Aharona glatman freedman social determinants sept 4-5 2013 -

465 views
437 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
465
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Aharona glatman freedman social determinants sept 4-5 2013 -

  1. 1. The Effect of Social and Behavioral Determinants on Immunization Programs Lessons learned from childhood vaccination programs AERAS September 4-5, 2013 Aharona Glatman-Freedman, M.D., M.P.H. Clin. Associate Professor Department of Pediatrics Department of Family and Community Medicine New York Medical College
  2. 2. Non-biological determinants of Immunization Programs
  3. 3. What will happen when a new vaccine for TB is available ? • • • • Introduction Public acceptance Finance Sustainability
  4. 4. Determinants important for the success of Immunization programs Biological Non-biological • Vaccine efficacy • Vaccine safety √ • Epidemiology √ • Economy/Finance √ • Politics/Government • Social environment • Logistics
  5. 5. Determinants important for the success of Immunization programs Biological Non-biological • Vaccine efficacy • Vaccine safety √ • Epidemiology √ • Economy/Finance √ • Politics/Government • Social environment • Logistics
  6. 6. Low Income Countries • • • • • • • • • • Household living conditions Parental education Religious and minority groups Migration War and civil unrest Gender-based inequity Women’s role and power Urban vs Rural residence Program accessibility Traditional healers High- and Middle- Income Countries • Vaccine safety • Information/Misinformation • Internet • Beliefs (religious, cultural, personal) • Immigration • Urban vs Rural residence • Complementary and Alternative Medicine • Financial Factors • Ethical issues
  7. 7. Low Income Countries Social and behavioral determinants • • • • • • • • • • Household living conditions Parental education Religious and minority groups Migration War and civil unrest Gender-based inequity Women’s role and power Urban vs Rural residence Program accessibility Traditional healers
  8. 8. • Childhood vaccines • Basic vaccines Polio, Diphtheria, Pertussis, Tetanus, Measles, BCG
  9. 9. Role of social environment Low Income Countries Availability of immunization services within a walking distance did not always translate to their usage
  10. 10. Low Income Countries Social and behavioral determinants • • • • • • • • • • Household living conditions Parental education Religious and minority groups Migration War and civil unrest Gender-based inequity Women’s role and power Urban vs Rural residence Program accessibility Traditional healers
  11. 11. Low Income Countries Social and behavioral determinants • • • • • • • • • • Household living conditions Parental education Religious and minority groups Migration War and civil unrest Gender-based inequity Women’s role and power Urban vs Rural residence Program accessibility Traditional healers Maternal education Access to higher education
  12. 12. Low Income Countries Social and behavioral determinants • • • • • • • • • • Household living conditions Parental education Religious and ethnic groups Migration War and civil unrest Gender-based inequity Women’s role and power Urban vs Rural residence Program accessibility Traditional healers
  13. 13. Low Income Countries Social and behavioral determinants • • • • • • • • • • Household living conditions Parental education Religious and minority groups Migration War and civil unrest Gender-based inequity Women’s role and power Urban vs Rural residence Program accessibility Traditional healers Infrastructure Surveillance Clean water Electricity – cold chain Transportation Communication Immunization rates
  14. 14. Low Income Countries Social and behavioral determinants • • • • • • • • • • Household living conditions Parental education Religious and minority groups Migration War and civil unrest Gender-based inequity Women’s role and power Urban vs Rural residence Program accessibility Traditional healers http://aidsinafrica1980s.wordpress.com
  15. 15. Low Income Countries Social and behavioral determinants • • • • • • • • • • Household living conditions Parental education Religious and minority groups Migration War and civil unrest Gender-based inequity Women’s role and power Urban vs Rural residence Program accessibility Traditional healers • Each Kilometer matters • Population-specific programs
  16. 16. Low Income Countries Social and behavioral determinants • • • • • • • • • • Household living conditions Parental education Religious and minority groups Migration War and civil unrest Gender-based inequity Women’s role and power Urban vs Rural residence Program accessibility Traditional healers
  17. 17. Determinants important for the success of Immunization programs Biological Non-biological • Vaccine efficacy • Vaccine safety √ • Epidemiology √ • Economy/Finance √ • Politics/Government • Social environment • Logistics
  18. 18. What happens when a new vaccine is introduced? Low-income countries
  19. 19. New Vaccines Low-income countries Vaccine Disease to prevent Hepatitis B Hepatitis / Liver cancer Haemophilus influenza type b Meningitis Epiglotitis Pneumonia Rotavirus Diarrhea Streptococcus pneumoniae Pneumonia Meningitus Neisseria meningitidis A Meningitis Human Papilloma Virus Cervical Cancer
  20. 20. New Vaccines Low-income countries Vaccine Disease to prevent Initial Year of GAVI’s support Hepatitis B Hepatitis/Liver cancer 2000 Haemophilus influenza type b Meningitis Epiglotitis Pneumonia 2000 Rotavirus Diarrhea 2007 Streptococcus pneumoniae Pneumonia Meningitus 2007 Neisseria meningitidis A Meningitis 2011 Human Papilloma Virus Cervical Cancer 2014
  21. 21. Models for Introduction of new vaccines into low-income countries • Haemophilus type b vaccine • Hepatitis B vaccine • The first new vaccines introduced to low income countries
  22. 22. New Vaccine Introduction GAVI-eligible African Nations GAVI phase I (2000-2005) Group I Hib and HepB Group II HepB Group III Neither Benin Cameroon Angola Burkina Faso Comoros Chad Burundi Cote D’Ivoire CAR Gambia Eritrea Congo Ghana Lesotho Congo DR Kenya Madagascar Ethiopia Malawi Mauritania Guinea Mali Mozambique Guinea-Bissau Rwanda Nigeria Liberia Senegal Tanzania Niger Uganda Zimbabwe Sierra-Leone Zambia Togo
  23. 23. New Vaccine Introduction GAVI-eligible African Nations GAVI phase I (2000-2005)
  24. 24. Determinants evaluated • • • • • • • Country population size Life expectancy - males life expectancy – females No. doctors/1,000 people No. nurses/ 1,000 people Financial indicators related to healthcare Country-level Governance Indicators
  25. 25. Determinants evaluated • • • • • • • Country population size No difference Life expectancy – males No difference life expectancy – females No difference No. doctors/1,000 people No difference No. nurses/ 1,000 people No difference Financial indicators related to healthcare Country-level Governance Indicators
  26. 26. Determinants evaluated • Healthcare financial indicators – GHECAP: Government healthcare expenditure per capita – THECAP: Total healthcare expenditure per capita – HEGDP: Total healthcare expenditure as % of GDP • Governance indicators – – – – – – Political stability Government effectiveness Rule of Law Quality control Control of corruption Voice and accountability
  27. 27. Financial healthcare indicators pre-GAVI and the first phase of GAVI's funding Figure 1 50 A Group I (HibHep) Group II (Hep) GHECAP ppp int. $ 40 * Group III (None) ** ** * 30 20 10 0 5 6 7 8 9 0 1 2 3 4 5 199 199 199 199 199 200 200 200 200 200 200 100 80 ppp int. $ THECAP B 60 40 20 5 6 7 8 9 0 1 2 3 4 5 199 199 199 199 199 200 200 200 200 200 200 8 C * 7 6 % HEGDP * 5 4 3 5 6 7 8 9 0 1 2 3 4 5 199 199 199 199 199 200 200 200 200 200 200 Year Glatman-Freedman A. et al. PLoS One 2010, 5 (11) e13802
  28. 28. Governance Indicators pre-GAVI and the first phase of GAVI's funding Figure 2 Group I (HibHep) Group II (Hep) Group III (None) A. Political stability B. Government effectiveness Percentile Rank A B 60 60 50 * * * 40 50 30 30 20 20 10 10 * ** 0 6 8 0 2 3 4 5 199 199 200 200 200 200 200 E. Control of corruption C Percentile Rank D. Quality control D 60 60 50 ** ** ** ** ** ** ** 40 50 30 30 20 20 10 10 * * * * * 0 Percentile Rank * * * * 0 6 8 0 2 3 4 5 199 199 200 200 200 200 200 6 8 0 2 3 4 5 199 199 200 200 200 200 200 F 60 60 50 ** ** * 40 50 40 30 20 ** ** * ** * * 30 20 10 0 * * * * 6 8 0 2 3 4 5 199 199 200 200 200 200 200 Glatman-Freedman A. et al. PLoS One 2010, 5 (11) e13802 ** ** ** ** ** ** 40 E F. Voice and accountability * ** ** ** ** * * 0 6 8 0 2 3 4 5 199 199 200 200 200 200 200 C. Rule of law * * ** ** ** ** ** 40 Year 10 0 * 6 8 0 2 3 4 5 199 199 200 200 200 200 200 Year
  29. 29. Figure 3 Combined Governance Indicator Score pre-GAVI and the first phase of GAVI's funding 60 Group I (HibHep) Group II (Hep) Group III (None) Percentile Rank 50 40 * ** ** ** ** ** ** ** * * * * * 2000 2002 2003 2004 2005 30 20 10 * 0 1996 1998 Year Glatman-Freedman A. et al. PLoS One 2010, 5 (11) e13802
  30. 30. Healthcare Financial Indicators Governance Indicators
  31. 31. QCA - Qualitative Comparative Analysis Pre-GAVI (1995-1999) Glatman-Freedman A. et al. PLoS One 2010, 5 (11) e13802
  32. 32. Healthcare Financial Indicators Governance Indicators Governance - better predictor than Finance for New vaccine introduction
  33. 33. Non-biological Determinants Conclusion • Social and behavioral environment • Governance • Finance Important factors to be considered in the introduction / implementation of vaccination program
  34. 34. New vaccine introduction Non-biological determinants Governance Finance Social and behavioral environment
  35. 35. Acknowledgments • • • • • • • Katherine A. Nichols David W. Britt Victor G. Rodwin Mary-Louise Cohen Robert F. Porges Ivy Rayos Saludes Kevin Steffens

×