addressing the social determinants of noncommunicable diseases
DESCRIPTION
Noncommunicable diseases (NCDs) - mainly cardiovascular disease, diabetes, cancer and chronic respiratory disease - are not just one of the world’s most pressing health concerns but also a significant development challenge. They impede social and economic development and are driven by underlying social, economic, political, environmental and cultural factors, broadly known as ‘social determinants’. Working alongside specialist health partners, actors outside the health sector are uniquely well positioned to address the social determinants of NCDs.TRANSCRIPT
Addressing the social determinants of noncommunicable diseases
Brian LutzPolicy Specialist: AIDS and MDGs
HIV, Health and Development PracticeBureau for Development Policy, UNDP
Jessy’s and other women’s stories at http://www.nytimes.com/2013/10/16/health/uganda-fights-stigma-and-poverty-to-take-on-breast-cancer.html
Video: http://www.nytimes.com/2013/10/16/health/uganda-fights-stigma-and-poverty-to-take-on-breast-cancer.html#videoModal
Stigma
Culture and identity
Poverty
Health care Transport
Education
http://www.undp.org/content/undp/en/home/librarypage/hiv-aids/discussion-paper--addressing-the-social-determinants-of-noncommu/
NCDs have social determinants
NCDs are a development issue
Action on social determinants of NCDs is possible and necessary
What are NCDs and their risk factors?
Source: Global status report on noncommunicable diseases 2010. Geneva: WHO, 2010
NCDs are a large and growing health challenge
Deaths globally
1990 2010 2015 20300%
20%
40%
60%
80%
100%
57% 65% 68% 74%
Deaths in lower middle-income countries
Source: Lozano et al. 2012; WHO projections of mortality and causes of death (http://www.who.int/healthinfo/global_burden_disease/projections/en/)
2015 20300%
20%
40%
60%
80%
100%
60% 69%
2015 20300%
20%
40%
60%
80%
100%
42% 54%
Deaths in low-income countries
Other
NCDs
NCDs are a major driver of disability
DALYs globally
DALYs in low- and middle-income countries
1990 20100%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
43%54%
2002 20300%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
33%45%
Source: Murray et al. 2012; Meyrowitsch and Bygbjerg 2007
Other
NCDs
NCDs also negatively impact human development
Source: see, e.g., Bloom et al. 2011; Global status report on noncommunicable diseases 2010. Geneva: WHO, 2010; Swartz 2010; Mahal et al. 2009
Macroeconomic• Premature morbidity• Premature mortality• Lost income, employment
Household• Higher healthcare expenses• Diversion of labour• Stigma and discrimination
Health system costs• Strain on health budgets• Diversion scarce resources• Worsening risk pools
MDGs NCDs and risk factors
NCDs have social determinants
NCDs are a development issue
Action on social determinants of NCDs is possible and necessary
Social choices drive NCD epidemics
Social (structural) determinants
Risk factors Health – level and distribution
Trade
Food/ ag policy
Employment
Urbanization
Social protection
Housing
Norms
Exclusion
Governance
Biological and behavioral risk factors• Obesity• Tobacco use
Health-seeking behavior
NCD morbidity and mortality• Cardiovascular
diseases
NC
D e
xam
ples
Examples follow
More non-health sector More health sector
CVD shows inequities by socio-economic status
Cardiovascular mortality (aged 45-64) by district socio-economic level in Porto Alegre, Brazil, 2008
Source: Bassanesi et al. 2008
Social gradients in obesity differ across countries
Obesity prevalence in women by education status in countries at different levels of economic development
Source: Monteiro et al. 2004
The poor in poorer countries smoke more
Smoking prevalence by income quintiles
Source: Global atlas on cardiovascular disease prevention and control. WHO, World Heart Federation and World Stroke Organization, 2011
Source: Hawkes 2006
NCDs have social determinants
NCDs are a development issue
Action on social determinants of NCDs is possible and necessary
Overarching frameworks exist
2003
2004
2008
2010
2010
2011
2013
2013
WHO Framework Convention on Tobacco Control
Global Strategy on Diet, Physical Activity and Health
Action Plan for the Global Strategy for the Prevention and Control of NCDs 2008-2013
Set of Recommendations on the Marketing of Foods and non-Alcoholic Beverages to Children
Global Strategy to Reduce Harmful Use of Alcohol
WHO ‘Best Buys’
NCD Global Monitoring Framework (GMF)
The Revised Global Action Plan for the Prevention and Control of NCDs 2013-2020
Typology of multisectoral action
NCD-specific: ban of tujilijili in Zambia
Source: http://www.add-resources.org/liquor-sachets-banned-in-zambia.5043749-76586.html; http://allafrica.com/stories/201204160957.html
NCD-sensitive: housing experiment in the USA
Less obesity
Less diabetesSource: Orr et al. 2003; Moving to Opportunity for Fair Housing Demonstration Program: Final Impacts Evaluation. US Department of Housing and Urban Development (HUD), 2011
Framework for action on SDH outside the health sector
Thank you !