The Social Determinants of Health in EMR: Working towards Regional and Country Policies - PowerPoint PPT Presentation

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The Social Determinants of Health in EMR: Working towards Regional and Country Policies

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The Social Determinants of Health in EMR: Working towards Regional and Country Policies WHO Eastern Mediterranean Region Capacity Development Workshop on Health ... – PowerPoint PPT presentation

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Title: The Social Determinants of Health in EMR: Working towards Regional and Country Policies


1
The Social Determinants of Health in EMRWorking
towards Regional and Country Policies
  • WHO Eastern Mediterranean Region
  • Capacity Development Workshop on Health System
    Development
  • Alexandria, Egypt
  • 20-24 May 2007

2
Why the social determinants of health?
  • SDH emphasize the PHC approach
  • Recent concern has been encouraged by the WHO
    Commission on the Social Determinants of Health.
  • This presentation will identify priority SDH in
    the Region and relate the SDH and health equity
    agenda to regional and country policies, and to
    health systems.

3
The Social Determinants of Health
  • The social determinants of health refer to both
    specific features and pathways by which societal
    conditions affect health and that potentially can
    be altered by informed action
  • Krieger N. A glossary for social epidemiology. J
    Epidemiol Community
  • Health 2001 55693-700

4
The core problem
  • Throughout the world, people who are
  • vulnerable and socially disadvantaged have
  • less access to health resources, get sicker, and
  • die earlier than people in more privileged social
  • positionsHealth gaps are growing.
  • Irwin A. et al. The Commission on Social
    Determinants of Health
  • Tackling the social roots of health inequities.
    PLoS Medicine 2006 3
  • (6), e 106.

5
Social determinants of high maternal mortality
  • Proximal determinants
  • Low level of mothers education
  • Lack of decision making power among women
  • Cultural norms which encourage women to downplay
    their health problems
  • Poor quality health services
  • Distal determinants
  • Poverty
  • Lack of national resources for health care
  • Lack of concern for the status of women on the
    part of governing elites
  • National and global failure to prioritize RH

6
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7
Health equity
  • The absence of systematic disparities in health
    (or its determinants) between more and less
    advantaged social groups
  • Certain differences are unfair and unjust
  • WHO has declared that health is a human right
  • Therefore health actions should be directed, at
    least in part, towards eliminating inequities in
    health

8
Health Systems, Programs, Determinants
Interrelationships
9
HEALTH SYSTEM CONCEPTUAL FRAMEWORK
Social Determinants of Health
GOALS OF HEALTH SYSTEM
SYSTEM BUILDING BLOCKS
Responsiveness
Information Support
Service provision
Governance leadership
Coverage
Health workforce
Quality, safety
Health
Efficiency
Medical products, technology
Provider performance
Financing
Financial protection
Equity
10
WHO Commission on the Social Determinants of
Health (CSDH)
  • Launched March 2005 to
  • Identify and tackle persistent health inequities
    experienced by socially disadvantaged and
    marginalized populations
  • Draw attention to the importance of the social
    causes of illhealth and to inequalities in health
    at the global, national and subnational levels
  • Revisit Health for All and the Alma Ata
    Declaration, 1978, and Primary Health Care as a
    mechanism for providing universal health care

11
CSDH activities include
  • Knowledge Networks to synthesize the knowledge
    base for the various SDH and provide examples of
    best practice
  • Working with civil society
  • Country level work
  • Preparation of a final report by the Commission

12
Work of EMROIdentification of priority SDH
working towards a knowledge base
  • Gender issues and womens enablement
  • Improving access to health care for women
  • Education/literacy for girls and women
  • Employment and social protection
  • Female genital mutilation as a gender and health
    issue in some countries of EMR
  • Child labour and street children the causes
    originate in poverty and its corrosive effects on
    family life

13
Priority SDH in EMR cont.
  • Migrant workers concerns about health rights and
    limited access to health services
  • Social exclusion
  • Low status occupational groups
  • The disabled
  • Groups with a sexual orientation labeled as
    deviant
  • Groups excluded on the basis of religion,
    ethnicity or language
  • Those with stigmatized diseases or conditions
    the mentally ill, those with HIV/AIDS, TB, cancer
    etc.

14
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15
Priority SDH in EMR cont.
  • Inequitable health systems as a barrier to health
    care
  • Scarce resources or a low national priority for
    health
  • National health policies that fail to prioritize
    health equity
  • Maldistribution of facilities and/or funding
  • Socially determined life styles and behaviors
    (the disadvantaged have fewer choices than the
    more advantaged)
  • Smoking
  • Nutrition related problems obesity and lack of
    adequate nutrition among the disadvantaged
  • Traffic accidents

16
Priority SDH in EMR cont.
  • Conflicts and emergencies loss of human rights
    is the major underlying social determinant,
    involving
  • Lack of security, living daily in fear
  • Displacement from home and the familiar
  • Loss of social networks and family structures
  • Loss of livelihood daily activity, access to
    land, employment etc. resulting in extreme
    poverty
  • Food insecurity due to lack of livelihood
  • Lack of shelter, services etc. necessary to live
    in dignity
  • Shelter a plastic sheet or the shade of a tree
  • Lack of clean water and safe sanitation
  • Lack of essential health and other services
  • Lack of communications isolation

17
Conflict Palestinian checkpoints
  • Photo here

18
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19
For EMRO the following SDH policy areas have been
identified
  • Developing a regional perspective on SDH, based
    on solid local evidence
  • Identifying best practices to tackle SDH
  • Improving health systems and financing to
    increase fairness
  • Advocating for inclusion of SDH in all national
    policies and programs
  • Implementing/facilitating interventions on the
    ground
  • Expanding partnerships with stakeholders in the
    Region

20
EMRO activities so farImproving the knowledge
base
  • A regional discussion paper on SDH
  • Papers on the knowledge base in Egypt, Iran,
    Jordan, Morocco, Oman, Pakistan and Palestine
  • Publication of paper in The British Medical
    Journal
  • Policy brief Tackling health inequities through
    action on the social determinants of health
  • Paper on conflict and SDH in EMR, for CSDH

21
Egypt the country study identified the following
SDH
  • Child labor
  • Poverty is the main cause of child labor
  • 21 of children aged 6-14 work at some time
    during the year, most of them in rural areas
  • 25 of working children had injuries at work
  • 4 of the injured suffered long-term problems
  • Gender issues Female-headed households
  • 22 households were headed by females of whom
    83 were illiterate (compared to national figure
    of 50)
  • Expenditure and income levels for these
    households were predominantly in the poorest two
    quintiles.

22
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23
Jordan the country study identified the
following SDH
  • Gender and employment issues
  • Women have had the right to vote and contest
    elections since 1974
  • Womens participation in the formal labor force
    grew from 15 to 24 between 1980 and 2002. BUT
    average unemployment rates among women were 25,
    compared to 15 for men

24
Islamic Republic of Iran current collaboration
between EMRO, WHO HQ, country office and MoHME
  • Preparation of an updated, revised situation
  • analysis of SDH in IRI, as a basis for future
  • collaboration in the preparation of a strategic
  • plan for tackling SDH and health equity.
  • This collaboration supports work in IRI,
  • identified by Geneva as a champion country
  • in the Region for SDH and health equity.

25
For country action, request from EMRO
  • Support to
  • Generate information on SD and the pathways
    through which they influence health
  • Promote intersectoral collaboration, for example
    by establishing a formal body with responsibility
    to forward the SDH and health equity agenda
    across government sectors, with civil society and
    private partners
  • Develop a national strategy for SDH

26
For further information see
  • Regional Observatory papers and data on SDH
  • http//www.who.int/social_determinants/en/
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