Addressing Social Determinants of Health to Ensure Health Rights

Dr. Thelma NarayanCommunity Health Cell, Bangalore

4th February 2008

Bringing together People & Public Health, Human Rights and Development

Communities.

Tackling Social Determinants of Health in an Era of Globalization.

There is an urgent need to address the root cause of inequalities in disease, disability and health.

Social conditions in which people live and work are referred to as the social determinants of health.

WHO Commission on Social Determinants of Health (WHO- CSDH, 2005 -2008)

Need for policies and practice that tackle social costs of unfair, avoidable suffering

Often aggravate deep rooted Social Inequalities that determine health

Gender Race, Ethnicity Language Belief system Disabilities

Politico-economic determinants (trade, commodity pricing, foreign relations) backed by unprecented wealth and concentration of

power

Politico-economic determinants (trade, commodity pricing, foreign relations) backed by unprecented wealth and concentration of

power

Corporate led globalization, Neo-liberal economic

reforms, Negative macro-policies

Corporate led globalization, Neo-liberal economic

reforms, Negative macro-policies

Adversely affect the social majority,

nationally & globally

Livelihoods,Incomes,

Food security,Increased conflict,War and violence,Access to water,

Access to health care,Environmental degradation,

Development : A Right to Health Perspective

What are the people saying

Health Status in India

National Family Health Survey ( NFHS) 3 – 2005-2006NFHS 1 (1992-93), NFHS 2 ( 1998 -99)Trends in Children’s Nutritional Status Percentage of Children under age three years.

Nutritional Status NFHS 2 NFHS 3

Stunting(Low height for age)

51 45

Wasting( Low weight for

height)

20 23

Underweight( Low weight for age)

43 40

Source: India, NFHS – 3, Key findings.In Bihar the Child Nutrition situation has become worse from 1998 -99 to 2005-06

ANAEMIA

Women – 53% Men- 24% Children- 70% ( 6-59 months)

Source: India, NFHS- 3 , Key Findings.

Proximal Health Determinants Toilets: Three fourth of rural households have

no toilets. 55% of all households (urban and Rural)

have no toilets. Water: 25% of all households have water piped

in to their dwelling, yard or plot.Source: NFHS 3

Poverty & Health Effects

Every hour > 1,200 children die, equivalent to 3 tsunami’s a month, every month, due to a single pathology – poverty

……but, with a little response

Every hour > 1,200 children die, equivalent to 3 tsunami’s a month, every month, due to a single pathology – poverty

……but, with a little response

INDIA: ? Shining Global example

Overall employment growth in 1990s was 2/3rd to half of 1980

For agricultural labourers, bulk of poor in India, rate of growth of real wages per annum almost halved in the 1990s, compared to 1980s.

Worsening of working conditions of labourers in the informal sector and agriculture in past decade

Open unemployment serious

- Jeyarajan and Swaminathan, 2003JOBLESS GROWTH

Informalization, Casualization of work, High prevalence of child and elderly

labour, Work with low skills, low capital, low

earnings, No social security, Adverse health effects, poor access to

health care, Burden on women,

Poverty, deprivation and quality of employment

Trade, Development and Health Over 2/3rd of the poor are small farmers /

agricultural laborers Unfair trade undermines their livelihood Led by EU and USA developed country

agricultural subsidies are over $ 350 billion a year, ie, almost $ 1 billion a day, supporting large farmers and corporate agri-business

For a fraction of the cost universal education, health and water for all can be achieved.

UNDP, 2006

Disparities hampering progress are systematic, reflecting hierarchies of advantage and disadvantage and public policy choice”

- UNDP, 2005

Globalization from BelowThe People’s Health Movement

A Globalization of solidarity and informed action working on determinants of health;

Bringing the Public back into Public Health, present in 90 countries;

Multilevel functioning:- Community- Government- Global policy advocacy

Coalition with broader movements

Globalization Of Health From Below Jan Swasthya Sabha, Kolkata 2000

Over 2000 participants in 5 peoples health trains

Mobilization across 19 states Adopted 20 point Indian People’s Charter Launched the Jan Swasthya Abhiyan, campaigning for Health for All Now Health as a Fundamental Human Right

Globalization Of Health From Below The First Global People’s Health Assembly

In 2000 December 1454 health activists from 75 countries met in Savar, Bangladesh to discuss the challenge of attaining Health for All, Now! Over 250 Indian delegates attended

Globalization Of Health From Below The People’s Charter for Health

Health is a social, economic and political issue and above all a fundamental human right.”

Globalization Of Health From Below The People’s Charter for Health

“Health for all means that powerful interests have to be challenged, that globalisation has to be opposed, and that political and economic priorities have to be drastically changed.”

Globalization Of Health From Below Globalization Of Health From Below Right to Health Movement Right to Health Movement

Globalization Of Health From Below Campaigns on Gender Issues

Campaign Against Sex Selective Abortion or Female Foeticide – 2001 onwards

Campaign on Violence against Women as a Public Health Challenge – 2000 onwards

Women’s Access to Primary Health Care - 2003

People’s Tribunal on Population Policies – 2004

Gender and Power Issues in Medical Education

Women’s Health Charter - 2007

Globalization Of Health From Below Interaction with National With National Rural Health Mission (NRHM)

Members of Task Force and Advisory Committee

Shifted the missions focus from Demography to Public Health

Community Monitoring People Rural Health Watch ASHA Mentoring Group

Globalization Of Health From Below Globalizing solidarity from over 80 countries at the Second People’s Health Assembly, Cuenca Ecuador

Globalization Of Health From Below

The Cuenca The Cuenca Declaration 2005Declaration 2005

“The human right to health and health care must take precedence over the profits of corporations, especially the profiteering of pharmaceutical companies.”

“Massive poverty and obscene inequality are

social evils, like slavery and apartheid”

- Mandela, 2005

“Massive poverty and obscene inequality are

social evils, like slavery and apartheid”

- Mandela, 2005

Public Health – an art and science; and also a movement dedicated to the equitable improvement of health and well-being (of communities with their full participation).

First and foremost, public health leaders must be catalysts for the public health movement………

The justification for action is that health is both an end in itself – a human right……..as well as a prerequisite for human development”

- WFPHA, 2004