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Dr Erio Ziglio

World Health Organization European Office for Investment for Health and Development

Social Determinants of Health:

Challenges & Opportunities in Europe

Uppsala University, 21 January 2005

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Characteristics of Europe

in 2005

Challenges & Opportunities

Implications

Outline of this presentation

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Characteristics of Europe in 2005

• WHO EURO 52 countries, total of 900m citizens

• 25% have less than 5 million inhabitants

• 20% have less than 3 million

• 47% have a high income (> $ 9,265 in 2000)

• 15% have a low income (< $ 756)

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LIFE EXPECTANCY Wide variations between countries

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Persistent and increasing inequalities

between countries and within

population groups of the same country

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Glasgow, Scotland

67 LIFE EXPECTANCY 77

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Torino, Italy

8 YEARS DIFFERENCE

in life expectancy

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8-10 YEARS DIFFERENCE

in life expectancy

Malmö, Sweden

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Looking at the last decade

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Relative Poverty is growing faster

in Europe and Central Asia

than anywhere else in the world.

(World Bank, 2001)

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43.8

98.2

1990 1999

People living on less than US$ 2 a day

Source: Global Economic Prospects, Worldbank, 2001

(CEE and CAR, millions of people)

INCOME POVERTY

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EU: People at risk of poverty and social exclusion (%)

Source: European Commission, data for 1997

Average of 18% or 60 million people below the threshold

INCOME POVERTY

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Progress towards reaching the poverty MDGs by regions

Source: www.developmentgoals.org

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Challenges &

Opportunities

Increased inequalities, poverty and psycho-social stress

Implications

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Why are we seeing an increase

in health inequalities across Europe ?

KEY QUESTION

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DETERMINANTS OF HEALTH

Population Health

Social Economic

EnvironmentalGenetic

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ALLOCATIVE EFFICIENCY

Promotion

Population Individual

Treatment

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European main factors

• Social safety nets

• Labour market policies, job security,

pension reforms

• Economic change and social disruption

• Economic regeneration schemes

• Poverty reduction

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Systems & Infrastructures constraints

• Intervention approaches often mismatched to country development conditions and capacity

• Unrealistic expectations of the individual

behaviour change approach

• Unstable and inadequate funding mechanisms

• The promotion of population health is too often

at the margins of decision processes

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Implications

Need to keep the vision but revisit the means

Increased inequalities, poverty and psycho-social stress

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Some long term outcomes (at age 21) of non-participation by young women at age 16-18

0 10 20 30 40 50 60 70 80 90 100

Without qualif ications

No training in current job

Not in full/part time w ork

Teenage parent

Parent (by age 21)

Tw o or more children

Depression

Full time home care responsabilities

Lives in rented accomodation

Acknow ledges family commitments as barrier to employment

Poor health

PercentageNon-Participant Participant

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Integrated problems

require

integrated solutions

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Assets

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Need LH

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The Promotion of population Health is increasingly recognized as key resource for social and economic development

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Social Development

Economic Development

Equitable

Sustainable

Promoting Population Health

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Ray Charles

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Communities rarely develop on the

basis of their deficiencies, (…) they

develop on the basis of their assets

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Need L

H Assets

H

L

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An integrated model of HP

Policies & actions to improve equity in social and economic conditions

Policies & actions to create health supporting environments and communities

Programmes to change unhealth knowledge attitudes and behaviours

The Building Blocks to Sustainable Population Health Promotion

Healthy Settings – workplaces, schools & communities

Changing Individual Risk Behaviour

Promoting healthy lifestyles

Creating the conditions - Reducing poverty, social exclusion for Good Health environmental hazards, improving sanitation

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Manage

Risk Factors

Manage

Risk Conditions

Manage

Assets

Investment for Health and Development

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The WHO Office for Investment for Health and Development

Venice, Italy

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The Venice Office has two main functions

1. To monitor, review and systematize the policy implications of emerging research findings on the social and economic determinants of health

2. To provide a set of services to increase the European capacity to promote population health by integrating into development agendas, policies and practice evidence on the social and economic determinants of health.

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Put HP within the development agenda of European countriesNeed to keep the

vision but revisit the means

Increased inequalities, poverty and psycho-social stress