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COMMISSION ON SOCIAL DETERMINANTS OF HEALTH Michael Marmot

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Title: COMMISSION ON SOCIAL DETERMINANTS OF HEALTH Michael Marmot


1
COMMISSION ON SOCIAL DETERMINANTS OF HEALTH
  • Michael Marmot
  • Launching Ceremony of CNDSS
  • PAHO/WHO Country Office, BRAZIL
  • March 15, 2006

2
CSDH Knowledge for action
  • The goal is not an academic exercise, but to
    marshal scientific evidence as a lever for policy
    change aiming toward practical uptake among
    policymakers and stakeholders in countries.

WHO Director-General LEE Jong-Wook, address to
the World Health Assembly, May 2004
3
CSDH
  • improving health and health equity through action
    on the socially determined causes of health
    inequities

4
What good does it do to treat people's illnesses
...
then send them back to the conditions that made
them sick?
5
Why Emphasize Social Determinants?
  • Social determinants of health have a direct
    impact on health
  • Social determinants structure other causes of
    health
  • Environment
  • Behaviour
  • Services
  • The causes of the causes

6
INEQUALITIES BETWEEN COUNTRIES
7
UNDER 5 MORTALITY RATE PER 1000 LIVE BIRTHS
SOURCE THE WORLD HEALTH REPORT 2004,WHO
8
PROBABILITY OF DYING BETWEEN AGES 15 AND 60
(males)
SOURCE THE WORLD HEALTH REPORT 2004,WHO
9
INEQUALITIES WITHIN COUNTRIES
10
UNDER 5 MORTALITY RATES BY SOCIOECONOMIC QUINTILE
OF HOUSEHOLD
Under 5 mortality per 1000
Victora et al Lancet , 362, 233-241 (2003)
11
MORTALITY AND EDUCATION IN MEN AGED 45-90 IN
MATLAB, BANGLADESH, 1982-1998
Rate ratio
Education
married at entry
(Hurt, Ronsmans Saha JECH 2004, 58, 315-320)
12
GROWING INEQUALITIES
13
TRENDS IN PROBABILITY OF SURVIVAL IN RUSSIAN MEN
BY EDUCATION (RELATIVES STUDY)
45 p20 probability of living to 65 yrs when
aged 20 yrs
Murphy et al, in press
14
A Growing Crisis Large ageing population and
an increase in chronic disease is creating a
financial burden on health systems
15
ESTIMATED POPULATION OVER 60 YRS

Vaupel et al, 1998
16
ADULT MORTALITY THE DOUBLE BURDEN OF DISEASE
(WHO 2005)
17
LEADING CAUSES OF DISEASE BURDEN AMONG ADULTS
(15-59) WORLDWIDE
HIV/AIDS
Unipolar depressive disorders
Tuberculosis
Road traffic injuries
Ischaemic heart disease
Alcohol use disorders
Hearing loss (adult onset)
Violence
Cerebrovascular disease
Self-inflicted injuries
DALYS(000)
World Health Report 2003
18
Commission on Macroeconomics and Health (CMH)
  • CMH called for increased public expenditure on
    health for economic development
  • CMH focused on low- and middle-income countries
  • CMH focused primarily on communicable diseases

19
World Health Report 2002
20
Ten Tips for Staying Healthy
  • Don't be poor. If you can, stop. If you can't,
    try not to be poor
  • for long.
  • Don't have poor parents.
  • Own a car.
  • Don't work in a stressful, low paid manual job.
  • Don't live in damp, low quality housing.
  • Be able to afford to go on a foreign holiday and
    sunbathe.
  • Practice not losing your job and don't become
    unemployed.
  • Take up all benefits you are entitled to, if you
    are unemployed, retired or sick or disabled.
  • Don't live next to a busy major road or near a
    polluting factory.
  • Learn how to fill in the complex housing benefit/
    asylum application forms before you become
    homeless and destitute.

Dave Gordon, 1999
21
  • The causes of the causes

22
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.

23
  • Commissioners
  • Knowledge networks
  • Civil society
  • Country action
  • Global initiative
  • WHO

24
COMMISSIONERS
  • The twenty Commissioners are global and national
    leaders from political, government, civil society
    and academic fields and from all geographic
    regions of the world.

25
KNOWLEDGE NETWORK THEMES
26
Civil Society
  • "The presence, advice and testimony of
    civil-society actors is essential to the work of
    the Commission and will be decisive to the
    general awakening we wish to promote".

Commissioner Ndioro Ndiaye, Comments on first
meeting of CSDH regional civil society
facilitators
27
Update Regional and Regional activities
Regional Meeting
National Meeting
Next National Meeting
Country Participants
28
Countries
29
Three strands within country stream
  • Within country
  • creating space for dialogue e.g Iran
  • putting SDs inequities on the policy agenda e.g
    Brazil, Kenya
  • focus, priorities, benchmarks, concrete areas of
    work e.g Chile
  • brokering people and institutional mechanisms
    e.g. Kyrgzstan
  • Influencing national resources and investments
    e.g. England, Canada
  • Collecting information on country situation

30
Three strands within country stream
  • 2. Between countries
  • facilitating supportive networking across
    countries
  • exchanging and sharing know-how
  • documentation and exchange of information
  • training support
  • and other demand driven support

31
Three strands within country stream
  • 3. Global international
  • identifying the way that global/international
    institutions are enabling or disabling country
    action
  • bringing concrete experience on how to act
    upstream on global policies (e.g. MDGs)
  • multi-country and regional alliances
  • re-enforcing change within WHO

32
REGIONAL ACTIVITIES
  • Nordic
  • Latin America
  • East Asia
  • Europe

33
Global Initiative
  • Advancing the CSDH agenda by engaging global
    institutions

34
WHO ACTION
  • The Commission will work with WHO to
    institutionalize social determinants capacities
    and approaches within WHO global and regional
    policies and programmes. This will be
    accomplished by integrating WHO country, regional
    and global personnel in all activities of the
    Commission.

35
COMMISSION MEETINGS
  • CHILE March 2005
  • CAIRO May 2005
  • INDIA September 2005
  • IRAN Jan 2006

36
THE SUCCESS OF AN ECONOMY AND OF A SOCIETY
CANNOT BE SEPARATED FROM THE LIVES THAT THE
MEMBERS OF THE SOCIETY ARE ABLE TO LEADWE NOT
ONLY VALUE LIVING WELL AND SATISFACTORILY, BUT
ALSO APPRECIATE HAVING CONTROL OVER OUR OWN
LIVESAmartya Sen, Development as Freedom
(1999)
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