A/HRC/44/48 D. Determinants of health and measurement 21. Critiqued for its individualizing disease focus, the Movement for Global Mental Health has started to take the determinants of health more seriously. 14 For example, a systematic review of epidemiological research in low- and middle-income countries found a very strong relationship between indicators of poverty and common mental health conditions, 15 and the Cape Vulnerability index evidences the relationships between geopolitical factors, foreign aid and mental health. 16 Other findings from Global Mental Health show that health determinants do not act uniformly and many factors, including local context, are important.17 22. Much global mental health research about the relationship between poverty and mental health focuses on pre-existing mental health conditions diagnosed through the international statistical classification of diseases and related health problems that contribute to poverty. It is not focused on how poverty and social injustice can produce mental distress. The focus has been on the burden and cost of mental health disorders. That is not consistent with a human rights-based approach and has been shown to be methodologically flawed. 23. That approach is rooted in economic arguments instead of being centred on human rights. The focus remains on individual rather than systemic change as a means of tackling poverty and oppression. By positioning mental distress as a barrier to economic development, mental health is recast as a problem of individual brains. That, in particular, enables psychiatric and psychological expertise to be mobilized in relation to persons in situations of poverty, contributing to the “psychologization” and “psychiatrization” of poverty. In that context, the “world-first” well-being budget adopted by New Zealand is an initiative that goes in the right direction by prioritizing mental health and well-being over gross domestic product. 24. Measurement is key to evidencing relationships between disability, mental health and the determinants of health, and in making mental health count as a global priority area. However, the measurement of health determinants often relies on psychiatric-diagnostic criteria translated into easy-to-administer checklists. Not only are the criteria and checklists deeply problematic but they have been critiqued for individualizing distress, raising problems with using them as tools to map the mental health effects of health determinants.18 Measurement systems should move away from individualized, causal models of health determinants and address structural conditions and root causes, meaningfully involving service users and persons with disabilities in decision-making about what counts in mental health. They should also develop indicators for actions on the determinants of mental health and include rights-based indicators to measure progress, as suggested by the Human Rights Council in its resolution 40/12. 25. As the determinants of health continue to attract important political attention, particularly within Global Mental Health, there is a risk that this attention remains rhetorical and not meaningfully integrated into the structural reforms required within mental health systems, particularly within the practice of psychiatry. 19 In his report on the education of the health-care workforce, the Special Rapporteur highlighted a range of pedagogical shifts that offer much promise in integrating this knowledge into practice (A/74/174). 14 15 16 17 18 19 See Vikram Patel and others, “The Lancet Commission on global mental health and sustainable development”, The Lancet, vol. 392, No. 10157 (October 2018). See Crick Lund and others, “Poverty and mental disorders: breaking the cycle in low- and middle-income countries”, The Lancet, vol. 378, No. 9801 (October 2011). See Albert Persaud and others, “Geopolitical factors and mental health I”, International Journal of Social Psychiatry, vol. 64, No. 8 (December 2018). Vikram Patel and Paul E. Farmer, “The moral case for global mental health delivery”, The Lancet, vol. 395, No. 10218 (January 2020). See China Mills, “From ‘invisible problem’ to global priority: the inclusion of mental health in the sustainable development goals”, Development and Change, vol. 49, No. 3 (2018). See Lisa Cosgrove and others, “A critical review of the Lancet Commission on global mental health and sustainable development: time for a paradigm change”, Critical Public Health (September 2019). 7