WORLD HEALTH & SOCIAL
DETERMINANTS
Dr Pascoal Mocumbi
EDCTP High Representative,
Mozambique’s Former Prime Minister at
Forosalud III National Health Conference,
Lima, Peru, 10.06.06
Mortality: 2002 estimates
30,000,000
25,000,000
20,000,000
15,000,000
I. Communicable
diseases, maternal
and perinatal
conditions and
nutritional
deficiencies
II. Noncommunicable
conditions
10,000,000
III. Injuries
5,000,000
0
Source: WHO Burden of Disease estimates, 2002
Mortality Estimates for 2002
(World Health Report 2004)
Infectious and Parasitic diseases
•HIV/AIDS
•Diarrhoeal diseases
•Tuberculosis
•Malaria
•Childhood diseases
•STI (excluding HIV)
•Meningitis
•(Other) Tropical Diseases
•Hepatitis B
•Hepatitis C
•Dengue
•Japanese encephalitis
•Intestinal nematode
•Leprosy
10 904 (000)
2 777 ¨
1 798 ¨
1 566 ¨
1 272 ¨
1 124 ¨
180 ¨
173 ¨
129 ¨
103 ¨
54 ¨
19 ¨
14 ¨
12 ¨
6 ¨
LEADING CAUSES OF DISEASE
BURDEN AMONG ADULTS (15-59)
WORLDWIDE
HIV/AIDS
68661
57843
Unipolar depressive disorders
Tuberculosis
28380
27264
26155
Road traffic injuries
Ischaemic heart disease
Alcohol use disorders
Hearing loss (adult onset)
Violence
Cerebrovascular disease
Self-inflicted injuries
19567
19486
18962
18749
18522
0
World Health Report 2003
10000
20000
30000
40000
50000
60000
70000
80000
DALYS(000)
1 = <50%
2 = 50-80%
3 = 80-95%
4 = >95%
5 = No data available
(36)
(68)
(33)
(41)
(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
Under 5 mortality
per 1000
200
150
100
50
0
Indonesia
Poorest fifth
2nd richest fifth
Brazil
India
2nd poorest fifth
Richest fifth
Victora et al Lancet , 362, 233-241 (2003)
Kenya
Middle fifth
MORTALITY AND EDUCATION IN MEN* AGED
45-90 IN MATLAB, BANGLADESH, 1982-1998
Own education
Rate ratio
Wife's education
1,05
1
0,95
0,9
0,85
0,8
0,75
0,7
0,65
0,6
None
Koranic
1 to 4 years
formal
5+ formal
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)
elementary
university
0,7
45 p 20
0,65
0,6
0,55
0,5
0,45
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
0,4
Calendar year
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
2005
Commission
social
Determinants
of Health
History: trends and
opportunities 2000s:
2005
"pendulum
swing" and new
chance for action.
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.
1993
1982
1978
1948
1990s: paradigm
of health as
"private" issue
dominant; some
exceptions.
2002
2001
2000
‘The causes of the causes’
Social Determinants and Health
Disadvantage
Source: Adapted from Diederichsen and Hallqvist 1998 Challenging inequities in health
Social
Context
I
Social Position
II
III
Specific exposure
Disease / injury
Policy
Context
I
Social Consequences of
ill health
IV
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:
May 04:
D-G Lee announces
CSDH at WHA
major meeting with int'l
public health experts,
London
Jan 05:
CSDH discussed at
WHO Executive Board
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)
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 DirectorGeneral 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 20062011- 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!