nsm-ncd2013 symposium 1 - ncd risk factors - a social determinant and ecological analysis in low and...
DESCRIPTION
By Prof Pascale AlloteyTRANSCRIPT
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Jeffrey Cheah School of Medicine and Health Sciences
NCD risk factors: a social determinants
and ecological analysis in low and middle
income countries
Pascale Allotey, Daniel D Reidpath, Davey T, Soyiri I, Yasin S
Areas to cover
Overview of social determinants approach
– example
Advantages and disadvantages
Expanding to ecological analysis
Utility of analysis
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The social production of health inequities. Developed by World Health Organization Department of Equity, Poverty and Social
Determinants of Health
A. Irwin , O. Solar , J. Vega
United Nations Commission on the Social Determinants of Health
International Encyclopedia of Public Health null 2008 64 - 69
http://dx.doi.org/10.1016/B978-012373960-5.00673-0
WOMEN GET SICKER,
MEN DIE QUICKER
http://www.cartoonstock.com/directory/l/life-span.asp
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Crude prevalence of self reported symptoms of chronic disease by age in men and women in urban and rural settings.
Miszkurka et al. BMC Public Health 2012 12:24 doi:10.1186/1471-2458-12-24
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Figure 3
Lancet 2011;
377:680-689
(DOI:10.1016/S014
0-6736(10)61506-1)
Data on SDH
Poorly collected and
generally outside the
health sector
Poorly analysed
Poorly used
Some data on gender
http://www.worldbank.org/en/news/video/2012/06/17/slideshow-toward-gender-equality-in-east-asia-and-the-pacific
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Sugar subsidies
Addressing needs of Indigenous communities
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Supporting lower socio-economic groups
Result?
300% increase in
obesity over 15 year
period
www.lovehijau.com
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So where are the solutions here?
Analysis of policy decisions – evidence to inform, evidence of
policy process and of implementation and evaluation – eg
health impact assessments
Classical social determinants, but also ecological,
environmental sustainability, culture and history
Classic social determinants, social inequalities,
institutionalized ethnicity based policy that affects risk,
exposure and treatment
Opportunities to conceptualize
multidisciplinary questions addressing
genetics, biology, social determinants in
exposure, risk, treatment etc
Source: Walsh / Carlines in Rayner and Lang
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15 There’s a consistent 50-year upward trend in every region except Oceania.
Changes in climate are already causing harm
Major floods per decade,
1950-2000
Information overload?
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Why do we need these sorts of analyses
Remedies for obesity based on individualism have a limited effect at population level (slimming industry grows alongside obesity rates)
Personalised choice is not a public health response but an ideological one
There are no comprehensive policy structures to tackle such multi-dimensional, multi-sectoral problems and diverse political/economic interests and pressures
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