demystifying social determinants
TRANSCRIPT
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Dr. Pandav is the National President of Indian Public
Health Association and a Professor and Head of
Centre for Community Medicine at the All India
Institute of Medical Sciences (AIIMS). He is a
Physician, Medical Scientist, Public Health Specialist,
Epidemiologist and Health Economist. Dr Pandav has
worked as a consultant for the WHO, UNICEF,
ICCIDD, PAMM and MI at the global, regional
(including China, Africa) levels for over 50 countries,
and also at the national level in India for the last 30
years.
Dr C S Pandav
Professor & Head,
Centre for Community
Medicine, AIIMS
SESSION MODERATOR
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Demystifying Social Determinants
in
Health & Nutrition
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Professor Sir Michael G. Marmot
MBBS, MPH, PhD, FRCP, FFPHM, FMedSci, FBA
Director, UCL Institute of Health Equity (Marmot Institute)
Chair, European Review on the Social Determinants of Health and the
Health Divide
Director: International Institute for Society and Health;
MRC Research Professor of Epidemiology and Public Health, University
College London
He was a member of the Royal Commission on Environmental Pollution for six years, and
served as President of the British Medical Association (BMA) in 2010-2011. He is a Fellow of
the Academy of Medical Sciences, an Honorary Fellow of the British Academy, and an
Honorary Fellow of the Faculty of Public Health of the Royal College of Physicians.
In 2000 he was knighted by Her Majesty The Queen, ‘for services to Epidemiology and the
understanding of health inequalities’. Internationally acclaimed, Professor Marmot is a Foreign
Associate Member of the Institute of Medicine (IOM), and a former Vice President of the
Academia Europaea.
He was Chair of the Commission on Social Determinants of Health (CSDH) , which was set up
by the World Health Organization in 2005, and produced the report entitled: ‘Closing the Gap in
a Generation’.
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AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers
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• Social justice
• Material, psychosocial, po
litical empowerment
• Creating the conditions
for people to have control
of their lives
www.who.int/social_determinants
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AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers
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Inequalities in health within and between
countries
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Inequalities between countries
Glasgow men (Calton) 54
Glasgow men(Lenzie) 82*
National data WHO 2009, Glasgow data: Hanlon et al. 2006
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Under 5 mortality per 1000 live births by wealth quintile
Source: DHS
Average U5M for high income countries is 7/1000
India
2005/6
Peru
2000
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AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers
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What is a ‘fair society’?
• Health as a measure of how well we are doing as a
society;
• Distribution of health across society;
• Health inequalities – the social gradient
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The Commission on
Social Determinants of
Health (CSDH) – Closing
the gap in a generation
Strategic Review of Health
Inequalities in England:
The Marmot Review – Fair
Society Healthy Lives
European
Review of
Social
Determinants
and the
Health Divide
2010-2012
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AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers
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A. Give every child the best start in life
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Marmot Review: 6 Policy Objectives
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A. Give every child the best start in life
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
6 Policy Objectives
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Moderate and severe stunting rates for children under age 5 by national
wealth (GNP per capita), 2008
EFA 2011
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Reading levels in grade 3 students: regional variation India
EFA 2011
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A. Give every child the best start in life
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Marmot Review: 6 Policy Objectives
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Share of workers in vulnerable employment by sex, selected
countries in South Asia
ILO
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A. Give every child the best start in life
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Marmot Review: 6 Policy Objectives
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Minimum standards (or income) for health
living
• To live a live of dignity
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A. Give every child the best start in life
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Marmot Review: 6 Policy Objectives
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Empowering communities: SEWA Case Study: The
Parivartan Programme
• Improve the basic physical infrastructure within the slums and in
the homes;
• Community development;
• City-level organisation for environmental upgrading of the slums
SEWA Case Study 2008
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SEWA: slum upgrading in India
• Slum upgrading in Ahmadabad, India, cost only US$
500/household.
• Community contributions of US$ 50/household.
• Following the investment in these slums, there was
improvement in health
– decline in waterborne diseases,
– children started going to school,
– women were able to take paid work, no longer having to
stand in long lines to collect water.
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MELADI NAGARBefore After
Slide courtesy of Gujarat Mahila Housing SEWA Trust
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A. Give every child the best start in life
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Marmot Review: 6 Policy Objectives
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Social patterning of cigarette smoking among men in Mumbai,
India
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
College (reference)
Secondary Middle Primary None/illiterate
Adju
ste
d o
dds r
atio*
Sorensen et al.2005 AJPH
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Source: IDF 2009
Global projections for the number of people with diabetes
(aged 20-79), 2010 - 2030
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• Social justice
• Tackling the inequitable
distribution of
power, money, and
resources
• Improving the conditions
in which people are
born, grow, live, work and
age;
• Monitoring, measuring and
researchwww.who.int/social_determinants
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Socioeconomic development AND
equity oriented policies
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•
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AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers
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A world where
social justice is
taken seriously
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AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers
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Questions & Answers
To submit a question for Sir Michael G. Marmot,
please message Dr. C. S. Pandav via the chat
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Closing Remarks