Social Determinants of Health: Concepts & Regional Experience - - PowerPoint PPT Presentation

Social Determinants of Health: Concepts & Regional Experience

Abdi Momin Ahmed WHO Regional Advisor, Health Policy & Planning

Capacity Development Workshop

Tehran 11-15 July, 2010,

Objectives of the Presentation

Define Social Determinants of Health &

Health Equity Concepts Sh th R i l E i i T kli

Share the Regional Experience in Tackling

SDH through national health systems

Discuss health systems as determinants of

Health

Why treat people… Why treat people…

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then send them back to the conditions that made them sick? then send them back to the conditions that made them sick?

Population health: Definition

Is both a description & a concept that underlies the discussion of health disparities. It is concerned with the living and working g g environments that affects people's health, the conditions that enable and support people in making health choices, and the services that promote and maintain health.

PHAC, 1997

Public health?

Is the combination of science, practical skills,

and values directed to the maintenance and improvement of health of all people. It is a set of p p p efforts organized by society to protect, promote, and restore the people’s health through collective and social action…………..Public health activities change with changing technology and values but the goal remains the same.

The WHO Commission on Social Determinants of Health (CSDH

It completed its initial work in May 2008 with 20

commissioners to provide evidence on policies that improve health by addressing the social conditions which people live & work. G l Goals:

To support policy change in countries by promoting

models & practices that effectively address the SDH

To support countries in placing health as a shared goal

to which many institutions contribute

To help build a sustainable global movement for action

• n health equity & SDH

What are the social determinants of health?

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Definitions and typology

“The social determinants of health refer to both

specific features and pathways by which societal conditions affect health and that potentially can be altered by informed action.”

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potentially can be altered by informed action.

Source: Krieger N. A glossary for social epidemiology. J Epidemiol Community Health 2001; 55:693-700

Two categories of social determinants:

structural – “fundamental structures of social hierarchy intermediate - “socially determined conditions in which

people are born, grow, live, work and age”

Themes underpinning SDH

Health equity

The absence of systematic disparities in health (or

its social determinants) between more or less advantaged groups, or geographical areas.

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The right to health

“The enjoyment of the highest attainable standard of

health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” (WHO

Constitution 1946).

What is health inequality?

Is a generic term used to designate differences,

variations, & disparities in health achievements & risk factors of individuals & groups

• not imply a moral judgment
• it may result from a personal choice

Some inequalities reflect random variations (unexplained

causes

Others result from individual biology, personal choices,

social organization, economic opportunity, or access to health care

What is health inequity?

Refers to those inequalities in health that

deemed to be unfair or stemming from some form of injustice.

Equity in health implies that there are no

differences in health services where health needs are equal (horizontal equity) or that enhanced health services are provided where greater health needs are present (vertical equity).

Equity definition cont’d

Equity covers the absence of systematic and potentially remediable differences in one or more aspect of health subgroups of population defined socially, economically, demographically,

• r geographically.

The Final Report of CSDH – evidence is needed to act

“Our children have dramatically different life

chances depending on where they were born. In Japan or Sweden they can expect to live more h 80 i B il 72 I di 63 Y ”

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than 80 years; in Brazil 72 years; India 63 Years.” And in many countries, less than 35 years! “In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.”

Equitable access

Geographical access – overcoming barriers of

distance

Economic access – overcoming barriers of cost

Cultural and social access

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Cultural and social access Adequate, appropriate services No barriers for women, or disadvantaged

groups

Providers who deal with all patients/clients

fairly, equally; according to their needs

Effective services for universal coverage

(Source: Final CSDH report,, p 99)

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Building a Knowledge Base

• n SDH in seven countries in the EMR: Regional Experience

Reviews from:

Egypt Islamic Republic of Iran Jordan Jordan Morocco Oman Pakistan Occupied Palestinian Territory

Egypt: Sensitization exercise on SDH

Objectives:

• To familiarize participants with report of CSDH and

recommendations for action;

• To present activities of Member States;
• To identify policy implications of these activities;

Participants: all govt. sectors, civil society, academia etc; Outcome: Regional strategy and recommendations for Member

States to:

• Advocate for the recognition of SDH and health equity at all

levels of government, both within and beyond the health sector;

• Collect and use examples of intersectoral action;
• Continue to engage partners: civil society, research and training

institutions, UN organizations etc.

Iran: success stories

• Identified as a “champion country” by the Commission – Islamic

Republic of Iran

• Support at highest level: Health equity incorporated into the National

Constitution;

• On-going reforms in Primary Health Care strategy to respond to

changing health needs;

• Establishment of Secretariat for Social Determinants of Health in

MOH & ME;

• Intersectoral action in response to Burden of Disease Study –

addressing traffic fatalities.

Yemen: Success stories

• ISA initiative began in late 2007 with SDH situation analysis;
• Health Policy Unit identified as the lead unit;
• Sensitization workshop in April 2008 prioritized major social
• Sensitization workshop in April 2008 prioritized major social

determinants of health;

• Incorporation of SDH into the health sector review activities;
• Support for social research;
• Increased awareness among all partners.

Sudan: Country success stories

• Civil society workshop, March 2006
• Identified major SDH
• recommended actions;
• ISA initiative began in late 2007;
• Task Force established by MoH conducted SDH situation analysis;
• National Health Coordination Committee identified as appropriate

lead organization;

• Partnership for Development in Health intersectoral workshop,

Marawi, January 2009;

• Plans for sensitization meeting early in 2010.

Jordan: Country success stories:

• Country SDH review;
• Sensitization workshop in July, 2009;
• National priorities for SDH identified;
• National Lead organization identified (High Health Council);
• Operational plan development: Prevention of obesity among

women as priority activity;

• Commitment to establish sustainable ISA structures at all

levels.

Morocco : Country success stories

• Review with focus on SDH associated with unusually high levels of

maternal & neonatal mortality;

• MOH plan for addressing maternal mortality through intersectoral

action;

• Stakeholder sensitization workshop
• Stakeholder sensitization workshop
• Commitment to ISA:
• Human Development Initiative launched by King Mohamed VI in

May 2005;

• CBI;
• Ministry of Social Development.

Countries initiating ISA activities

Egypt: Sensitization meeting (early December); Syria: Launching SDH review; Pakistan: Contract for on-going health equity study; sensitization

Pakistan: Contract for on going health equity study; sensitization workshop in planning stage;

Lebanon: intersectoral country launch of final commission report;

situation analysis prepared and planning for sensitization exercise.

Bahrain: sensitization workshop in June 2010 Somalia: SDH sensitization exercise in September, 2010

150 200 Poorest Less poor Middle Less rich Richest

Under Under 5 mortality per mortality per 1000 1000 live births by live births by wealth quintile wealth quintile

Average U5M for high income countries is 7/1000

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50 100 Uganda 2000/01 India 1998/99 Turkmenistan 2000 Egypt 2000 Morocco 2003/04

Gwatkin et al 2007, DHS data

100 120 Poorest Less poor Middle Less rich Richest Pop average

Under Under 5 mortality per mortality per 1000 1000 live births by wealth live births by wealth quintile, Morocco quintile, Morocco 1992 1992 and and 2003 2003/04 04

Average U5M for high income countries is 7/1000

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20 40 60 80 Morocco 1992 Morocco 2003/04

Gwatkin et al 2007, DHS data

Conclusion

Many argue that more evidence is needed It is however believed that adequate

evidence is available M j t l t dd SDH d h lth

Major tools to address SDH and health

inequity is well known

Both research and action should go together Functional ISA is a pre-requisite for a

successful national initiative on SDH

Tashakur!!!