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TACKLING WIDER DETERMINANTS OF HEALTH DEVELOPING PRACTICE

TACKLING WIDER DETERMINANTS OF HEALTH DEVELOPING PRACTICE. Sarah Wamala, PhD., Associate Professor National Institute of Public Health and Karolinska Institutet Stockholm, Sweden Sarah.wamala@fhi.se. CONTENTS. Overview of determinants of health How to tackle determinants of health

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TACKLING WIDER DETERMINANTS OF HEALTH DEVELOPING PRACTICE

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  1. TACKLING WIDER DETERMINANTS OF HEALTHDEVELOPING PRACTICE Sarah Wamala, PhD., Associate Professor National Institute of Public Health and Karolinska Institutet Stockholm, Sweden Sarah.wamala@fhi.se

  2. CONTENTS • Overview of determinants of health • How to tackle determinants of health • The Swedish national public health policy • Steps to implementation • Global initiatives

  3. Determinants of health- overview

  4. Determinants of health Up-stream factors Contextual effects Multi-level interactions Determinants of health Down-stream factors Compositional effects

  5. Specific determinants of health • Socio-economic conditions • Stress • Circumstances in early life • Workplace conditions • Employment status • Social support and networks • Addiction • Food • Transport Source: Social determinants of health- the solid facts. WHO, 2003

  6. Health determinants as a result of: • Effects from globalisation • Neo-liberal policies and politics • General socio-economic, cultural and environmental conditions • Access to health services • Physical environment- living and working conditions • Community influences which can sustain/damage health • Individual characteristics and behaviors

  7. Globalisation,Int’l polictics GLOBAL LEVEL Neo-liberal policies Discrimination Political Economy Civic Culture Institutions Community- Neighborhood - Work MACRO LEVEL History Family - Friends - Peers MESO LEVEL Individual socioeconomic factors behaviors,psychosocial characteristics MACRO LEVEL Biological Level Genetic Predispositions Gender perspective Multi-time point HEALTH    Birth Childhood Adulthood Old Age

  8. “Multi-thinking”is the way to go

  9. Tackling determinants of health How?

  10. How to tackle determinants of health • Through various mechanisms • Involve politicians - early in the process • Integrating various policy layers and actors • Extending health policies to other sectors, other than health • Clear description of tasks for each actor • Involve global actors

  11. Tackling determinants of health through mechanisms Socioeconomic position Specific exposures What determines this? At what level? Social consequences of disease Disease outcomes Ref: Whitehead, Diderichsen, 2000

  12. Integrating various policy layers and actors Environment (living, working conds) Socio-political and macroeconomic policies Community services Health system Individual health

  13. Health policies Health systems Health services Community servs Sectors outside health Socio-political Macroeconomic policies Social security Education Housing Security Labour market Environment Transport Agriculture Industry Energy Determinants of health Family Individual Sou Source: Global Forum for Health Research

  14. To achieve these goals…. • Governments should commit- a national contract - political action • Involve the nation, regions, local communities and individuals, and global actors • Clearly describe the potential roles and tasks of each actor

  15. The Swedish national Public health policy

  16. The Swedish National Public Health Policy • 1987: Govt appointed a commission to formulate guidelines for a public health policy • 1992: Establishment of the Natl Inst of Public Health • 1997: A parliamentary commission, Natl Public Health Committee (parliamentary parties, research experts) • 2002: Govt submitted 11 objectives for public health work to the parliament • 2003: The Swedish Parliament passed the public health objectives bill Source: www.fhi.se

  17. The Swedish Public Health Objectives were formulated based on health determinantsnot on disease outcomes

  18. The Swedish Public Health Objectives • The first six objectives reflect structural factors- which can be influenced primarily through public opinion and political decisions at different levels • The last five objectives concern lifestyles of the individuals with a strong emphasis on the role that the social environment play Source: www.fhi.se

  19. Moving the agenda forward • Systematic monitoring • Development of indicators • Coordination with and active involvement of other government agencies • Advocating for “health” in non-health oriented agencies • Reporting to the government (decision-makers) – regular public health reports • Evaluation of the impact of policies on health (HIA) • Intervention and Policy analyses • Gender-based analyses Source: www.fhi.se

  20. Steps to implementation

  21. Monitoring the Public Health Objectives • Various policy layers, actors and political arenas were given specific government tasks to develop indicators for the objectives related to their respective policy area • The NIPH was given the task to monitor the objectives, coordinate various actors and report back to the minister of health. Source: www.fhi.se

  22. Government tasks to various actors • Identify indicators for the determinants of health • Strategies applied • Effects of strategies • Priorities to optimise effects on public health • HIA application in new policies

  23. Reporting to the government Step 1 Birateral discussions with various actors Comments from NIPH + revisions Step 3 Step 2 Prel. Report from various actors to NIPH Public Health Report to the minister Step 4 Ref. Lundgren, et al 2004

  24. Global initiatives to tackle determinants of health

  25. The World Bank recognizes that…. • ”Inequalities in incomes, in health and in educational outcomes have long been a stark fact of life in many developing countries. These are often accompanied by profound differences in influence, power and social status, whether at the level of individuals or groups. High inequalities matter for development and need to be addressed by domestic and international policies and institutions” Source: www.dgroups.org/groups/worldbank/WDR2006

  26. World Development Report 2006 • The World Development Report (WDR) is the WB’s annual guide to the economic, social and environmental state of the world today. • WDR 2006 explores the role of equity in development. Source: www.dgroups.org/groups/worldbank/WDR2006

  27. Tackling determinants of health World Bank • The role of policies and institutions in the global arena • The extent to which the pattern of globalisation can be shaped to lead to greater global equity Source: www.dgroups.org/groups/worldbank/WDR2006

  28. Areas of intervention – identified by WB • International policies on trade and property rights (agricultural pdts, pharmaceuticals, environmental resources) • International migration • International capital flows and aid • International dimensions of influence and recognition (equitable influence in int’l decision-making Source: www.dgroups.org/groups/worldbank/WDR2006

  29. Conclusions • The health sector alone cannot accomplish the task of tackling wider determinants of health • Health policies intended to tackle determinants of health may only be effective if they are integrated into a number of socio-political interventions • Recognition of the effects of globalisation- incorporateinternational institutions and policies

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