erio ziglio, 21 jan
DESCRIPTION
TRANSCRIPT
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Dr Erio Ziglio
World Health Organization European Office for Investment for Health and Development
Social Determinants of Health:
Challenges & Opportunities in Europe
Uppsala University, 21 January 2005
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Characteristics of Europe
in 2005
Challenges & Opportunities
Implications
Outline of this presentation
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Characteristics of Europe in 2005
• WHO EURO 52 countries, total of 900m citizens
• 25% have less than 5 million inhabitants
• 20% have less than 3 million
• 47% have a high income (> $ 9,265 in 2000)
• 15% have a low income (< $ 756)
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LIFE EXPECTANCY Wide variations between countries
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Persistent and increasing inequalities
between countries and within
population groups of the same country
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Glasgow, Scotland
67 LIFE EXPECTANCY 77
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Torino, Italy
8 YEARS DIFFERENCE
in life expectancy
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8-10 YEARS DIFFERENCE
in life expectancy
Malmö, Sweden
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Looking at the last decade
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Relative Poverty is growing faster
in Europe and Central Asia
than anywhere else in the world.
(World Bank, 2001)
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43.8
98.2
1990 1999
People living on less than US$ 2 a day
Source: Global Economic Prospects, Worldbank, 2001
(CEE and CAR, millions of people)
INCOME POVERTY
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EU: People at risk of poverty and social exclusion (%)
Source: European Commission, data for 1997
Average of 18% or 60 million people below the threshold
INCOME POVERTY
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Progress towards reaching the poverty MDGs by regions
Source: www.developmentgoals.org
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Challenges &
Opportunities
Increased inequalities, poverty and psycho-social stress
Implications
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Why are we seeing an increase
in health inequalities across Europe ?
KEY QUESTION
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DETERMINANTS OF HEALTH
Population Health
Social Economic
EnvironmentalGenetic
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ALLOCATIVE EFFICIENCY
Promotion
Population Individual
Treatment
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European main factors
• Social safety nets
• Labour market policies, job security,
pension reforms
• Economic change and social disruption
• Economic regeneration schemes
• Poverty reduction
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Systems & Infrastructures constraints
• Intervention approaches often mismatched to country development conditions and capacity
• Unrealistic expectations of the individual
behaviour change approach
• Unstable and inadequate funding mechanisms
• The promotion of population health is too often
at the margins of decision processes
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Implications
Need to keep the vision but revisit the means
Increased inequalities, poverty and psycho-social stress
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Some long term outcomes (at age 21) of non-participation by young women at age 16-18
0 10 20 30 40 50 60 70 80 90 100
Without qualif ications
No training in current job
Not in full/part time w ork
Teenage parent
Parent (by age 21)
Tw o or more children
Depression
Full time home care responsabilities
Lives in rented accomodation
Acknow ledges family commitments as barrier to employment
Poor health
PercentageNon-Participant Participant
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Integrated problems
require
integrated solutions
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Assets
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Need LH
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The Promotion of population Health is increasingly recognized as key resource for social and economic development
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Social Development
Economic Development
Equitable
Sustainable
Promoting Population Health
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Ray Charles
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Communities rarely develop on the
basis of their deficiencies, (…) they
develop on the basis of their assets
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Need L
H Assets
H
L
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An integrated model of HP
Policies & actions to improve equity in social and economic conditions
Policies & actions to create health supporting environments and communities
Programmes to change unhealth knowledge attitudes and behaviours
The Building Blocks to Sustainable Population Health Promotion
Healthy Settings – workplaces, schools & communities
Changing Individual Risk Behaviour
Promoting healthy lifestyles
Creating the conditions - Reducing poverty, social exclusion for Good Health environmental hazards, improving sanitation
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Manage
Risk Factors
Manage
Risk Conditions
Manage
Assets
Investment for Health and Development
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The WHO Office for Investment for Health and Development
Venice, Italy
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The Venice Office has two main functions
1. To monitor, review and systematize the policy implications of emerging research findings on the social and economic determinants of health
2. To provide a set of services to increase the European capacity to promote population health by integrating into development agendas, policies and practice evidence on the social and economic determinants of health.
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Put HP within the development agenda of European countriesNeed to keep the
vision but revisit the means
Increased inequalities, poverty and psycho-social stress