Overarching Recommendation I: Improve daily living conditions

1. Overarching Recommendation I: Improve daily living conditions Thaksaphon Thamarangsi Alcohol Policy Research (APR) & Tackling Obesity Program (TOP) International Health Policy Program (IHPP) thaksaphon@ihpp.thaigov.net

2. Why Social Determinants of Health? ‘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’.

3. 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

4. Three Overarching Recommendations • Improve Daily Living Conditions • Tackle the inequitable Distribution of Power, Money, and Resources • Measure and Understand the Problem and Access the Impact of Action

5. 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

6. CH5 Equity from the start Why? • Most powerful investment • Long term health problems • Long term social and economic problems • Intergenerational transmission of disadvantage • Programs will most benefit deprived children

7. 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

8. CH5 Equity from the start (4 RECs) 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

9. 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

10. CH6: Healthy place- healthy people (5 RECs) 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

11. CH6: Healthy place- healthy people (5 RECs) 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

12. 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

13. 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

14. CH7 Fair employment and decent work (5 RECs) 7.1 Full and fair employment and decent workbe made a shared objective of internationalinstitutions and a central part of national policyagendas and development strategies, withstrengthened representation of workers in thecreation of policy, legislation, and programmesrelating to employment and work • 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 implementeconomic and social policies that provide securework and a living wage that takes into accountthe real and current cost of living for health • Toward full employment • Healthy living wage; reflect real cost of living, health needs (inc nutrition, shelter, water& sanitation, and social participation) • Training for work

15. CH7 Fair employment and decent work (5 RECs) 7.3 Public capacity be strengthened to implementregulatory mechanisms to promote and enforcefair employment and decent work standards forall workers • Labour standard; i.e. ILO Standard, voluntary codes of conduct • Work-life balance; workload, flexibility 7.4 Governments reduce insecurity among people inprecarious work arrangements including informalwork, temporary work, and part-time workthrough policy and legislation to ensure thatwages are based on the real cost of living, socialsecurity, 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

16. CH7 Fair employment and decent work (5 RECs) 7.5 Occupational Health and Safety (OHS) policy and programmes be applied toall workers – formal and informal – and thatthe range be expanded to include work-relatedstressors and behaviours as well as exposure tomaterial hazards • Protection for all: OHS legislation, OHS training, OHS in primary health care • The breadth of occupational health and safety

17. 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

18. CH8 Social protection across the lifecourse (3 RECs) 8.1 Governments, where necessary with help fromdonors and civil society organizations, and whereappropriate in collaboration with employers,build universal social protection systems andincrease their generosity towards a level that issufficient 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 fromdonors and civil society organizations, and whereappropriate in collaboration with employers,use targeting only as back up for those who slipthrough 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

19. CH8 Social protection across the lifecourse (3 RECs) 8.3 Governments, where necessary with help fromdonors and civil society organizations, and whereappropriate in collaboration with employers,ensure that social protection systems extendto include those who are in precarious work,including informal work and household or carework • 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

20. CH 9 Universal health care Why? • Inequitable distribution of health care • Health care system: more than tratment of disease • Health sector reform

21. CH 9 Universal health care (4 RECs) 9.1 National governments, with civil society anddonors, build health-care services on the principleof universal coverage of quality services, focusingon 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 sectorleadership in health-care systems financing,focusing on tax-/insurance-based funding,ensuring universal coverage of health careregardless of ability to pay, and minimizing outofpocket health spending

22. CH 9 Universal health care (4 RECs) 9.3 National governments and donors increaseinvestment in medical and health personnel,balancing health-worker density in rural andurban areas 9.4 International agencies, donors and nationalgovernments address the health human resourcesbrain-drain, focusing on investment in increasedhealth human resources and training, and bilateralagreements to regulate gains and losses

23. Thank you