Social Determinants of Health
Dr Rüdiger Krech
Director, WHO Department of Ethics, Equity,
Trade and Human Rights
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Social Determinants of Health, 17 May 2010
Why treat people ...
then send them back to the conditions that
made them sick?
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Social Determinants of Health, 17 May 2010
Outline
 What are the social determinants of health?
 What is WHO doing about it?
 How can health communicators contribute?
 Q&A and further discussion…
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Social Determinants of Health, 17 May 2010
What are the social determinants
of health (SDH)?
The circumstances in which people are born, grow up,
live, work and age, and the systems put in place to
deal with illness.
A girl in Lesotho is likely to
live 42 years less than
another in Japan.
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Social Determinants of Health, 17 May 2010
What are inequities?
The unfair, unjust and
avoidable causes of ill
health
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Social Determinants of Health, 17 May 2010
What then influence the SDH and
inequities?
"(The) toxic combination of bad
policies, economics, and politics
is, in large measure responsible for
the fact that a majority of people in
the world do not enjoy the good
health that is biologically possible,”
-WHO Commission on the Social
Determinants of Health
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Social Determinants of Health, 17 May 2010
Life expectancy at birth (men)
Glasgow, Scotland (deprived suburb)
54
India
61
Philippines
65
Korea
65
Lithuania
66
Poland
71
Mexico
72
Cuba
75
US
75
UK
76
Glasgow, Scotland (affluent suburb)
82
(WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)
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Social Determinants of Health, 17 May 2010
Outline
 What are the social determinants of health?
What is WHO doing about it?
 How can health communicators contribute?
 Q&A and further discussion…
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Social Determinants of Health, 17 May 2010
Commission on Social Determinants of
Health
1. Improve Daily Living Conditions
2. Tackle the Inequitable Distribution
of Power, Money, and Resources
3. Measure and Understand the
Problem and Assess the Impact of
Action.
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Social Determinants of Health, 17 May 2010
WHO Streams of Work
 Intersectoral action/ “health in all policies”
 Addressing social determinants in public health
programmes
 Measuring health inequities and monitoring
impact of policies on inequities
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Social Determinants of Health, 17 May 2010
Health in All Policies
“government objectives are best achieved
when all sectors include health and wellbeing as a key component of policy
development”
-Adelaide Statement on
Health in All Policies, 2010.
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Social Determinants of Health, 17 May 2010
Health as a resource for broader
government goals
Sector
Interrelationships with health and well-being
Economy and
employment
A resilient ,vibrant and innovative economy depends on a having healthy population. Healthier
people are more productive, experience lower levels of absenteeism, can adapt more easily to work
changes, and can remain in the workforce longer.
Stable, secure employment and access to health safety nets, improves health across different social
groups and workers in both informal or formal sectors of the economy, .
Security and
justice
Security and health both depend upon the same societal conditions, including secure food, water,
sanitation, housing, work opportunities, and the ability to participate in society.
Health inequalities result in more violent societies with higher crime, family violence and civil
unrest. Mental illness (and associated drug and alcohol problems) can be both a cause and a
consequence of crime and imprisonment.
Education
Poor health of children or family members impedes educational attainment, reducing educational
potential and abilities to solve life challenges and pursue opportunities.
Schools are an optimal setting for health promotion, such as nutrition initiatives. Evidence shows
that when children receive a meal at school, attendance and matriculation increases.
Agriculture
and the food
industry
Consideration of health and well-being in production, manufacturing and marketing promotes
consumer confidence, a more sustainable market, and enables innovation and growth.
Healthy and accessible foods are critical for health and growth across the lifespan. Supportive
economic and social policy for farming communities enhances their health and well-being.
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Social Determinants of Health, 17 May 2010
Health sector responsibilities
 Understanding the political agendas and administrative
imperatives of other sectors;
 Building the evidence base of policy options and
strategies;
 Assessing comparative health consequences of options
within the policy development process;
 Creating regular platforms for dialogue and problem
solving with other sectors;
 Evaluating the effectiveness of intersectoral work and
integrated policy-making.
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Social Determinants of Health, 17 May 2010
SDH within health programs
 Few global targets (e.g. MDGs) will be met without
addressing social determinants
 A social determinants approach mean moving out of
comfort-zones to work across sectors
 Communication of programmes should focus on
supporting a critical public policy dialogue
 Equity is a matter of how resources [and power] are
distributed - all programmes and societies can afford to
be more equitable.
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Social Determinants of Health, 17 May 2010
Global Plan: Tb eliminated by 2050
Current trend (0.5%)
extrapolated
1000
Global Plan prediction:
incidence falls 5-6%
per year
100
10
Desired trend
Elimination target: 1 / million / year by 2050
1990
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2000
2010
Social Determinants of Health, 17 May 2010
2020
2030
2040
1
2050
Incidence/million/yr
10000
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Social Determinants of Health, 17 May 2010
Adherers
Participants
Total reached
Target Population
Total Population
PH programmes need to address the SDH
and health equity
Beneficiaries
Social determinants in health programmes:
framework for analysis
 Organized the work along a
common framework
 Three phases
– Analysis
– Interventions and implications
– Measurement
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Social Determinants of Health, 17 May 2010
Outline
 What are the social determinants of health?
 What is WHO doing about it?
 How can health communicators contribute?
 Q&A and further discussion…
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Social Determinants of Health, 17 May 2010
How does communication affect SDH?
 Discovers and reports the “causes of the causes”
 Holds bureaucrats and policy/makers accountable
for equitable outcomes
 Is a platform for civil society voice
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Social Determinants of Health, 17 May 2010
Questions for health bureaucrats and
policy/makers
 How are you living up to your responsibility to
address broader social issues?
 Does this programme/policy combine equity,
effectiveness and efficiency goals?
 What is your plan to increase equity despite fiscal
constraint?
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Social Determinants of Health, 17 May 2010
Outline
 What are the social determinants of health?
 What is WHO doing about it?
 How can health communicators contribute?
Q&A and further discussion…
22 |
Social Determinants of Health, 17 May 2010
Conclusion
 The majority of factors that contribute to ill health and
health inequities lie outside the traditional mandate of
the health sector
 The social determinants of health must be considered
within health programmes and across government
policies in order to reach broader societal
 Policy-makers and bureaucrats must be held
accountable for reducing health inequities
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Social Determinants of Health, 17 May 2010