Transcript No Slide Title

PROGRESS ON COMMISSION ON
SOCIAL DETERMINANTS OF
HEALTH
Sir Michael Marmot
Chair of the Commission on
Social Determinants of Health
Key Messages
Social, economic and political circumstances
affect life and well-being and health;
Policies should address early life development,
working age, and ageing;
Action on the determinants of health should
involve the whole of government;
Action on SDH should be founded on evidence.
Health Equity & Core Values
Health equity can be defined as:
– “The absence of unfair and avoidable or remediable
differences in health among groups defined socially,
economically, demographically or geographically“;
– Both within countries and between countries
Governments are accountable;
Tackling health inequities requires action on
SDH.
Commission Activities
A Structure of Work Streams
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Commissioners
Knowledge Networks
Country Work
Civil Society Work
Global Initiatives
WHO Reference Group
Commissioner Meetings
Chile – March 2005
Egypt – May 2005
India – September 2005
Iran – Jan 2006
Kenya – June 2006
Brazil – Sept 2006
CSDH Knowledge – the Causes of the Causes
SOCIAL CONTEXT
CULTURE, RELIGION, SOCIAL SYSTEM,
HUMAN RIGHTS, LABOUR MARKET,
EDUCATION SYSTEM
INCOME, EDUCATION, GENDER, ETHNICITY, AGEING
INTERMEDIARY DETERMINANTS
LIVING AND WORKING CONDITIONS, HEALTH-RELATED BEHAVIOURS
BIOLOGICAL PROCESSES
HEALTH
HEALTH SYSTEMS
GLOBALIZATION
STRUCTURAL DETERMINANTS
Integrating Knowledge for Action
Commission’s SDH Thematic Areas
Env. Change
Education
Aid
Migration
Globalisation
Sonia was born to a poor family
in a remote
rural village. With no
ECD
Ageing
formal schooling,
her mother works as casual labour. Her father
is
Gender
Rural
Social Excl She attends
unemployed,
after losing his small-holding to creditors.
Settings
a local primary school, when she is not looking after her younger
brothers,
when she is not sick. She has hadPPHC
bouts of illness
Mental
Urbanand
Settings
Health
from birth, but has given up going to the health centre where she
is
Food
looked down on and treated badly, and rarely has the money to pay
Working Conditions
Health Systems
the fees.
Evidence/Measurement
Violence
Alcohol
Psychosocial
Medical Education
Putting Knowledge to Work
The Globalisation KN looks both at ways in which
globalisation can improve social and economic
conditions, and at how it needs to be fair;
The Employment Conditions KN looks at how
processes of global economic integration and power
relations at the local level interact to affect conditions of
labour;
The Urban Settings KN looks at the natural, physical,
social and economic capital of the urban environment;
Urbanisation is understood in the context of rural
issues such as patterns of land-holding, and food
access and availability.
Putting Knowledge to Work
The Gender KN focuses on disparities between the
sexes in opportunities for participation along the life
course;
The Health Systems KN focuses on cross-government
stewardship for health, in which the health care system
plays a central role;
The Early Child Development KN is working to
strengthen approaches to physical, emotional and
cognitive development from the beginning;
The Social Exclusion KN emphasises the impact
across society of selective marginalisation of groups.
CSDH Country Work
AMRO / PAHO
Chile
(Formal Partner)
Brasil
(Formal Partner)
Canada (Formal Partner)
Bolivia
(Formal Partner)
Peru
(Formal Partner)
Nicaragua (Exploring)
EMRO
Iran (Formal Partner)
Exploring with regional office
SEARO
India (Exploring)
Sri-Lanka (Formal Partner)
EURO
Sweden
(Formal Partner)
England
(Formal Partner)
Kyrgyzstan (Formal Partner)
Norway
(Exploring)
AFRO
Kenya
(Formal Partner)
Senegal
(Exploring)
Mozambique (Sending Letter Exploring)
Malawi
(Exploring)
Tanzania
(Exploring)
Zambia
(Exploring)
WPRO
Mongolia
(Exploring)
New Zealand (Exploring)
Country 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 Society
Civil Society Work
Plurality of perspectives, and direct representation
Understanding how civil society can effect policy
Partnership strengthening the sustainability of the SDH
movement
Regional Meeting
National Meeting
Country Participants
Update Regional and Regional activities
Global Initiatives
Global Targets
Env. Change
Education
Aid
Migration
Globalisation
ECD
Rural
Settings
Ageing
Global
Fora
Gender
Donors
Social Excl
IFIs
PPHC
Urban Settings
UN
Food
Working Conditions
Regional
Orgs.
Evidence/Measurement
Violence
Alcohol
Psychosocial
Mental
Health
Health Systems
Medical Education
Global Initiatives
Engage global institutions
– To foster globalisation that protects equity;
– To take into account equity in health in their policies, and
support national policy space for health;
– To increase investments towards action on social
determinants of health .
Engaging with multiple stakeholders, including G8, the
World Bank, ECOSOC, the UN;
Aiming regionally (in LAC) to engage with ECLAC,
OAS, IADB and others.
CSDH: Reporting and Action
Sept 06
Dec 06
Mar 07
Value
Statement
Brasil meeting
endorsement
Jun 07
Interim
Statement
KN products inflow
Other work streams
inflow
May 08
Final Report
2008: 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
of Health and Brazilian National Commission on Social
Determinants
An opportunity to explore collaboration around:
Knowledge, advocacy and action;
At national, regional and global level
– Nordic, Asian and Latin American