Social Determinants of Health

Pre RC Technical Meetings62nd Session of the WHO Regional Committee for the

Eastern Mediterranean5-8 OCTOBER 2015, Kuwait

Main Objective of this Session

1. To update MS on the work done since the 61st session of the RC of 2014 in the area of SDH and

2. To agree on the way forward.

The Social Determinants of Health are...

…the conditions in which people

born

grow work

age

Structural determinants:Governance, economic, social and public policies, culture and societal Values, social class, gender ethnicity, education, occupation, income and place of living

Intermediary determinants of health: Material circumstances (living and working conditions, food availability, etc.), exposure to risks, risk-behaviors, biological factors and psychosocial factors

WHO’s and Government's commitment • 2005 - Established commission on SDH - to

identify the ways to overcome health inequities;

• 2008 - Commission submitted report to WHA 62.14

• 2009 - WHA resolution 62.14 “Calls MSs and WHO for reducing health inequities through action on SDH”

• 2011 – World Conference on SDH Brazil - Rio political declaration (governance for health, participation, reorienting health sector and monitoring progress)

• SDG Goal no 10 and other goals

Sixty-first Session of the Regional Committee, 2014 Acknowledged

There are significant health inequities that can be reduced by acting on SDH.

Producing evidence for advocacy and political commitment are vital. Action by the whole government and non-health sectors is crucial. Partnership with UN organizations and stakeholders is needed. Progress in the 5 regional priorities cannot be achieve without acting

on SDH. Health Ministers have a vital role in leading action on SDH:o Advocacy o improving health equityo Providing and using evidence o Identifying data gapso Develop multi-sector

programmeso mainstreaming health equity in all public

policieso Developing accountability framework

Outcome of the 61st RC RC requested WHO to:

• Prepare a regional strategy/strategic directions on SDH with action-oriented framework for country plans of action;

• To conduct an inter-country meeting to discuss strategic directions and develop a clear vision on the way forward to be presented to the 62nd Session of the RC;

WHO response: A regional consultation was conducted in Tehran, in April, 2015. Attended by 22 participants from 13 countries, 15 experts, and

staff representing the UN Programmes and WHO.

Components of the SDH Framework • Evidence-building, advocacy and capacity-building:

– Support countries in conducting in-depth assessments of health inequity – Engage multiple departments/ministries in identifying data gaps.– Conduct national workshop to agree on the data gap and key interventions– Develop economic and social case studies– Develop policy briefs for advocacy

• Governance and integration of social determinants of health in the five WHO priority areas:– Establish a high-level multisectoral task force, – Incorporate SDH in national development policies and plans– Integrate SDH in the five priority programmes – Conduct an assessment of health system performance, and plan to

improve access to quality care. – Integrate SDH in health, medical and nursing pre-service education.

Components of the SDH Framework continue • Partnership and harmonization

– Map UN interventions in line with the SDH concept and methodology.– Direct the UN Country Team to strengthen synergy between UN

agencies and partners on SDH interventions.

Four countries: I. R. Iran , Jordan, Morocco and Sudan. Also Palestine expressed interest in the exercise. The 5 countries conducted or in the process of conducting in-depth assessment on SDH and health inequity

Preliminary results of the in-depth assessment in the 5 countries

Common factors:

• High political commitment

• Multi-sectoral mechanisms exist either for SDH or for other purposes,

• Data on health inequity are available but incomplete with significant data gaps especially at subnational level

• While social determinants are country specific, some determinants are common to all countries

• Ministries of health of the five countries are facilitating and coordinating the work on SDH and HiAPs and are taking the agenda forward

Sudan Key SDH for Health :

• Access to health care • Education (women’s education)• Gender issues• Access to safe water and

sanitation• Nutrition and food security• Instability (displaced, refugees) • Unemployment and poverty

Roadmap:

• Strengthening multisectoral coordination structures

• Strengthening commitment of the national Health Council and the Parliament

• Building capacity for effective implementation to address health inequities

• Mainstreaming SDH in all policies, health programmes and initiatives

• Building accountability (M&E)

MoroccoKey SDH for Health :

• Education (women’s education)• Poverty • Gender• Residence: urban-rural and

geographical distance between regions

Way forward:

• Conduct a national debate• Establish a multisectoral mechanism• Regionalization: Development of

action plan on SDH with a regional and local focus

• Strengthen availability and utilization of data

• Capacity building• Implement the WHO 5- step tool• Advocacy and consensus building

with key actors and sectors

Palestine (Special Contexts)

West Bank • Limited accessibility to

health care• Lack of water and sanitation• Unemployment • Poverty • Infrastructure damage• Lack of social protection• Poor food quality

Gaza • 35% of deaths and 2.4% has

sever physical disability (2014)• Destruction of health facilities • Limited access to care• Poverty 39% • Unemployment 47%• Food insecurity: 72% are either

food insecure or vulnerable • Increased mental disorders and

substance use

War and occupation are the main SDH

Way Forward

Countries• Countries that conducted the assessment need to develop appropriate

multisectoral plans and share experiences. • Agree on a core set of indicators to monitor health inequities and SDH to

be integrated within the HIS.• Monitor progress achieved with focus on impact assessment of adopted

interventions• Other countries may wish to consider conducting the exercise

WHO and IHE:• To prepare analysis of four country data • To organize a regional meeting to agree on a list of core equity indicators• To finalize the Regional strategy/strategic direction based on the results of

the country assessments• To provide technical support especially during the national workshops

THANK YOU