Erio Ziglio, 21 jan

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Erio Ziglio, 21 jan

  1. 1. - - Dr Erio Ziglio World Health Organization European Office for Investment for Health and Development Social Determinants of Health: Challenges & Opportunities in Europe Uppsala University, 21 January 2005
  2. 2. - - Characteristics of Europe in 2005 Challenges & Opportunities Implications Outline of this presentation
  3. 3. - - Characteristics of Europe in 2005 • WHO EURO 52 countries, total of 900m citizens • 25% have less than 5 million inhabitants • 20% have less than 3 million • 47% have a high income (> $ 9,265 in 2000) • 15% have a low income (< $ 756)
  4. 4. - - LIFE EXPECTANCY Wide variations between countries
  5. 5. - - Persistent and increasing inequalities between countries and within population groups of the same country
  6. 6. - - Glasgow, Scotland 67 LIFE EXPECTANCY 77
  7. 7. - - Torino, Italy 8 YEARS DIFFERENCE in life expectancy
  8. 8. - - 8-10 YEARS DIFFERENCE in life expectancy Malmö, Sweden
  9. 9. - - Looking at the last decade
  10. 10. - - Relative Poverty is growing faster in Europe and Central Asia than anywhere else in the world. (World Bank, 2001)
  11. 11. - - 43.8 98.2 1990 1999 People living on less than US$ 2 a day Source: Global Economic Prospects, Worldbank, 2001 (CEE and CAR, millions of people) INCOME POVERTY
  12. 12. - - EU: People at risk of poverty and social exclusion (%) Source: European Commission, data for 1997 Average of 18% or 60 million people below the threshold INCOME POVERTY
  13. 13. - - Progress towards reaching the poverty MDGs by regions Source: www.developmentgoals.org
  14. 14. - - Challenges & Opportunities Increased inequalities, poverty and psycho-social stress Implications
  15. 15. - - Why are we seeing an increase in health inequalities across Europe ? KEY QUESTION
  16. 16. - - DETERMINANTS OF HEALTH Population Health Social Economic EnvironmentalGenetic
  17. 17. - - ALLOCATIVE EFFICIENCY Promotion Population Individual Treatment
  18. 18. - - European main factors • Social safety nets • Labour market policies, job security, pension reforms • Economic change and social disruption • Economic regeneration schemes • Poverty reduction
  19. 19. - - Systems & Infrastructures constraints • Intervention approaches often mismatched to country development conditions and capacity • Unrealistic expectations of the individual behaviour change approach • Unstable and inadequate funding mechanisms • The promotion of population health is too often at the margins of decision processes
  20. 20. - - Implications Need to keep the vision but revisit the means Increased inequalities, poverty and psycho-social stress
  21. 21. - - Some long term outcomes (at age 21) of non-participation by young women at age 16-18 0 10 20 30 40 50 60 70 80 90 100 Without qualifications No training in current job Not in full/part time w ork Teenage parent Parent (by age 21) Tw o or more children Depression Full time home care responsabilities Lives in rented accomodation Acknow ledges family commitments as barrier to employment Poor health PercentageNon-Participant Participant
  22. 22. - - Integrated problems require integrated solutions
  23. 23. - - Assets
  24. 24. - - Need LH
  25. 25. - - The Promotion of population Health is increasingly recognized as key resource for social and economic development
  26. 26. - - Social Development Economic Development Equitable Sustainable Promoting Population Health
  27. 27. - - Ray Charles
  28. 28. - - Communities rarely develop on the basis of their deficiencies, (…) they develop on the basis of their assets
  29. 29. - - Need L H Assets H L
  30. 30. - - An integrated model of HP Policies & actions to improve equity in social and economic conditions Policies & actions to create health supporting environments and communities Programmes to change unhealth knowledge attitudes and behaviours The Building Blocks to Sustainable Population Health Promotion Healthy Settings – workplaces, schools & communities Changing Individual Risk Behaviour Promoting healthy lifestyles Creating the conditions - Reducing poverty, social exclusion for Good Health environmental hazards, improving sanitation
  31. 31. - - Manage Risk Factors Manage Risk Conditions Manage Assets Investment for Health and Development
  32. 32. - - The WHO Office for Investment for Health and Development Venice, Italy
  33. 33. - - The Venice Office has two main functions 1. To monitor, review and systematize the policy implications of emerging research findings on the social and economic determinants of health 2. To provide a set of services to increase the European capacity to promote population health by integrating into development agendas, policies and practice evidence on the social and economic determinants of health.
  34. 34. - - Put HP within the development agenda of European countriesNeed to keep the vision but revisit the means Increased inequalities, poverty and psycho-social stress

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