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International Conference on Education, Social Capitol and Health

International Conference on Education, Social Capitol and Health. KEY CHALLENGES TO BETTER HEALTH Chris Brown WHO EUROPEAN OFFICE FOR INVETSMENT FOR HEALTH AND DEVELOPMENT OSLO NORWAY 25-26 FEBRUARY, 2010. BROWN, OSLO FEBRUARY 25 TH & 26 TH 2010. KEY CHALLENGES TO BETTER HEALTH.

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International Conference on Education, Social Capitol and Health

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  1. International Conference on Education, Social Capitol and Health KEY CHALLENGES TO BETTER HEALTH Chris Brown WHO EUROPEAN OFFICE FOR INVETSMENT FOR HEALTH AND DEVELOPMENT OSLO NORWAY 25-26 FEBRUARY, 2010 BROWN, OSLO FEBRUARY 25TH& 26TH 2010

  2. KEY CHALLENGES TO BETTER HEALTH 2008, Report of WHO Commission on Social Determinants of Health Key Findings and Implications BROWN, OSLO FEBRUARY 25TH& 26TH 2010

  3. 1. INEQUITIES: BETWEEN COUNTRIES Life Expectancy at birth (men and women) selected countries. 82.3 JAPAN HONG KONG 81.9 JAPAN ICELAND 81.5 SWITZERLAND 81.3 AUSTRALIA 80.9 CHINA 72.5 BRAZIL 71.7 RUSSIAN FEDERATION 65 INDIA 63.7 MOZAMBIQUE 42.8 41.8 SIERRA LEONE 41.7 ANGOLA 40.9 ZIMBABWE 40.5 ZAMBIA 0 20 40 60 80 100 National LE data 2007/2008, Glasgow data: Hanlon et al. 2006 BROWN, OSLO FEBRUARY 25TH& 26TH 2010

  4. THE REAL PICTURE OF HEALTH IN OECD MEMBER STATES • Average life expectancy has improved BUT significant differences in life expectancy and number of healthy life years • 7-12 years, difference between people living in the same town or city • Depending on • number of years in education • levels and security of income, • employment type & security • social & living conditions • Access to and Availability of appropriate services • Social capitol BROWN, OSLO FEBRUARY 25TH& 26TH 2010

  5. 2. INEQUITIES WITHIN COUNTRIESEXAMPLE : Shortfall in population health due to social inequalities In Netherlands, mortality and morbidity in the population would be reduced by 25-50% if men with lower education had the same mortality and morbidity levels as those with university education In Spain, excess mortality in the more deprived areas compared with more affluent areas amounts to 35,000 deaths per year In England, if all men aged 20-64 had the same death rates as professionals and managers, there would be 17000 fewer deaths per year The economic gain of ‘levelling up’ the health of the population to that experiences by those with higher education would be between 1.2% and 9% of EU GDP (Mackenbach et al, 2007) BROWN, OSLO FEBRUARY 25TH& 26TH 2010

  6. SOCIAL CAPITOL AND HEALTH Source: Rocco, L & Suhrcke M, 2009

  7. 3. CSDH Conceptual Framework Source: CSDH Final Report, WHO 2008, adapted from Solar & Irwin, 2007 BROWN, OSLO FEBRUARY 25TH& 26TH 2010

  8. 4. HEALTH INEQUITIES FOLLOW A SOCIAL GRADIENT Poverty explains poorer health (and development outcomes) in poorer countries but cannot explain the size and trends in inequities in higher income countries 1. The age of onset and degree of severity of non communicable diseases including cardio vascular disease and cancers, follows a gradient by levels of education, social inclusion and employment security. This is true even after accounting for differences in lifestyle and behavior 2. In young people aged between 11 - 15-years, lower socioeconomic status is associated with lower levels of mental well-being. BROWN, OSLO FEBRUARY 25TH& 26TH 2010

  9. Prevalence of poor mental health among manual workers by type of employment contract (Spain) Source: CSDH, WHO, 2008 BROWN, OSLO FEBRUARY 25TH& 26TH 2010 Source: CSDH, WHO, 2008

  10. Changes in life expectancy in Estonia at age 25 by educational level: 1989-2000 SOURCE : Leinsalu et al, Int J Epidemiology 2003) BROWN, OSLO FEBRUARY 25TH& 26TH 2010 (Leinsalu et al, Int J Epidemiology 2003)

  11. 5. IMPLICATIONS FOR ACTION Policy and Governance systems need to . . . . • Act across the gradient on the distribution of social determinants of inequities in health -‘targeted universalism’ - Reduce differential opportunity to be healthy through universal policies - action on socioeconomic position - Reduce differential exposure of being exposed to specific pathogenic factors - Mitigate deifferential consequences - of ill health • Move from projects to systematic action - to ensure action of the scale and size necessary to have an impact and sustain this over time BROWN, OSLO FEBRUARY 25TH& 26TH 2010

  12. IMPLICATIONS FOR RESEARCH 1. Research to strengthen the evidence of what works at a sufficient scale to make a difference 2. Innovations in research are needed to identify the strategic drivers of reductions in health inequalities the differential effects of policy interventions and the impact of alternative options for enhancing health equity 3. Evaluating live policies and synthesis of learning which can be transferred across countries and policy contexts. BROWN, OSLO FEBRUARY 25TH& 26TH 2010

  13. THANK YOU CHRIS BROWN EURO Focal Point for CSDH, Country Action chb@ihd.euro.who.int WHO European Office for Investment for Health & Development www.euro.who.int/SocialDeterminants BROWN, OSLO FEBRUARY 25TH& 26TH 2010

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