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The Employment Conditions Network final report is a political, anti-neoliberal & welfare state move.

Sir,

As members of the Employment Conditions (EMCONET) Knowledge network of the WHO Commission on Social Determinants of Health (SDOH) we appreciate Nayar and Kapoor's recent editorial (1) praising the Commission's contribution to bring to light the issue of SDOH as a global social justice concern. We also have to agree with the critique of the Commission's report, at least partially, as it did not sufficiently emphasize the role of the state, (class) power relations, or the effects of neoliberal capitalism, among other limitations (2). Nevertheless, we think that the editorial's critical remarks do not apply to every network, especially to our network, EMCONET. These are grossly inaccurate (3).

First, we should note that the Commission's Knowledge Network (KN) contributed independently, although sometimes worked cohesively with other KN. Due to the different political views and scientific background of their members (e.g., from neoliberal to socialist) the conceptual frameworks and the proposed actions greatly varied by KN. This is why the editorial's (1) critique does not apply to the EMCONET report (3). Our report explicitly mentions the role of states in the creation and reduction of labour market inequities within a power relations framework: for example, in section 3.3., "Labor Markets and Welfare States" and on figure 3, where we identify "worker's bargaining power" as the exogenous determinant of "strong welfare state" and ultimately population health. Second, power relations between capital and labour are at the origin of our theoretical framework (page 31), becoming the key social mechanism driving occupational health disparities (3). And rather than ignoring politics, these are very much at the core of our model as in several previous articles (4-8). For example, politics figure our adoption of Korpi's "power resources" model of social democratic welfare states. The EMCONET report also analyzed the health damaging role of precariousness, slave labour, child labour and gender labour market inequities all of these associated with the expansion of neoliberal policies. In that context we brought power relations and politics to the forefront with labour regulations, collective bargaining, and trade unions; and also when addressing the distributive role of the welfare state, that is, the extent to which the state exerts its distributive power through the implementation of social policies.

In spite of these errors with regard to EMCONET, we agree with the editorial (1) on the importance of mobilizing countries to adopt national policies inspired in the commission's report. Although it is a challenging task to influence national policy makers, some countries like Brazil have already adopted some recommendations made by the commission.

References

(1.) Nayar KR, Kapoor SS. Commission on Social Determinants in Health: A piece meal move? Indian J Med Res 2009; 129 : 117-9.

(2.) Muntaner C, Sridharan S, Solar O, Benach J. Against unjust global distribution of power and money: The WHO Social Determinants of Health Report, global inequality and the future of public health policy. J Public Health Policy 2009; 30 : 163-75.

(3.) Benach J, Muntaner C, Santana V. Employment Conditions and Health Inequalities: Final Report to the Commission on Social Determinants of Health (CSDOH). Employment Conditions Network (EMCONET) Geneva, WHO, 2007. Available from http://www.who.int/social_determinants/ knowledge_networks/employment/en/index.html, accessed on July 14, 2009.

(4.) Espelt A, Borrell C, Rodriguez-Sanz M, Muntaner C, Pasarin M, Benach J, et al. Answer to the commentary: Politics and public health--some conceptual considerations concerning welfare state characteristics and public health outcomes. Int J Epidemiol 2009 Jan 8. [Epub ahead of print] PubMed.

(5.) Espelt A, Borrell C, Rodriguez-Sanz M, Muntaner C, Pasarin MI, Benach J, et al. Inequalities in health by social class dimensions in European countries of different political traditions. Int J Epidemiol 2008 37 : 1095-105.

(6.) Muntaner C, Salazar RM, Benach J, Armada F. Venezuela's Barrio Adentro: an alternative to neoliberalism in health care. Int J Health Serv 2006; 36 : 803-11.

(7.) Navarro V, Muntaner C, Borrell C, Benach J, Quiroga A, Rodriguez-Sanz M, et al. Politics and health outcomes. Lancet 2006; 368 : 1033-7.

(8.) Muntaner C, Lynch JW, Hillemeier M, Lee JH, David R, Benach J, et al. Economic inequality, working-class power, social capital, and cause-specific mortality in wealthy countries. Int J Health Serv 2002; 32 : 629-56.

Atanu Sarkar *, Carles Muntaner **, (+) Haejoo Chung & Joan Benach **

* Members of the Employment Conditions Network of the WHO CSDOH &

** Co-Chairs of the Employment Conditions Network of the WHO CSDOH

(+) For correspondence:

Dr C. Muntaner

Psychiatric & Addictions Nursing Research Chair & Professor

University of Toronto

155 College, Room 386

Toronto, ON M5T 1P8

Canada

carles.muntaner@utoronto.ca

Author's response

Sir

Our critique largely applies to the Report as a whole and not to any specific Knowledge Network. We agree that EMCONET Knowledge Network is distinct in its recommendations. However, the inability to influence the whole (CSDH report) by the part (EMCONET network) is a critical commentary on the credibility of the collective efforts such as the Commission on Social Determinants. One distinct suggestion of the EMCONET report is to include occupational health and safety programmes within the primary health care to provide universal coverage. However, it is relevant at this juncture to point out that the philosophy of primary health care is now forgotten and efforts should be made to resurrect it. In our view, if the PHC works well, then workers' interests and universal coverage will be ensured without having to include any special vertical arms to the already tnmcated public health programmes.

K.R Nayar * & Sonali Sahni Kapoor

Centre of Social Medicine & Community Health

Jawaharlal Nehru University

New Delhi 110 067, India

* For correspondence: krnayar@mail.jnu.ac.in
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Author:Sarkar, Atanu; Muntaner, Carles; Chung, Haejoo; Benach, Joan
Publication:Indian Journal of Medical Research
Article Type:Letter to the editor
Geographic Code:1CANA
Date:Jul 1, 2009
Words:927
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