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WORLD HEALTH & SOCIAL DETERMINANTS

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. I. Communicable. diseases, maternal. and perinatal. 25,000,000.

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WORLD HEALTH & SOCIAL DETERMINANTS

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  1. 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

  2. Mortality: 2002 estimates 30,000,000 I. Communicable diseases, maternal and perinatal 25,000,000 conditions and nutritional 20,000,000 deficiencies 15,000,000 II. Noncommunicable conditions 10,000,000 III. Injuries 5,000,000 0 LMIC HIC Source: WHO Burden of Disease estimates, 2002

  3. Mortality Estimates for 2002 (World Health Report 2004) • Infectious and Parasitic diseases 10 904 (000) • HIV/AIDS 2 777 ¨ • Diarrhoeal diseases 1 798 ¨ • Tuberculosis 1 566 ¨ • Malaria 1 272 ¨ • Childhood diseases 1 124 ¨ • STI (excluding HIV) 180 ¨ • Meningitis 173 ¨ • (Other) Tropical Diseases 129 ¨ • Hepatitis B 103 ¨ • Hepatitis C 54 ¨ • Dengue 19 ¨ • Japanese encephalitis 14 ¨ • Intestinal nematode 12 ¨ • Leprosy 6 ¨

  4. 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

  5. (36) 1 = <50% (68) 2 = 50-80% 3 = 80-95% (33) (41) 4 = >95% (1) 5 = No data available

  6. UNDER 5 MORTALITY RATE PER 1000 LIVE BIRTHS SOURCE: THE WORLD HEALTH REPORT 2004,WHO

  7. % PROBABILITY OF DYING BETWEEN AGES 15 AND 60 (males) SOURCE: THE WORLD HEALTH REPORT 2004,WHO

  8. UNDER 5 MORTALITY RATES BY SOCIOECONOMIC QUINTILE OF HOUSEHOLD Under 5 mortality per 1000 Victora et al Lancet , 362, 233-241 (2003)

  9. 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)

  10. GROWING INEQUALITIES

  11. 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

  12. 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

  13. 2005 Commission social Determinants of Health History: trends and opportunities 2000s: "pendulum swing" and new chance for action. 2005 2002 1990s: paradigm of health as "private" issue dominant; some exceptions. 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. 2001 2000 C-PHC S-PHC Reforms & Minimum Packages MDG Scaling-up 1993 1982 1978 1948

  14. ‘The causes of the causes’

  15. Social Determinants and Health Disadvantage Source: Adapted from Diederichsen and Hallqvist 1998 Challenging inequities in health

  16. What good does it do to treat people's illnesses ... then send them back to the conditions that made them sick?

  17. 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

  18. 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.

  19. Dec 2003 Present From Aug 2004: linking with UN agencies and projects (FAO, ILO, MP, etc) From June 2004: outreach to civil society From July 2004: initial contacts with potential partner countries From Feb 2004: consultations in WHO HQ and Regions A broad consultative process June 04: major meeting with int'l public health experts, London Jan 05: CSDH discussed at WHO Executive Board May 04: D-G Lee announces CSDH at WHA

  20. 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 Director-General is equity and social justice". Lee Jong-Wook, Address to the World Health Assembly, May 2004

  21. PERU ForoSalud • Example of civil society involvement • III Conferencia Nacional de Salud: Voz Y Proposta Por el Derecho a la Salud 2006-2011- A call for action by government by a civil society movement that assumes its responsibility in promoting EQUAL OPPORTUNITIES TO HEALTH FOR ALL

  22. Muchas Gracias, Thank you!

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