1.1.3 AWHN Conference 6 2010 Federation:
Commission on the Social Determinants of Health: gendering health inequities.
Southgate Institute for Health, Society & Equity,
Flinders University
Adelaide
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1.1.3 Fran Baum
1. Commission on the Social
Determinants of Health: gendering
health inequities
Fran Baum
Southgate Institute for Health, Society & Equity,
Flinders University
Adelaide
2. In my talk I will ….
• Provide an overview of the work of the
Commission on the Social
Determinants of Health
• Highlight aspects of the CSDH work
through the lens of some of the women
associated with the CSDH’s work
– Empowerment
– Informal settlements
– Primary Health Care and maternal child
health
– Politics, Values and Policy
3. Commission on the Social
Determinants of Health
• Launched 28th
August
2008 by Dr. Margaret
Chan, Director
General, WHO in
Geneva
• "Health inequity really
is a matter of life and
death" Margaret Chan
4. Commissioners
• Sir Michael
Marmot (Chair)
• 18 (9 women)
others representing
academics,
politicians, civil
society, senior
public health
bureaucrats
5. "(The) toxic combination of bad
policies, economics, and politics is, in
large measure responsible for the fact
that a majority of people in the world
do not enjoy the good health that is
biologically possible. Social injustice is
killing people on a grand scale."
6. • “The Commission’s main finding is
straightforward. The social
conditions in which people are
born, live, and work are the single
most important determinant of
good health or ill health, of a long
and productive life, or a short and
miserable one. ……..This ends the
debate decisively. Health care is an
important determinant of health.
Lifestyles are important
determinants of health. ….But, let
me emphasize, it is factors in the
social environment that determine
access to health services and
influence lifestyle choices in the
first place”.
7. Basic logic: what good does it do to
treat people's illnesses .........
then give them no choice to go back to or no control
over the conditions that made them sick?
8. Final Report: Value Base
• Need for more health
equity because “it is
right and just” & a
human right
• Quality and
distribution of health
seen as a judge of the
success of a society
• Empowerment central
9. CSDH Report: Action Areas
• Equity from the start
• Healthy places- healthy people
• Fair employment –decent work
• Social protection across the life course
• Universal health care
• Health Equity in All Policies
• Fair financing
• Market responsibility
• Gender equity
• Political empowerment – inclusion and voice
• Good global governance
• Monitoring, research, training
• Building a global movement
Full report downloadable at http://www.who.int/social_determinants/en/
Daily Living Conditions
Power, Money and
Resources
Knowledge, Monitoring
and Skills
11. Male and female life expectancy at birth (years)
by country income group/region 1997 - 2006
Source: World Bank – World Development Reports
Country income
group/region
LE 1997 LE 2006
women men women men
Low Income
(inc S-SA)
64 62 58 56
Middle Income 72 66 71 67
High Income 81 74 82 76
12. Female life expectancy at birth by country income group
and region, 1950–2005
Source: WHO - Women & Health 2009
14. Risk factors for women’s health in Australia
• Life expectancy for Australian women is increasing and
now ranks equal second in the world
• On-going or emerging risk factors for chronic illness,
injury and premature death, include:
– Overweight and obesity – nearly half of Australian women are
overweight and of those 17% obese
– Physical inactivity – about one third of women do not exercise
– Poor diet – over consumption of high fat and sugar foods;
inadequate intake of fruit and vegetables
– Stress – compensation claims for workplace stress almost
doubled between 1996 and 2004
– Smoking, alcohol consumption, unprotected sex, and self harm
in young women
Source: Commonwealth Gov’t – Developing a Women’s Health Policy for Australia
These risk factors are all underpinned by social &
economic factors
15. Health Inequities – Aboriginal and Torres
Strait Islander Women
• Life expectancy 10 years lower than non-
indigenous women (recent revision)
• Experienced dispossession and stolen
generation
• Higher rates of mental illness
• Hospitalisation due to assault at a rate 33 times
higher than non-indigenous women
• In 2004–05, 34% of Aboriginal and Torres Strait
Islander women were obese, double the rate of
non-Indigenous women
• 49% were current daily smokers, more than
twice the rate of non-Indigenous women
Source: Commonwealth Gov’t – Developing a Women’s Health Policy for Australia
16. Health Inequities – Women subject to
socioeconomic disadvantage
As a group, women subject to low income or
education, insecure housing and/or
unemployment have:
– Reduced life expectancy relative to more advantaged women
– Higher rates of mental illness, suicide and cardiovascular
disease
– Higher exposure to risk factors including: overweight, smoking,
poor diet
– Higher usage of doctors and hospital outpatient services, but
less use of preventive health services
Source: Commonwealth Gov’t – Developing a
Women’s Health Policy for Australia
17. CSDH Women and Gender
Equity Knowledge Network
• Gender relations of power
constitute the root causes of
gender inequality and are among
the most influential of the social
determinants of health.
18. Stephen Lewis (UN Special
Envoy on HIV/AIDS)
“Once you’ve
mainstream gender, its’
everybody’s business
and nobody’s business.
Everyone’s accountable
and no one’s
accountable” (Lewis,
2005, p. 125)
Led to establishment of
the CSDH Women &
Gender Knowledge
Network
19. Women’s employment: a global snapshot
• Globally, women’s share of paid, non-
agricultural employment continues to
increase marginally
• Close to 2/3 of all women have vulnerable
jobs; self-employed or unpaid work in a
family business
• Low-paid work or unemployment reduces
access to health care
• Women often face the stress of combining
paid and household work
Source: UN Millennium Development Goals Report 2009
20. Income differences
Source: UNDP Human Development Report 2009
Estimated earned income PPP* (US$) 2007 (*Purchasing power parity)
Country Women Men
Norway 46,576 60,394
Australia 28,759 41,153
Mexico 8,375 20,157
Malaysia 7,972 18,886
Philippines 2,506 4,293
Uganda 861 1,256
Ethiopia 624 936
21. Girl’s education: global report card
• Significant gains have been made in female
enrolment in primary education between 2000
and 2006
• Child mortality rates are typically highest in
households where the education of the mother is
lowest
• Girls still account for 55% of the out-of-school
population
• Worldwide, over 580 million women are
illiterate (double the number of illiterate
men), and more than 70 million girls are not in
school
Source: WHO - Women & Health 2009
22. 0
10
20
30
40
50
60
70
80
Total
rural
Total
urban
Poorest
20%
2nd 20% 3rd 20% 4th 20% Richest
20%
Girls
Boys
Global secondary school attendance by place of residence,Global secondary school attendance by place of residence,
or household wealth (% of all girls or boys)or household wealth (% of all girls or boys)
Source: UN Millennium Development Goals Report 2009
23. Leading causes of disease burden (DALYs) for women aged
15–44 years, high-income countries, and low-
and middle-income countries, 2004
Source: WHO Health Statistics and
Informatics
24. African women & HIV
• “It’s impossible to tear the productive generations out of
the heart of a country without facing an incomparable
crisis”
• Crisis of capacity because of so many deaths
• Crisis of orphans and Grandmothers assuming
overwhelming burden of care
• Central importance of education especially of women –
call for WB & IMF to foot the bill for free primary
education in Africa “mandatory restitution” -
• Says lack of secondary education means “Lost to the
world will be hundreds of thousands of creative, gifted,
often brilliant spirits”
• What is need is “universal, unimpeded, unequivocal free
education – absolutely no costs, hidden or otherwise”
25. There are enough resources..
• “In 2005, the world will pass the trillion-
dollar mark in the expenditure, annually,
on arms. We’re fighting for $50 billion
annually for foreign aid for Africa: the
military total outstrips human needs by
20:1. Can someone please explain to me
our contemporary balance of values?”
(Lewis, 2005, p. 189)
27. Self-employed women’s
association(SEWA)
SEWA is a trade union
registered in 1972. It is an
organisation of poor, self-
employed women workers.
These are women who earn a
living through their own labour
or small businesses. They do
not obtain regular salaried
employment with welfare
benefits like workers in the
organised sector.
28.
29. MAKING A DIFFERENCE TO
PEOPLE’S LIVES: SEWA
• Vegetable sellers in
Ahmedabad
• Micro credit Vegetable
wholesalers
• Legal right to sell
vegetables
• Child care provision
• Health care provision
• Housing
• Pensions
• SEWA Bank
30. Primary health care
• SEWA’s healthcare training program has provided new &
upgraded skills to rural and urban women. Working in
conjunction with consulting doctors and medical
professionals, members have been trained to provide a
variety of healthcare services and now form the core of
SEWA’s community health team.
• Provides safe and modern childbirth practices, basic
emergency care, and preventative care such as
immunizations.
31. Financial services
• Member-trained financial managers
assist in managing all aspects of
SEWA’s financial services including
savings, credit, and insurance
programs.
• A team of grassroots bankers have
been trained to collect deposits in
isolated villages, provide "hand
holding" consultations about SEWA’s
range of financial services, and
manage rural savings and credit
groups.
32. “The success of an economy
and of a society cannot be
separated from the lives that
the members of the society are
able to lead… we not only
value living well and
satisfactorily, but also
appreciate having control
over our lives.”
Amartya Sen (1999) Development as
Freedom
•Material
•Psychosocial
•Political
EMPOWERMENT
Equity is not just about
poverty also about
capabilities and enabling
people to live flourishing lives
33. Aboriginal reports of racism
• 153 Aboriginal people
living in Adelaide
• Non-random sample
• Interviews conducted
by Aboriginal project
manager and
Aboriginal
interviewers
34. Racism in at least one institutional
setting
Never/
hardly ever
Sometimes Often/
very often
16 30 54
84% experienced racism in institutional
settings at least sometimes, over half often/very often
35. Racism in at least one informal
setting
Never/
hardly ever
Sometimes Often/
very often
16 42 42
84% experiencing racism in informal settings
settings at least sometimes
36. – “People are always watching you and
watching what you’re doing and, you
know. Watching where your hands are
and shit. Like I said now I just go and
show them my bag anyway, as I’m
walking out. Just you know…even if
they don’t ask” (Belinda, 30yrs)
–“You get called ‘black mongrel’ when
you’re walking along’ (Mary, 51 yrs)
37. Responses to racism
Often/
very often
Sometimes Never/
hardly ever
Feel angry, annoyed or frustrated 62 32 6
Talk, write, draw, sing or paint 52 26 22
Try to avoid it 46 26 28
Get a headache, upset stomach,
other physical reaction
37 41 22
Do something 33 30 37
Ignore, accept, forget it 28 37 35
Feel amused or sorry for person 34 31 35
Feel ashamed, humiliated, anxious
or fearful
29 32 39
Feel powerless, hopeless or
depressed
26 32 43
38.
39. “Our appointment and terms of reference arose out of allegations of
sexual abuse of Aboriginal Children. Everything we have learned
since convinces us that these are just symptoms of a breakdown of
Aboriginal culture and society. There is, in our view, little point in an
exercise of band-aiding …what is required is a determined, co-
ordinated effort to break the cycle and provide the necessary
strength, power and appropriate support and services to local
communities, so they can lead themselves out of the malaise: in a
word, empowerment”
Rex Wilde & Pat Anderson Co-Chairs, Inquiry into the Protection of
Aboriginal Children from Sexual Abuse
40. Anna Tibaijuka Executive Director of UN-
HABITAT
Slums
Gender
Violence
Ndioro Ndiaye
Deputy Director-
General of the
International
Organization for
Migration
41. Urban slums
• Lack basic infrastructure
• Women spend most time
there – less mobile -
childcare
• Less likely to get jobs &
be lower paid
• Don’t own property
• Violence
42. Solid fuel pollution
• Breathing fumes from solid fuels
(esp. as used for cooking) is thought
to be responsible for approx half of
the 1.3 million female deaths
worldwide per year from chronic
obstructive pulmonary disorder
(COPD)
• COPD caused by exposure to indoor
smoke is over 50% higher among
women than among men
Sources: WHO - Women & Health 2009, UN – Millennium Development Goals Report 2009
43. Women are disproportionately responsible for
collecting fuel and water for household use
As of 2006, 2.5 billion people worldwide were still
unserved by improved sanitation, including 580
million in Southern Asia
18% of the world’s population — 1.2 billion people
— practise open defecation; mostly those who live
in rural areas
Sources: WHO - Women & Health 2009, UN – Millennium Development Goals Report 2009)
44. Gendered and domestic violence against women
• In a WHO 10-country study on women's health and domestic
violence (2005):
Between 15% and 71% of women reported physical or sexual violence
by a husband or partner
Many women said that their first sexual experience was not consensual
(24% in rural Peru, 28% in Tanzania, 30% in rural Bangladesh, and 40%
in South Africa)
Between 4% and 12% of women reported being physically abused
during pregnancy
• Every year, about 5,000 women are murdered by family members in
the name of honour
• Trafficking of women and girls for forced labour and sex is
widespread and often affects the most vulnerable
• Forced marriages and child marriages are widely practiced in many
countries in Asia, the Middle East and sub-Saharan Africa
• Worldwide, up to one in five women and one in 10 men report
experiencing sexual abuse as children
Source: WHO Fact Sheet – ‘Violence Against Women’ 2009
45. Cities, women & safety
“Cities which are unsafe for
women, are also unsafe for
the children they support.
Investing in women friendly
cities is also an investment
in a better future for our
children. It is not rocket
science here. Cities that are
safe, are cities that are good
for business”. Anna Tibaijuka Executive
Director of UN-HABITAT
47. Health systems which promote
health & well-being
• Publicly funded health system – universal
– accessible to all members of society
• Choice as real not code word for privilege
• Health systems with a social conscience –
connecting people through groups,
empowering & respectful practice,
affordable and accessible to low income
people
• Based on comprehensive PHC
48. Maternal health and access to health care
• Each year, over 500,000 women and girls die due to
complications during pregnancy, childbirth or the six
weeks following delivery
• 99% of these death occur in developing countries
• Developed regions report nine maternal deaths per
100,000 live births, compared to 450 maternal deaths in
developing regions
• 14 countries have maternal mortality ratios of at least
1,000 per 100,000 live births
• Half of all maternal deaths occur in sub-Saharan Africa
and another third in Southern Asia. These two regions
account for 85 per cent of all maternal deaths
Source: UN Millennium Development Goals Report
2009
50. Under-5 Mortality Rates
Source: World Bank – World Development Reports
U-5 Mortality Rates per 1,000 live births
Country income
group/region
1990 2006
Sub-Saharan
Africa
184 157
Low Income 164 135
Middle Income 75 49
High Income 12 7
51. SCF (2010) Women on the Frontline of Health care. State of the World’s Mother, p. 32
55. Access to maternal health care
Source: World Bank – World Development Report 2009
Births attended by skilled health staff (% of total)
Country income
group/region
1990 2000-07*
Low Income 33 41
Middle Income 48 73
High Income - 99
Latin America 75 88
Sub-Saharan Africa 44 45
South Asia 30 41
*Most recent available data during this period
56. Births attended by skilled health personnel, by
household wealth quintile, selected countries
Source: WHO - Women & Health 2009
57. Density of health workers by country: WHO
Source: WHO World Health Report 2006
58. Migration of health professionals:
Example of the U.S.A. & Sub-Saharan Africa
Source: Hagopian, A. et al (2004) ‘The migration of physicians from sub-
Saharan Africa to the United States of America: measures of the African brain
drain’. Human Resources for Health, 2 (17)
• In 2004, over 23% of USA’s 770,000 physicians were
trained outside the USA, the majority (64%) in low-
income or lower middle-income countries.
• Of that group, 5334 physicians were from sub-Saharan
Africa, representing more than 6% of total physicians
practicing in that region.
59. Brain Looting
• Using the conservative figure of US$
20,000 to train a medical doctor,
Zimbabwe lost US$ 16.8 million
through the loss of 840 doctors.
• Using the same conservative
estimate Nigeria incurred a loss of
US$ 420 million due to the migration
of 21,000 physicians to the United
States.
• However, if the UNCTAD figure of
US$ 184,000 per trained
professional is used to calculate
savings, the United States saved
US$ 3.86 billion.
Bridget Lloyd (2005)
60. Comprehensive
PHC
Selective PHC
Health Promotion &
Disease prevention
addressing the SDH
Behavioural Disease
Prevention
Values: solidarity, collective,
citizenship, universal, publicly
funded and free or minimal cost
at point of use
Values: individualism,
health care a commodity,
consumers
Clinical interventions with individuals
61. Cuba: large investment
in PHC
Life Expectancy on a par
with US
Spends far less on health
Comprehensive PHC – free
and accessible
Average income about 10%
of US
62. Example: Comprehensive PHC
• NACCHO
• Congress established
1973 as a community
controlled health service
• Free access and drugs
• Good care co-ordination
• Advocacy on social
determinants
64. Health inequities and values
• “On the other hand, inequity (of health
or otherwise) is a moral category
rooted in values, social stratification,
embedded in political reality and the
negotiations of social power
relations”. Bégin, 2007
66. Creating a demand for SDH
• Popular movements – People’s Health
Movement
• Policy makers with commitment
• Politicians who see the sense of a SDH
approach and have a value commitment
to equity
69. Social determinants: key messages
• Social & health gradient
• Health inequalities for women result from social
inequalities which reflect systematic unfairness
in all sectors – education, employment, housing,
health, environment etc
• Economic benefits: losses from HI associated
with productivity losses, reduced tax revenue,
higher welfare payments, increased treatment
costs
70. Social Determinants key messages
• Measure more than economic growth – also fair
distribution of health, well-being and sustainability and
these are good outcome measures for society as a
whole – for women measure women’s unpaid work
• Aim of action on SDH is to:
– Give every child the best start in life
– Increase control over lives – participatory decision making
– Create fair employment and good work for all
– Ensure a healthy standard of living for all
– Create and develop healthy and sustainable places and
communities
– More emphasis on disease prevention
71. Social determinants: key messages
• These policy objectives will require action
by all levels of government, health service,
NGOs, private sector and community
groups.
• Effective local delivery requires
participatory decision making at the local
level and will require empowering local
communities and individuals
72. HiaP: the governance mechanism
for action on SDH
• Central vision of greater health, well-being and
equity adopted by all sectors of government and
accountability to achieve this
• Policy levers to make co-operation across
government the easy option
• Political (head of state) and bureaucratic
sponsorship
• Empowerment and involvement
74. Adelaide April 2010
• Joint WHO & South
Australian
Government meeting
• 120 high level
executives, policy
makers and
researchers
• Adelaide Declaration
Frances Baum: Australia
Professor of Public Health, Flinders University, Adelaide; Global Steering
Committee, People's Health Movement
Monique Bégin: Canada
Professor Emeritus, Faculty of Health Sciences, University of Ottawa; former
Canadian Minister of National Health and Welfare
Giovanni Berlinguer: Italy
Member of European Parliament; Professor of Hygiene, Occupational Health and of
Bioethics (Emeritus), University "La Sapienza", Rome
Mirai Chatterjee: India
Coordinator of Social Security, Self-Employed Women's Association (SEWA)
Manuel Dayrit: Philippines
Secretary of Health, Philippines
William Foege: USA
Emeritus Presidential Distinguished Professor of International Health, Emory
University, and Gates Fellow; former Director of the US Centers for Disease
Control and Prevention
Kiyoshi Kurokawa: Japan
President of the Science Council of Japan
Ricardo Lagos: Chile
President of the Republic of Chile
Stephen Lewis: Canada
United Nations Special Envoy for HIV/AIDS in Africa
Alireza Marandi: Iran
Professor of Pediatrics at Shaheed Behesti University, Tehran; former Minister
of Health and Medical Education, Islamic Republic of Iran
Michael Marmot: UK
Commission Chair and Director, International Centre for Health and Society,
University College London
Charity Ngilu: Kenya
Minister of Health, Kenya
Hoda Rashad: Egypt
Research Professor and Director, Social Research Centre, American University of
Cairo; Member of El Shoura Council of the Senate
Amartya Sen: India
1998 Nobel laureate in economics; Lamont University Professor, Harvard
University, Cambridge
David Satcher: USA
Interim President of the Morehouse School of Medicine, Atlanta, Georgia; former
Surgeon General of the USA
Anna Tibaijuka: Tanzania
Executive-Director, UN-HABITAT
Denny Vagero: Sweden
Director of the Centre for Health Equity Studies (CHESS), Stockholm University/
Karolinska Institute
Glei and Horiuchi (2007) provide a range of data showing that sex differences in LE at birth have declined in many developed countries since about 1975, following a steady increase from the 1920s to 70s. They have some good tables if it would be useful. They argue that some of the change could be due to changes in sex-specific mortality rates, arising from factors such as increased smoking in women or improved treatment for heart disease with greater gains for longevity in men. (One might suspect that increased chronic stress for women arising from increased workforce participation, or relationship breakdown, etc could also have something to do with it.)
However, so far as I understand it, they also say that some of the decline may be accounted for as a by-product of the way these things are calculated, because of differences in the age distribution of deaths for men and women. They say, “Because the age distribution of deaths is usually less dispersed for women than men (at least in recent decades), the sex difference in e(0) may narrow as mortality declines, even if age-specific rates of mortality decline are the same for both sexes. Thus, the recent narrowing of the sex differential may have resulted primarily from differences in the age pattern of mortality, rather than from slower mortality decline for women than men.” e(0) refers to life expectancy at birth
Quote from ‘Developing a Women's Health Policy for Australia’
“Social Determinants of Health:
Health inequities, “the avoidable inequalities in health between groups of people within countries and between countries”, are shaped by the social and economic conditions of people’s lives. The AIHW has identified some of these as the broad features of society, eg culture, affluence, political and economic systems, and socioeconomic characteristics, eg education, employment and income. The World Health Organization (WHO) Commission on Social Determinants of Health report “Closing the Gap in a generation: health equity through action on the social determinants of health” found that in all countries at all levels of income, “health and illness follow a social gradient: the lower the socioeconomic position, the worse the health”.
Changes in the adverse conditions of people’s lives are necessary to reduce avoidable health inequalities. It is the adverse social and economic circumstances of people’s lives that lead to high levels of stress and unhealthy behaviours that then lead to high rates of
disease and injury.”
Like other poor self-employed women, the vegetable sellers of Ahmedabad, India, live in poor conditions. SEWA, a union of almost 1 million workers, is an example of collective action by these women to challenge and change these conditions.
Frequently harassed by local authorities, the vegetable sellers campaigned with SEWA to strengthen their status through formal recognition in the form of licences and identity cards and representation on the urban boards that govern market activities and urban development. That campaign, started within Gujarat, subsequently went all the way to the Supreme Court of India.
To strengthen control over their livelihoods, all SEWA members linked together to set up their own wholesale vegetable shop, cutting out exploitative middlemen. SEWA also organizes childcare, running centres for infants and young children, and campaigns at the state and national level for childcare as an entitlement for all women workers. Further, SEWA members are improving their living conditions through slum upgrading programmes to provide basic infrastructure. This happens in partnerships with government, civil society organizations, and the corporate sector. In order to solve the problem of access to credit, the SEWA Bank provides small loans and banking facilities to poor self-employed women. The bank is owned by its members, and its policies are formulated by an elected board of women workers Box 13.14: Providing childcare services in India
SEWA is a trade union of poor, self-employed women. Its members expressed the need for childcare, which would allow them to work without jeopardizing their children’s safety and development. Working closely with the government, SEWA’s 100 childcare centres are managed by cooperatives of childcare providers, which have been formed with SEWA’s support. Each serves 35 children, ranging from birth to 6 years of age. They focus on the overall development of the children, including their physical and intellectual growth. The teachers hold regular meetings with the mothers, where they discuss and give suggestions for the child’s development. Children are regularly weighed and records of their growth are properly maintained. The childcare centres double as centres for childhood immunization and antenatal and postnatal care. SEWA’s studies show important impacts of childcare provision: mothers reported income increases of over 50%, with spin-offs to, among others, child nutrition. They said that for the first time they could bring vegetables and lentils to feed their children. They also reported ‘peace of mind’, knowing that their children were well looked after while they were at work. Furthermore, older siblings, especially girls, entered school for the first time as they were released from childcare responsibilities. Also, the physical growth of young children improved significantly with the nutrition at the centres, as did their cognitive skills. All children started primary school at the age of 6 years and the majority continued until high school.
Adapted, with permission of the author, from SEWA Social Security (nd).
If women do not feel safe, the city is unsafe. And this means providing safety
from the home and all those places in between—streets, parks, schools,
neighbourhoods and other public spaces. It must be a continuum – from door to
door, day and night.
It is unacceptable that this is merely something women should put up with. It is
unacceptable that millions of women, especially those living in poverty, have to
be on their guard every waking hour when they venture outdoors anywhere. Cities
where rape statistics show daily and sometimes hourly violations are cities of
shame.
Successful approaches to improve women’s safety and to make cities women friendly
must start with the planning of our urban spaces.
Address by
Mrs. Anna Tibaijuka
Under-Secretary-General of the United Nations
and Executive Director of UN-HABITAT
on the occasion of the Gender and Women Roundtable
in Rio de Janeiro,
Wednesday 24 March 2010
What is the difference between CPHC and SPHC
“I entitled this presentation “Do I See a Demand?...” It refers to a lesson in Politics 101 that I learned in Cabinet in 1978 when I first presented the case to create the Child Tax Credit (now called Canada Child Tax Benefit) - a reform particularly dear to my heart. Still a relatively new Minister, I knew my dossier inside out and presented it, I thought, brilliantly. Suffice it to say, in respect of Cabinet confidentiality, that when the discussion was over, a very senior player turned to the Prime Minister and simply said: “Do I See a Demand?...” Not another word was said, but the proposal died there immediately. What a catch 22 situation, for Cabinet documents cannot be discussed outside! (By the way, changed circumstances gave me another opportunity later that year to present and to see the proposal approved.) “
1. Reducing health inequalities 1 is a matter of fairness and social justice. In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 and 2.5 million extra years of life.
2. There is a social gradient in health – the lower a person’s social position, the worse his or her health. Action should focus on reducing the gradient in health.
3. Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health.
4. Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism.
5. Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.
6. Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.
7. Reducing health inequalities will require action on six policy objectives:- Give every child the best start in life- Enable all children young people and adults to maximise their capabilities and have control over their lives- Create fair employment and good work for all- Ensure healthy standard of living for all- Create and develop healthy and sustainable places and communities- Strengthen the role and impact of ill-health prevention
8. Delivering these policy objectives will require action by central and local government, the NHS, the third and private sectors and community groups. National policies will not work without effective local delivery systems focused on health equity in all policies.
9. Effective local delivery requires effective participatory decision-making at local level. This can only happen by empowering individuals and local communities.