Abstract
Despite the immeasurable means deployed (1), most African countries were not able to meet their Millennium Development Goals (MDGs) by the 2015 deadline. While this poor performance can be attributed to several factors, many analyses have revealed the main cause to be the absence of systematic and coordinated action on the social determinants of health, which are in large part outside of the health sector. Today, in light of the Sustainable Development Goals (SDGs), it is absolutely necessary to address this shortcoming (2 –4). To reach the SDGs we must act on the social determinants of health and reduce social inequalities (4). However, the current way health systems in the region operate emphasizes a frontal attack on disease, which is not conducive to improving health indicators (3). In the region today, it is as if health systems were waiting for people to fall ill before taking care of them, as it was written in the Lalonde Report in the early 1970s (5).
The Lalonde Report highlighted the mechanism that enables us to sustainably address health problems: tackling the social determinants of health (5). Even if the African region has experienced measurable advances when it comes to social determinants of health on the whole, individual countries show disparate and rather uncomfortable situations (3). One of the principal reasons for this is the chronic shortage of trained professionals in health promotion who could use their skills towards implementing truly relevant and context-specific public policies to tackle the social determinants of health (3).
We must therefore reflect on the key competencies, training and accreditation of health professionals for an interdisciplinary and multisectoral approach that enables action on the social determinants of health. While English-speaking countries in Africa do offer a few degree programs in health promotion, the French-speaking countries still lag behind (6).
Health promotion training not only encompasses expertise on addressing the social determinants of health and reducing social inequalities in health, but also the approach of health in all policies. Moreover, it provides skills in the area of health impact assessment, an important tool for the health sector in its collaborations with other sectors, so that health is taken into consideration in different, non-health policies.
Currently, there is only one university in French-speaking Africa (in Parakou, Benin, since 2014) that offers a degree program in health promotion at the Master’s degree level. Every country in the region has at least one Master’s program in public health, but few if any mention health promotion in their considerations of social determinants of health, public policy, social sciences and health, etc. The needs are therefore far from being met.
In light of the SDGs, it has grown urgent for the African region to accelerate training of professionals who are skilled in acting on the social determinants of health. We believe that it would bring human resources to the countries in the region that could help reorient health services and enable us, at last, to place health in all policies.