Health Promotion and Economic Development: Interactions and Dilemmas

1. Health Promotion andEconomic Development:Interactions and Dilemmas Sylvie Stachenko Deputy Chief Public Health Officer

2. Road Map • 1.Clarifying our understanding • Exploring the interactions • Investing in health for sustainable development

3. Broadening the Landscape for Health What good does it do to treat people's illnesses ... then send them back to the conditions that made them sick? Source:Michael Marmot, Reducing Health Disparities Symposium, Toronto, March 2006

4. Determinants of HealthBroadening Involvement

5. Key Milestones • Lalonde Report 1974. . . health more than medical services • Ottawa Charter 1986. . . prerequisities for health • Jakarta Declaration 1997. . . investments for health development • Mexico Statement 2000. . . health necessary for social and economic development • Bangkok 2005. . . influence of globalization on health

6. Influence of Globalization on Health Source:Spiegel, Labonte and Ostry, International Joint Occupational Environmental Health, 2004

7. Finanscapes:The Trade, Diet and Health Nexus • Market-oriented agriculture policies • Open and increased food trade • Retail restructuring (superstores) • Global agribusiness and transnational food companies • Annual Turnover Selected US TFCs $258.6 billion $66.7 billion $22 billion

8. Mediascapes: Diet and Obesity

9. Exploring the Interactions Health promotion Economic development

10. Life Expectancy and Income per capita for Selected Countries, 20th Century Source:World Development Report, 1993

11. Health Care Spending and Life Expectancy

12. Under-5 Mortality Ratesby Income Groups of Countries Source:The Lancet, “Applying an equity lens to child health and mortality: more of the same is not enough” Vol. 362, #9379, July 2003

13. Increasing Health Inequalities Between and Within Countries

14. Some Groups are More Vulnerable than Others Percent Low Income by Family Type Source:Improving the Health of Canadians, 2004

15. The Social Gradient Occupational class differences in life expectancy, England and Wales, 1997-1999

16. Commission on Macroeconomics and Health • Positioned health as a determinant of economic development • Focused on low and middle income countries • Focused primarily on communicable diseases

17. The Challenge of Cardiovascular Disease in Developing Economies

18. The Cost of Lifestyle and Unhealthy Environments Obesity in Europe Source:International Obesity Task Force, 2002

19. The Poverty Spiral Source:WHO, An estimation of the economic impact of chronic noncommunicable diseases in selected countries, 2006

20. Loss of Labour Force Projected Chronic Disease Death Rates By Country, Age 30 – 69 years, 2005 Source:WHO, Preventing Chronic Diseases: A Vital Investment, 2005

21. Full-Income Losses Full-income losses due to heart disease, stroke and diabetes in 2005 compared with 2015 estimates Source:WHO, Preventing Chronic Diseases: A Vital Investment, 2005

22. Investing in Health for Sustainable Development

23. Human Development and Balanced Growth

24. UN Measures of Human Development Source:United Nations Development Program, Human Development Report 1998

25. The Impact of Income on Human Development Selected Countries Luxembourg Norway United States Sweden Chile Mexico Uruguay Brazil Panama GDPper capita 62,298 37,670 37,562 26,750 10,274 9,168 8,280 7,790 6,854 Human DevelopmentIndex Rank 4 1 10 6 37 53 46 63 56 Human PovertyIndex Rank Index 2 8 2 17 1 Index 1 2 13 1 20 9 Source:World Development Report, 2005

26. Policy Choices can have Major Effects Source:UNICEF Innocenti Research. (2000). A League Table of Child Poverty in Rich Nations. Innocenti Report Card No.1. Florence:UNICEF Innocenti Research Centre. <www.unicef-icdc.org>.

27. Making the Healthy Choices the Easy Choices Manipulating Sales Taxes can Benefit the Diet of the Poor Source:Smed S & Denver S. Food & Resource Economics Ints. KVL Univ., Denmark, April 2005.

28. Towards Intersectoral Policy Approaches • Whole of government approaches • Broad commitment to health as a collective goal • Community participation • Challenges • Limited incentives for working across sectors • Accountability and financial structures not conducive to collaboration • Knowledge deficit re effectiveness • Political will and leadership

29. NGO alliances Global Prevention Alliance on Obesity (IOTF) Chronic Disease Prevention Alliance of Canada Interministerial mechanisms Sweden UK British Columbia, Canada Multilevel networks Canada’s Public Health Network Emerging Collaboration Models at International and National Levels

30. Community Driven Development

31. Strategic Knowledge Development What Kinds of Research? • Studies on social and other determinants • Health modelling and economic analysis • Health policy and system governance analysis • Inter/trans disciplinary and multi-sectoral public policy and implementation research • Translational research • New evaluation tools e.g. health impact assessment of policy proposals

32. Investing in Public Health and Health Promotion “Over the next 20 years, ensuring that care is of a high clinical quality and provided with minimum waiting will not be sufficient… [We need to strike] an appropriate balance between … health and social care, between primary and secondary care and between treatment and prevention.” … Wanless Report, 2002, UK

33. Health Promotion and Economic Development “The success of an economy and a society cannot be separated from the lives that the members of society are able to lead…we not only value living well and satisfactorily, but also appreciate having control over our own lives.” “The success of an economy and a society cannot be separated from the lives that the members of society are able to lead…we not only value living well and satisfactorily, but also appreciate having control over our own lives.” … Amartya Sen, Development as Freedom (1999)

34. Health Promotion and Economic Development Obrigada!