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Overarching Recommendation I: Improve daily living conditions

Thaksaphon ThamarangsiAlcohol Policy Research (APR) & Tackling Obesity

Program (TOP)International Health Policy Program (IHPP)

thaksaphon@ihpp.thaigov.net

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‘Lack of health care is not the cause of huge global burden of illness: water-borne disease are not caused by lack of antibiotics but by dirty water and by the political, social, and economic forces that fail to make clean water available to all; heart disease is caused not by a lack of coronary care units but by the lives people lead, which are shaped by the environments in which they live; obesity is not caused by moral failure on the part of individuals but by the excess availability of high-fat and high-sugar foods’.

Why Social Determinants of Health?

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Commission on SDH

• Beyond ‘business as usual’• Health inequity: inter- and intra-country• Aim: should be ‘to bring the health of those

worse off up to the level of the best’• Concept of social gradient in health• Vital role of health sector to improve health, but

not all, SDH will make health service more effective.

• ‘Economic growth without appropriate social policies, brings no benefit to health’

• What is evidence?• Implication (of the recommendations) for

different actors

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Three Overarching Recommendations

1. Improve Daily Living Conditions2. Tackle the inequitable Distribution of

Power, Money, and Resources3. Measure and Understand the Problem

and Access the Impact of Action

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Overarching recommendation I: Improve daily conditions

‘The circumstances in which people are born, grow, live, work, and age’

• Equity from the start (CH5)-4 RECs• Healthy places- healthy people (CH6)-5 RECs• Fair employment and decent work (CH7)- 5 RECs• Social protection across the lifecourse (CH8)- 3

RECs• Universal health care (CH9)- 4RECs

Total for Overarching Recommendation I= 26 RECs

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Why?• Most powerful investment• Long term health problems• Long term social and economic

problems• Intergenerational transmission of

disadvantage• Programs will most benefit deprived

children

CH5 Equity from the start

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CH5 Equity from the start (4 RECs)5.1 WHO and Unicef set up an interagency mechanism to

ensure policy coherence for early child development (ECD)

5.2 Governments build universal coverage of a comprehensive package of quality ECD programmes and services for children, mothers, and other caregivers, regardless to ability to pay

– Comprehensiveness; time, scope & continuum (i.e covers these areas; social/emotional, language/cognitive, education of children and caregivers, breastfeeding, food security, incomes, gender equity, work of caregivers, early educaiton)

– Integrated to every sector, on established programs– Reaching all children, or prioritizing most

deprived/vulnerable children

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5.3 Governments provide quality education that pays attention to children’s physical, social/emotional and language/cognitive development, starting in pre-primary school

5.4 Governments provide quality compulsory primary and secondary education for all boys and girls, regardless to ability to pay, identify and address the barriers to girls and boys enrolling and staying in school, and abolish user fee for primary school– Scope of education: formal/informal, lifelong process– Quality of primary and secondary, inc. life skill and

social/emotional learning– Accessibility: Education to All– Child-friendly, gender equity (physical and social;

environments)– Infrastructure; teachers, buildings, etc– Free of charge, subsidy for school fee, meals– Diminishing barrier for school attendance: health, financial

incentive

CH5 Equity from the start (4 RECs)

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CH6: Healthy place- healthy people

Why? • Urbanization• Environmental problems• Lifestyle change• Change in health problem in urban

setting; aging, NCD, nutrition change inc obesity, violence, alcohol, RTI, mental health

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6.1 Local government and civil society, backed by national government, establish local participatory governance mechanisms that enable communities and local government to partner in building healthier and safer cities– Healthy setting– Participation

6.2 National and local government, in collaboration with civil society, manage urban development to ensure greater availability of affordable quality housing. With support from UN-HABITAT where necessary, invest in urban slum upgrading including, as a priority, provision of water and sanitation, electricity, and paved streets for all household regardless of ability to pay– Adequacy & quality of shelter and services– Securing tenure ; soft loan, tax credit– Housing and slum upgrading, inc. to healthy house– Air quality and environmental degradation

CH6: Healthy place- healthy people (5 RECs)

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6.3 Local government and civil society plan and design urban areas to promote physical activity through investment in active transport; encourage healthy eating through retail planning to manage availability of and access to food; and reduce violence and regulatory controls, including control of the number of alcohol outlets– Dietary– Physical activity: i.e. Congestion Charge– Violence and crime; alcohol, environmental design,

neighborhood watch, gun control

CH6: Healthy place- healthy people (5 RECs)

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CH6: Healthy place- healthy people (5 RECs)

6.4 National and local government develop and implement policies and programmes that focus on: issue of rural land tenure and rights; year-round rural job opportunities; agricultural development and fairness in international trade arrangements; rural infra structure including health , education, roads and services; and policies that protect the health of rural-to-urban migrants– Land rights– Rural livelihoods; sustainable agriculture, rural household income,

nutrition– Trade agreements– Rural infrastructure and services

6.5 International agencies and national governments building on the Intergovernmental Panel on Climate Change recommendations, consider the health equity impact of agriculture, transport, fuel, building, industry, and waste strategies, concerned with adaptation to and mitigation of climate change

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CH7 Fair employment and decent work

Decent work= opportunities for work that is productive and delivers a fair income, security in the workplace, and social protection for families; better prospects for personal development and social integration; freedom for people to express their concerns, organize, and participate in the decisions that affect their lives; and equality of opportunity and treatment for all women and men

Fair employment= inc. public health perspective, behaviours, outcomes, practices, and institutions

Why? • Work and health inequities• Employment conditions; unemployment and precarious works

(inc. informal work, temporary work, contract work, child labour, slavery/ bonded labour)

• Working conditions• Trends: increasing power of transnational corporations• Lack of control in LAMI Countries• Vulnerable population; children, female

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7.1 Full and fair employment and decent work be made a share d objective of international institutions and a central part of

national policy agendas and development strategies, with st rengthened representation of workers in the creation of polic

y, legislation, and programmes relating to employment andwork– A supportive international environment: i.e. reduce

dependency, safeguard provisions in WTO agreements, end of dumping of products

– Fair representation of workers in developing the national policy agenda

7.2 National governments develop and implement economic a nd social policies that provide secure work and a living wage

that takes into account the real and current cost of living forhealth– Toward full employment– Healthy living wage; reflect real cost of living, health needs (inc

nutrition, shelter, water& sanitation, and social participation)– Training for work

CH7 Fair employment and decent work (5 RECs)

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7.3 Public capacity be strengthened to implement regulatory mechanisms to promote and enforce fair employment and

decent work standards for all workers– Labour standard; i.e. ILO Standard, voluntary codes of

conduct– Work-life balance; workload, flexibility

7.4 Governments reduce insecurity among people in precario us work arrangements including informal work, temporary

- work, and part time work through policy and legislation to ensure that wages are based on the real cost of living , soci

al security, and support for parents– Regulation to protect the health of those in precarious work

inc. subcontracting– Protecting working conditions, wages, OHS, and other

benefits– To expand program coverage toward informal working

arrangement – The role of workers and civil society in achieving better

employment conditions

CH7 Fair employment and decent work (5 RECs)

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7.5 Occupational Health and Safety (OHS) policy and programmes be applied to all workers – for mal and informal – and that the range be expan -ded to include work related stressors and beha

viours as well as exposure to material hazards– Protection for all: OHS legislation, OHS training, OHS

in primary health care– The breadth of occupational health and safety

CH7 Fair employment and decent work (5 RECs)

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CH8 Social protection across the lifecourse

Social protection: broad range of services and benefits, inc. basic income security, entitlements to non-income transfers, health care, education

Why? • Social protection as step toward securing

health equity, protecting poverty and living in sub-standard

• Social protection as social justice and developmental goal

• Vulnerability and older people; aging society and nuclear family

• Social protection in a globalizing world

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8.1 Governments, where necessary with help from donors an d civil society organizations, and where appropriate in coll

aboration with employers, build universal social protectionsystems and increase their generosity towards a level thatis sufficient for healthy living– Protection to each population group: children, working age,

old age– Protection in crisis period– Developing, implementing and evaluating pilot projects

8.2 Governments, where necessary with help from donors an d civil society organizations, and where appropriate in coll

aboration with employers, use targeting only as back up fo r those who slip through the net of universal systems– Degree of generosity of social protection policies: sufficient

for healthy living– Universal protection more effective than targeted

approaches, but can run together

CH8 Social protection across the lifecourse (3 RECs)

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8.3 Governments, where necessary with help from donors a nd civil society organizations, and where appropriate in c

ollaboration with employers, ensure that social protectio n systems extend to include those who are in precarious

work, including informal work and household or care work– Including all through tax- and aid-based security systems;

particular those in informal sector– Including all through contributory social security systems– Sustainability of social protection programs

CH8 Social protection across the lifecourse (3 RECs)

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CH 9 Universal health care

Why?• Inequitable distribution of health care• Health care system: more than tratment

of disease• Health sector reform

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CH 9 Universal health care (4 RECs)

9.1 National governments, with civil society and donors, bui - ld health care services on the principle of universal cover

age of quality services , focusing on Primary Health Care– Universal Primary Health Care– Community engagement– Prevention and promotion– Using targeted health care to build UC

9.2 National governments ensure public sector leadership i n - health care systems financing, -focusing on tax /insuran

- ce based funding, ensuring universal coverage of healthcare regardless of ability to pay, and minimizing out of p

ocket health spending

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CH 9 Universal health care (4 RECs)

9.3 National governments and donors increase investment i n medical and health personnel, balancing - health worker

density in rural and urban areas9.4 International agencies, donors and national governmen

ts address the health human resources -brain drain , focus ing on investment in increased health human resources and training , and bilateral agreements to regulate gains and losses

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Thank you