1. Understanding the UN post-2015 development agenda process: Opportunities and challenges for health PAULO M. BUSS, MD, MPH The Oswaldo Cruz Foundation, Brazil (FIOCRUZ Center for Global Health) Brazilian National Academy of Medicine IOM WEBINAR With the support of PAHO and NIEHS/NIH October 18, 2012

2. Premises Healthy populations are essential for development Health is central to the full realization of the potential of human life, there will be no development without health Health is deeply conditioned by the modes of production and consumption and by social, economic and environmental determinants, over which is possible to act in a integrated and intersectoral way

3. Rio+20: The Future We Want “We recognize that health is a precondition for and an outcome and indicator of all three dimensions of sustainable development. We understand the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and non-communicable diseases, and where populations can reach a state of physical, mental and social well-being”. “We are convinced that action on the social and environmental determinants of health, both for the poor and the vulnerable and for the entire population, is important to create inclusive, equitable, economically productive and healthy societies”. Paragraph 138

4. Resolution WHA62.14 (2009) Director General: “to convene a global event, with the assistance of Member States, before the 2012 Sixty-fifth World Health Assembly in order to discuss renewed plans for addressing the alarming trends of health inequities through addressing social determinants of health”.

5. Resolution WHA65.8 (2012) (1/2) Member States expressed their political will to improve public health, and reduce health inequities through action on the social determinants of health (SDH). The focus is on addressing the challenges of eradicating hunger and poverty; ensuring food security; enabling access to healthcare and affordable medicines; and improving daily living conditions through provision of safe drinking-water and sanitation, employment opportunities and social protection.

6. Resolution WHA65.8 (2012) (2/2) “(3.3) to take into account health equity in all national policies that address social determinants of health, and to consider developing and strengthening universal comprehensive social protection policies, including health promotion, disease prevention and health care, and promoting availability of and access to goods and services essential to health and well-being”; and “(3.4) to ensure dialogue and cooperation among relevant sectors with the aim of integrating a consideration of health into relevant public policies and enhancing intersectoral action”.

7. Rio Political Declaration on Social Determinants of Health - Adopt better governance for health and development to tackle the root causes of, and reduce health inequities. - Promote participation in policy-making and implementation for action on SDH, engaging actors and influencers outside of government, including civil society. - Further reorient the health sector towards reducing health inequities, including moving towards universal health coverage that is accessible, affordable, and good quality for all. - Strengthen global governance and collaboration, including coordinated global action on SDH aligned with national government policies and global priorities. - Monitor progress and increase accountability to inform policies on SDH. http://dssbr.org

8. Contribution of the health sector to SD Development of universal, equitable, integral, politically and financially sustainable, high-quality health systems focused on health promotion, disease prevention and primary health care. The universal health coverage aspect is promissing, but insufficient, because it refers only to one of the dimensions of universal health systems. Broaden the concept: “Universal health coverage” “Universal health systems

9. The Brazilian health system Basic structure: Federal Constitution (1988). It will be 25 years old in 2013. Unified Health System (SUS): universal, integral and high-quality; needs improvement as to equity and quality. Several extra-sectoral policies, including advances in income distribution, have been improving the quality of life and the health of Brazilians. Social and health indicators: improvements in the Gini index; increase in the level of income and in the quality of employment; reduction in child and maternal mortality, in child malnutritition, in vaccine-preventable diseases and some infectious-parasitic diseases; and better access to basic education. Remaining challenge: non-communicable diseases and a few reemerging diseases.