Download - WORLD HEALTH & SOCIAL DETERMINANTS
WORLD HEALTH & SOCIAL DETERMINANTS
Dr Pascoal MocumbiEDCTP High Representative,
Mozambique’s Former Prime Minister at Forosalud III National Health Conference,
Lima, Peru, 10.06.06
Mortality: 2002 estimates
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
LMIC
HIC
I. Communicablediseases, maternaland perinatalconditions andnutritionaldeficiencies
II. Noncommunicableconditions
III. Injuries
Source: WHO Burden of Disease estimates, 2002
Mortality Estimates for 2002 (World Health Report 2004)
Infectious and Parasitic diseases 10 904 (000)•HIV/AIDS 2 777 ¨•Diarrhoeal diseases 1 798 ¨•Tuberculosis 1 566 ¨•Malaria 1 272 ¨•Childhood diseases 1 124 ¨•STI (excluding HIV) 180 ¨•Meningitis 173 ¨•(Other) Tropical Diseases 129 ¨•Hepatitis B 103 ¨•Hepatitis C 54 ¨•Dengue 19 ¨•Japanese encephalitis 14 ¨•Intestinal nematode 12 ¨•Leprosy 6 ¨
LEADING CAUSES OF DISEASE BURDEN AMONG ADULTS (15-59)
WORLDWIDE
18522
18749
18962
19486
19567
26155
27264
28380
57843
68661
0 10000 20000 30000 40000 50000 60000 70000 80000
HIV/AIDS
Unipolar depressive disordersTuberculosis
Road traffic injuries
Ischaemic heart disease
Alcohol use disorders
Hearing loss (adult onset)Violence
Cerebrovascular diseaseSelf-inflicted injuries
World Health Report 2003 DALYS(000)
1 = <50% (36)2 = 50-80% (68)3 = 80-95% (33)4 = >95% (41)5 = No data available (1)
UNDER 5 MORTALITY RATE PER 1000 LIVE BIRTHS
SIERRA LEONE 316
BOLIVIA 80
KYRGYZSTAN 63
SRI LANKA 20
ICELAND 3
SOURCE: THE WORLD HEALTH REPORT 2004,WHO
% PROBABILITY OF DYING BETWEEN AGES 15 AND 60 (males)
LESOTHO 90.2
RUSSIA 46.9
BOLIVIA 26
SRI LANKA 23.8
COLOMBIA 23.6
PAKISTAN 22.7
SWEDEN 8.3
SOURCE: THE WORLD HEALTH REPORT 2004,WHO
UNDER 5 MORTALITY RATES BY SOCIOECONOMIC QUINTILE OF
HOUSEHOLD
0
50
100
150
200
Indonesia Brazil India Kenya
Poorest fifth 2nd poorest fifth Middle fifth
2nd richest fifth Richest fifth
Under 5 mortalityper 1000
Victora et al Lancet , 362, 233-241 (2003)
MORTALITY AND EDUCATION IN MEN* AGED 45-90 IN MATLAB, BANGLADESH,
1982-1998
0,60,650,7
0,750,8
0,850,9
0,951
1,05
None Koranic 1 to 4 yearsformal
5+ formal
Own education Wife's educationRate ratio
Education*married at entry (Hurt, Ronsmans & Saha JECH 2004, 58, 315-320)
GROWING INEQUALITIES
TRENDS IN PROBABILITY OF SURVIVAL IN RUSSIAN MEN BY EDUCATION
(RELATIVES STUDY)
0,4
0,45
0,5
0,55
0,6
0,65
0,7
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Calendar year
45 p
20
elementary university
45 p20 = probability of living to 65 yrs when aged 20 yrs
Murphy et al, in press
A very complex health development landscape…
• Outcomes-based development
• "Scaling Up!"
• Growing rapidly: from millions to billions
• Predominant disease/intervention program (vertical) focus
• Unsatisfactory performance of health systems
C
-PHC S
-PHC Reform
s & Minimum Packages
MDG
Scaling-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
‘The causes of the causes’
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
What good does it do to treat people's illnesses ...
then send them back to the conditions that made them sick?
Social, political, economic and environmental threats to health identified as the basic causes of
ill health and the inequitable distribution of health within and
between countries have increased
CSDH GOALS
• To support policy change in countries by promoting models and practices that effectively address the social determinants of health.
• To support countries in placing health as a shared goal to which many government departments and sectors of society contribute.
• To help build a sustainable global movement for action on health equity and social determinants, linking governments, international organizations, research institutions, civil society and communities.
A broad consultative process
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)
May 04:
D-G Lee announces CSDH at WHA
Jan 05:
CSDH discussed at WHO Executive Board
Equity and WHO
• Constitutional foundations 1948• Alma Ata Conference 1978• Equity Team created 2003• Commission on Social Determinants
launched 2005, will report in 2008
"The underlying theme of my first year as Director-General is equity and social justice".
Lee Jong-Wook, Address to the World Health Assembly, May 2004
PERU ForoSalud
• Example of civil society involvement
• III Conferencia Nacional de Salud: Voz Y Proposta Por el Derecho a la Salud 2006-2011- A call for action by government by a civil society movement that assumes its responsibility in promoting EQUAL OPPORTUNITIES TO HEALTH FOR ALL
Muchas Gracias, Thank you!