R眉diger Krech - Social Determina

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					              Social Determinants of Health

                                             Dr Rüdiger Krech

              Director, WHO Department of Ethics, Equity,
                        Trade and Human Rights



1 | Social Determinants of Health, 17 May 2010
                                Why treat people ...




then send them back to the conditions that
            made them sick?
2 | Social Determinants of Health, 17 May 2010
                                                 Outline

 What are the social determinants of health?

 What is WHO doing about it?

 How can health communicators contribute?

 Q&A and further discussion…




3 | Social Determinants of Health, 17 May 2010
         What are the social determinants
                of health (SDH)?
   The circumstances in which people are born, grow up,
   live, work and age, and the systems put in place to
   deal with illness.



                                                 A girl in Lesotho is likely to
                                                 live 42 years less than
                                                 another in Japan.




4 | Social Determinants of Health, 17 May 2010
                             What are inequities?



                                                 The unfair, unjust and
                                                 avoidable causes of ill
                                                 health




5 | Social Determinants of Health, 17 May 2010
        What then influence the SDH and
                  inequities?

                                                 "(The) toxic combination of bad
                                                 policies, economics, and politics
                                                 is, in large measure responsible for
                                                 the fact that a majority of people in
                                                 the world do not enjoy the good
                                                 health that is biologically possible,”

                                                 -WHO Commission on the Social
                                                 Determinants of Health




6 | Social Determinants of Health, 17 May 2010
              Life expectancy at birth (men)
 Glasgow, Scotland (deprived suburb)                                               54
 India                                                                             61
 Philippines                                                                       65
 Korea                                                                             65
 Lithuania                                                                         66
 Poland                                                                            71
 Mexico                                                                            72
 Cuba                                                                              75
 US                                                                                75
 UK                                                                                76
 Glasgow, Scotland (affluent suburb)                                               82
                                       (WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)


7 | Social Determinants of Health, 17 May 2010
                                                 Outline

 What are the social determinants of health?

What is WHO doing about it?
 How can health communicators contribute?

 Q&A and further discussion…




8 | Social Determinants of Health, 17 May 2010
Commission on Social Determinants 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.


9 | Social Determinants of Health, 17 May 2010
                            WHO Streams of Work

 Intersectoral action/ “health in all policies”

 Addressing social determinants in public health
  programmes

 Measuring health inequities and monitoring
  impact of policies on inequities




11 | Social Determinants of Health, 17 May 2010
                              Health in All Policies

“government objectives are best achieved
when all sectors include health and well-
being as a key component of policy
development”
                          -Adelaide Statement on
                       Health in All Policies, 2010.



12 | Social Determinants of Health, 17 May 2010
            Health as a resource for broader
                   government goals
Sector            Interrelationships with health and well-being
Economy and       A resilient ,vibrant and innovative economy depends on a having healthy population. Healthier
employment        people are more productive, experience lower levels of absenteeism, can adapt more easily to work
                  changes, and can remain in the workforce longer.
                  Stable, secure employment and access to health safety nets, improves health across different social
                  groups and workers in both informal or formal sectors of the economy, .
Security and      Security and health both depend upon the same societal conditions, including secure food, water,
justice           sanitation, housing, work opportunities, and the ability to participate in society.
                  Health inequalities result in more violent societies with higher crime, family violence and civil
                  unrest. Mental illness (and associated drug and alcohol problems) can be both a cause and a
                  consequence of crime and imprisonment.
Education         Poor health of children or family members impedes educational attainment, reducing educational
                  potential and abilities to solve life challenges and pursue opportunities.
                  Schools are an optimal setting for health promotion, such as nutrition initiatives. Evidence shows
                  that when children receive a meal at school, attendance and matriculation increases.
Agriculture       Consideration of health and well-being in production, manufacturing and marketing promotes
and the food      consumer confidence, a more sustainable market, and enables innovation and growth.
industry          Healthy and accessible foods are critical for health and growth across the lifespan. Supportive
                  economic and social policy for farming communities enhances their health and well-being.




 13 | Social Determinants of Health, 17 May 2010
                Health sector responsibilities
 Understanding the political agendas and administrative
  imperatives of other sectors;

 Building the evidence base of policy options and
  strategies;

 Assessing comparative health consequences of options
  within the policy development process;

 Creating regular platforms for dialogue and problem
  solving with other sectors;

 Evaluating the effectiveness of intersectoral work and
  integrated policy-making.

14 | Social Determinants of Health, 17 May 2010
                  SDH within health programs

 Few global targets (e.g. MDGs) will be met without
  addressing social determinants

 A social determinants approach mean moving out of
  comfort-zones to work across sectors

 Communication of programmes should focus on
  supporting a critical public policy dialogue

 Equity is a matter of how resources [and power] are
  distributed - all programmes and societies can afford to
  be more equitable.

15 | Social Determinants of Health, 17 May 2010
      Global Plan: Tb eliminated by 2050
                                                                                    10000

                                                          Current trend (0.5%)
                                                              extrapolated          1000




                                                                                            Incidence/million/yr
                                                         Global Plan prediction:    100
                                                          incidence falls 5-6%
                                                                per year

                                                                                    10
                                                         Desired trend

                 Elimination target: 1 / million / year by 2050
                                                                                     1
       1990            2000            2010       2020     2030      2040        2050

16 | Social Determinants of Health, 17 May 2010
PH programmes need to address the SDH
          and health equity




                                                                                  Adherers
                                                                                             Beneficiaries




                                                                   Participants
                                                   Total reached
                           Target Population
       Total Population




 17 | Social Determinants of Health, 17 May 2010
       Social determinants in health programmes:
                 framework for analysis


                                                   Organized the work along a
                                                    common framework

                                                   Three phases
                                                      – Analysis
                                                      – Interventions and implications
                                                      – Measurement




18 | Social Determinants of Health, 17 May 2010
                                                  Outline

 What are the social determinants of health?

 What is WHO doing about it?

 How can health communicators contribute?
 Q&A and further discussion…




19 | Social Determinants of Health, 17 May 2010
 How does communication affect SDH?

 Discovers and reports the “causes of the causes”

 Holds bureaucrats and policy/makers accountable
  for equitable outcomes

 Is a platform for civil society voice




20 | Social Determinants of Health, 17 May 2010
   Questions for health bureaucrats and
              policy/makers
 How are you living up to your responsibility to
  address broader social issues?

 Does this programme/policy combine equity,
  effectiveness and efficiency goals?

 What is your plan to increase equity despite fiscal
  constraint?




21 | Social Determinants of Health, 17 May 2010
                                                  Outline

 What are the social determinants of health?

 What is WHO doing about it?

 How can health communicators contribute?

Q&A and further discussion…




22 | Social Determinants of Health, 17 May 2010
                                              Conclusion

 The majority of factors that contribute to ill health and
  health inequities lie outside the traditional mandate of
  the health sector

 The social determinants of health must be considered
  within health programmes and across government
  policies in order to reach broader societal

 Policy-makers and bureaucrats must be held
  accountable for reducing health inequities




23 | Social Determinants of Health, 17 May 2010

				
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