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Addressing the social determinants
of noncommunicable diseases

Brian Lutz
Policy Specialist: AIDS and MDGs
HIV, Health and Development Practice
Bureau for Development Policy, UNDP
Jessy’s and other women’s stories at http://www.nytimes.com/2013/10/16/health/uganda-fights-stigmaand-poverty-to-take-on-breast-cancer.html
Video: http://www.nytimes.com/2013/10/16/health/uganda-fights-stigma-and-poverty-to-take-on-breastcancer.html#videoModal
Culture and identity

Poverty

Stigma

Health care

Transport

Education
http://www.undp.org/cont
ent/undp/en/home/library
page/hiv-aids/discussionpaper--addressing-thesocial-determinants-ofnoncommu/
NCDs are a development issue

NCDs have social determinants

Action on social determinants of
NCDs is possible and necessary
What are NCDs and their risk factors?

Source: Global status report on noncommunicable diseases 2010. Geneva: WHO, 2010
NCDs are a large and growing health challenge
100%
80%

Deaths
globally

60%
40%

65%

68%

74%

1990

20%

57%

2010

2015

2030

0%

Deaths in lowincome
countries

100%
80%
60%
40%
20%
0%

54%

2015

Deaths in lower
middle-income
countries

42%

2030
Other

100%
80%
60%
40%

NCDs
60%

69%

2015

20%

2030

0%

Source: Lozano et al. 2012; WHO projections of mortality and causes of death
(http://www.who.int/healthinfo/global_burden_disease/projections/en/)
Addressing the Social Determinants of Noncommunicable Diseases
NCDs also negatively impact human development

•
•
•

Macroeconomic
Premature morbidity
Premature mortality
Lost income, employment

NCDs and risk
factors

MDGs

•
•
•

•
•
•

Household
Higher healthcare expenses
Diversion of labour
Stigma and discrimination

Health system costs
Strain on health budgets
Diversion scarce resources
Worsening risk pools

Source: see, e.g., Bloom et al. 2011; Global status report on noncommunicable diseases 2010. Geneva: WHO,
2010; Swartz 2010; Mahal et al. 2009
NCDs are a development issue

NCDs have social determinants

Action on social determinants of
NCDs is possible and necessary
Social choices drive NCD epidemics

NCD examples

Social (structural)
determinants

Trade
Food/ ag policy
Employment
Urbanization
Social protection
Housing
Norms
Exclusion
Governance

More non-health sector

Risk factors

Biological and
behavioral risk
factors
• Obesity
• Tobacco use

Health-seeking
behavior

Health – level
and distribution

NCD morbidity and
mortality
• Cardiovascular
diseases

Examples follow

More health sector
CVD shows inequities by socio-economic status
Cardiovascular mortality (aged 45-64) by district socio-economic level in Porto Alegre,
Brazil, 2008

Source: Bassanesi et al. 2008
Social gradients in obesity differ across countries
Obesity prevalence in women by education status in countries at different levels of
economic development

Source: Monteiro et al. 2004
The poor in poorer countries smoke more

Smoking prevalence by income quintiles

Source: Global atlas on cardiovascular disease prevention and control. WHO, World Heart Federation and World Stroke Organization, 2011
Source: Hawkes 2006
NCDs are a development issue

NCDs have social determinants

Action on social determinants of
NCDs is possible and necessary
Overarching frameworks exist
2003

WHO Framework Convention on Tobacco Control

2004

Global Strategy on Diet, Physical Activity and Health

2008

Action Plan for the Global Strategy for the Prevention
and Control of NCDs 2008-2013

2010

Set of Recommendations on the Marketing of Foods
and non-Alcoholic Beverages to Children

2010

Global Strategy to Reduce Harmful Use of Alcohol

2011

WHO ‘Best Buys’

2013

NCD Global Monitoring Framework (GMF)

2013

The Revised Global Action Plan for the Prevention and
Control of NCDs 2013-2020
Typology of multisectoral action
NCD-specific: ban of tujilijili in Zambia

Source: http://www.add-resources.org/liquor-sachets-banned-in-zambia.5043749-76586.html; http://allafrica.com/stories/201204160957.html
NCD-sensitive: housing experiment in the USA

Less obesity
Less diabetes
Source: Orr et al. 2003; Moving to Opportunity for Fair Housing Demonstration
Program: Final Impacts Evaluation. US Department of Housing and Urban
Development (HUD), 2011
Framework for action on SDH outside the health sector
Thank you !

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Addressing the Social Determinants of Noncommunicable Diseases

  • 1. Addressing the social determinants of noncommunicable diseases Brian Lutz Policy Specialist: AIDS and MDGs HIV, Health and Development Practice Bureau for Development Policy, UNDP
  • 2. Jessy’s and other women’s stories at http://www.nytimes.com/2013/10/16/health/uganda-fights-stigmaand-poverty-to-take-on-breast-cancer.html Video: http://www.nytimes.com/2013/10/16/health/uganda-fights-stigma-and-poverty-to-take-on-breastcancer.html#videoModal
  • 5. NCDs are a development issue NCDs have social determinants Action on social determinants of NCDs is possible and necessary
  • 6. What are NCDs and their risk factors? Source: Global status report on noncommunicable diseases 2010. Geneva: WHO, 2010
  • 7. NCDs are a large and growing health challenge 100% 80% Deaths globally 60% 40% 65% 68% 74% 1990 20% 57% 2010 2015 2030 0% Deaths in lowincome countries 100% 80% 60% 40% 20% 0% 54% 2015 Deaths in lower middle-income countries 42% 2030 Other 100% 80% 60% 40% NCDs 60% 69% 2015 20% 2030 0% Source: Lozano et al. 2012; WHO projections of mortality and causes of death (http://www.who.int/healthinfo/global_burden_disease/projections/en/)
  • 9. NCDs also negatively impact human development • • • Macroeconomic Premature morbidity Premature mortality Lost income, employment NCDs and risk factors MDGs • • • • • • Household Higher healthcare expenses Diversion of labour Stigma and discrimination Health system costs Strain on health budgets Diversion scarce resources Worsening risk pools Source: see, e.g., Bloom et al. 2011; Global status report on noncommunicable diseases 2010. Geneva: WHO, 2010; Swartz 2010; Mahal et al. 2009
  • 10. NCDs are a development issue NCDs have social determinants Action on social determinants of NCDs is possible and necessary
  • 11. Social choices drive NCD epidemics NCD examples Social (structural) determinants Trade Food/ ag policy Employment Urbanization Social protection Housing Norms Exclusion Governance More non-health sector Risk factors Biological and behavioral risk factors • Obesity • Tobacco use Health-seeking behavior Health – level and distribution NCD morbidity and mortality • Cardiovascular diseases Examples follow More health sector
  • 12. CVD shows inequities by socio-economic status Cardiovascular mortality (aged 45-64) by district socio-economic level in Porto Alegre, Brazil, 2008 Source: Bassanesi et al. 2008
  • 13. Social gradients in obesity differ across countries Obesity prevalence in women by education status in countries at different levels of economic development Source: Monteiro et al. 2004
  • 14. The poor in poorer countries smoke more Smoking prevalence by income quintiles Source: Global atlas on cardiovascular disease prevention and control. WHO, World Heart Federation and World Stroke Organization, 2011
  • 16. NCDs are a development issue NCDs have social determinants Action on social determinants of NCDs is possible and necessary
  • 17. Overarching frameworks exist 2003 WHO Framework Convention on Tobacco Control 2004 Global Strategy on Diet, Physical Activity and Health 2008 Action Plan for the Global Strategy for the Prevention and Control of NCDs 2008-2013 2010 Set of Recommendations on the Marketing of Foods and non-Alcoholic Beverages to Children 2010 Global Strategy to Reduce Harmful Use of Alcohol 2011 WHO ‘Best Buys’ 2013 NCD Global Monitoring Framework (GMF) 2013 The Revised Global Action Plan for the Prevention and Control of NCDs 2013-2020
  • 19. NCD-specific: ban of tujilijili in Zambia Source: http://www.add-resources.org/liquor-sachets-banned-in-zambia.5043749-76586.html; http://allafrica.com/stories/201204160957.html
  • 20. NCD-sensitive: housing experiment in the USA Less obesity Less diabetes Source: Orr et al. 2003; Moving to Opportunity for Fair Housing Demonstration Program: Final Impacts Evaluation. US Department of Housing and Urban Development (HUD), 2011
  • 21. Framework for action on SDH outside the health sector