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Addressing Social Determinants of Health to Ensure Health Rights

Addressing Social Determinants of Health to Ensure Health Rights. Dr. Thelma Narayan Community Health Cell, Bangalore. Bringing together People & Public Health, Human Rights and Development Communities. 4 th February 2008. Tackling Social Determinants of Health in an Era of Globalization.

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Addressing Social Determinants of Health to Ensure Health Rights

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  1. Addressing Social Determinants of Health to Ensure Health Rights Dr. Thelma Narayan Community Health Cell, Bangalore Bringing together People & Public Health, Human Rights and Development Communities. 4th February 2008

  2. Tackling Social Determinants of Health in an Era of Globalization. • There is an urgent need to address the root cause of inequalities in disease, disability and health. • Social conditions in which people live and work are referred to as the social determinants of health. • WHO Commission on Social Determinants of Health (WHO- CSDH, 2005 -2008) • Need for policies and practice that tackle social costs of unfair, avoidable suffering

  3. Politico-economic determinants (trade, commodity pricing, foreign relations) backed by unprecented wealth and concentration of power • Often aggravate deep rooted Social • Inequalities that determine health • Gender • Race, Ethnicity • Language • Belief system • Disabilities

  4. Corporate led globalization, Neo-liberal economic reforms, Negative macro-policies Livelihoods, Incomes, Food security, Increased conflict, War and violence, Access to water, Access to health care, Environmental degradation, Adversely affect the social majority, nationally & globally

  5. Development: A Right to Health Perspective What are the people saying

  6. Health Status in India National Family Health Survey ( NFHS) 3 – 2005-2006 NFHS 1 (1992-93), NFHS 2 ( 1998 -99) Trends in Children’s Nutritional Status Percentage of Children under age three years. Source: India, NFHS – 3, Key findings. In Bihar the Child Nutrition situation has become worse from 1998 -99 to 2005-06

  7. ANAEMIA • Women – 53% • Men- 24% • Children- 70% ( 6-59 months) Source: India, NFHS- 3 , Key Findings.

  8. Proximal Health Determinants • Toilets: • Three fourth of rural households have no toilets. • 55% of all households (urban and Rural) have no toilets. • Water: • 25% of all households have water piped in to their dwelling, yard or plot. Source: NFHS 3

  9. Poverty & Health Effects • Every hour > 1,200 children die, equivalent to 3 tsunami’s a month, every month, due to a single pathology – poverty • ……but, with a little response

  10. INDIA: ? Shining Global example • Overall employment growth in 1990s was 2/3rd to half of 1980 • For agricultural labourers, bulk of poor in India, rate of growth of real wages per annum almost halved in the 1990s, compared to 1980s. • Worsening of working conditions of labourers in the informal sector and agriculture in past decade • Open unemployment serious - Jeyarajan and Swaminathan, 2003 JOBLESS GROWTH

  11. Poverty, deprivation and quality of employment • Informalization, • Casualization of work, • High prevalence of child and elderly labour, • Work with low skills, low capital, low earnings, • No social security, • Adverse health effects, poor access to health • care, • Burden on women,

  12. Trade, Development and Health • Over 2/3rd of the poor are small farmers / agricultural laborers • Unfair trade undermines their livelihood • Led by EU and USA developed country agricultural subsidies are over $ 350 billion a year, ie, almost $ 1 billion a day, supporting large farmers and corporate agri-business • For a fraction of the cost universal education, health and water for all can be achieved. UNDP, 2006

  13. Disparities hampering progress are systematic, reflecting hierarchies of advantage and disadvantage and public policy choice” - UNDP, 2005

  14. Globalization from BelowThe People’s Health Movement A Globalization of solidarity and informed action working on determinants of health; Bringing the Public back into Public Health, present in 90 countries; Multilevel functioning: - Community - Government - Global policy advocacy Coalition with broader movements

  15. Globalization Of Health From BelowJan Swasthya Sabha, Kolkata 2000 • Over 2000 participants in 5 peoples health trains • Mobilization across 19 • states • Adopted 20 point Indian • People’s Charter • Launched the Jan • Swasthya Abhiyan, • campaigning for • Health for All Now • Health as a Fundamental • Human Right

  16. Globalization Of Health From BelowThe First Global People’s Health Assembly In 2000 December 1454 health activists from 75 countries met in Savar, Bangladesh to discuss the challenge of attaining Health for All, Now! Over 250 Indian delegates attended

  17. Globalization Of Health From BelowThe People’s Charter for Health Health is a social, economic and political issue and above all a fundamental human right.”

  18. Globalization Of Health From BelowThe People’s Charter for Health • “Health for all means that powerful interests have to be challenged, that globalisation has to be opposed, and that political and economic priorities have to be drastically changed.”

  19. Globalization Of Health From Below Right to Health Movement

  20. Globalization Of Health From BelowCampaigns on Gender Issues • Campaign Against Sex Selective Abortion or Female Foeticide – 2001 onwards • Campaign on Violence against Women as a Public Health Challenge – 2000 onwards • Women’s Access to Primary Health Care - 2003 • People’s Tribunal on Population Policies – 2004 • Gender and Power Issues in Medical Education • Women’s Health Charter - 2007

  21. Globalization Of Health From BelowInteraction with National With National Rural Health Mission (NRHM) • Members of Task Force and Advisory Committee • Shifted the missions focus from Demography to Public Health • Community Monitoring • People Rural Health Watch • ASHA Mentoring Group

  22. Globalization Of Health From Below Globalizing solidarity from over 80 countries at the Second People’s Health Assembly, Cuenca Ecuador

  23. The Cuenca Declaration 2005 “The human right to health and health care must take precedence over the profits of corporations, especially the profiteering of pharmaceutical companies.” Globalization Of Health From Below

  24. “Massive poverty and obscene inequality are social evils, like slavery and apartheid” - Mandela, 2005

  25. Public Health – an art and science; and also a movement dedicated to the equitable improvement of health and well-being (of communities with their full participation). First and foremost, public health leaders must be catalysts for the public health movement……… The justification for action is that health is both an end in itself – a human right……..as well as a prerequisite for human development” - WFPHA, 2004

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