sylvie stachenko deputy chief public health officer health promotion and economic development :...
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Sylvie Stachenko
Deputy Chief Public Health Officer
Health Promotion and Economic Development:Interactions and Dilemmas
Health Promotion and Economic Development
Road Map
1. Clarifying our understanding
2. Exploring the interactions
3. Investing in health for sustainable development
Health Promotion and Economic Development
Broadening the Landscape for Health
What good does it do to treat people's illnesses ... then send them back to the conditions that
made them sick?Source: Michael Marmot, Reducing Health Disparities Symposium, Toronto, March 2006
Health Promotion and Economic Development
Determinants of HealthBroadening Involvement
Health Promotion and Economic Development
Key Milestones
• Lalonde Report 1974. . . health more than medical services
• Ottawa Charter 1986. . . prerequisities for health
• Jakarta Declaration 1997. . . investments for health development
• Mexico Statement 2000. . . health necessary for social and economic development
• Bangkok 2005. . . influence of globalization on health
Health Promotion and Economic Development
Influence of Globalization on Health
Source: Spiegel, Labonte and Ostry, International Joint Occupational Environmental Health, 2004
Health Promotion and Economic Development
Finanscapes: The Trade, Diet and Health Nexus
• Market-oriented agriculture policies
• Open and increased food trade
• Retail restructuring (superstores)
• Global agribusiness and transnational food companies
Annual Turnover Selected US TFCs
$258.6 billion
$66.7 billion
$22 billion
Health Promotion and Economic Development
Mediascapes: Diet and Obesity
Exploring the Interactions
Health promotion
Economic development
Health Promotion and Economic Development
Life Expectancy and Income per capita for Selected Countries, 20th Century
Source: World Development Report, 1993
Health Promotion and Economic Development
Health Care Spending and Life Expectancy
Health Promotion and Economic Development
Under-5 Mortality Ratesby Income Groups of Countries
Source: The Lancet, “Applying an equity lens to child health and mortality: more of the same is not enough” Vol. 362, #9379, July 2003
Health Promotion and Economic Development
Increasing Health Inequalities Between and Within Countries
UNDER 5 MORTALITY RATES BY UNDER 5 MORTALITY RATES BY SOCIOECONOMIC QUINTILE OF HOUSEHOLDSOCIOECONOMIC QUINTILE OF HOUSEHOLD
0
50
100
150
200
Indonesia Brazil India Kenya
Poorest fifth 2nd poorest fifth Middle fifth
2nd richest fifth Richest fifth
Under 5 mortalityper 1000
Victora et al Lancet , 362, 233-241 (2003)
Health Promotion and Economic Development
Some Groups are More Vulnerable than Others
Low Income by Family Type
Percent
Source: Improving the Health of Canadians, 2004
Health Promotion and Economic Development
The Social Gradient Occupational class differences in life
expectancy, England and Wales, 1997-1999
Health Promotion and Economic Development
Commission on Macroeconomics and Health
•Positioned health as a determinant of economic development
•Focused on low and middle income countries
•Focused primarily on communicable diseases
Health Promotion and Economic Development
The Challenge of
Cardiovascular Disease
in Developing Economies
Health Promotion and Economic Development
The Cost of Lifestyle and Unhealthy Environments
Obesity in Europe
Country Direct costs in Euros (millions) % health expenditure
England (1995 816 (+3,270 indirect) 1.5%
France (1992) 640 – 1,320 1.5%
Germany (1996) 10,600 N/A
Portugal (1996) 230 3.5%
Netherlands (1981-89) 454 4%
Source: International Obesity Task Force, 2002
Health Promotion and Economic Development
The Poverty Spiral
Source: WHO, An estimation of the economic impact of chronic noncommunicable diseases in selected countries, 2006
Health Promotion and Economic Development
Projected Chronic Disease Death Rates
By Country, Age 30 – 69 years, 2005
Source: WHO, Preventing Chronic Diseases: A Vital Investment, 2005
Loss of Labour Force
Health Promotion and Economic Development
Full-Income Losses
Source: WHO, Preventing Chronic Diseases: A Vital Investment, 2005
Full-income losses due to heart disease, stroke and diabetes in 2005 compared with 2015 estimates
Investing in Health for Sustainable Development
Health Promotion and Economic Development
Human Development and Balanced Growth
Health Promotion and Economic Development
UN Measures of Human Development
Source: United Nations Development Program, Human Development Report 1998
Health Promotion and Economic Development
Source: World Development Report, 2005
The Impact of Income on Human DevelopmentSelected Countries
Human PovertyIndex Rank
Index 2
8
2
17
1
Index 1
2
13
1
20
9
Human DevelopmentIndex Rank
4
1
10
6
37
53
46
63
56
GDPper capita
62,298
37,670
37,562
26,750
10,274
9,168
8,280
7,790
6,854
Luxembourg
Norway
United States
Sweden
Chile
Mexico
Uruguay
Brazil
Panama
Health Promotion and Economic Development
Source: UNICEF Innocenti Research. (2000). A League Table of Child Poverty in Rich Nations.Innocenti Report Card No.1. Florence:UNICEF Innocenti Research Centre. <www.unicef-icdc.org>.
Policy Choices can have Major Effects
Health Promotion and Economic Development
Making the Healthy Choices the Easy Choices
Manipulating Sales Taxes can Benefit the Diet of the Poor
Source: Smed S & Denver S. Food & Resource Economics Ints. KVL Univ., Denmark, April 2005.
Health Promotion and Economic Development
Towards Intersectoral Policy Approaches
• Whole of government approaches
• Broad commitment to health as a collective goal
• Community participation
• Challenges
• Limited incentives for working across sectors
• Accountability and financial structures not conducive to collaboration
• Knowledge deficit re effectiveness
• Political will and leadership
Health Promotion and Economic Development
Emerging Collaboration Models
at International and National Levels
• NGO alliances– Global Prevention Alliance on Obesity (IOTF)
– Chronic Disease Prevention Alliance of Canada
• Interministerial mechanisms– Sweden
– UK
– British Columbia, Canada
• Multilevel networks– Canada’s Public Health Network
Health Promotion and Economic Development
Community Driven Development
Health Promotion and Economic Development
Strategic Knowledge Development
• Studies on social and other determinants
• Health modelling and economic analysis
• Health policy and system governance analysis
• Inter/trans disciplinary and multi-sectoral public policy and implementation research
• Translational research
• New evaluation tools e.g. health impact assessment of policy proposals
What Kinds of Research?
Health Promotion and Economic Development
Investing in Public Health and Health Promotion
“Over the next 20 years, ensuring that care is of a high clinical quality and provided with minimum waiting will not be sufficient… [We need to strike] an appropriate balance between … health and social care, between primary and secondary care and between treatment and prevention.”
… Wanless Report, 2002, UK
“The success of an economy and a society cannot be separated from the lives that the members of 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)
Health Promotion and Economic Development
“The success of an economy and a society cannot be separated from the lives that the members of society are able to lead…we not only value living well and satisfactorily, but also appreciate having control over our own lives.”
Health Promotion and Economic Development Health Promotion and Economic Development
Obrigada!