globalization & health equity investigating the connections_schrecker & labonte_ 23 jan 07

8/9/2019 Globalization & Health Equity Investigating the Connections_Schrecker & Labonte_ 23 Jan 07

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Globalization and Health Equity:Globalization and Health Equity:Investigating the ConnectionsInvestigating the Connections

Ted Schrecker, RonaldTed Schrecker, Ronald LabontLabont

Basic Science Departments presentation toBasic Science Departments presentation to

Dean of Medicine, University of OttawaDean of Medicine, University of Ottawa

January 23, 2007January 23, 2007


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GlobalizationGlobalization

A process of greater integration within the worldA process of greater integration within the world

economy through movements of goods andeconomy through movements of goods andservices, capital, technology and (to a lesserservices, capital, technology and (to a lesserextent) labour, which lead increasingly toextent) labour, which lead increasingly to

economic decisions being influenced by globaleconomic decisions being influenced by globalconditionsconditions(Jenkins, 2004)(Jenkins, 2004)

Health EquityHealth Equity

The absence of disparities in health that areThe absence of disparities in health that areavoidable, unfair, and systematically related toavoidable, unfair, and systematically related tosocial disadvantagesocial disadvantage


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GlobalizationGlobalization ss challengeschallengesforforpopulation healthpopulation health include:include:

Increased economic inequality and insecurityIncreased economic inequality and insecurity

New forms of social exclusion and polarizationNew forms of social exclusion and polarization

Speeds up diffusion of unhealthy lifestylesSpeeds up diffusion of unhealthy lifestyles

Limits governmentsLimits governmentsability to protect and enhanceability to protect and enhancehealthhealth

IncreasesIncreasesbrain drainbrain drainof health professionals fromof health professionals from

developing countriesdeveloping countries


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PathwaysPathwaysfrom globalizationfrom globalizationto (il l) healthto (il l) health include:include:

Lack ofLack ofmaterial resourcesmaterial resourcesfor health, often leadingfor health, often leadingto or worsening effects ofto or worsening effects of

Exposure toExposure to hazardshazards(unsafe drinking water,(unsafe drinking water,

pollution, road accidents)pollution, road accidents) PsychosocialPsychosocial stressstress, both acute and chronic, both acute and chronic

Unhealthy lifestyles (smoking, drinking, bad diet)Unhealthy lifestyles (smoking, drinking, bad diet)

Inadequate access to health careInadequate access to health care

Adapted in part from w ork by Giovanni Andrea Cornia and colleagues for GlobalizationKnow ledge Network, WHO Commission on Social Determinants of Health


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MultipleMultiple entry pointsentry pointsfor policies tofor policies toaddress the effects of globalizationaddress the effects of globalization

Source: Modified from Diderichsen, Evans & Whitehead, 2001

S

OCIALAND

PO

LITICALCONTE

XT

SOCIAL

STRATIFICATION

DIFFERENTIAL

EXPOSURE

DIFFERENTIAL

VULNERABILITY

DIFFERENTIALCONSEQUENCES

HEALTH

OUTCOMES:

ILLNESS

HEALTH

DISPARITIES

HEALTH

SYSTEM

CHARACTER-

ISTICS

GLOBALIZATION

DIFFERENTIAL

VULNERABILITY


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The G8 and global health:The G8 and global health:An ongoing report card (2001An ongoing report card (2001 -- ))

Work began in advance of 2002 (Canadian) G8Work began in advance of 2002 (Canadian) G8SummitSummit

Initial publications led to development of healthInitial publications led to development of healthequity agendas, collaboration with civil societyequity agendas, collaboration with civil societyorganizationsorganizations contributions tocontributions to Global HealthGlobal HealthWatchWatch

Funding: International Development ResearchFunding: International Development ResearchCentre, CIHR, Nuffield TrustCentre, CIHR, Nuffield Trust


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How do commitments made by the worldHow do commitments made by the worlds richests richestand most powerful nations at their annual Summitsand most powerful nations at their annual Summitsaffecting population health?affecting population health?

Are the G8 fulfilling their Summit commitments?Are the G8 fulfilling their Summit commitments?

Are the commitmentsAre the commitments adequateadequate??

Are the commitmentsAre the commitments appropriateappropriate??

Key research questionsKey research questions


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The G8 and global health:The G8 and global health:An ongoing report card (2001An ongoing report card (2001 -- ))

Sample productsSample products


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Globalization Know ledge Network,Globalization Know ledge Network,WHO Commission on SocialWHO Commission on SocialDeterminants of Health (2005Determinants of Health (2005 -- 2007)2007)

Based at Institute of Population Health (NetworkBased at Institute of Population Health (Networkleader R.leader R. LabontLabont; coordinator T. Schrecker); coordinator T. Schrecker)

One of nine Knowledge Networks that are theOne of nine Knowledge Networks that are theCommissionCommissions main knowledge gathering mechanisms main knowledge gathering mechanism

29 participants from all regions of the world29 participants from all regions of the world

13 commissioned research synthesis papers13 commissioned research synthesis papers(nearing completion)(nearing completion)

Two Network meetings (completed)Two Network meetings (completed)

CanadianCanadianreference groupreference groupfor Commissionfor Commission


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Social Determinants of HealthSocial Determinants of Health

Conditions in which people live and work thatConditions in which people live and work that

affect their opportunities to live healthy livesaffect their opportunities to live healthy lives UpstreamUpstreamasas

distinct fromdistinct from

downstreamdownstreaminfluencesinfluences

Closely relatedClosely related

to poverty,to poverty,inequality,inequality,discriminationdiscrimination


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What does the best available evidence tell us aboutWhat does the best available evidence tell us abouthow globalization is affecting social determinants ofhow globalization is affecting social determinants ofhealth and health outcomes?health and health outcomes?

How are the gains and losses from globalizationHow are the gains and losses from globalizationdistributed, and what are the health implications?distributed, and what are the health implications?

What policies will mitigate the actual and potentialWhat policies will mitigate the actual and potentialharmful effects of globalization on health?harmful effects of globalization on health?



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Final report of Network: March/June, 2007Final report of Network: March/June, 2007

Final report of Commission: May, 2008Final report of Commission: May, 2008

Early product: T. Schrecker and R. Labonte,Early product: T. Schrecker and R. Labonte,Globalization and Social Determinants of Health: AGlobalization and Social Determinants of Health: ADiagnostic Overview and Agenda for Action,Diagnostic Overview and Agenda for Action,WIDERWIDERConference on Health Equity, Helsinki, SeptemberConference on Health Equity, Helsinki, September

2006 (now under journal review)2006 (now under journal review)


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Anticipated products: Monograph series based onAnticipated products: Monograph series based oncommissioned papers; edited book (University ofcommissioned papers; edited book (University ofOttawa Press?); journal articles; teaching materialsOttawa Press?); journal articles; teaching materials

Funding: International Affairs Directorate, HealthFunding: International Affairs Directorate, HealthCanadaCanada


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Health in an Unequal World:Health in an Unequal World:Global Ethics and Policy ChoicesGlobal Ethics and Policy Choices(2006(2006 -- 2009)2009)

CoCo--PIs R.PIs R. LabontLabont, T. Schrecker, M. Johri (, T. Schrecker, M. Johri (UniversitUniversitde Montrde Montral); ral); research network of 14 investigators atesearch network of 14 investigators ateight universities launched November 2006eight universities launched November 2006

Methodology: multidisciplinaryMethodology: multidisciplinaryworkingworkingconversationconversationin such forums asin such forums as

PrePre--conference on global health ethics at Canaconference on global health ethics at Cana--diandian

Bioethics Society annual meeting (May 2007)Bioethics Society annual meeting (May 2007)

Funding: CIHR (Ethical, Legal and Social IssuesFunding: CIHR (Ethical, Legal and Social IssuesStrategic Initiative)Strategic Initiative)


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What international obligations exist to designWhat international obligations exist to designpolicies and institutions to secure access to healthpolicies and institutions to secure access to healthfor all and eliminate inequities in access?for all and eliminate inequities in access?

What are the appropriate roles and limits of marketsWhat are the appropriate roles and limits of marketsin allocating resources necessary for access toin allocating resources necessary for access tohealth?health?

What are the strengths and implications of rightsWhat are the strengths and implications of rights--

based approaches to health, and the socialbased approaches to health, and the socialdeterminants of health, as a response todeterminants of health, as a response toglobalization?globalization?



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Canada and Migration of HealthCanada and Migration of HealthProfessionals from subProfessionals from sub--Saharan AfricaSaharan Africa(2005(2005 -- 2009)2009)

PI R.PI R. LabontLabont; r; research involves three Canadianesearch involves three Canadianuniversities and collaborators in the regionuniversities and collaborators in the region

Phase One completed; sample productPhase One completed; sample product


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Are health worker flows from SSA to CanadaAre health worker flows from SSA to Canada

increasing, decreasing or remaining the same?increasing, decreasing or remaining the same? What are the financial costs (and, via remittances,What are the financial costs (and, via remittances,

benefits) to source countries of health workerbenefits) to source countries of health worker

migration? What are the financial benefits (inmigration? What are the financial benefits (inavoided training costs) to Canada?avoided training costs) to Canada?

What is the level of health system support inWhat is the level of health system support in

Canada for different policy options that minimizeCanada for different policy options that minimizepush and pull factors and improve health equity inpush and pull factors and improve health equity inboth source countries and receiving (Canadian)both source countries and receiving (Canadian)provinces?provinces?



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Canada and Migration of HealthCanada and Migration of HealthProfessionals from subProfessionals from sub--Saharan AfricaSaharan Africa(2005(2005 -- 2009)2009)

Methods: SemiMethods: Semi--structured interviews, secondarystructured interviews, secondarydata analysisdata analysis

Funding (Phase One): CIHR; (Phase Two): SocialFunding (Phase One): CIHR; (Phase Two): SocialSciences and Humanities Research Council ofSciences and Humanities Research Council ofCanadaCanada


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Globalization and the Health of CanadiansGlobalization and the Health of Canadians(2006(2006 -- 2011)2011)

PI R.PI R. LabontLabont; r; research team of 20 investigatorsesearch team of 20 investigatorsfrom 10 universitiesfrom 10 universities

Launched February 2007 at conference coLaunched February 2007 at conference co--

sponsored with Parkland Institutesponsored with Parkland Institute


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How will globalization affect health of children inHow will globalization affect health of children inlowlow--income metropolitan households (Montrincome metropolitan households (Montral,al,Toronto, Vancouver, Calgary, Edmonton)Toronto, Vancouver, Calgary, Edmonton)??

What are the distinctive impacts on women and onWhat are the distinctive impacts on women and onrecent immigrants?recent immigrants?

What are the multiple dimensions of vulnerabilityWhat are the multiple dimensions of vulnerabilitythat are relevant to understanding globalizationthat are relevant to understanding globalizationss

impacts?impacts? How does globalization affect the internationalHow does globalization affect the international

policy context within which Canada must respond?policy context within which Canada must respond?



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How effectively has Canadian public policyHow effectively has Canadian public policyresponded to the challenges?responded to the challenges?

What best practices can be identified from theWhat best practices can be identified from theexperience of other countries?experience of other countries?

What might the pattern of health disparities in majorWhat might the pattern of health disparities in majorCanadian metropolitan areas look like in 2025?Canadian metropolitan areas look like in 2025?

What are the most important policy entry points forWhat are the most important policy entry points for

Canadian governments?Canadian governments?

Key research questions (contKey research questions (cont d)d)


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Globalization and the Health of CanadiansGlobalization and the Health of Canadians(2006(2006 -- 2011)2011)

Multiple methods: generating andMultiple methods: generating and mappingmappingaaneighbourhoodneighbourhood--level Globalizationlevel Globalization--Relevant Index ofRelevant Index ofDisadvantage (GRID); systematic reviews of policyDisadvantage (GRID); systematic reviews of policy

interventions (for Cochrane/Campbell Health Equityinterventions (for Cochrane/Campbell Health EquityField); qualitative research; multivariate nationalField); qualitative research; multivariate national--level statistical analyses; scenario constructionlevel statistical analyses; scenario construction

Funding: CIHR Reducing Health Disparities andFunding: CIHR Reducing Health Disparities andImproving Health Equity Strategic InitiativeImproving Health Equity Strategic Initiative


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Revitaliz ing Health for All: Learning fromRevitalizing Health for All: Learning fromComprehensive Primary Health CareComprehensive Primary Health CareExperiences (2007Experiences (2007 -- 2011)2011)

CoCo--PIs R.PIs R. LabontLabont and D. Sanders (University of theand D. Sanders (University of theWestern Cape)Western Cape); 53 investigators in India, South; 53 investigators in India, SouthAfrica, Tanzania, Zimbabwe, Guatemala, ElAfrica, Tanzania, Zimbabwe, Guatemala, El

Salvador, Nicaragua, Bolivia, Brazil, AustraliaSalvador, Nicaragua, Bolivia, Brazil, Australia

Focus on comprehensive primary health care (CPHC)Focus on comprehensive primary health care (CPHC)


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Comprehensive Primary Health Care:Comprehensive Primary Health Care:

A political philosophy and implementation strategy forA political philosophy and implementation strategy forhealth systems that emphasizes equity in healthhealth systems that emphasizes equity in healthoutcomes through universally accessible, affordableoutcomes through universally accessible, affordableand quality health care; actions on the socialand quality health care; actions on the social

determinants of healthdeterminants of health; and citizen participation in; and citizen participation inhealth system policyhealth system policy--makingmaking


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How effective is CPHC in terms of:How effective is CPHC in terms of:a.a. Equity in access to health care, other services essential toEquity in access to health care, other services essential to

healthhealth

b.b.

Reduced vulnerabilitiesReduced vulnerabilitiesc.c. Reduced exposure to risk through changes in social andReduced exposure to risk through changes in social and

environmental determinants of healthenvironmental determinants of health

d.d. Improved participatory mechanisms and opportunitiesImproved participatory mechanisms and opportunities

e.e. Increased community resilience to enable effectiveIncreased community resilience to enable effectiveresponses to promote and protect healthresponses to promote and protect health

f.f. Health equity as measured by population health outcomes?Health equity as measured by population health outcomes?



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How can an international capacity building programHow can an international capacity building programon research skills for CPHC contribute toon research skills for CPHC contribute tostrengthening the evidence base for effectiveness?strengthening the evidence base for effectiveness?

What approaches to research, and what evaluationWhat approaches to research, and what evaluationtools and methods, are most useful in advancingtools and methods, are most useful in advancingunderstanding and implementation of CHPC?understanding and implementation of CHPC?

Key research questions (contKey research questions (cont d)d)


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Revitaliz ing Health for All: Learning fromRevitalizing Health for All: Learning fromComprehensive Primary Health CareComprehensive Primary Health CareExperiences (2007Experiences (2007 -- 2011)2011)

Multiple methods: systematic reviews; researchMultiple methods: systematic reviews; researchcapacity training workshops; new field research incapacity training workshops; new field research infour regions; regional network meetings andfour regions; regional network meetings and

development; international conferencedevelopment; international conference Funding: CIHR/International Development ResearchFunding: CIHR/International Development Research

Centre TeasdaleCentre Teasdale--CortiCorti InitiativeInitiative


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Immediate future plans:Immediate future plans: Globalization andGlobalization andhealth equity training programhealth equity training program

CIHR Strategic Training Initiative for HealthCIHR Strategic Training Initiative for HealthResearch (round 2): RFA for letters of intent to beResearch (round 2): RFA for letters of intent to bereleased July 2007released July 2007

A multidisciplinary, multiA multidisciplinary, multi--faculty University offaculty University ofOttawa graduate training program that willOttawa graduate training program that will

Build onBuild on LabontLabontss experience as PI of a program atexperience as PI of a program at

Universities of Regina and Saskatchewan funded inUniversities of Regina and Saskatchewan funded inround 1round 1


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How much good does it doHow much good does it do

to treat people's il lnesses ...to treat people's illnesses ...

only to send them back to the conditionsthat made them sick?


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For further informationFor further information

On the globalization and health equity researchOn the globalization and health equity researchprogram:program: [email protected]@uottawa.ca [email protected]@uottawa.ca

On the WHO Commission on Social DeterminantsOn the WHO Commission on Social Determinantsof Health:of Health:http://www.who.int/social_determinants/enhttp://www.who.int/social_determinants/en

globalization & health equity investigating the connections_schrecker & labonte_ 23 jan 07

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