COMMISSION ON SOCIAL DETERMINANTS OF HEALTH Michael Marmot

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COMMISSION ON SOCIAL DETERMINANTS OF HEALTH

• Michael Marmot
• Launching Ceremony of CNDSS
• PAHO/WHO Country Office, BRAZIL
• March 15, 2006

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CSDH Knowledge for action

• The goal is not an academic exercise, but to
  marshal scientific evidence as a lever for policy
  change aiming toward practical uptake among
  policymakers and stakeholders in countries.

WHO Director-General LEE Jong-Wook, address to
the World Health Assembly, May 2004
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CSDH

• improving health and health equity through action
  on the socially determined causes of health
  inequities

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What good does it do to treat people's illnesses
...
then send them back to the conditions that made
them sick?
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Why Emphasize Social Determinants?

• Social determinants of health have a direct
  impact on health
• Social determinants structure other causes of
  health
• Environment
• Behaviour
• Services
• The causes of the causes

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INEQUALITIES BETWEEN COUNTRIES
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UNDER 5 MORTALITY RATE PER 1000 LIVE BIRTHS
SOURCE THE WORLD HEALTH REPORT 2004,WHO
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PROBABILITY OF DYING BETWEEN AGES 15 AND 60
(males)
SOURCE THE WORLD HEALTH REPORT 2004,WHO
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INEQUALITIES WITHIN COUNTRIES
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UNDER 5 MORTALITY RATES BY SOCIOECONOMIC QUINTILE
OF HOUSEHOLD
Under 5 mortality per 1000
Victora et al Lancet , 362, 233-241 (2003)
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MORTALITY AND EDUCATION IN MEN AGED 45-90 IN
MATLAB, BANGLADESH, 1982-1998
Rate ratio
Education
married at entry
(Hurt, Ronsmans Saha JECH 2004, 58, 315-320)
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GROWING INEQUALITIES
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TRENDS IN PROBABILITY OF SURVIVAL IN RUSSIAN MEN
BY EDUCATION (RELATIVES STUDY)
45 p20 probability of living to 65 yrs when
aged 20 yrs
Murphy et al, in press
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A Growing Crisis Large ageing population and
an increase in chronic disease is creating a
financial burden on health systems
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ESTIMATED POPULATION OVER 60 YRS

Vaupel et al, 1998
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ADULT MORTALITY THE DOUBLE BURDEN OF DISEASE
(WHO 2005)
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LEADING CAUSES OF DISEASE BURDEN AMONG ADULTS
(15-59) WORLDWIDE
HIV/AIDS
Unipolar depressive disorders
Tuberculosis
Road traffic injuries
Ischaemic heart disease
Alcohol use disorders
Hearing loss (adult onset)
Violence
Cerebrovascular disease
Self-inflicted injuries
DALYS(000)
World Health Report 2003
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Commission on Macroeconomics and Health (CMH)

• CMH called for increased public expenditure on
  health for economic development
• CMH focused on low- and middle-income countries
• CMH focused primarily on communicable diseases

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World Health Report 2002
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Ten Tips for Staying Healthy

• Don't be poor. If you can, stop. If you can't,
  try not to be poor
• for long.
• Don't have poor parents.
• Own a car.
• Don't work in a stressful, low paid manual job.
• Don't live in damp, low quality housing.
• Be able to afford to go on a foreign holiday and
  sunbathe.
• Practice not losing your job and don't become
  unemployed.
• Take up all benefits you are entitled to, if you
  are unemployed, retired or sick or disabled.
• Don't live next to a busy major road or near a
  polluting factory.
• Learn how to fill in the complex housing benefit/
  asylum application forms before you become
  homeless and destitute.

Dave Gordon, 1999
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• The causes of the causes

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CSDH GOALS

• To support policy change in countries by
  promoting models and practices that effectively
  address the social determinants of health.
• To support countries in placing health as a
  shared goal to which many government departments
  and sectors of society contribute.
• To help build a sustainable global movement for
  action on health equity and social determinants,
  linking governments, international organizations,
  research institutions, civil society and
  communities.

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• Commissioners
• Knowledge networks
• Civil society
• Country action
• Global initiative
• WHO

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COMMISSIONERS

• The twenty Commissioners are global and national
  leaders from political, government, civil society
  and academic fields and from all geographic
  regions of the world.

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KNOWLEDGE NETWORK THEMES
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Civil Society

• "The presence, advice and testimony of
  civil-society actors is essential to the work of
  the Commission and will be decisive to the
  general awakening we wish to promote".

Commissioner Ndioro Ndiaye, Comments on first
meeting of CSDH regional civil society
facilitators
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Update Regional and Regional activities
Regional Meeting
National Meeting
Next National Meeting
Country Participants
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Countries
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Three strands within country stream

• Within country
• creating space for dialogue e.g Iran
• putting SDs inequities on the policy agenda e.g
  Brazil, Kenya
• focus, priorities, benchmarks, concrete areas of
  work e.g Chile
• brokering people and institutional mechanisms
  e.g. Kyrgzstan
• Influencing national resources and investments
  e.g. England, Canada
• Collecting information on country situation

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Three strands within country stream

• 2. Between countries
• facilitating supportive networking across
  countries
• exchanging and sharing know-how
• documentation and exchange of information
• training support
• and other demand driven support

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Three strands within country stream

• 3. Global international
• identifying the way that global/international
  institutions are enabling or disabling country
  action
• bringing concrete experience on how to act
  upstream on global policies (e.g. MDGs)
• multi-country and regional alliances
• re-enforcing change within WHO

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REGIONAL ACTIVITIES

• Nordic
• Latin America
• East Asia
• Europe

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Global Initiative

• Advancing the CSDH agenda by engaging global
  institutions

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WHO ACTION

• The Commission will work with WHO to
  institutionalize social determinants capacities
  and approaches within WHO global and regional
  policies and programmes. This will be
  accomplished by integrating WHO country, regional
  and global personnel in all activities of the
  Commission.

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COMMISSION MEETINGS

• CHILE March 2005
• CAIRO May 2005
• INDIA September 2005
• IRAN Jan 2006

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THE SUCCESS OF AN ECONOMY AND OF A SOCIETY
CANNOT BE SEPARATED FROM THE LIVES THAT THE
MEMBERS OF THE SOCIETY ARE ABLE TO LEADWE NOT
ONLY VALUE LIVING WELL AND SATISFACTORILY, BUT
ALSO APPRECIATE HAVING CONTROL OVER OUR OWN
LIVESAmartya Sen, Development as Freedom
(1999)