Health Equity Presentation @ Istanbul Development Dialogues
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Transcript of Health Equity Presentation @ Istanbul Development Dialogues
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SEEDs* of Health and Health EquityIn the Context of Sustainable Human Development
Dr. Ruth BellSenior Advisor
UCL Institute of Health Equity London, UK
Dr. Zlatko NikoloskiAssistant Professorial Research FellowLondon School of EconomicsLondon, UK
John MacauleyRegional HHD Specialist
UNDP Istanbul Regional HubIstanbul, Turkey
* Social, Economic and Environmental Determinants
Promoting Health Equity in EECA
• Supports action for health and well-being in a whole-of-government and whole-of-society approach
• Adopted by all 53 WHO Europe member states, including all EECA countries
• Its two strategic objectives are:
• improving health for all and reducing health inequalities
• improving leadership and participatory governance for health
INTRODUCTION
Promoting Health Equity in EECA
• SDG 3 and 10 focus on health and inequity explicitly
• Ensure healthy lives and promote well-being for all
• Reduce inequality within and among countries
INTRODUCTION
Promoting Health Equity in EECA
• SDG 3 and 10 focus on health and inequity explicitly
• Ensure healthy lives and promote well-being for all
• Reduce inequality within and among countries
• Health in All Policies means Health in All SDGs
INTRODUCTION
INTRODUCTION
The social, economic and environmental factors constituting the three interlinking pillars of sustainable human development and determine health and its distribution.
80 SEEDs of Health, including
• Social support/community networks
• Transparency and accountability• Housing quality• Access to green spaces• Job creation• Wealth distribution
The absence of avoidable and unjust systematic differences in health between groups with different levels of social advantage and disadvantage
14 Dimensions of Inequity, including
• Gender• Age• Educational attainment• Income• Ethnicity• Sexual orientation• Marginalisation (including
vulnerable migrants, IDP, refugees, prisoners, sex workers and others)
Health Equity
INTRODUCTION
SEEDs of Health
Health and Wealth
EVIDENCE
0.00 2000.00 4000.00 6000.00 8000.00 10000.00 12000.00 14000.0055.0
60.0
65.0
70.0
75.0
80.0
65.5
68.268.869.470.2 70.570.770.871.2
72.574.174.6 74.875.1 75.2fYRoM76.3
77.5
GDP per capita (US$)
Life
Expe
ctan
cy a
t Birt
h
World Bank, 2014
Inter-regional and Gender Inequities in average Life Expectancy
EVIDENCE
Turkm
enista
n
Tajiki
stan
Uzbekis
tan
Kazak
hstan
Kyrgy
zstan
Armen
ia
Azerba
ijan
Moldov
a
Albania
Ukraine
Serbi
a
Belarus
Georgi
a
Monten
egro
fYROM
Turke
y
Bosnia
and H
erzeg
ovina
55
60
65
70
75
80
85
Female MaleWHO/Europe average female WHO/Europe average male
Life
Expe
ctan
cy (Y
ears
)
WHO, 2012
Gender Inequities in Premature NCD Deaths
EVIDENCE
NCD deaths under age 70 as percentage of all NCD deaths
Albania
Georgi
a
Armen
ia
Bosnia
and H
erzeg
ovina
fYROM
Monten
egro
Serbi
a
Ukraine
Turke
y
Azerba
ijan
Belarus
Moldov
a
Uzbekis
tan
Tajiki
stan
Kazak
hstan
Kyrgy
zstan
Turkm
enista
n0
10
20
30
40
50
60
70
80
Female Male
Perc
enta
ge o
f pre
mat
ure
NCD
Deat
hs
Global Health Observatory, 2012
Ethnic Inequities in Morbidity
0-6 years 7-14 years 15-24 years
25-34 years
35-44 years
45-54 years
55-64 years
65 years and older
0
10
20
30
40
50
60
70
80
Roma non-Roma
Perc
enta
ge R
epor
ting
Illnes
ses
EVIDENCE
Percentage of Roma and non-Roma reporting long-standing illnesses in EECA
Mihailov, 2012
GDP per capita, growth of GDP per capita, income inequality (Gini), institutional strength (measured by Polity IV index).
• Socioeconomic status/Household wealth
• Gender• Educational attainment• Family Composition (Marital
Status)• Marginalised groups (Migrant
Status)
• Wealth distribution (Gini Coefficient)
• Transparency and accountability in governance (measured by Polity IV Index)
• Social support/community networks
• GDP per capita and GDP per capita growth
• Life satisfaction
Dimensions of Inequity significantly correlated withself-assessed Health
SEEDs of Health significantly correlated with self-assessed Health status
EVIDENCE
* Based on LiTS 2010 Data for Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Slovenia, Tajikistan, Uzbekistan
Monten
egro
Albania
Uzbekis
tan
Slove
nia BH
Tajiki
stan
Maced
onia
Kyrgy
zstan
Croatia
Serbi
a
Bulgari
a
Azerba
ijan
Roman
ia
Kazak
hstan
Belarus
Russia
Georgi
a
Moldov
a
Ukraine
Armen
ia0
10
20
30
40
50
60
70
80
90
100
Perc
enta
ge re
porti
ng g
ood/
very
goo
d he
alth
Cross-Country Inequity in (average) self-perceived Health
EVIDENCE
Life in Transition Survey, 2010
• Marginalised groups (for all key population groups studied)
• Socio-economic status (for PWID, SW and prisoners)
• Gender (for PWID and SW), which is related to gender-based violence
• Sexual orientation (for MSM)
• Life course stage
Dimensions of Inequity for HIV • Access to healthcare &
availability of healthcare services
• Discrimination and stigma
• Exposure to violence & effective policing
• Human rights
• Transparency and accountability in governance
• Treatment adherence
SEEDs of HIV
EVIDENCE
Marginalization and Sexual Orientation-related Inequities in Morbidity
EVIDENCE
I am a prisoner.
I am a man who has sex with other men.
I am an injecting drug user.
I am a sex worker.
PWID MSM SW
9
5.7
2.2
0.9
General adult population
HIV
Prev
alen
ce (%
)
UNAIDS, 2014
HIV Treatment Coverage (Access to Healthcare)
EVIDENCE
Republic of Moldova
Armenia Kyrgyzstan Belarus Kazakhstan Georgia15
20
25
30
35
40
45
50
Eastern Europe and Central Asia GlobalEast and Southern Africa
HIV
Trea
tmen
t Cov
erag
e (%
)
International funding as % of total funding for national HIV responses
EVIDENCE
Armenia, 2012
Kyrgyzstan, 2013
Moldova, 2013
Georgia, 2014
Ukraine, 2010
Belarus, 2013
Kazakhstan, 2013
Russia, 2008
0 10 20 30 40 50 60 70 80 90 100
E-Discussion Feedback: UNDP’s Role in Addressing Health Equity & HIV
PROGRAMMATIC ACTION
Outreach and Contributions
• 3 Mailouts to 2000+ direct contacts
• #TalkInequality 76 Tweets, 107 Retweets, 54 Likes and counting
• 16 contributions from UKR(5), TUR(4), SRB (2), BLR, TAJ, UZB, US and NZ including UNDP (7), CSO (5), Academia and Government
Engage the whole of government and society to • forge alliances between health and
other sectors• promote human rights • empower civil society
Support the SDGs and Health 2020 and build commitment to address HIV as part of the health equity and sustainable human development agendas
Support programmatic action to• build capacities • improve allocative and technical
efficiency • facilitate collaboration and knowledge
exchange
Accumulation of positive and negative effects on health and
wellbeing
Life course stages
Pre-natal
Family Building
Pre-school School Training Employment Retirement
PROGRAMMATIC ACTION
Life Course Approach: Adding Value for Development Programming
Macro-level Context: Sustainable Development
Systems: GovernanceWider Society: Resilience
• Fully operational
• Agreed Work Plan and Agency Division of Labor
• Reporting to the Regional Director’s Working Group across all agencies
• First issue based coalition for operationalizing the SDGs
• Other Coalitions to be developed on gender and migration
Regional UN Inter-Agency Thematic Group on NCDs and SEEDs of Health
PROGRAMMATIC ACTION
PROGRAMMATIC ACTION
Procurement Support Services to The Ministry of Health of Ukraine
Global Fund Partnership: HIV, Tuberculosis and Malaria
“We have broken a big corruption scheme in medicine procurements (…) and several-fold price reduction for some drugs serves as a direct proof.” - Egor Sobolev, Chairman Verkhovna Rada Committee on Preventing and Fighting Corruption
• In Kyrgyzstan, local Tuberculosis Centers increased average fund delivery rates from 5% to 85-95%
• In Belarus, 37,000 people access anonymous counselling, 700 patients receive methadone and 70,000 prisoners access HIV services as of 2011
Phase I: SEEDs of H/HE Analysis of UNDP Eurasia Project Portfolio
• Develop SEEDs screening tool
• Monitor co-benefits for health & development
• Scale up
• Disseminate
Phase II: Integration of SEEDs of H/HE in Belarus Country Portfolio
PROGRAMMATIC ACTION
THANK YOU FOR YOUR ATTENTION.
Dr. Christoph HamelmannRegional Team Leader (EECA), Senior Advisor (Arab States), HHD, Coordinator, Secretariat UN iIATT SPHS
[email protected]: @cahamelmann
John MacauleyRegional Programme Specialist, HHD (EECA)
[email protected]: @johnmacauley
Esther WerlingConsultant, SEEDs of Health and Health Equity, HHD (EECA)
[email protected]: @estherwerling
Dr. Ruth Bell Senior AdvisorUCL Institute of Health Equity
Dr. Zlatko NikoloskiAssistant Professorial Research FellowLondon School of Economics