Health Equity Presentation @ Istanbul Development Dialogues

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c SEEDs* of Health and Health Equity In the Context of Sustainable Human Development Dr. Ruth Bell Senior Advisor UCL Institute of Health Equity London, UK Dr. Zlatko Nikoloski Assistant Professorial Research Fellow London School of Economics London, UK John Macauley Regional HHD Specialist UNDP Istanbul Regional Hub Istanbul, Turkey * Social, Economic and Environmental Determinants

Transcript of Health Equity Presentation @ Istanbul Development Dialogues

Page 1: Health Equity Presentation @ Istanbul Development Dialogues

c

SEEDs* of Health and Health EquityIn the Context of Sustainable Human Development

Dr. Ruth BellSenior Advisor

UCL Institute of Health Equity London, UK

Dr. Zlatko NikoloskiAssistant Professorial Research FellowLondon School of EconomicsLondon, UK

John MacauleyRegional HHD Specialist

UNDP Istanbul Regional HubIstanbul, Turkey

* Social, Economic and Environmental Determinants

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Promoting Health Equity in EECA

• Supports action for health and well-being in a whole-of-government and whole-of-society approach

• Adopted by all 53 WHO Europe member states, including all EECA countries

• Its two strategic objectives are:

• improving health for all and reducing health inequalities

• improving leadership and participatory governance for health

INTRODUCTION

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Promoting Health Equity in EECA

• SDG 3 and 10 focus on health and inequity explicitly

• Ensure healthy lives and promote well-being for all

• Reduce inequality within and among countries

INTRODUCTION

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Promoting Health Equity in EECA

• SDG 3 and 10 focus on health and inequity explicitly

• Ensure healthy lives and promote well-being for all

• Reduce inequality within and among countries

• Health in All Policies means Health in All SDGs

INTRODUCTION

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INTRODUCTION

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The social, economic and environmental factors constituting the three interlinking pillars of sustainable human development and determine health and its distribution.

80 SEEDs of Health, including

• Social support/community networks

• Transparency and accountability• Housing quality• Access to green spaces• Job creation• Wealth distribution

The absence of avoidable and unjust systematic differences in health between groups with different levels of social advantage and disadvantage

14 Dimensions of Inequity, including

• Gender• Age• Educational attainment• Income• Ethnicity• Sexual orientation• Marginalisation (including

vulnerable migrants, IDP, refugees, prisoners, sex workers and others)

Health Equity

INTRODUCTION

SEEDs of Health

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Health and Wealth

EVIDENCE

0.00 2000.00 4000.00 6000.00 8000.00 10000.00 12000.00 14000.0055.0

60.0

65.0

70.0

75.0

80.0

65.5

68.268.869.470.2 70.570.770.871.2

72.574.174.6 74.875.1 75.2fYRoM76.3

77.5

GDP per capita (US$)

Life

Expe

ctan

cy a

t Birt

h

World Bank, 2014

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Inter-regional and Gender Inequities in average Life Expectancy

EVIDENCE

Turkm

enista

n

Tajiki

stan

Uzbekis

tan

Kazak

hstan

Kyrgy

zstan

Armen

ia

Azerba

ijan

Moldov

a

Albania

Ukraine

Serbi

a

Belarus

Georgi

a

Monten

egro

fYROM

Turke

y

Bosnia

and H

erzeg

ovina

55

60

65

70

75

80

85

Female MaleWHO/Europe average female WHO/Europe average male

Life

Expe

ctan

cy (Y

ears

)

WHO, 2012

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Gender Inequities in Premature NCD Deaths

EVIDENCE

NCD deaths under age 70 as percentage of all NCD deaths

Albania

Georgi

a

Armen

ia

Bosnia

and H

erzeg

ovina

fYROM

Monten

egro

Serbi

a

Ukraine

Turke

y

Azerba

ijan

Belarus

Moldov

a

Uzbekis

tan

Tajiki

stan

Kazak

hstan

Kyrgy

zstan

Turkm

enista

n0

10

20

30

40

50

60

70

80

Female Male

Perc

enta

ge o

f pre

mat

ure

NCD

Deat

hs

Global Health Observatory, 2012

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Ethnic Inequities in Morbidity

0-6 years 7-14 years 15-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65 years and older

0

10

20

30

40

50

60

70

80

Roma non-Roma

Perc

enta

ge R

epor

ting

Illnes

ses

EVIDENCE

Percentage of Roma and non-Roma reporting long-standing illnesses in EECA

Mihailov, 2012

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GDP per capita, growth of GDP per capita, income inequality (Gini), institutional strength (measured by Polity IV index).

• Socioeconomic status/Household wealth

• Gender• Educational attainment• Family Composition (Marital

Status)• Marginalised groups (Migrant

Status)

• Wealth distribution (Gini Coefficient)

• Transparency and accountability in governance (measured by Polity IV Index)

• Social support/community networks

• GDP per capita and GDP per capita growth

• Life satisfaction

Dimensions of Inequity significantly correlated withself-assessed Health

SEEDs of Health significantly correlated with self-assessed Health status

EVIDENCE

* Based on LiTS 2010 Data for Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Slovenia, Tajikistan, Uzbekistan

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Monten

egro

Albania

Uzbekis

tan

Slove

nia BH

Tajiki

stan

Maced

onia

Kyrgy

zstan

Croatia

Serbi

a

Bulgari

a

Azerba

ijan

Roman

ia

Kazak

hstan

Belarus

Russia

Georgi

a

Moldov

a

Ukraine

Armen

ia0

10

20

30

40

50

60

70

80

90

100

Perc

enta

ge re

porti

ng g

ood/

very

goo

d he

alth

Cross-Country Inequity in (average) self-perceived Health

EVIDENCE

Life in Transition Survey, 2010

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• Marginalised groups (for all key population groups studied)

• Socio-economic status (for PWID, SW and prisoners)

• Gender (for PWID and SW), which is related to gender-based violence

• Sexual orientation (for MSM)

• Life course stage

Dimensions of Inequity for HIV • Access to healthcare &

availability of healthcare services

• Discrimination and stigma

• Exposure to violence & effective policing

• Human rights

• Transparency and accountability in governance

• Treatment adherence

SEEDs of HIV

EVIDENCE

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Marginalization and Sexual Orientation-related Inequities in Morbidity

EVIDENCE

I am a prisoner.

I am a man who has sex with other men.

I am an injecting drug user.

I am a sex worker.

PWID MSM SW

9

5.7

2.2

0.9

General adult population

HIV

Prev

alen

ce (%

)

UNAIDS, 2014

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HIV Treatment Coverage (Access to Healthcare)

EVIDENCE

Republic of Moldova

Armenia Kyrgyzstan Belarus Kazakhstan Georgia15

20

25

30

35

40

45

50

Eastern Europe and Central Asia GlobalEast and Southern Africa

HIV

Trea

tmen

t Cov

erag

e (%

)

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International funding as % of total funding for national HIV responses

EVIDENCE

Armenia, 2012

Kyrgyzstan, 2013

Moldova, 2013

Georgia, 2014

Ukraine, 2010

Belarus, 2013

Kazakhstan, 2013

Russia, 2008

0 10 20 30 40 50 60 70 80 90 100

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E-Discussion Feedback: UNDP’s Role in Addressing Health Equity & HIV

PROGRAMMATIC ACTION

Outreach and Contributions

• 3 Mailouts to 2000+ direct contacts

• #TalkInequality 76 Tweets, 107 Retweets, 54 Likes and counting

• 16 contributions from UKR(5), TUR(4), SRB (2), BLR, TAJ, UZB, US and NZ including UNDP (7), CSO (5), Academia and Government

Engage the whole of government and society to • forge alliances between health and

other sectors• promote human rights • empower civil society

Support the SDGs and Health 2020 and build commitment to address HIV as part of the health equity and sustainable human development agendas

Support programmatic action to• build capacities • improve allocative and technical

efficiency • facilitate collaboration and knowledge

exchange

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Accumulation of positive and negative effects on health and

wellbeing

Life course stages

Pre-natal

Family Building

Pre-school School Training Employment Retirement

PROGRAMMATIC ACTION

Life Course Approach: Adding Value for Development Programming

Macro-level Context: Sustainable Development

Systems: GovernanceWider Society: Resilience

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• Fully operational

• Agreed Work Plan and Agency Division of Labor

• Reporting to the Regional Director’s Working Group across all agencies

• First issue based coalition for operationalizing the SDGs

• Other Coalitions to be developed on gender and migration

Regional UN Inter-Agency Thematic Group on NCDs and SEEDs of Health

PROGRAMMATIC ACTION

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PROGRAMMATIC ACTION

Procurement Support Services to The Ministry of Health of Ukraine

Global Fund Partnership: HIV, Tuberculosis and Malaria

“We have broken a big corruption scheme in medicine procurements (…) and several-fold price reduction for some drugs serves as a direct proof.” - Egor Sobolev, Chairman Verkhovna Rada Committee on Preventing and Fighting Corruption

• In Kyrgyzstan, local Tuberculosis Centers increased average fund delivery rates from 5% to 85-95%

• In Belarus, 37,000 people access anonymous counselling, 700 patients receive methadone and 70,000 prisoners access HIV services as of 2011

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Phase I: SEEDs of H/HE Analysis of UNDP Eurasia Project Portfolio

• Develop SEEDs screening tool

• Monitor co-benefits for health & development

• Scale up

• Disseminate

Phase II: Integration of SEEDs of H/HE in Belarus Country Portfolio

PROGRAMMATIC ACTION

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THANK YOU FOR YOUR ATTENTION.

Dr. Christoph HamelmannRegional Team Leader (EECA), Senior Advisor (Arab States), HHD, Coordinator, Secretariat UN iIATT SPHS

[email protected]: @cahamelmann

John MacauleyRegional Programme Specialist, HHD (EECA)

[email protected]: @johnmacauley

Esther WerlingConsultant, SEEDs of Health and Health Equity, HHD (EECA)

[email protected]: @estherwerling

Dr. Ruth Bell Senior AdvisorUCL Institute of Health Equity

[email protected]

Dr. Zlatko NikoloskiAssistant Professorial Research FellowLondon School of Economics

[email protected]