Global Health Equity and the     Social Determinants of                      HealthRamon Lorenzo Luis Rosa Guinto, MD     ...
Alma Ata, 1978The International Conference on PrimaryHealth Care calls for urgent action by allgovernments, all health and...
From Beaglehole and Bonita, 2012
Life expectancy at birth (men)Glasgow, Scotland (deprived suburb)                              54India                    ...
Source: Dr. Ramon Paterno, University of the Philippines
Mortality over 25 years according to level in the                        occupational hierarchy: Whitehall Study(Marmot & ...
Life expectancy and disability-free life expectancy at birthby neighbourhood income deprivation, 1999-2003
Angola
Brazil
Burkina Faso
European Union
The Jubilee Line of Health InequalityTravelling east from Westminster, each tube stop representsup to one year of male lif...
Definitions• Inequalities/Disparities in health – „differences‟ in  health across individuals / population groups• Inequit...
Definitions• Horizontal equity – equal access for equal needs• Vertical equity – unequal access for unequal needs         ...
Elaboration of disparities in wealth• The world‟s richest 1% receive income = to the poorest  57%• The income of the world...
Champagne Glass
Social Production of Disease         Do we not always       find the diseases of           the populace       traceable to...
Source: Ravi Narayan, SOCHARA, India
Source: Ravi Narayan, SOCHARA, India
Source: Ravi Narayan, SOCHARA, India
Source: Ravi Narayan, SOCHARA, India
Source: Ravi Narayan, SOCHARA, India
Rudolf Virchow                             remedy for                             epidemics was:                          ...
The Constitution of WHO, 1948“Health is a state of complete physical, mental, and social well-being and not   merely the a...
Alma Ata Declaration      “Economic and social    development… is of basic     importance to the fullest attainment of hea...
Alma Ata Declaration   “Involves, in addition to the     health sector, all related sectors and aspects of national  and c...
Ottawa Charter• The Ottawa Charter for Health  Promotion (WHO 1986)  identified 8 key determinants  (prerequisites) of hea...
McKeown‟s Thesis
Tuberculosis                  TB deaths in England4.5  4                                                BCG Vaccination3.5...
Source: Ravi Narayan, SOCHARA, India
Source: David Sanders, South Africa
Social Determinants           of Health• Conditions in the  social, physical, and economic  environment in which people ar...
Dahlgren and Whitehead, 1991
From Fran Baum
Epidemiology of Inequality
“Unequal distribution of health-damagingexperiences is not in any sense a „naturalphenomenon, but is a result of the toxic...
Commission on SocialDeterminants of Health    1. Improve Daily Living Conditions    2. Tackle the Inequitable Distribution...
CSDH Report: Action Areas                              •   Equity from the startDaily Living Conditions                   ...
Basic question: What good does it do to treat people‟s                      Illnesses …only to send them back to the condi...
The new physician as champion of social       determinants approach to health
From Fran Baum
The Power of Medicine      "Medicine… has the    obligation to point out   problems and to attempt        their theoretica...
Health for All!Alma Ata, USSR, 1978   Almaty, Kazakhstan, 2008         Thank You Very Much!
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
Global Health Equity and the Social Determinants of Health
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Global Health Equity and the Social Determinants of Health

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From the workshop "Closing the Gap in OUR Generation: Reducing health inequities through action on the global and local determinants of health" held last March 5-9, 2013 in Baltimore, Maryland, USA during the 62nd General Assembly March Meeting of the International Federation of Medical Students' Associations (IFMSA). Brought to you by the IFMSA Global Health Equity Initiative (http://www.ifmsa.org/Activities/Initiatives/The-IFMSA-Global-Health-Equity-Initiative).

For more information about the workshop, visit http://www.scribd.com/doc/131377723/Closing-the-Gap-in-OUR-Generation-PreGA-Final

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Global Health Equity and the Social Determinants of Health

  1. 1. Global Health Equity and the Social Determinants of HealthRamon Lorenzo Luis Rosa Guinto, MD Liaison Officer to the World Health Organization and Founding Coordinator, Global Health Equity InitiativeInternational Federation of Medical Students‟ Associations (IFMSA) Youth Commissioner, Lancet-University of Oslo Commission on Global Governance for Health
  2. 2. Alma Ata, 1978The International Conference on PrimaryHealth Care calls for urgent action by allgovernments, all health and developmentworkers, and the world community to protectand promote the health of all the people ofthe world by the year 2000.
  3. 3. From Beaglehole and Bonita, 2012
  4. 4. Life expectancy at birth (men)Glasgow, Scotland (deprived suburb) 54India 61Philippines 65Korea 65Lithuania 66Poland 71Mexico 72Cuba 75US 75UK 76Glasgow, Scotland (affluent suburb) 82 (WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)
  5. 5. Source: Dr. Ramon Paterno, University of the Philippines
  6. 6. Mortality over 25 years according to level in the occupational hierarchy: Whitehall Study(Marmot & Shipley, BMJ, 1996)
  7. 7. Life expectancy and disability-free life expectancy at birthby neighbourhood income deprivation, 1999-2003
  8. 8. Angola
  9. 9. Brazil
  10. 10. Burkina Faso
  11. 11. European Union
  12. 12. The Jubilee Line of Health InequalityTravelling east from Westminster, each tube stop representsup to one year of male life expectancy lost at birth (2002-06)Male LifeExpectancy Male Life78.6 (CI 76.0-81.2) Expectancy Canning Town 72.8 (CI 71.1-74.6)Female Life Expectancy84.6 (CI 82.5-86.7) Female Life Expectancy 81.4 (CI 79.3-83.6) Westminster Canary London Bridge Wharf River Thames Canada North Bermondsey Water Greenwich Waterloo Southwark Electoral wards just a few miles apart geographically have life expectancy spans varying by years. For instance, there are eight stops between Westminster and Canning TownLondon Underground Jubilee Line on the Jubilee Line – so as one travels east, each stop, on average, marks up a year of shortened lifespan. 11 Source: Analysis by London Health Observatory using Office for National Statistics data revised for 2002-06. Diagram produced by Department of Health
  13. 13. Definitions• Inequalities/Disparities in health – „differences‟ in health across individuals / population groups• Inequities in health – avoidable differences• „Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. It is this that we label health inequity.‟ WHO Commission on Social Determinants of Health (2008) From Mike Rowson, 2011
  14. 14. Definitions• Horizontal equity – equal access for equal needs• Vertical equity – unequal access for unequal needs From Mike Rowson, 2011
  15. 15. Elaboration of disparities in wealth• The world‟s richest 1% receive income = to the poorest 57%• The income of the world‟s richest 5% = 114 X that of the poorest 5% » UN Human Development Report 2002
  16. 16. Champagne Glass
  17. 17. Social Production of Disease Do we not always find the diseases of the populace traceable to defects in society? Dr. Rudolf Virchow Father of Social Medicine
  18. 18. Source: Ravi Narayan, SOCHARA, India
  19. 19. Source: Ravi Narayan, SOCHARA, India
  20. 20. Source: Ravi Narayan, SOCHARA, India
  21. 21. Source: Ravi Narayan, SOCHARA, India
  22. 22. Source: Ravi Narayan, SOCHARA, India
  23. 23. Rudolf Virchow remedy for epidemics was: “prosperity, education & liberty”Doctor, Pathologist, Biologist, Politician: first to recognizeLeukemia, elucidated embolism, founded “Social Medicine”founded discipline of Anthropology,
  24. 24. The Constitution of WHO, 1948“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease orinfirmity… a fundamental human right”
  25. 25. Alma Ata Declaration “Economic and social development… is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries.”
  26. 26. Alma Ata Declaration “Involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors…”
  27. 27. Ottawa Charter• The Ottawa Charter for Health Promotion (WHO 1986) identified 8 key determinants (prerequisites) of health:• peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity.
  28. 28. McKeown‟s Thesis
  29. 29. Tuberculosis TB deaths in England4.5 4 BCG Vaccination3.5 32.5 2 Streptomycin1.5 10.5 0 1838 1860 1880 1900 1920 1940 1960 TB deaths* David Werner, Questioning the Solution: The Politics of Primary Health Care and Child Survival,Healthwrights, 1997, p. 76. (cited also in WHO SDH Background papers)
  30. 30. Source: Ravi Narayan, SOCHARA, India
  31. 31. Source: David Sanders, South Africa
  32. 32. Social Determinants of Health• Conditions in the social, physical, and economic environment in which people are born, grow, live, work, and age, including access to health care• Policies, programs, and institutions• Social structure, community factors
  33. 33. Dahlgren and Whitehead, 1991
  34. 34. From Fran Baum
  35. 35. Epidemiology of Inequality
  36. 36. “Unequal distribution of health-damagingexperiences is not in any sense a „naturalphenomenon, but is a result of the toxiccombination of poorsocial policies andprograms, unfaireconomic arrangementsand bad politics.”WHO Commission on SocialDeterminants of Health, 2008
  37. 37. Commission on SocialDeterminants of Health 1. Improve Daily Living Conditions 2. Tackle the Inequitable Distribution of Power, Money, and Resources 3. Measure and Understand the Problem and Assess the Impact of Action.
  38. 38. CSDH Report: Action Areas • Equity from the startDaily Living Conditions • Healthy places- healthy people • Fair employment –decent work • Social protection across the life course • Universal health care • Health Equity in All PoliciesPower, Money and • Fair financingResources • Market responsibility • Gender equity • Political empowerment – inclusion and voice • Good global governanceKnowledge, Monitoring • Monitoring, research, trainingand Skills • Building a global movement Full report downloadable at http://www.who.int/social_determinants/en/ Source: Fran Baum, Flinders University
  39. 39. Basic question: What good does it do to treat people‟s Illnesses …only to send them back to the conditions that made them sick?
  40. 40. The new physician as champion of social determinants approach to health
  41. 41. From Fran Baum
  42. 42. The Power of Medicine "Medicine… has the obligation to point out problems and to attempt their theoretical solution…The physicians are the natural attorneys of the poor…” Dr. Rudolf Virchow Father of Social Medicine
  43. 43. Health for All!Alma Ata, USSR, 1978 Almaty, Kazakhstan, 2008 Thank You Very Much!

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