WORLD HEALTH & SOCIAL DETERMINANTS

Dr Pascoal MocumbiEDCTP High Representative,

Mozambique’s Former Prime Minister at Forosalud III National Health Conference,

Lima, Peru, 10.06.06

Mortality: 2002 estimates

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

LMIC

HIC

I. Communicablediseases, maternaland perinatalconditions andnutritionaldeficiencies

II. Noncommunicableconditions

III. Injuries

Source: WHO Burden of Disease estimates, 2002

Mortality Estimates for 2002 (World Health Report 2004)

Infectious and Parasitic diseases 10 904 (000)•HIV/AIDS 2 777 ¨•Diarrhoeal diseases 1 798 ¨•Tuberculosis 1 566 ¨•Malaria 1 272 ¨•Childhood diseases 1 124 ¨•STI (excluding HIV) 180 ¨•Meningitis 173 ¨•(Other) Tropical Diseases 129 ¨•Hepatitis B 103 ¨•Hepatitis C 54 ¨•Dengue 19 ¨•Japanese encephalitis 14 ¨•Intestinal nematode 12 ¨•Leprosy 6 ¨

LEADING CAUSES OF DISEASE BURDEN AMONG ADULTS (15-59)

WORLDWIDE

18522

18749

18962

19486

19567

26155

27264

28380

57843

68661

0 10000 20000 30000 40000 50000 60000 70000 80000

HIV/AIDS

Unipolar depressive disordersTuberculosis

Road traffic injuries

Ischaemic heart disease

Alcohol use disorders

Hearing loss (adult onset)Violence

Cerebrovascular diseaseSelf-inflicted injuries

World Health Report 2003 DALYS(000)

1 = <50% (36)2 = 50-80% (68)3 = 80-95% (33)4 = >95% (41)5 = No data available (1)

UNDER 5 MORTALITY RATE PER 1000 LIVE BIRTHS

SIERRA LEONE 316

BOLIVIA 80

KYRGYZSTAN 63

SRI LANKA 20

ICELAND 3

SOURCE: THE WORLD HEALTH REPORT 2004,WHO

% PROBABILITY OF DYING BETWEEN AGES 15 AND 60 (males)

LESOTHO 90.2

RUSSIA 46.9

BOLIVIA 26

SRI LANKA 23.8

COLOMBIA 23.6

PAKISTAN 22.7

SWEDEN 8.3

SOURCE: THE WORLD HEALTH REPORT 2004,WHO

UNDER 5 MORTALITY RATES BY SOCIOECONOMIC QUINTILE OF

HOUSEHOLD

0

50

100

150

200

Indonesia Brazil India Kenya

Poorest fifth 2nd poorest fifth Middle fifth

2nd richest fifth Richest fifth

Under 5 mortalityper 1000

Victora et al Lancet , 362, 233-241 (2003)

MORTALITY AND EDUCATION IN MEN* AGED 45-90 IN MATLAB, BANGLADESH,

1982-1998

0,60,650,7

0,750,8

0,850,9

0,951

1,05

None Koranic 1 to 4 yearsformal

5+ formal

Own education Wife's educationRate ratio

Education*married at entry (Hurt, Ronsmans & Saha JECH 2004, 58, 315-320)

GROWING INEQUALITIES

TRENDS IN PROBABILITY OF SURVIVAL IN RUSSIAN MEN BY EDUCATION

(RELATIVES STUDY)

0,4

0,45

0,5

0,55

0,6

0,65

0,7

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

Calendar year

45 p

20

elementary university

45 p20 = probability of living to 65 yrs when aged 20 yrs

Murphy et al, in press

A very complex health development landscape…

• Outcomes-based development

• "Scaling Up!"

• Growing rapidly: from millions to billions

• Predominant disease/intervention program (vertical) focus

• Unsatisfactory performance of health systems

C

-PHC S

-PHC Reform

s & Minimum Packages

MDG

Scaling-up

1978

1993

2000

2001

2002

1982

Social dimensions of health affirmed in WHO Constitution (1948), downplayed during 1950s era of disease campaigns.

Determinants re-emerge under Health for All agenda (1970s), action falters in 1980s.

1990s: paradigm of health as "private" issue dominant; some exceptions.

2000s: "pendulum swing" and new chance for action.

History: trends and opportunities

1948

2005

2005 Commission social Determinants of Health

‘The causes of the causes’

Social Determinants and Health Disadvantage

Source: Adapted from Diederichsen and Hallqvist 1998 Challenging inequities in health

Social Context

Policy Context

Social Position

Specific exposure

Disease / injury

Social Consequences of ill health

IV

II

I

I

III

What good does it do to treat people's illnesses ...

then send them back to the conditions that made them sick?

Social, political, economic and environmental threats to health identified as the basic causes of

ill health and the inequitable distribution of health within and

between countries have increased

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.

A broad consultative process

June 04:

major meeting with int'l public health experts, London

Dec 2003 Present

From Feb 2004: consultations in WHO HQ and Regions

From June 2004: outreach to civil society

From July 2004: initial contacts with potential partner countries

From Aug 2004: linking with UN agencies and projects (FAO, ILO, MP, etc)

May 04:

D-G Lee announces CSDH at WHA

Jan 05:

CSDH discussed at WHO Executive Board

Equity and WHO

• Constitutional foundations 1948• Alma Ata Conference 1978• Equity Team created 2003• Commission on Social Determinants

launched 2005, will report in 2008

"The underlying theme of my first year as Director-General is equity and social justice".

Lee Jong-Wook, Address to the World Health Assembly, May 2004

PERU ForoSalud

• Example of civil society involvement

• III Conferencia Nacional de Salud: Voz Y Proposta Por el Derecho a la Salud 2006-2011- A call for action by government by a civil society movement that assumes its responsibility in promoting EQUAL OPPORTUNITIES TO HEALTH FOR ALL

Muchas Gracias, Thank you!