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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.

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Social determinants of health network rif redet

  • 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

RIF-REDET

1


Social determinants of health network rif redet

Recognition:

Social Determinants of Health Network

PAHO/WHO

FAO

UNICEF

OBSAN

FNSP-UDEA

LIHP 2012

2


Presentation outline

Presentation Outline

  • What is the current SDH situation in LAC?

  • What are the SDH?

  • How do you act on the SDH?

  • Recommendations from the CSDH

  • SDH and PHC

  • Conclusion


Social determinants of health network rif redet

The Americas is the region with the greatest inequality in the world with 220 million people living in poverty


Social determinants of health network rif redet

La Región más Desigual del Mundo

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 COMPARISON:

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.

Source: UNDP/2007-2008


Social determinants of health network rif redet

Relationship between Equity, Poverty and Health

“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.

Schools

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

Source: UNDP


Social determinants of health network rif redet

Reducing Inequalities

Reducing inequalities in Latin America

Constant challenges:

  • The environment built by society – the case of urbanization and its effect on inequality

  • Increase in the frequency and intensity of extreme climate events, including disasters and their effect on inequality

  • Changes in eating habits and the provision of water have an effect on nutritional safety with the potential of increasing inequality

  • Create opportunities for more participative governance and decision-making


Concept of health

Concept of Health

  • Determined by biological, psychological and social components in dynamic unity with disease.

  • Result of interaction between individuals and their environment, determining levels of physical, mental and social wellbeing.

  • Allows for full development of a social, active, and economically productive community. The health of individuals is a necessary condition but not sufficient to promote the process of socio-economic development.


Concept of health cont

Concept of Health(cont.)

  • Is a condition of each historical development in society.

  • Health is a fundamental human right and is an invaluable social good.

  • It is a basic need of every individual

    Villar & Capote


Concept of health1

Concept of Health

“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.”

OtawaCharter

Canada, 1986.


Determinants of health

Determinants of Health

Definition:

  • Factors influencing individual health that interact at different levels of organization to determine the health of the population.


What are the social determinants of health

What are the Social Determinants of Health?

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)


Social determinants of health sdh background and concepts

Social Determinants of Health (SDH) BACKGROUND AND CONCEPTS

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


The who commission on the social determinants of health csdh

The WHO Commission on the Social Determinants of Health (CSDH)

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


Why pay attention to the social determinants of health

Why pay attention to the Social Determinants of Health?

Because they:

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


Social determinants of health network rif redet

FOCUS OF THE SOCIAL DETERMINANTS

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.


Health promotion

Health Promotion

  • Orientation with a focus in the determinants

  • Support of national public health policies

  • Support from CNDSS

  • Development of healthy settings (cities, schools, residences, workplaces)

  • Urban health attention in large urban areas

  • Urban security, violence, green areas, management in the city system

  • Network of potentially Healthy Municipalities

  • Healthy Lifestyles (Tabaco, nutrition, physical activity)

  • Social Participation


Equity in health

EQUITY IN HEALTH

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)


Equity in health1

EQUITY IN HEALTH

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 ...


Social determinants of health network rif redet

Renovation of Primary Healthcare in the Americas

  • Challenges for 2015: Achieving the MDGs

  • The Health Agenda for the Americas

Achieving

MGDs in 2015

Representación OPS/OMS

Chile 2008


Social determinants of health network rif redet

Renovation of Primary Healthcare in the Americas

  • Work to identify the strategies to address the structural and intermediate determinants

Representación OPS/OMS

Chile 2008


Alma ata 1978

Alma Ata 1978


Alma ata conference 1978

Alma Ata Conference, 1978

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

Primary Health Care

  • Primary Health Care

    • Alma Ata Declaration

“ 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.”


Renewing phc through 4 areas for reform

Renewing PHC through 4 areas for reform


The phc sun

The PHC Sun

  • Core Values, Principles and Elements in a PHC-Based Health System:


Millenium development goals

Millenium Development Goals

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


Social determinants of health network rif redet

Malnutrition in Women and Children

  • Diseases

  • Poor food security

  • Unhealthy Living

  • Illiteracy

  • Inadequate health services

  • Environmental contamination

  • Unemployment

  • Family violence

  • Low production

Determinantes

  • Poverty

  • Violation of rights

  • Inequality

  • Discrimination


Social determinants of health network rif redet

School-age

Preschoolers

Infants

6 m to 2 y

Infants

< 6 m

Childbirth and Newborns

Pregnant

Teenagers

  • No exclusive breastfeeding

  • Lack of care and stimulation in the home

  • Incomplete vaccination

  • Non-institutional delivery

  • Childbirth poorly served

  • Inadequate handling of the Newborn

  • Incomplete vaccination

  • Poor and insufficient diet

  • Parasitic Infections andaccidents

  • Not Breastfeeding

  • Inappropriate complementary feeding

  • Incomplete vaccination

  • Inadequate attention to disease

  • Lack of care and stimulation in the home

  • Poor access and quality of prenatal care

  • Smoking / alcohol use

  • Maternal malnutrition / anemia

  • Domestic Violence

  • Parasitic infections

  • Teen Pregnancy

  • Ignorance of sexual and reproductive health


Social determinants of health network rif redet

Framework of the main categories and areas of action on the determinants

Comisión DSS –OMS Solar e Irwin2005


Social determinants of health network rif redet

Conceptual Framework

Comisión DSS –OMS Solar e Irwin2005


International health conceptual model lihp 2009

International health Conceptual model: LIHP 2009


Issues addressed

Issues Addressed:


Social determinants of health network rif redet

“Health equity is an indicator of progress and social justice.” (Technical Secretariat WHO Commission on Social Determinants of Health)

Mortality

Poor

Increasing the gap

GAP

Wealthy

Time

. Reunión CG3 Marzo 2007


Social determinants of health network rif redet

“All men are born equal, but that is the last time this is so” (Abraham Lincoln)


Action on the social determinants of health

Action on the social determinants of health

Recommendations from the commission:


Social determinants of health network rif redet

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


1 improve living conditions

1. Improve living conditions

  • Improve the wellbeing of girls and women and the circumstances in which children are born

  • Management of urban development

  • Ensure that urban planning promotes healthy and safe behaviors according to equity criteria

  • Ensure that policies regarding climate change take into account health equity.


1 improve living conditions 2

1. Improve living conditions (2)_

  • Make full and fair employment along with decent work a central element in policy formulation and development strategies

  • Help from international organizations for countries to protect their workers

  • Progressively improve social protection systems

  • Create quality health systems with universal coverage and centered on primary health care


2 fight against the unequal distribution of power money and resources 1

2. Fight against the unequal distribution of power, money and resources (1)

  • Place responsibility for action on health and health equity at the highest level of government

  • Create a coherent set of social determinants of health, focusing on the Poverty Reduction Strategy Papers

  • Institutionalize the consideration of health consequences and health equity of national and international economic agreements and the formulation of policies

  • Reinforce the fundamental role of the State in the provision of essential basic services for health and the regulation of goods and services with important consequences for health


2 fight against the unequal distribution of power money and resources 2

2. Fight against the unequal distribution of power, money and resources (2)

  • Approve and apply laws that promote gender equity

  • Increase the investment in sexual and reproductive health services and programs, with universal coverage and the respect of rights

  • Ensure the representation and participation of individuals and communities in decision-making related to health

  • Enable civil society to organize and act in a manner that promotes and respects their political and social rights affecting health equity.

  • Make health equity a global development goal


3 evaluate and analyze the problem and conduct impact assessments

3. Evaluate and analyze the problem and conduct impact assessments

  • Ensure that routine monitoring systems of health equity and the social determinants of health are in place, locally, nationally and internationally

  • Invest in generating and sharing new data on the social determinants of health and the effectiveness of the implemented measures

  • Train policy actors, stakeholders and health professionals on the social determinants of health, and invest in raising public awareness


Sdh and phc

SDH and PHC

  • Many elements in common

  • Different relationships with the health systems and the broader context

  • Synergies


Conclusion

Conclusion


Social determinants of health network rif redet

"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


The end

The End

THANK YOU


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