Social Determinants of Health Inequities

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Lecture given during the pre-APRM workshop on Social Determinants of Health and Global Health Equity, September 11, 2012, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur

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Social Determinants of Health Inequities

  1. 1. Social Determinants of Health InequitiesRamon Lorenzo Luis Rosa Guinto, MD Regional Coordinator for the Asia-Pacific 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. Source: Ravi Narayan, SOCHARA, India
  3. 3. Source: Ravi Narayan, SOCHARA, India
  4. 4. Source: Ravi Narayan, SOCHARA, India
  5. 5. Source: Ravi Narayan, SOCHARA, India
  6. 6. Source: Ravi Narayan, SOCHARA, India
  7. 7. 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
  8. 8. 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,
  9. 9. 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”
  10. 10. 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.”
  11. 11. 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…”
  12. 12. 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.
  13. 13. McKeown’s Thesis
  14. 14. 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)
  15. 15. Source: Ravi Narayan, SOCHARA, India
  16. 16. Source: David Sanders, South Africa
  17. 17. 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
  18. 18. Dahlgren and Whitehead, 1991
  19. 19. From Fran Baum
  20. 20. From Fran Baum
  21. 21. Commissioners• Sir Michael Marmot (Chair)• 18 others representing academics, politicians, civil society, senior public health bureaucrats
  22. 22. “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
  23. 23. 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.
  24. 24. 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
  25. 25. Basic question: What good does it do to treat people’s Illnesses …only to send them back to the conditions that made them sick?
  26. 26. World Conference on SDH “To engage high level political support to make progress on national policies to address socialdeterminants of health to reduce health inequities”
  27. 27. Five Thematic Areas• Adopt better governance• Promote participation• Reorient the health sector• Strengthen global cooperation• Monitor progress and increase accountability
  28. 28. Major Achievements• Revival of the Alma Ata spirit• Governments start speaking the SDH language• WHO engagement with civil society
  29. 29. The New “Alma Ata”?• It needed to be said again.• We know a great deal more than we did.• The CSDH gave practical direction to realize Alma Ata.
  30. 30. Major Criticisms• Avoided the crucial questions – structural determinants of health• Lack of coherence with other pressing global issues• Rio Declaration drafted behind closed doors – lack of ambition
  31. 31. 1 billion undernourished people in the developing worldIFPRI, Global Hunger Index 2010
  32. 32. two billion people are overweight
  33. 33. 3 drivers of dietary change1. Liberalisation of international food trade2. Increased foreign direct investment3. Globalised advertising and marketing Source: Sharon Friel, Australia
  34. 34. Top 10 manufacturers of packaged foods Three quarters of world food sales involve processed foods, for which the largest manufacturers hold over a third of the global market.Stuckler et al (2012) Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities IncludingProcessed Foods, Alcohol, and Tobacco. PLoS Med 9(6): e1001235. doi:10.1371/journal.pmed.1001235
  35. 35. CALL TO ACTION
  36. 36. POOR GLOBAL HEALTH SICK WORLD HEALTH INEQUITY within and among nations SOCIAL, POLITICAL, ECONOMIC,CULTURAL, AND ENVIRONMENTAL Determinants of Health
  37. 37. SDH to shape the post-MDG world eradicate extreme improve maternal poverty and health hunger achieve universal combat HIV/AIDS, primary malaria and other education diseasespromote gender equality ensure environmental and empower women sustainability reduce child develop a global mortality partnership for development
  38. 38. The Global Health System and the link to other Sectors
  39. 39. Revitalize the SDH movement and enhance capacity for SDH actionat national and sub-national levels
  40. 40. Transformative scale-up of medicaleducation – integrate SDH thinking
  41. 41. The new physician as champion of social determinants approach to health
  42. 42. From Fran Baum
  43. 43. 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
  44. 44. The Power of Young People“The youth arethe hope of the Fatherland.” Dr. Jose Rizal National Hero of the Philippines
  45. 45. Fathers of Social Medicine
  46. 46. Health for All!Alma Ata, USSR, 1978 Almaty, Kazakhstan, 2008 Thank You Very Much!

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