SOCIAL DETERMINANTS OF HEALTH: INTRODUCTION Dr. Eduardo Guerrero Espinel Facultad Nacional de Salud Publica Coordinador de la Especializacion en Salud Internacional Universidad de Antioquia, Medellin, Colombia APRIL 2012.
SOCIAL DETERMINANTS OF HEALTH NETWORK
Social Determinants of Health Network
The Americas is the region with the greatest inequality in the world with 220 million people living in poverty
La Región más Desigual del Mundo the world with 220 million people living in poverty
The richest ten percent of the population in Latin America earn 48% of the total income, while the poorest tenth percentile of the population earn 1.6%.
In industrialized countries, the tenth percentile of the population with the highest income receives 29.1%, while the tenth percentile with the lowest income earns 2.5%.
LAC is the most unequal region in the world, with the highest “average Gini coefficient”. The distribution of income, wealth and resources is more polarized than in any other region.
Relationship between Equity, Poverty and Health the world with 220 million people living in poverty
“The Poverty Trap”
The future of a child is determined by the home that he/she is born into, the region, the educational level of his/her parents, their nutrition and his/her initial health status.
20% do not have portable water,
33% do not have enough sanitary facilities,
47% do not have libraries,
63% do not have computer rooms
There is a strong statistical correlation between the average GINI coefficient and school performance, therefore… **
Higher inequity means lower school performance
10% of the richest population receive
7 more years of learning
than the poorest 30% of the population
**The 2009 Serce-UNESCO study
Reducing Inequalities the world with 220 million people living in poverty
Reducing inequalities in Latin America
Villar & Capote
“Health is created by caring for oneself and others, by being able to take decisions and have control over one's life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members.”
“Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love.”
SDH are the circumstances in which people are born, grow, live, work and age, including the health system – resulting from the distribution of income, power and resources
They explain health inequities
(World Health Organization, 2008)
1970-80s: Criticism of the traditional health approach (risk factors)
Creation of the SDH social and structural models
2008: WHO launches report of SDH (goal to reduce health inequities through action on social determinants of health)
WHO, 2009: 62nd World Health Assembly considers the CSDH Reportand creates recommendations to governments
2009, 2011: ALAMES supports the CSDH report but has criticism on the stance.
Global Meeting SDH, Rio de Janeiro
Initially created in 2005 by the late Dr. J. W. Lee, D. G. of the WHO
Three years of unprecedented collection of knowledge and data on health inequities and SDH
Final report published on August 28, 2008
Have a direct effect on health
Allow you to predict the greatest proportion of variability in health status (health inequity)
Structure the behaviors related with health
Mutually interact with the generation of health
WHO defines social determinants such as the social conditions in which people live and work.These conditions reflect the differences between people in their social position, power, prestige and resources, and reflects the social hierarchy.
It is an ethical concept assicoated with principles of social justice and human rights
Is equity the same as equality?
The equalitarian concept of equity is in terms of how attention is distributed en términos de cómo la atención se distribuye de acuerdo con la necesidad y, se financia de acuerdo con la capacidad de pago(Braverman)
Is minimizing avoidable disparities in health and its determinants in care, between groups of people who have different levels of social privilege (Braverman, Paula), 1998., module 6 REDET
Absence of systemic disparities in health between groups with different levels of underlying social advantages / disadvantages (Braveman and Gruskin 2003)
According to AmartyaSen, Equality is opportunities ...... Capacity Development Model ...
MGDs in 2015
A call for action!
“Are you ready to fight the political and technical battles required to overcome any social and economic obstacles and professional resistance to the universal introduction of primary health care?”
“ Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.”
Improve Maternal Health
Eradicate Poverty and hunger
Combat HIV/AIDS, Malaria, and other diseases
Universay Primary Education
Guarantee Environmental Sustainability
Gender Equity and Women’s Empowerment
Promote a Global Alliance for Development
Reduce Infant Mortality
6 m to 2 y
< 6 m
Childbirth and Newborns
Comisión DSS –OMS Solar e Irwin2005
Conceptual Framework determinants
Comisión DSS –OMS Solar e Irwin2005
“Health equity is an indicator of progress and social justice.” (Technical Secretariat WHO Commission on Social Determinants of Health)
Increasing the gap
. Reunión CG3 Marzo 2007
“All men are born equal, but that is the last time this is so” (Abraham Lincoln)
Recommendations from the commission:
To maximize the contributions of the focus on sustainable health environments, it will be necessary to refocus our work towards recognizing and facing the challenges of the current globalized world
"The same humanity able to send instruments to Mars to study the composition of its rocks witnesses indifferently the deaths of millions from hunger
José Saramago. Nobel Prize in Literature