PROGRESS ON COMMISSION ON PROGRESS ON COMMISSION ON SOCIAL DETERMINANTS OF SOCIAL DETERMINANTS OF

HEALTHHEALTH

Sir Michael MarmotChair of the Commission on

Social Determinants of Health

Key MessagesKey Messages

Social, economic and political circumstances Social, economic and political circumstances affect life and well-being and health;affect life and well-being and health;

Policies should address early life development, Policies should address early life development, working age, and ageing;working age, and ageing;

Action on the determinants of health should Action on the determinants of health should involve the whole of government;involve the whole of government;

Action on SDH should be founded on evidence.Action on SDH should be founded on evidence.

Health Equity & Core ValuesHealth Equity & Core Values

Health equity can be defined as:Health equity can be defined as:– ““TThe absence of he absence of unfair and avoidableunfair and avoidable or remediable or remediable

differences in health among groups defined socially, differences in health among groups defined socially, economically, demographically or geographically“; economically, demographically or geographically“;

– Both within countries and between countriesBoth within countries and between countries

Governments are accountable; Governments are accountable;

Tackling health inequities requires action on Tackling health inequities requires action on SDH.SDH.

Commission ActivitiesCommission Activities

A Structure of Work StreamsA Structure of Work Streams

CommissionersCommissioners Knowledge NetworksKnowledge Networks Country WorkCountry Work Civil Society Work Civil Society Work Global InitiativesGlobal Initiatives WHO Reference GroupWHO Reference Group

Commissioner MeetingsCommissioner Meetings

Chile – March 2005Chile – March 2005

Egypt – May 2005Egypt – May 2005

India – September 2005India – September 2005

Iran – Jan 2006Iran – Jan 2006

Kenya – June 2006Kenya – June 2006

Brazil – Sept 2006Brazil – Sept 2006

CSDH Knowledge – the Causes of the CausesG

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CULTURE, RELIGION, SOCIAL SYSTEM, HUMAN RIGHTS, LABOUR MARKET,

EDUCATION SYSTEM

INCOME, EDUCATION, GENDER, ETHNICITY, AGEING

LIVING AND WORKING CONDITIONS, HEALTH-RELATED BEHAVIOURS

BIOLOGICAL PROCESSES

HEALTH

SOCIAL CONTEXT

STRUCTURAL DETERMINANTS

INTERMEDIARY DETERMINANTS

Integrating Knowledge for ActionIntegrating Knowledge for Action

Commission’s SDH Thematic AreasCommission’s SDH Thematic Areas

Sonia was born to a poor family in a remote rural village. With no formal schooling, her mother works as casual labour. Her father is

unemployed, after losing his small-holding to creditors. She attends a local primary school, when she is not looking after her younger brothers, and when she is not sick. She has had bouts of illness

from birth, but has given up going to the health centre where she is looked down on and treated badly, and rarely has the money to pay

the fees.

Ageing

MigrationAid

Mental Health

Env. Change

Alcohol

Food

Rural Settings

Psychosocial

Medical Education

Education

Violence

GenderSocial Excl

Globalisation

Health Systems

Urban Settings PPHC

Working Conditions

ECD

Evidence/Measurement

Putting Knowledge to WorkPutting Knowledge to WorkThe Globalisation KN looks both at ways in which The Globalisation KN looks both at ways in which globalisation can improve social and economic globalisation can improve social and economic conditions, and at how it needs to be fair;conditions, and at how it needs to be fair;The Employment Conditions KN looks at how The Employment Conditions KN looks at how processes of global economic integration and power processes of global economic integration and power relations at the local level interact to affect conditions relations at the local level interact to affect conditions of labour;of labour;The Urban Settings KN looks at the natural, physical, The Urban Settings KN looks at the natural, physical, social and economic capital of the urban environment;social and economic capital of the urban environment;Urbanisation is understood in the context of rural Urbanisation is understood in the context of rural issues such as patterns of land-holding, and food issues such as patterns of land-holding, and food access and availability.access and availability.

Putting Knowledge to WorkPutting Knowledge to WorkThe Gender KN focuses on disparities between the The Gender KN focuses on disparities between the sexes in opportunities for participation along the life sexes in opportunities for participation along the life course;course;

The Health Systems KN focuses on cross-government The Health Systems KN focuses on cross-government stewardship for health, in which the health care system stewardship for health, in which the health care system plays a central role;plays a central role;

The Early Child Development KN is working to The Early Child Development KN is working to strengthen approaches to physical, emotional and strengthen approaches to physical, emotional and cognitive development from the beginning;cognitive development from the beginning;

The Social Exclusion KN emphasises the impact The Social Exclusion KN emphasises the impact across society of selective marginalisation of groups.across society of selective marginalisation of groups.

CSDH Country WorkCSDH Country Work

AMRO / PAHOAMRO / PAHO ChileChile ( (Formal Partner)Formal Partner) Brasil Brasil ((Formal Partner)Formal Partner) Canada Canada ((Formal Partner) Formal Partner) BoliviaBolivia ( (Formal Partner)Formal Partner)Peru (Peru (Formal Partner)Formal Partner)Nicaragua Nicaragua (Exploring) (Exploring)

EUROEUROSweden Sweden (Formal Partner)(Formal Partner)England (England (Formal Partner)Formal Partner)KyrgyzstanKyrgyzstan (Formal Partner)(Formal Partner)Norway Norway (Exploring)(Exploring)

AFROAFROKenyaKenya (Formal Partner) (Formal Partner) Senegal Senegal (Exploring(Exploring) ) Mozambique Mozambique (Sending Letter - (Sending Letter - Exploring)Exploring)Malawi Malawi (Exploring)(Exploring)Tanzania Tanzania (Exploring)(Exploring)Zambia Zambia (Exploring) (Exploring)

WPROWPROMongolia Mongolia (Exploring)(Exploring)New Zealand New Zealand (Exploring)(Exploring)

EMROEMROIran Iran (F(Formal Partner) ormal Partner) Exploring with regional officeExploring with regional office

SEAROSEAROIndia India (Exploring)(Exploring)Sri-Lanka Sri-Lanka (Formal Partner)(Formal Partner)

Country Knowledge into ActionCountry Knowledge into Action

Developing a national SDH equity plan of action, and participatory process;

– Whole of government, cross-sectoral action to address the disadvantages Sonia experiences;

Baseline situation analysis and implementation/ evaluation of specific policies/programmes;

– Recognising, identifying and acting on community needs.

Setting up national health equity information systems;– Ensuring sustainable and timely information to underpin

government strategy

Making the economic case for investing upstream in health;– Increasing investment in the causes of the causes

Building evidence and knowledge of good practice;– Strengthening the community of knowledge– Capacity building

Civil SocietyCivil Society

Plurality of perspectives, and direct representation

Understanding how civil society can effect policy

Partnership strengthening the sustainability of the SDH movement

Civil Society WorkCivil Society Work

Regional Meeting

National Meeting

Country Participants

Update Regional and Regional activitiesUpdate Regional and Regional activities

Global InitiativesGlobal Initiatives

Global TargetsGlobal Targets

Ageing

MigrationAid

Mental Health

Env. Change

Alcohol

Food

Rural Settings

Psychosocial

Medical Education

Education

Violence

GenderSocial Excl

Globalisation

Health Systems

Urban Settings PPHC

Working Conditions

ECD

Evidence/Measurement

Global Fora

Donors

Regional Orgs.

UN

IFIs

Global InitiativesGlobal Initiatives

Engage global institutions Engage global institutions – To foster globalisation that protects equity;To foster globalisation that protects equity;– To take into account equity in health in their policies, and To take into account equity in health in their policies, and

support national policy space for health;support national policy space for health;– To increase investments towards action on social To increase investments towards action on social

determinants of health .determinants of health .

Engaging with multiple stakeholders, including G8, the Engaging with multiple stakeholders, including G8, the World Bank, ECOSOC, the UN;World Bank, ECOSOC, the UN;

Aiming regionally (in LAC) to engage with ECLAC, Aiming regionally (in LAC) to engage with ECLAC, OAS, IADB and others.OAS, IADB and others.

CSDH: Reporting and ActionCSDH: Reporting and Action

Value Statement

Sept 06 Dec 06 Mar 07 Jun 07 May 08

Interim Statement

Final Report

Brasil meeting endorsement

KN products inflow Other work streams inflow

2008: A Global Launch2008: A Global Launch

A historical opportunity? 1948-1978-2008;

A global media launch – CNN;

A global movement – a critical mass of world leadership;

Engaging all levels – heads of state, country governments, regional champions – to build and institutionalise sustainable commitment to the SDH agenda.

Joint meeting of global Commission on Social Determinants Joint meeting of global Commission on Social Determinants of Health and Brazilian National Commission on Social of Health and Brazilian National Commission on Social

DeterminantsDeterminants

An opportunity to explore collaboration around:An opportunity to explore collaboration around:

Knowledge, advocacy and action;Knowledge, advocacy and action;

At national, regional and global levelAt national, regional and global level– Nordic, Asian and Latin AmericanNordic, Asian and Latin American