Commission on Social Determinants of Health Commission and... · action on the social determinants...
Transcript of Commission on Social Determinants of Health Commission and... · action on the social determinants...
World Health Organization
Commission on Social Determinants of Health
Hernan SandovalCommissioner for the CSDH
Regional ConsultationBrazzaville, Congo
27 July 2005
World Health Organization
Presentation Outline
WHAT WE MEAN BY SOCIAL DETERMINANTS OF HEALTH (SDH)
WHY THEY MATTER
WHY A COMMISSION ON SDH?
HOW THE CSDH WILL OPERATE
EXPECTED OUTCOMES
World Health Organization
Social Determinants and Health Disadvantage Source: Adapted from Diederichsen and Hallqvist 1998 Challenging inequities in health
Social Context
Policy Context
Social Position
Specific exposure
Disease / injury
Social Consequences of ill health
IV
II
I
I
III
World Health Organization
Social Determinants and the Spectrum of Health Disadvantage
Risks to ill-health–Exposures–Vulnerabilities/susceptibilities
Access to health services–Location, appropriateness, affordability
Consequences of ill-health–Work-related income loss–Costs associated with providing care
World Health Organization
PRINCIPLES TO INFORM POLICY
Socio-political Context
Community participation in
decisions
Intersectoral action
Effective interventions
MA
IN P
OLI
CY
ENTR
Y PO
INTS
Decrease differential exposure
Decrease differential vulnerability
Decrease differential access
Decrease differential consequences
Decrease social stratification
Adapted model Diderichsen and Mackenbach
World Health Organization
Presentation Outline
WHAT WE MEAN BY SOCIAL DETERMINANTS OF HEALTH (SDH)
WHY THEY MATTER
WHY A COMMISSION ON SDH?
HOW THE CSDH WILL OPERATE
EXPECTED OUTCOMES
World Health Organization
What good does it do to treat people's illnesses ...
then send them back to the conditions that made them sick?
World Health Organization
A very complex health development landscape…Outcomes-based development"Scaling Up!"Growing rapidly: from millions to billionsPredominant disease/intervention program (vertical) focus Unsatisfactory performance of health systems
World Health Organization
Grand challenges in systems performance
Scale --- safe, proven and cheap interventions not reaching those in needDistribution --- those with unmet needs are disproportionately those with lesser meansProtection/Safety --- too many are worse off through encounters with the health system
World Health Organization
JLI report JLI report recommends at least recommends at least
1,000,0001,000,000health workers health workers required in SSA required in SSA
over next 6 years to over next 6 years to ensure access to ensure access to essential health essential health interventions.interventions.
More informationhttp://www.globalhealthtrust.org
World Health Organization
Trends in skilled birth attendance by income quintileEgy[t
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
1 2 3 4 5
199520001992
Indonesia
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
1 2 3 4 5
199419971991
Zimbabwe
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
1 2 3 4 5
199419991988
Bolivia
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
1 2 3 4 5
199419981989
World Health Organization
Number of People Suffering Financial Catastrophe and Impoverishment due to Health Spending
- 30 60 90
WPR
AMR
SEA
EUR
AFR
EMR
Number of people (million)
impoverishment
catastrophic
World Health Organization
Risk and Treatment Disparities in Tuberculosis, Kenya 2003
01020304050607080
% of patients surveyed
Expected Cases Rx Completion
PoorNon Poor
Adapted from Hanson et al 2003
World Health Organization
Tuberculosis Treatment Disparities, Kenya
DOTS for Rx of Smear +ve
TB
Expected Efficacy
Case detection
Diagnostic delay
Visits to providers
Patient Adherence
Cost of Care
Actual Effectiven
ess
Least Poor:PoorestRatio
Poorest 98% low high high
low
high 20%
Least Poor 98% high low
high
high low 80%4
Sources of disparities
More equitable service provision requires action on the social determinants of health
Adapted from data from Hanson et al 2003 and from framework of Peter Tugwell
World Health Organization
Why are poorer populations…
Two times more likely to have TB?Three times less likely to access care for TB?Four times less likely to complete TB treatment?Five (?) times more likely to incur impoverishing payments for TB care?
World Health Organization
Presentation Outline
WHAT WE MEAN BY SOCIAL DETERMINANTS OF HEALTH (SDH)
WHY THEY MATTER
WHY A COMMISSION ON SDH?
HOW THE CSDH WILL OPERATE
EXPECTED OUTCOMES
World Health Organization
C-PHC S
-PHC Reforms & Minimum Packages
MDG S
caling-up
1978
1993
2000
2001
2002
1982
Social dimensions of health affirmed in WHO Constitution (1948), downplayed during 1950s era of disease campaigns.
Determinants re-emerge under Health for All agenda (1970s), action falters in 1980s.
1990s: paradigm of health as "private" issue dominant; some exceptions.
2000s: "pendulum swing" and new chance for action.
History: trends and opportunities
1948
2005
2005 Commission social Determinants of Health
World Health Organization
Why do we think the CSDH can do better?
Will learn historical lessons, build on gains of previous erasMillennium Development Goals indicate a policy space– adopted by 189 countries– intersectoral connections– health central– health MDGs require action
on social determinants
World Health Organization
Presentation Outline
WHAT WE MEAN BY SOCIAL DETERMINANTS OF HEALTH (SDH)
WHY THEY MATTER
WHY A COMMISSION ON SDH
HOW THE CSDH WILL OPERATE
EXPECTED OUTCOMES
World Health Organization
A broad consultative processJan 05:
CSDH discussed at WHO Executive Board
May 04:
D-G Lee announces CSDH at WHA
June 04:
major meeting with int'l public health experts, London
Dec 2003 Present
From Feb 2004: consultations in WHO HQ and Regions
From June 2004: outreach to civil society
From July 2004: initial contacts with potential partner countries
From Aug 2004: linking with UN agencies and projects (FAO, ILO, MP, etc)
World Health Organization
IMPROVED HEALTH & HEALTH EQUITY
AdvocacyAdvocacyLearningLearningActionAction
Integrating Social Determinants of Health into Policy and Programs
Communication/ExchangeCommunication/Exchange
LeadershipLeadership
World Health Organization
Strategic decisionsEvidence/learning
Evidence is knowledge for action Prioritize learning in developing countriesFocus on limited number of determinants
Leadership/advocacyKeep it real: meetings sited to engage real experience of social disadvantageEngaging civil society is key for sustainabilityFocus on promoting action on SDH policy/programs that differ by country
World Health Organization
Phases of work
Produce policy & Produce policy & institutional changeinstitutional change
Expand policy interest,Expand policy interest,ScaleScale--up & up &
Develop communities of practiceDevelop communities of practice
Building knowledge Building knowledge & leadership& leadership
Jan 05- Dec 06
Jan 06- Dec 07
Jan 08-
World Health Organization
Commission report; WHO institutional Commission report; WHO institutional Integration; public lobbies; countryIntegration; public lobbies; country
and global championsand global champions
Regional, international, Global Regional, international, Global policy interest and practice, policy interest and practice,
societal debate on SDHsocietal debate on SDH
Organised knowledge, Organised knowledge, Country models, Country models, visible leadershipvisible leadershipJan 05-Dec 06
Jan 06-Dec 07
Jan 08-May 08
Outcomes across phases of work
World Health Organization
Presentation Outline
WHAT WE MEAN BY SOCIAL DETERMINANTS OF HEALTH (SDH)
WHY THEY MATTER
WHY A COMMISSION ON SDH
HOW THE CSDH WILL OPERATE
EXPECTED OUTCOMES
World Health Organization
Progress can be achieved in short time periods
In 7 years In 9 years In 15 yearsLIFE
EXPECTANCYPOTABLEWATER
PRIMARY SCHOOL ENROLLMENTPOVERTY
15m56 yrs 33% 89%
46%48 yrs 18%7m
Botswana1970 - 85
Sri Lanka1946 - 53
South Africa1994-2001
China1990 - 99
World Health Organization
CSDH's vision of a changed world
Local, national and global institutions using knowledge on SDH to implement public policy that
affects health
SDH are understood, widely debated and
recognised as importantLeadership, public
interest and capable institutions sustain policy and action
SDH incorporated into WHO planning, policy and technical work
World Health Organization
Social determinants incorporated into national policy processes.
Knowledge consolidated, gaps clarified for action.
Working with selected country towards improving health and reducing inequities.
Incorporation of social determinants of health into the strategy and program of WHO.
CSDH Outcomes
Poverty and painting: representations in
19th century EuropePhilippa
Howden-Chapman, Johan Mackenbach
BMJ VOLUME 325 21–28 DECEMBER 2002
Poverty and painting: representations in 19th
century EuropePhilippa Howden-Chapman,
Johan MackenbachBMJ VOLUME 325 21–28
DECEMBER 2002