Who’s in Charge of Social Determinants of Health? Understanding the Office of the Municipal Health Officer in Urban Areas

Abstract

The need to address Social Determinants of Health (SDH) for a healthy society is uncontested, even though we have less of a sense of how to operationalize this action, or of what institutional structures exist and may be needed for this purpose. We undertook to describe one institutional structure required for action on SDH in urban areas as part of a 31-city appraisal carried out by the Technical Resource Group (TRG) of the National Urban Health Mission (NUHM), supplemented with a purposive review of the literature. We identified the institution of the Municipal Health Officer (MHO), which was particularly designed in the colonial period to address health and its determinants. Limited finances and privatization have led to a non-uniform decline in the powers of the MHO across cities. In metropolitan areas with substantial municipal financial capacity, the office of the MHO has survived along with both clinical and SDH functions. In second tier cities with a lack of financial capacity, State Health Departments have taken over health and clinical services, resulting in an overemphasis on these services and a shift away from SDH. In third tier cities, the office of the MHO was under threat due to the takeover of health facilities by State Health Department along with heavy financial and technical capacity constraints. Notwithstanding this, we conclude that the office of the MHO is an existing and important institutional structure through which to address SDH in an integrated fashion. We argue that this office must be sustained, and efforts redoubled to augment necessary technical support, infrastructure and finance, particularly in second and third tier cities.