Table 4 Examples of statements in strategic documents describing WHO’s role and barriers to addressing the broader determinants of health

Medium-term strategic plan 2008–2013

 “Although essential for achieving lasting health improvements across populations, the underlying determinants of health have received relatively little attention at WHO, necessitating a substantial increase from the baseline.”

  “lack of effective consensus among partners, including organizations of the United Nations system, other international bodies and nongovernmental organizations on policies and framework for action; insufficient investment by national governments for building and deploying adequate skills to ensure that tools to analyse human rights, ethical, economic, gender and poverty aspects are widely and effectively implemented.”

 “The health sector is only poorly able to influence policies in other sectors to promote occupational and environmental health and lacks the tools, knowledge and skills to engage other sectors.”

 “Health systems are on the whole not even identifying the environmental determinants of health as part of their remit, let alone as a priority for improving public health. The few existing data indicate that only about 2 % of a typical national health budget is currently invested in preventive health strategies. Clearly, health institutions face both the challenge of controlling health costs and the opportunity to do so through more effective environmental health strategies and interventions.”

 “The mandate for WHO’s action in this area is firmly anchored in the Constitution and the history of public health practice and achievements. In the framework of United Nations reform, WHO has an opportunity to show a more global leadership in public health and the environment, linking health explicitly to the goals of sustainable development.”

Eleventh General Programme of Work 2006–2015

 “Many of the determinants of health are outside WHO’s direct sphere of influence, but WHO will work with ministries of health to build their understanding of what can realistically be done by working with other sectors. WHO will monitor global trends that are of significance to health in areas such as trade and agriculture, and keep ministries of health informed.”

 “More research is required for a better understanding of the links between determinants and their consequences, and for how governments, in particular ministries of health, can best influence other government sectors.”

 “At the international level, governments will need to engage effectively with negotiated agreements such as TRIPS and the General Agreement on Trade in Services, given their increasing importance for health goods and services. Engagement with industry in general, covering areas such as food, pharmaceuticals and insurance, should continue, focusing on commonly agreed public health agendas. WHO has a responsibility to keep governments informed and engaged in the process.”

 “The action required to tackle most of these determinants goes beyond the influence of ministries of health, and involves a large number of government and commercial responsibilities. If these determinants are to be dealt with effectively, therefore, the boundaries of public health action have to change. Governments, especially health ministries, must play a bigger role in formulating public policies to improve health, through collective action across many sectors. It is the responsibility of WHO to keep governments informed of the situation, raise awareness, and advocate policies to tackle the determinants when opportunities arise.”

Twelfth General Programme of Work 2014–2019

 “The concept of social determinants of health constitutes an approach and a way of thinking about health that requires explicit recognition of the wide range of social, economic and other determinants associated with ill health, as well as with inequitable health outcomes. Its purpose is to improve health outcomes and increase healthy life expectancy. The wider application of this approach–in line with the title of the Twelfth General Programme of Work and in a range of different domains across the whole of WHO–is therefore a leadership priority for the next six years in its own right.”

 “As a public health agency, WHO continues to be concerned not only with the purely medical aspects of illness, but with the determinants of ill health and the promotion of health as a positive outcome of policies in other sectors”

 “One consequence of the growing political interest in health and the recognition of the connection between health and many other areas of social and economic policy, is a growing demand for intergovernmental, rather than purely technical processes, in order to reach durable and inclusive agreements. In the general programme of work it is foreseen that this demand is unlikely to decrease. As a consequence, WHO will put in place the requisite capacities to prepare for meetings, brief participants and manage these processes as effectively as possible.”