available for viewing after the event at http://www.rwjf.org/pr/product.jsp?id=73477 (UPDATED)

  • Welcome
    8:45 - 9:30am
    Shelley Hearne, Risa Lavizzo-Mourey, David Erickson
  • Morning Keynote: Progress, One Year Later
    9:30 - 10:00am
    Tamera Luzzatto, Melody Barnes
  • Working Together: Regional Models, Lessons, and Strategies for Scale
    10:15 - 11:15am
    Lisa Richter, Paul Grogan, David Fleming, Kimberlee Cornett
  • Bending the Cost Curve: Integrating Health and Community Development
    11:15am - 12:00pm
    Douglas Jutte, Ronda Kotelchuck, David Kindig, Neal Halfon
  • Lunch
    12:15 - 1:15pm
    Susan Dentzer
  • Systems Change: Capital
    1:15 – 2:15pm
    Nancy Andrews, Alicia Glen, Dan Letendre, Annie Donovan
  • Systems Change: Data
    2:30 – 3:30pm
    Nancy Adler, Aaron Wernham, Sister Lillian Murphy, Catherine Ross, Todd Park
  • Systems Change: Policy
    3:30 – 5:00pm
    Nicolas Retsinas, Raphael Bostic, Julie Moreno, Larkin Tackett, Lisa Garcia
  • Closing and Next Steps
    5:00 – 5:15pm
    James Marks, David Erickson

3 November 2011

How Can We Get the Social Determinants of Health Message on the Public Policy and Public Health Agenda?

A study from Utah, USA that has relevance globally and published as a background WHO paper for the World Conference on Social Determinants of Health in Brazil this month.

The social gradient is deeper 
Inequalities in health resulting in disparities in life expectancies are evident even at the lowest reportable data level, down to the small area or zip code-level. The challenge has always been what to do about it.

Communicating contextualised and actional data
In as much as comprehensive epidemiology reports are helpful and serve various purposes, to act on the evidence, policy makers and public health practitioners need simple, precise, accurate, easy-to-understand,
easy-to-learn, visualizeable information at their constituents’ level. Where reliable data are already available and regularly reported; use technology and  existing health metrics to support the SDH message.  A succinct and visualize-able demographic and health landscape that focuses on vital priorities at the community level can be a mechanism by which the social determinants of health message  could be recognized, acted upon, directed, and evaluated down to the local levels of governance.

Framing the message according to local needs: “What’s wrong? Why does it matter? What should be done about it?”
The problem is not always the lack of data as much as how they are communicated. How we communicate the evidence is strategic in engaging both policy makers and the public. Presented wisely, used effectively, directed to the right audience, within the context of the social determinants of health, data can elicit interest, help inform, engage, advocate, and initiate action. Existing data framed in a manner that speak to community needs and issues that the people can connect with and in a language that people can understand is more likely to resonate across the political spectrum.

Keep repeating the message.
The social determinants of message can get lost in a flurry of competing political and health issues. Marketing the message calls for repeatedly disseminating and reiterating the information to counter the fatalistic mindset towards effecting change.

Engaging the right people in doing the right thing: Having a shared vision and focus of improved health and reduction of health disparities. 
The social determinants of health result from “the way we organize our affairs in society.”7 These factors are so intricately embedded in the realities of daily living that reducing the inequities we have created means partnering with the right people from various sectors ---those who share a vision and have the skills, courage, and resolve to bring about change in the system or with the system.

2 November 2011

Washington DC Health Impact Assessment Meeting in April 2012

From the Health Impact Project:

Save the date for the Inaugural National Health Impact Assessment Meeting, to be held in Washington, D.C. April 3-4, 2012. The meeting will convene policy makers, public health professionals, planners, HIA practitioners, and anyone else with an interest in learning more about HIA. A special, one-day forum tailored specifically to policy makers will also be offered.

Information on the meeting will be posted as it becomes available at http://www.regonline.com/NationalHIAMeeting2012. Scholarships may be available for travel and registration.

1 November 2011

Social Determinants and the Health Divide in the WHO European Region

Interesting conceptual model linking policies and practices to social determinants of health (Pages 13 and 11).

My take home paragraph is (Pages 21-22):

"A human rights–based approach to health equity is needed Oldring & Jerbi (66) discussed human rights and health.

Today there is growing recognition of the links between health and a wide range of human rights, as well as a growing appreciation of the right to the highest attainable standard of health itself. There is broad agreement that health policies, programmes and practices can have a direct bearing on the enjoyment of human rights, while a lack of respect for human rights can have  serious health consequences. Protecting human rights is recognized as key to protecting public health.

The right to health means that governments must generate conditions in which everyone can be as healthy as possible. A human rights–based approach to health gives importance not only to goals and outcomes but also to the processes in trying to achieve these goals and outcomes. Health policy-making should be guided by human rights standards and aim at developing the capacity of those in positions of responsibility – for policy-making and delivery – to meet their obligations and empower rights-holders (the public) to effectively claim their rights.

Eliminating all forms of discrimination is at the core of a human rights–based approach, with a particular focus on gender equity in all policies. Human rights standards and principles, such as participation, equality, non-discrimination, transparency and accountability, should be integrated into all stages of policy-making and implementation.

The human rights principles and efforts to improve  health equity should be mutually reinforcing. The right to health complements the health equity concept by aiming for everyone to enjoy his or her full health potential. Moreover, the human rights principles of nondiscrimination and equality strengthen the conceptual foundation of health equity for the groups in society for whom inequities in health are related to wider vulnerability. "

Click here to download the 2nd Interim Report - Interim second report on social determinants of 
health and the health divide in the WHO European Region, WHO, 2011.

Click here to download the 1st Interim Report - Interim first report on social determinants of health and the health divide in the Regional Office for Europe WHO European Region