COMMISSION ON SOCIAL DETERMINANTS OF HEALTH

1. COMMISSION ON SOCIAL DETERMINANTS OF HEALTH Michael Marmot Launching Ceremony of CNDSS PAHO/WHO Country Office, BRAZIL March 15, 2006

2. CSDH: Knowledge for action “ The goal is not an academic exercise, but to marshal scientific evidence as a lever for policy change — aiming toward practical uptake among policymakers and stakeholders in countries”. WHO Director-General LEE Jong-Wook, address to the World Health Assembly, May 2004

3. CSDH • improving health and health equity through action on the socially determined causes of health inequities

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

5. Why Emphasize Social Determinants? • Social determinants of health have a direct impact on health • Social determinants structure other causes of health: • Environment • Behaviour • Services • The ‘causes of the causes’

6. INEQUALITIES BETWEEN COUNTRIES

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

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

9. INEQUALITIES WITHIN COUNTRIES

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

11. 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)

12. GROWING INEQUALITIES

13. 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

14. A Growing Crisis: Large ageing population and an increase in chronic disease is creating a financial burden on health systems

15. ESTIMATED % POPULATION OVER 60 YRS % Vaupel et al,1998

16. ADULT MORTALITY: THE DOUBLE BURDEN OF DISEASE (WHO 2005)

17. 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

18. Commission on Macroeconomics and Health (CMH) • CMH called for increased public expenditure on health for economic development • CMH focused on low- and middle-income countries • CMH focused primarily on communicable diseases

19. World Health Report 2002

20. Ten Tips for Staying Healthy • Don't be poor. If you can, stop. If you can't, try not to be poor for long. • Don't have poor parents. • Own a car. • Don't work in a stressful, low paid manual job. • Don't live in damp, low quality housing. • Be able to afford to go on a foreign holiday and sunbathe. • Practice not losing your job and don't become unemployed. • Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled. • Don't live next to a busy major road or near a polluting factory. • Learn how to fill in the complex housing benefit/ asylum application forms before you become homeless and destitute. Dave Gordon, 1999

21. ‘The causes of the causes’

22. 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.

23. Commissioners • Knowledge networks • Civil society • Country action • Global initiative • WHO

24. COMMISSIONERS • The twenty Commissioners are global and national leaders from political, government, civil society and academic fields and from all geographic regions of the world.

25. KNOWLEDGE NETWORK THEMES

26. Civil Society "The presence, advice and testimony of civil-society actors is essential to the work of the Commission and will be decisive to the general awakening we wish to promote". Commissioner Ndioro Ndiaye, Comments on first meeting of CSDH regional civil society facilitators

27. Update Regional and Regional activities Regional Meeting National Meeting Next National Meeting Country Participants

28. Countries

29. Three strands within country stream • Within country • creating space for dialogue e.g Iran • putting SDs & inequities on the policy agenda e.g Brazil, Kenya • focus, priorities, benchmarks, concrete areas of work e.g Chile • brokering people and institutional mechanisms e.g. Kyrgzstan • Influencing national resources and investments e.g. England, Canada • Collecting information on country situation

30. Three strands within country stream 2. Between countries • facilitating supportive networking across countries • exchanging and sharing know-how • documentation and exchange of information • training support • and other demand driven support

31. Three strands within country stream 3. Global international • identifying the way that global/international institutions are enabling or disabling country action • bringing concrete experience on how to act upstream on global policies (e.g. MDGs) • multi-country and regional alliances • re-enforcing change within WHO

32. REGIONAL ACTIVITIES • Nordic • Latin America • East Asia • Europe

33. Global Initiative • Advancing the CSDH agenda by engaging global institutions

34. WHO ACTION The Commission will work with WHO to institutionalize social determinants capacities and approaches within WHO global and regional policies and programmes. This will be accomplished by integrating WHO country, regional and global personnel in all activities of the Commission.

35. COMMISSION MEETINGS • CHILE – March 2005 • CAIRO – May 2005 • INDIA – September 2005 • IRAN – Jan 2006

36. ‘THE SUCCESS OF AN ECONOMY AND OF A SOCIETY CANNOT BE SEPARATED FROM THE LIVES THAT THE MEMBERS OF THE 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)