PROGRESS ON COMMISSION ON SOCIAL DETERMINANTS OF HEALTH

1
PROGRESS ON COMMISSION ON SOCIAL DETERMINANTS OF
HEALTH

• Sir Michael Marmot
• Chair of the Commission on Social Determinants of
  Health

2
Key Messages

• Social, economic and political circumstances
  affect life and well-being and health
• Policies should address early life development,
  working age, and ageing
• Action on the determinants of health should
  involve the whole of government
• Action on SDH should be founded on evidence.

3
Health Equity Core Values

• Health equity can be defined as
• The absence of unfair and avoidable or
  remediable differences in health among groups
  defined socially, economically, demographically
  or geographically
• Both within countries and between countries
• Governments are accountable
• Tackling health inequities requires action on SDH.

4
Commission Activities
5
A Structure of Work Streams

• Commissioners
• Knowledge Networks
• Country Work
• Civil Society Work
• Global Initiatives
• WHO Reference Group

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Commissioner Meetings

• Chile March 2005
• Egypt May 2005
• India September 2005
• Iran Jan 2006
• Kenya June 2006
• Brazil Sept 2006

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CSDH Knowledge the Causes of the Causes
SOCIAL CONTEXT
CULTURE, RELIGION, SOCIAL SYSTEM, HUMAN RIGHTS,
LABOUR MARKET, EDUCATION SYSTEM
STRUCTURAL DETERMINANTS
INCOME, EDUCATION, GENDER, ETHNICITY, AGEING
GLOBALIZATION
HEALTH SYSTEMS
INTERMEDIARY DETERMINANTS
LIVING AND WORKING CONDITIONS, HEALTH-RELATED
BEHAVIOURS
BIOLOGICAL PROCESSES HEALTH
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Integrating Knowledge for Action
9
Commissions SDH Thematic Areas
Sonia was born to a poor family in a remote
rural village. With no formal schooling, her
mother works as casual labour. Her father is
unemployed, after losing his small-holding to
creditors. She attends a local primary school,
when she is not looking after her younger
brothers, and when she is not sick. She has had
bouts of illness from birth, but has given up
going to the health centre where she is looked
down on and treated badly, and rarely has the
money to pay the fees.
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Putting Knowledge to Work

• The Globalisation KN looks both at ways in which
  globalisation can improve social and economic
  conditions, and at how it needs to be fair
• The Employment Conditions KN looks at how
  processes of global economic integration and
  power relations at the local level interact to
  affect conditions of labour
• The Urban Settings KN looks at the natural,
  physical, social and economic capital of the
  urban environment
• Urbanisation is understood in the context of
  rural issues such as patterns of land-holding,
  and food access and availability.

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Putting Knowledge to Work

• The Gender KN focuses on disparities between the
  sexes in opportunities for participation along
  the life course
• The Health Systems KN focuses on cross-government
  stewardship for health, in which the health care
  system plays a central role
• The Early Child Development KN is working to
  strengthen approaches to physical, emotional and
  cognitive development from the beginning
• The Social Exclusion KN emphasises the impact
  across society of selective marginalisation of
  groups.

12
CSDH Country Work
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• AMRO / PAHO
• Chile (Formal Partner)
• Brasil (Formal Partner)
• Canada (Formal Partner)
• Bolivia (Formal Partner)
• Peru (Formal Partner)
• Nicaragua (Exploring)

• EURO
• Sweden (Formal Partner)
• England (Formal Partner)
• Kyrgyzstan (Formal Partner)
• Norway (Exploring)
• AFRO
• Kenya (Formal Partner)
• Senegal (Exploring)
• Mozambique (Sending Letter - Exploring)
• Malawi (Exploring)
• Tanzania (Exploring)
• Zambia (Exploring)
• WPRO
• Mongolia (Exploring)
• New Zealand (Exploring)

• EMRO
• Iran (Formal Partner)
• Exploring with regional office
• SEARO
• India (Exploring)
• Sri-Lanka (Formal Partner)

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Country Knowledge into Action

• Developing a national SDH equity plan of action,
  and participatory process
• Whole of government, cross-sectoral action to
  address the disadvantages Sonia experiences
• Baseline situation analysis and implementation/
  evaluation of specific policies/programmes
• Recognising, identifying and acting on community
  needs.

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• Setting up national health equity information
  systems
• Ensuring sustainable and timely information to
  underpin government strategy
• Making the economic case for investing upstream
  in health
• Increasing investment in the causes of the causes
• Building evidence and knowledge of good practice
• Strengthening the community of knowledge
• Capacity building

16
Civil Society
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Civil Society Work

• Plurality of perspectives, and direct
  representation
• Understanding how civil society can effect policy
• Partnership strengthening the sustainability of
  the SDH movement

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Update Regional and Regional activities
Regional Meeting
National Meeting
Country Participants
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Global Initiatives
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Global Targets
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Global Initiatives

• Engage global institutions
• To foster globalisation that protects equity
• To take into account equity in health in their
  policies, and support national policy space for
  health
• To increase investments towards action on social
  determinants of health .
• Engaging with multiple stakeholders, including
  G8, the World Bank, ECOSOC, the UN
• Aiming regionally (in LAC) to engage with ECLAC,
  OAS, IADB and others.

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CSDH Reporting and Action
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2008 A Global Launch

• A historical opportunity? 1948-1978-2008
• A global media launch CNN
• A global movement a critical mass of world
  leadership
• Engaging all levels heads of state, country
  governments, regional champions to build and
  institutionalise sustainable commitment to the
  SDH agenda.

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Joint meeting of global Commission on Social
Determinants of Health and Brazilian National
Commission on Social Determinants

• An opportunity to explore collaboration around
• Knowledge, advocacy and action
• At national, regional and global level
• Nordic, Asian and Latin American